A nurse is teaching a client who is in her first trimester of pregnancy about over-the-counter medications that are a pregnancy risk category B. Which of the following medications should the nurse include?

Choice A reason:

The statement “Rinse mouth 2 times per day with an alcohol-based mouthwash” is incorrect. Methotrexate can cause mouth sores and irritation, and using an alcohol-based mouthwash can exacerbate these symptoms. Instead, patients are often advised to use a non-alcoholic mouthwash or a saline rinse to help prevent and soothe mouth sores.

Choice B reason:

The statement “Take the medication with an NSAID” is incorrect. Methotrexate should not be taken with nonsteroidal anti-inflammatory drugs (NSAIDs) without medical supervision because this combination can increase the risk of severe side effects, including bone marrow suppression and gastrointestinal toxicity. Patients should always consult their healthcare provider before combining these medications.

Choice C reason:

The statement “Take an antiemetic 1 hour following administration” is not standard advice for methotrexate. While methotrexate can cause nausea, antiemetics are typically taken before or at the same time as the methotrexate dose to prevent nausea, not after. Patients should follow their healthcare provider’s instructions regarding the timing of antiemetics.

Choice D reason:

The statement “Drink 2 to 3 liters of water per day” is correct. Methotrexate can cause kidney damage, and staying well-hydrated helps to prevent this by promoting the excretion of the drug and reducing its concentration in the kidneys. Drinking plenty of fluids is an important part of managing methotrexate therapy safely.

Choice A reason:

Being sleepy but arousing when her name is called is a common side effect of morphine, which is a potent opioid analgesic. Morphine can cause drowsiness and sedation, but this is not necessarily an adverse effect unless it progresses to a state where the patient cannot be easily aroused. Therefore, while this is a side effect, it is not as concerning as respiratory depression.

Choice B reason:

A respiratory rate of 8/min is an adverse effect of morphine. Opioids like morphine can depress the respiratory center in the brain, leading to a decreased respiratory rate. Normal respiratory rates for adults are typically between 12 and 20 breaths per minute. A rate of 8 breaths per minute indicates significant respiratory depression, which can be life-threatening and requires immediate intervention.

Choice C reason:

A pain level of 6 on a scale from 0 to 10 indicates that the morphine has not fully alleviated the client’s pain. While this is important to address, it is not an adverse effect of the medication. The primary concern with morphine administration is monitoring for serious side effects like respiratory depression.