A client is prescribed alprazolam (Xanax) for anxiety disorder. The nurse should instruct the client to avoid which of the following substances while taking this medication?

Correct answer: b) "I should avoid using mouthwash that contains alcohol."

Rationale: Disulfiram works by inhibiting the enzyme that metabolizes alcohol, causing a buildup of acetaldehyde in the body. This produces a severe reaction when alcohol is consumed, which includes flushing, headache, nausea, vomiting, chest pain, and hypotension. The reaction can occur even with small amounts of alcohol found in mouthwash, cough syrup, perfume, or food.

Incorrect choices:

a) "I can drink alcohol as long as I skip the dose of disulfiram.": This is incorrect as the effects of disulfiram can last for up to two weeks after the last dose. The client should abstain from alcohol completely while taking disulfiram and for at least 14 days after stopping the medication.

c) "I will experience euphoria if I drink alcohol while taking disulfiram.": This is incorrect as the reaction caused by disulfiram and alcohol is unpleasant and aversive, not euphoric. The purpose of disulfiram is to deter the client from drinking alcohol by creating a negative association.

d) "I can stop taking disulfiram once I have been sober for a month.": This is incorrect as disulfiram is not a cure for alcohol use disorder, but a tool to help the client maintain sobriety. The client should continue taking disulfiram as prescribed by the provider and participate in other forms of treatment such as counseling, support groups, and relapse prevention.

Correct answer: a) Grapefruit juice

Rationale: Grapefruit juice can increase the blood levels of alprazolam and other benzodiazepines by inhibiting their metabolism in the liver. This can result in increased sedation, drowsiness, and risk of adverse effects.

Incorrect choices:

b) Green tea: Green tea does not interact with alprazolam or other benzodiazepines.

c) Vitamin C: Vitamin C does not interact with alprazolam or other benzodiazepines.

d) Calcium supplements: Calcium supplements do not interact with alprazolam or other benzodiazepines.