A nurse is reviewing the laboratory findings of a client who has liver failure with ascites. The client takes spironolactone. Which of the following findings is an adverse effect of themedication?

a. Restrict oral fluids to 800 to 1,000 mL/day: Hyponatremia is a characteristic finding in SIADH, and fluid restriction is a key intervention to correct the imbalance.

b. Maintain an IV of 0.45% sodium chloride: Infusing hypertonic (3%) saline may be indicated in severe cases of hyponatremia, but the initial step is fluid restriction.

c. Ensure the client receives a 2 g/day sodium diet: Dietary sodium restriction is not the primary intervention for SIADH. Fluid restriction is more critical.

d. Administer desmopressin acetate 0.2 mg orally: Desmopressin acetate is an antidiuretic

hormone and would exacerbate the retention of water, further decreasing sodium levels. It is not the appropriate intervention for this client.

Rationale for A: Taking enteric-coated pills with meals is generally acceptable as food does not affect the integrity of the enteric coating. The coating is designed to withstand the acidic environment of the stomach and dissolve in the more neutral pH of the intestine.
Rationale for B: Enteric-coated tablets should not be crushed as this destroys the coating designed to protect the stomach lining from the medication's potentially irritating effects, ensuring the medication is released in the intestine.
Rationale for C: This statement is correct; enteric-coated medications are formulated to bypass the stomach and dissolve in the intestine, which can help minimize gastric side effects and irritation.
Rationale for D: It is common for anti-inflammatory medications like naproxen to take several weeks to reach full efficacy. This statement reflects a correct understanding of the medication's expected onset of action.