A nurse is teaching a client who has a new prescription for an antacid to treat a gastric ulcer. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason: Limit caffeine intake is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone does not interact with caffeine or affect the heart rate or blood pressure. Caffeine is a stimulant that can cause nervousness, insomnia, or palpitations in some people, but it does not worsen asthma symptoms or interfere with fluticasone therapy. The nurse should advise the client to consume caffeine in moderation and avoid it before bedtime.

Choice B reason: Take the medication with meals is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone is administered by inhalation, not by mouth, and it does not affect the digestion or absorption of food. The nurse should instruct the client to use the inhaler as prescribed, usually twice a day, regardless of the mealtimes.

Choice C reason: Rinse the mouth after administration is an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone is a corticosteroid, which can cause side effects such as oral thrush, hoarseness, or sore throat if it remains in the mouth after inhalation. The nurse should instruct the client to rinse the mouth with water and spit it out after each dose of fluticasone to prevent these side effects. The nurse should also teach the client how to use the inhaler properly and check the inhaler technique regularly.

Choice D reason: Check the pulse after medication administration is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone does not affect the heart rate or blood pressure, and it is not a rescue medication that should be used for acute asthma symptoms. The nurse should monitor the respiratory rate and the oxygen saturation of the client after administering fluticasone and advise the client to use a short acting bronchodilator, such as albuterol, for quick relief of wheezing or shortness of breath.

Choice A reason: This is correct. Nausea, vomiting, and diarrhea are the most common side effects of metformin, especially when the drug is started or the dose is increased. These side effects occur because metformin can interfere with the absorption of glucose and other nutrients in the intestines, causing osmotic diarrhea. The nurse should advise the client to take metformin with food, start with a low dose and gradually increase it, and drink plenty of fluids to prevent dehydration. The nurse should also monitor the client for signs of lactic acidosis, a rare but serious complication of metformin that causes severe diarrhea, abdominal pain, muscle cramps, and difficulty breathing.

Choice B reason: This is incorrect. Palpitations are not a common side effect of metformin. Palpitations are the sensation of a rapid, irregular, or pounding heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, nicotine, or heart problems. Metformin does not affect the heart rate or rhythm directly, but it can lower the blood sugar levels, which can trigger the release of adrenaline, a hormone that can cause palpitations. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, avoid alcohol and caffeine, and report any chest pain or shortness of breath.

Choice C reason: This is incorrect. Headaches are not a common side effect of metformin. Headaches are the pain or discomfort in the head, scalp, or neck, which can be caused by various factors, such as stress, dehydration, or sinus infection. Metformin does not cause headaches directly, but it can lower the blood sugar levels, which can cause headaches as a symptom of hypoglycemia. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, drink plenty of water, and take painkillers as needed.

Choice D reason: This is incorrect. Heartburn is not a common side effect of metformin. Heartburn is the burning sensation in the chest or throat, which is caused by the reflux of stomach acid into the esophagus. Metformin does not cause heartburn directly, but it can worsen it if the client already has gastroesophageal reflux disease (GERD), a condition where the lower esophageal sphincter is weak or relaxed and allows the acid to flow back. The nurse should advise the client to take metformin with food, avoid spicy or fatty foods, elevate the head of the bed, and take antacids as needed.