A nurse is reviewing the medication record of a client who has hypertension. Which of the following medications should the nurse administer to lower the client's blood pressure?

• NSAID use. The client has been taking ibuprofen (an NSAID) twice daily while also receiving prednisone (a corticosteroid) for asthma exacerbation. Both NSAIDs and corticosteroids inhibit prostaglandin production, which normally protects the stomach lining. This combination increases the risk of gastric irritation, peptic ulcers, and gastrointestinal bleeding.
• Recent immunization. The client received the influenza vaccine three days ago, but this does not significantly increase the risk of infection. The flu shot contains inactivated or weakened virus, meaning it cannot cause the flu. The client’s asthma may increase their risk of complications from the flu, but the vaccine helps reduce this risk rather than increasing it.
• Weight gain. The client has gained 1.36 kg (3 lb) in one week, which is likely due to fluid retention from prednisone use. While long-term corticosteroid use can lead to Cushing syndrome, this condition develops over weeks to months of high-dose steroid therapy, not within a short period. Therefore, the client is at a higher risk of peptic ulcers rather than Cushing syndrome.
• Cushing syndrome. Cushing syndrome results from chronic corticosteroid use leading to fat redistribution, muscle weakness, skin thinning, and hyperglycemia. However, this client is on a short-term tapering dose of prednisone, making Cushing syndrome unlikely at this stage.
• Influenza. Although the client has asthma, which increases the risk of complications from respiratory infections, there is no indication that they have developed the flu. The flu shot helps prevent infection, and there are no reports of fever, body aches, or respiratory symptoms suggestive of influenza.
• Peptic ulcers. The combination of NSAIDs and corticosteroids significantly increases the risk of peptic ulcer disease by weakening the stomach lining and promoting acid production. The client should be advised to monitor for signs of gastric irritation, such as abdominal pain, black stools, or nausea, and may require a proton pump inhibitor (PPI) like omeprazole for ulcer prevention.

A. Aspirate before injecting the medication. Aspirating before injecting heparin is not recommended because it can cause tissue trauma and increase the risk of hematoma formation. Heparin is administered into the subcutaneous tissue, which has fewer blood vessels than intramuscular tissue, making aspiration unnecessary. Aspiration can also lead to bruising and discomfort, which should be minimized when administering anticoagulants.

B. Use a 25-gauge, 1/2-inch needle to administer the medication. Heparin should be administered using a small-gauge (25- to 27-gauge) needle with a length of 1/2 to 5/8 inch to reduce tissue trauma and minimize the risk of bleeding. The small needle size helps ensure that the medication is delivered into the subcutaneous tissue rather than deeper layers. Proper needle selection is important to prevent bruising and irritation, which are common concerns when administering anticoagulants.

C. Administer the medication within 2 cm (1 in) of the umbilicus. Heparin should not be injected near the umbilicus because this area has a higher density of blood vessels and an increased risk of bruising. The preferred injection sites are the abdomen (at least 5 cm or 2 inches away from the umbilicus), the upper outer thigh, or the outer upper arm. Injecting in these areas ensures proper absorption while minimizing complications such as hematoma formation.

D. Massage the site after injecting the medication. Massaging the injection site after administering heparin is contraindicated because it can lead to increased bruising, tissue irritation, and the potential for excessive bleeding. Instead of massaging, gentle pressure can be applied with a gauze pad if necessary to control minor bleeding. Clients should be advised to avoid rubbing or applying unnecessary pressure to the injection site to reduce the risk of local complications.