A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Choice D reason: Probenecid is a uricosuric drug that increases the excretion of uric acid in the urine by inhibiting its reabsorption in the kidneys. Uric acid is a waste product that results from the breakdown of purines, which are found in certain foods and drinks, such as meat, seafood, beer, and wine. Probenecid is used to treat gout, a type of arthritis that occurs when uric acid crystals accumulate in the joints and cause inflammation, pain, swelling, and stiffness. By lowering uric acid levels in the blood, probenecid can prevent gout attacks and reduce joint damage.

Choice A reason: Increasing the strength of the urine stream is not a purpose of probenecid, but rather a possible effect of some medications that relax or dilate the urinary tract muscles, such as alpha-blockers or anticholinergics. These medications can help to improve urinary flow and reduce symptoms of benign prostatic hyperplasia (BPH), or enlarged prostate gland, which can cause difficulty urinating or weak urine stream.

Choice B reason: Preventing the formation of kidney stones is not a purpose of probenecid, but rather a potential benefit of some medications that lower calcium or oxalate levels in the urine, such as thiazide diuretics or potassium citrate. These medications can help to prevent calcium oxalate stones, which are one of the most common types of kidney stones. Kidney stones are hard deposits of minerals and salts that form in the kidneys and can cause severe pain, nausea, vomiting, and blood in the urine.

Choice C reason: Decreasing pain and burning during urination is not a purpose of probenecid, but rather a desired outcome of some medications that treat urinary tract infections (UTIs), such as antibiotics or phenazopyridine. These medications can help to eliminate the bacteria that cause UTIs and relieve the discomfort and inflammation that they cause. UTIs are infections that affect the bladder, urethra, or kidneys and can cause frequent or urgent urination, pain or burning during urination, cloudy or foul-smelling urine, and fever.

Choice A reason: Replacing leafy vegetables with a protein source is not necessary or advisable for a vegetarian client who takes warfarin. Leafy vegetables are rich in vitamin K, which can interfere with warfarin's anticoagulant effect, but they also provide other nutrients and benefits for health. Protein sources such as nuts or beans may also contain vitamin K or other substances that can affect warfarin's action.

Choice B reason: Commending the client for her healthy lifestyle and encouraging her to continue her current diet habits is not appropriate or safe for a vegetarian client who takes warfarin. Leafy vegetables can alter warfarin's anticoagulant effect and increase the risk of bleeding or clotting complications if not monitored closely by the healthcare provider.

Choice C reason: Advising the client that the healthcare provider needs to be made aware of her current diet is the best response for a vegetarian client who takes warfarin. Leafy vegetables can affect warfarin's anticoagulant effect by increasing vitamin K levels in the body, which counteracts warfarin's action. The healthcare provider can adjust the warfarin dose accordingly and monitor the client's international normalized ratio (INR), which is a measure of blood clotting time.

Choice D reason: Confirming that her diet choices will help the medication be more effective in preventing blood clots is incorrect and misleading for a vegetarian client who takes warfarin. Leafy vegetables can decrease warfarin's anticoagulant effect by increasing vitamin K levels in the body, which enhances blood clotting. This can reduce the effectiveness of warfarin and increase the risk of thromboembolic events, such as stroke or pulmonary embolism.