A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions?

Choice A reason: 3% sodium chloride is a hypertonic solution that can cause fluid shifts and dehydration. It is not a suitable replacement for TPN, which is also hypertonic but provides calories, electrolytes, vitamins, and minerals. Infusing 3% sodium chloride can lead to hypernatremia, increased intracranial pressure, and cellular damage.

Choice B reason: Dextrose 10% in water is a hypertonic solution that can provide some calories and prevent hypoglycemia. It is the best option among the choices to replace TPN temporarily, until the new container arrives. However, it does not provide adequate nutrition or electrolytes, so it should not be used for a long time.

Choice C reason: Lactated Ringer's is an isotonic solution that can maintain fluid balance and electrolytes. It is not a suitable replacement for TPN, which is hypertonic and provides more calories and nutrients. Infusing Lactated Ringer's can lead to fluid overload, hyponatremia, and metabolic alkalosis.

Choice D reason: 0.9% sodium chloride is an isotonic solution that can maintain fluid balance and sodium levels. It is not a suitable replacement for TPN, which is hypertonic and provides more calories and nutrients. Infusing 0.9% sodium chloride can lead to fluid overload, hyponatremia, and metabolic acidosis.

Choice A reason: "If my breathing begins to feel tight, I will use the cromolyn immediately." is an incorrect statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. Cromolyn is a medication that prevents the release of inflammatory substances from the mast cells in the airways, which can cause bronchospasm and asthma symptoms¹. Cromolyn is not a rescue medication, but a maintenance medication that should be used regularly to prevent asthma attacks. The client should use Albuterol, a short acting beta agonist, to relieve acute bronchospasm and wheezing.

Choice B reason: "I will be sure to take the albuterol before taking the Atrovent." is a correct statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. Albuterol is a medication that relaxes the muscles in the airways and increases the airflow to the lungs, which can improve the breathing and reduce the wheezing in patients with asthma. Atrovent is a medication that blocks the action of acetylcholine, a neurotransmitter that causes bronchoconstriction and mucus secretion, which can worsen the asthma symptoms. The client should take the Albuterol before the Atrovent, as this will allow the Albuterol to open the airways and enhance the absorption and effectiveness of the Atrovent.

Choice C reason: "I will administer the medications 10 minutes apart." is an unnecessary statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. The client does not need to wait 10 minutes between the administration of the two medications, as they can be given together in the same nebulizer chamber. This will save time and simplify the treatment regimen for the client. The client should follow the instructions on the medication label or the prescriber's order regarding the dosage and frequency of the nebulizer treatments.

Choice D reason: "I will use both medications immediately after exercising." is an inappropriate statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. The client should not use both medications immediately after exercising, as this may not prevent or relieve exercise induced bronchospasm, a condition that causes the airways to narrow during or after physical activity. The client should use Albuterol, a short acting beta agonist, before exercising, as this will prevent the bronchospasm and allow the client to exercise safely and comfortably. The client should use Atrovent, an anticholinergic, as prescribed, usually twice a day, to control the chronic symptoms of asthma.