The nurse is planning the home care of a client who is receiving a mydriatic medication. Which environment is best for this client?

Choice A reason: Recent use of other antidepressants is important to know, as duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that can interact with other antidepressants, especially monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). However, this information is not as important as liver function laboratory results, as duloxetine can cause hepatotoxicity in some clients.

Choice B reason: Weight change in the last month is relevant to monitor, as duloxetine can cause weight loss or gain in some clients. However, this information is not as important as liver function laboratory results, as duloxetine can cause liver damage in some clients.

Choice C reason: Family history of mental illness is useful to assess, as duloxetine may be more effective or less effective in clients with certain genetic factors. However, this information is not as important as liver function laboratory results, as duloxetine can cause liver failure in some clients.

Choice D reason: Liver function laboratory results are most important to obtain, as duloxetine is metabolized by the liver and can cause hepatotoxicity in some clients. The nurse should monitor the client's liver enzymes and bilirubin levels before and during treatment with duloxetine and report any signs of liver impairment, such as jaundice, dark urine, abdominal pain, or fatigue.

Choice B reason: Vancomycin is an antibiotic that can treat serious bacterial infections that are resistant to other antibiotics. However, vancomycin can also cause nephrotoxicity, or damage to the kidneys, especially when given in high doses or for prolonged periods. Nephrotoxicity can lead to AKI, which is a sudden and severe decrease in kidney function that can cause fluid and electrolyte imbalances, acid-base disorders, uremia, and death. Therefore, the nurse should closely monitor the client who is receiving vancomycin for development of AKI by checking their serum creatinine and blood urea nitrogen (BUN) levels, urine output and specific gravity, and signs and symptoms of fluid overload or dehydration.

Choice A reason: Sucralfate is an anti-ulcer drug that forms a protective coating over the stomach lining and prevents further damage from acid or pepsin. Sucralfate does not cause nephrotoxicity or AKI and has minimal systemic absorption or side effects. Therefore, the nurse does not need to closely monitor the client who is taking sucralfate for development of AKI.

Choice C reason: Lorazepam is a benzodiazepine that can treat anxiety, insomnia, seizures, or alcohol withdrawal. Lorazepam does not cause nephrotoxicity or AKI and has low renal clearance or elimination. Therefore, the nurse does not need to closely monitor the client who is taking lorazepam for development of AKI.

Choice D reason: Digoxin is a cardiac glycoside that can treat heart failure or atrial fibrillation by increasing the force and efficiency of heart contractions and slowing down the heart rate. Digoxin does not cause nephrotoxicity