A client is receiving tamsulosin, an alpha-adrenergic blocking agent, for the management of urinary retention due to benign prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide?

Choice A reason:

Insomnia is a known side effect of St. John’s wort. While it can be bothersome, it does not typically require further instruction beyond standard advice on managing insomnia. Patients should be advised to take the medication earlier in the day to minimize sleep disturbances.

Choice B reason:

St. John’s wort can interact with hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. This interaction occurs because St. John’s wort induces the enzymes that metabolize contraceptive hormones, leading to lower levels of these hormones in the body. Therefore, it is crucial to instruct the client to use an additional form of contraception to prevent pregnancy.

Choice C reason:

Sensitivity to the sun, or photosensitivity, is a documented side effect of St. John’s wort. Patients should be advised to use sunscreen and wear protective clothing when exposed to sunlight. While this side effect requires caution, it does not necessitate further instruction beyond these preventive measures.

Choice D reason:

Using hard candy to alleviate dry mouth is a common and effective strategy. St. John’s wort can cause dry mouth, and sucking on sugar-free hard candy can help stimulate saliva production. This advice is appropriate and does not require further instruction.

Choice A reason: Omeprazole is a proton pump inhibitor used to treat gastroesophageal reflux disease (GERD). While it is generally safe, it is not commonly associated with causing jaundice. Omeprazole can cause liver enzyme elevations in rare cases, but it is not a primary concern for drug-induced jaundice.

Choice B reason: Acetaminophen is known to cause hepatotoxicity, especially in high doses or with prolonged use. It is one of the most common causes of drug-induced liver injury, which can lead to jaundice. The nurse should notify the healthcare provider about the use of acetaminophen, as it is a likely culprit for the client’s jaundice.

Choice C reason: Captopril is an ACE inhibitor used to treat hypertension. While it can cause various side effects, it is not typically associated with causing jaundice. The primary concerns with captopril are related to renal function and electrolyte imbalances.

Choice D reason: Prednisone is a corticosteroid used to reduce inflammation in conditions like osteoarthritis. Although long-term use of corticosteroids can affect liver function, it is not commonly associated with causing jaundice. The nurse should still monitor liver function but focus on more likely causes.