A nurse is teaching a client who is taking methotrexate and has stomatitis. Which of the following statements by the client indicates an understanding of the teaching?

A. Examine the client's upper body for flushing of the skin during the infusion: Red man syndrome is a common adverse effect of rapid IV vancomycin administration. It presents as flushing or rash on the upper body, and monitoring for this reaction is essential to ensure client safety.

B. Monitor for hypertension while the medication infuses: Vancomycin is more commonly associated with hypotension rather than hypertension during infusion, so monitoring for high blood pressure is not a primary concern.

C. Check for a penicillin cross-sensitivity before infusing the medication: Vancomycin is not a beta-lactam antibiotic, so penicillin allergy does not predict vancomycin reactions. Screening for cross-sensitivity is not required.

D. Infuse the medication over 30 min: Rapid infusion increases the risk of adverse effects such as red man syndrome. Vancomycin should typically be infused over at least 60 minutes or longer, depending on the dose, to reduce this risk.

Rationale for correct choices:

• Sodium 124 mEq/L: The client’s serum sodium is critically low, indicating severe hyponatremia, a known serious adverse effect of oxcarbazepine. Hyponatremia can lead to confusion, seizures, and potentially life-threatening neurological complications, requiring immediate provider follow-up and possible medication adjustment or discontinuation.
• Difficulty remembering medication times: Cognitive changes or confusion may indicate central nervous system effects of oxcarbazepine or complications from hyponatremia. This finding signals the need for urgent reassessment and intervention to prevent medication errors or toxicity.
• Nausea/vomiting: Persistent nausea and vomiting, especially after a recent dose increase, may be a sign of drug intolerance, early hyponatremia symptoms, or central nervous system effects. Immediate follow-up is necessary to prevent further complications and dehydration.

Rationale for Incorrect Choices:

• Mild headache: While headaches may occur with oxcarbazepine, the mild nature and recent onset are less urgent compared with severe hyponatremia and neurological symptoms.
• Vital signs (HR 86, BP 110/66, Temp 36.3° C, RR 16): These are slightly lower than baseline but not immediately concerning. The priority is lab abnormality and neurological changes.
• Hct 40%, Hgb 13 g/dL: These values remain within normal limits and do not require immediate intervention.
• Use of oral contraceptives: This is important for counseling because oxcarbazepine can reduce contraceptive efficacy, but it is not an urgent clinical finding compared to hyponatremia.