A female client with mild depression reports to the nurse recently starting St. John's wort. Which information provided by the client requires further instruction?

Choice A reason: Eliminating use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, is an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that stabilizes mood and prevents manic episodes. NSAIDs can increase the blood levels of lithium and cause toxicity, which can manifest as nausea, vomiting, tremors, confusion, or seizures.

Choice B reason: Monitoring blood glucose levels daily is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not affect the blood sugar levels or the risk of diabetes. Blood glucose levels may be important for the general health of the client, but they are not related to lithium therapy.

Choice C reason: Notifying healthcare provider prior to dental procedures is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interact with local anesthetics or antibiotics that may be used during dental procedures. However, the client should inform the dentist about their medical history and medications, as a precaution.

Choice D reason: Avoiding consuming all foods that contain iodine is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interfere with the thyroid function or the metabolism of iodine. Iodine is an essential nutrient that is found in many foods, such as seafood, dairy products, eggs, and iodized salt. Avoiding iodine can cause deficiency and lead to goiter or hypothyroidism.

Choice A reason: Trouble sleeping is not a relevant information for administering pyridostigmine, which is a cholinesterase inhibitor that improves muscle strength and function in patients with myasthenia gravis. Trouble sleeping may be caused by other factors, such as stress, pain, or medication side effects.

Choice B reason: Difficulty with urination is not a pertinent information for administering pyridostigmine, which does not affect urinary function or bladder control. Difficulty with urination may indicate a urinary tract infection, prostate enlargement, or kidney stones.

Choice C reason: Unexplained weight loss is not a significant information for administering pyridostigmine, which does not affect metabolism or appetite. Unexplained weight loss may be a sign of an underlying condition, such as hyperthyroidism, diabetes, or cancer.

Choice D reason: Recent oral intake is the correct information for administering pyridostigmine, which should be taken on an empty stomach or before meals to enhance its absorption and effectiveness. Pyridostigmine can also help prevent or reduce dysphagia (difficulty swallowing), which is a common symptom of myasthenia gravis.