A client who is taking dextroamphetamine-amphetamine extended-release tablets for attention deficit hyperactivity disorder (ADHD), reports about having difficulty sleeping at night. Which assessment is most important for the nurse to obtain?

A) Request a prescription to change the route of administration and use the available heparin:
Changing the route of administration without a prescription is not within the nurse's scope of practice and could lead to medication errors or adverse effects. It's essential to follow the prescribed route of administration to ensure patient safety.

B) Calculate and administer the equivalent dose of the available low molecular weight heparin:
Low molecular weight heparin (LMWH) has different dosing and potency compared to unfractionated heparin. Calculating an equivalent dose without a specific conversion ratio could result in under- or overdosing, leading to ineffective anticoagulation or increased risk of bleeding.

C) Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately:
This is the correct action. Since the prescription specifies unfractionated heparin administered intravenously, the nurse should notify the pharmacy to provide the correct medication promptly. Using a different form of heparin could lead to dosing errors or ineffective treatment.

D) Dilute the available heparin in 250 mL of normal saline solution prior to IV administration:
This action is not appropriate because it assumes that the available heparin is suitable for intravenous administration, which may not be the case. Dilution may also alter the concentration and potency of the medication, leading to inaccurate dosing and potential adverse effects.

A) Keep medication refrigerated:
Metronidazole tablets do not typically require refrigeration. Storing the medication at room temperature is usually sufficient. Refrigeration may not be necessary and could potentially lead to confusion or unnecessary inconvenience for the client.

B) Drink a liter of water daily:
While maintaining hydration is generally important for overall health, there's no specific requirement to drink a liter of water daily solely because of metronidazole therapy. However, encouraging adequate fluid intake is beneficial to prevent dehydration, especially if diarrhea is present due to Clostridium difficile infection.

C) Take one hour after eating:
Metronidazole can be taken with or without food. It's generally well tolerated with food to reduce gastrointestinal side effects such as nausea. However, taking it with food or on an empty stomach does not significantly affect its effectiveness.

D) Avoid the use of alcohol:
This is the correct answer. Consuming alcohol while taking metronidazole can lead to a disulfiram-like reaction, characterized by symptoms such as flushing, headache, nausea, vomiting, and abdominal cramps. This reaction occurs because metronidazole inhibits the breakdown of acetaldehyde, leading to its accumulation in the body when alcohol is consumed. Therefore, it's crucial to advise clients to abstain from alcohol during metronidazole therapy and for at least 48 hours after completing the course of treatment.