A 60-year-old female client with a 5-year history of diabetes mellitus type 2 visits her primary health care provider with report of an "itchy" skin rash that she has never had before. On inspection, the nurse notes that she has multiple raised reddened lesions of varying sizes located primarily on her legs and arms.

The client reports that her diet has not changed and that she feels embarrassed about her skin problem. The nurse documents her current medications:

• Glipizide 5 mg orally once daily with breakfast for diabetes mellitus type 2
• Furosemide 20 mg orally once every other day for hypertension
• Lovastatin 40 mg orally once daily for high cholesterol
• Duloxetine 60 mg orally once daily for clinical depression
• Trimethoprim/sulfamethoxazole DS 1 tablet every 12 hours for acute urinary tract infection

Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided.

The nurse will instruct the client that she should not continue taking The nurse will instruct the client that she may not be able to continue taking ___________________ .

Choice A rationale: Furosemide is a loop diuretic used to increase urine output by blocking the reabsorption of sodium and water. It's not typically associated with hyperkalemia. In fact, it's more common for loop diuretics like furosemide to cause hypokalemia (low potassium) due to increased urinary excretion of potassium.

Choice B rationale: Lovastatin is a statin used to lower cholesterol levels. It is not related to increased cholesterol. Additionally, there is no known direct interaction between lovastatin and furosemide. Furosemide is a diuretic, while selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants, and they do not typically interact in a way that requires discontinuation.

Choice C rationale: Duloxetine is an antidepressant (SNRI), and glipizide is an oral diabetes medication. There's no direct interaction between duloxetine and glipizide that would necessitate discontinuation.

Choice D rationale: Trimethoprim/sulfamethoxazole (Bactrim) is a sulfonamide antibiotic, and glipizide belongs to the sulfonylurea class of medications. Both drugs contain sulfur groups in their chemical structures, and there is a possibility of cross-reactivity or drug interaction. This interaction can potentially reduce the effectiveness of glipizide, leading to compromised blood sugar control. Additionally, sulfonamide antibiotics like trimethoprim/sulfamethoxazole can cause adverse reactions, including skin rashes or hypersensitivity reactions, particularly in individuals sensitive to sulfa medications.