A teenage client is taking duloxetine (Cymbalta) for a generalized anxiety disorder. The dose has been changed by the physician.
What adverse effects will the nurse advise the client and family to watch?

Choice A rationale

Misoprostol (Cytotec) is contraindicated in pregnant women because it can induce labor or cause miscarriages. It is sometimes used in obstetrics to induce labor or to treat postpartum hemorrhage, but it should never be used in pregnant women to treat peptic ulcers.
Choice B rationale
There is no contraindication for using misoprostol in a client who has osteoarthritis.
Choice C rationale
Misoprostol does not interact with medications typically used to treat urinary tract infections, and there is no contraindication for its use in these clients.
Choice D rationale
Misoprostol does not interact with medications typically used to treat kidney stones, and there is no contraindication for its use in these clients.

Choice A rationale
Coffee contains caffeine, a stimulant that can increase alertness and counteract the effects of anxiolytics and sedatives. However, not all individuals with anxiety or insomnia need to avoid coffee. Some people may find that they can tolerate a small amount of caffeine without it worsening their symptoms.
Choice B rationale
Like coffee, tea also contains caffeine, which can counteract the effects of anxiolytics and sedatives. However, the amount of caffeine in tea is usually less than in coffee, and some types of tea, such as herbal teas, are naturally caffeine-free.
Choice C rationale
Chocolate, especially dark chocolate, contains small amounts of caffeine. However, the amount of caffeine in chocolate is usually much less than in coffee or tea. Some people with anxiety or insomnia may find that they can tolerate chocolate without it worsening their symptoms.
Choice D rationale
All of the above (coffee, tea, and chocolate) contain caffeine, which can counteract the effects of anxiolytics and sedatives and may worsen anxiety symptoms. Therefore, individuals taking these medications for anxiety and insomnia should be advised to avoid or limit their intake of these items.