A patient who has been taking opioids for several weeks tells the nurse, "The medication doesn't seem to work as well anymore." The nurse recognizes this as a sign of:

Choice A reason: This is incorrect. Distributing the doses evenly throughout the day may increase the risk of daytime sedation and impair the client's ability to perform daily activities. Diphenhydramine is a sedating antihistamine that causes drowsiness and reduces alertness.

Choice B reason: This is correct. Taking most of the daily dose at bedtime may minimize daytime sedation and help the client sleep better at night. Diphenhydramine is often used as a short-term treatment for insomnia.

Choice C reason: This is incorrect. Taking the medication with meals does not affect the sedative effect of diphenhydramine. It may only reduce the risk of stomach upset, which is not a common side effect of diphenhydramine.

Choice D reason: This is incorrect. Gradually decreasing the dose once tolerance to the effect is reached may not be advisable, as it may reduce the effectiveness of the medication for relieving pruritus. Diphenhydramine is an antihistamine that blocks the action of histamine, a chemical that causes itching and inflammation in allergic reactions.

Choice A reason: Monitor the patient for addiction is not a necessary measure for the nurse to take when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Codeine is a Schedule V medication, which means that it has a low potential for abuse and dependence compared to other opioids. The nurse should follow the prescriber's order and the label instructions and use the lowest effective dose for the shortest duration. The nurse should also assess the patient's pain level, respiratory status, and cough frequency and severity.

Choice B reason: Advise the patient that the medication helps to thin out their secretions is an incorrect statement for the nurse to make when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Codeine does not affect the viscosity or production of the mucus in the airways, but rather reduces the urge to cough. The nurse should advise the patient to drink plenty of fluids, use a humidifier, or use saline nasal spray to help loosen and clear the secretions.

Choice C reason: Advise the patient to minimize intake of beets is not a relevant measure for the nurse to take when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Beets are a vegetable that are rich in antioxidants, fiber, and nitrates, which can lower blood pressure and improve blood flow. Beets do not interact with codeine or affect its metabolism or clearance. The nurse should encourage the patient to eat a balanced and nutritious diet, unless they have any dietary restrictions or allergies.

Choice D reason: Advise the patient that constipation is an adverse effect of the medication is the correct and appropriate measure for the nurse to take when administering codeine cough syrup, which is a medication that suppresses the cough reflex by acting on the brain¹. Codeine can also act on the opioid receptors in the gastrointestinal tract, which can reduce the peristalsis and cause constipation. The nurse should advise the patient to prevent or treat constipation by increasing their fluid and fiber intake, exercising regularly, and using laxatives or stool softeners as needed.