A nurse in the emergency department is caring for a client who accidentally doubled their last dose of diazepam.
After assessing the client, which of the following medications should the nurse plan to administer?

Choice A rationale

Gastrointestinal reflux, or GERD, is a condition where stomach acid flows back into the esophagus. While triptans can sometimes cause mild gastrointestinal upset, GERD itself is not a contraindication to sumatriptan use. The mechanism of action of sumatriptan involves serotonin receptor agonism, which does not significantly exacerbate or directly interact with the pathophysiology of gastrointestinal reflux disease.

Choice B rationale

Angina pectoris is chest pain caused by reduced blood flow to the heart muscle, often due to coronary artery disease. Sumatriptan causes vasoconstriction by acting on serotonin 5-HT1B/1D receptors. This generalized vasoconstrictive effect can lead to coronary artery spasm and worsen myocardial ischemia, making it a significant contraindication in patients with cardiovascular conditions like angina pectoris or a history of myocardial infarction.

Choice C rationale

Routine acetylsalicylic acid (aspirin) use is common for its antiplatelet and analgesic properties. There is no known direct contraindication to sumatriptan use in patients taking routine acetylsalicylic acid. While both medications can affect platelet function, their mechanisms of action and indications are distinct, and concurrent use is generally considered safe if no other contraindications exist.

Choice D rationale

Eczema is an inflammatory skin condition characterized by dry, itchy patches. Eczema is a dermatological condition and does not have any physiological or pharmacological interaction with sumatriptan's mechanism of action, which primarily involves vasoconstriction in the cerebral vasculature and inhibition of trigeminal nerve activity. Therefore, eczema is not a contraindication to sumatriptan therapy.

Choice A rationale

Documenting the client's refusal and the stated reason in the nurses' notes is crucial for legal and ethical reasons. It provides a clear record of the event, ensures continuity of care by informing other healthcare providers, and allows for follow-up interventions to address the client's concerns or alternative medication strategies. It upholds the client's right to refuse treatment.

Choice B rationale

Delegating medication administration to an assistive personnel (AP) is inappropriate as medication administration is a complex nursing function requiring assessment, judgment, and patient education, which are outside the scope of practice for an AP. An AP's role is typically limited to basic care activities, and they are not trained or authorized to administer medications.

Choice C rationale

Notifying the pharmacist is not the immediate or primary action when a client refuses medication. While the pharmacist may offer insights into alternative formulations or administration routes, the nurse's initial responsibility is to understand the client's refusal, document it, and then notify the prescribing provider for a revised plan of care.

Choice D rationale

Mixing medication in juice without the client's explicit consent is considered a breach of the client's autonomy and can be construed as coercive or deceptive. It violates the client's right to self-determination and informed consent regarding their treatment. Medications should only be administered with the client's knowledge and cooperation.