A client taking atorvastatin develops an increased serum creatine phosphokinase (CK) level. The nurse should assess the client for the onset of which problem?

Choice A reason: This is not a correct information for the nurse to include in the discharge instructions. Taking the tablet with a daily multivitamin is not advisable, as some vitamins and minerals, such as calcium, zinc, and vitamin C, can interfere with the absorption of iron and reduce its effectiveness. The client should take the tablet on an empty stomach or with a small amount of food that does not contain these substances.

Choice B reason: This is not a correct information for the nurse to include in the discharge instructions. Bedtime is not the best time to take the tablet, as it may cause gastrointestinal side effects, such as nausea, vomiting, constipation, or diarrhea, that can disrupt the client's sleep and comfort. The client should take the tablet at least 2 hours before or after meals, and preferably in the morning.

Choice C reason: This is a correct information for the nurse to include in the discharge instructions. Waiting 2 hours after meals to take the tablet is recommended, as it ensures that the stomach is empty and that the iron is not affected by any food or beverages that may impair its absorption. The client should also drink plenty of water with the tablet to facilitate its passage and prevent irritation of the esophagus.

Choice D reason: This is not a correct information for the nurse to include in the discharge instructions. Crushing the tablets and mixing with pudding is not appropriate, as it can damage the enteric coating of the tablets, which is designed to protect the iron from being destroyed by the stomach acid and to reduce the gastrointestinal side effects. The client should swallow the tablets whole and not chew, break, or crush them.

Choice A reason: This is not a correct action for the nurse to include in this client's plan of care. Administering sucralfate once a day, preferably at bedtime, is not the recommended dosage or timing for this medication. Sucralfate is a mucosal protectant that forms a protective barrier over the ulcer and prevents further damage from acid and pepsin. It should be taken four times a day, one hour before meals and at bedtime, to ensure optimal coverage and healing of the ulcer.

Choice B reason: This is the correct action for the nurse to include in this client's plan of care. Giving sucralfate on an empty stomach is essential for the effectiveness of this medication. Sucralfate needs an acidic environment to activate and form a complex with the ulcer site. If the client takes sucralfate with food or beverages, the pH of the stomach may increase and reduce the ability of sucralfate to bind to the ulcer. The client should take sucralfate one hour before meals and at bedtime, and avoid antacids within 30 minutes of taking sucralfate.

Choice C reason: This is not a correct action for the nurse to include in this client's plan of care. Monitoring for electrolyte imbalance is not a specific or relevant intervention for this medication. Sucralfate does not affect the electrolyte levels in the blood, as it is not absorbed systemically and does not alter the renal function. The nurse should monitor the electrolyte levels for other reasons, such as dehydration, vomiting, or diuretic use, but not because of sucralfate therapy.

Choice D reason: This is not a correct action for the nurse to include in this client's plan of care. Assessing for secondary Candida infection is not a common or necessary intervention for this medication. Sucralfate does not increase the risk of fungal infections, as it does not suppress the immune system or alter the normal flora of the GI tract. The nurse should assess for signs of infection, such as fever, leukocytosis, or purulent drainage, for other reasons, such as perforation, abscess, or sepsis, but not because of sucralfate therapy.