The health care provider prescribes the antibiotic tetracycline HCl for an adult client who arrived at an outpatient clinic. Which instruction should the nurse include in the teaching plan for this client?

Choice A reason: Taking levothyroxine on an empty stomach ensures better absorption and prevents interference from food or other medications. The client should take levothyroxine at least 30 minutes before breakfast or four hours after the last meal of the day.

Choice B reason: Consuming foods that are high in iodine is not recommended for clients taking levothyroxine, as it may affect the thyroid function and the dosage of the medication. Foods that are high in iodine include seafood, seaweed, dairy products, and iodized salt.

Choice C reason: Administering levothyroxine at bedtime is not advisable, as it may cause insomnia, anxiety, or palpitations. Levothyroxine is best taken in the morning, as it mimics the natural secretion of thyroid hormones.

Choice D reason: Avoiding the use of iron supplements is not necessary for clients taking levothyroxine, as long as they are taken at different times. Iron supplements can interfere with the absorption of levothyroxine, so they should be taken at least four hours apart.

Choice A reason: This is not the most important adverse effect for the nurse to report. Nausea is a common side effect of metoclopramide, which is a prokinetic and antiemetic drug that stimulates the motility of the upper GI tract and blocks the dopamine receptors in the chemoreceptor trigger zone. Nausea may be mild or moderate, and it may subside with time or dose adjustment. The nurse should monitor the client's nausea and provide supportive measures, such as fluids, crackers, or ginger, but it is not a priority.

Choice B reason: This is the most important adverse effect for the nurse to report. Involuntary movements, or extrapyramidal symptoms, are a serious and potentially irreversible side effect of metoclopramide, which can occur due to the blockade of the dopamine receptors in the basal ganglia. Involuntary movements can include dystonia, akathisia, parkinsonism, or tardive dyskinesia, and they can affect the face, neck, limbs, or trunk. The nurse should assess the client for any signs of involuntary movements and notify the healthcare provider immediately. The nurse should also prepare to administer an anticholinergic drug, such as benztropine, to counteract the effects of metoclopramide.

Choice C reason: This is not the most important adverse effect for the nurse to report. Unusual irritability is a rare and mild side effect of metoclopramide, which may be related to the central nervous system effects of the drug. Unusual irritability may manifest as restlessness, anxiety, or agitation, and it may resolve with time or dose adjustment. The nurse should monitor the client's mood and behavior and provide reassurance and comfort, but it is not a priority.

Choice D reason: This is not the most important adverse effect for the nurse to report. Diarrhea is a rare and mild side effect of metoclopramide, which may be related to the increased motility of the GI tract. Diarrhea may be transient or self-limiting, and it may be managed with fluids, electrolytes, or antidiarrheal drugs. The nurse should monitor the client's stool frequency and consistency and provide hydration and hygiene, but it is not a priority.