A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?

A. Divalproex: Divalproex is typically administered with food to minimize gastrointestinal side effects and enhance absorption. Administering it after breakfast or with a meal is recommended to reduce the risk of stomach upset and improve its bioavailability. Taking divalproex with food also helps to slow its absorption, which can decrease the incidence of adverse effects such as nausea and vomiting.
B. Mycostatin mouthwash: Mycostatin mouthwash is a topical antifungal medication used to treat oral candidiasis. Unlike systemic medications, its efficacy is not significantly influenced by food intake. Therefore, it can be administered before or after meals as prescribed, depending on the convenience of the patient. However, if the patient has oral lesions or discomfort, administering it after meals may be preferable to provide relief and ensure maximum contact time with affected areas.
C. Digoxin: Digoxin is a cardiac glycoside commonly used to treat heart failure and atrial fibrillation. It is typically administered on an empty stomach to facilitate optimal absorption. Giving digoxin before breakfast allows for consistent drug levels and reduces the risk of food interfering with its absorption. By administering it before meals, the nurse ensures that the medication is absorbed efficiently and its therapeutic effects are maximized.
D. Alendronate: Alendronate is a bisphosphonate medication used in the treatment of osteoporosis to prevent bone loss and reduce the risk of fractures. It requires administration on an empty stomach in the morning, usually at least 30 minutes before the first meal or beverage of the day, with a full glass of water. This timing ensures adequate absorption and minimizes the risk of esophageal irritation and ulceration. Alendronate has poor oral bioavailability, and taking it with food, beverages, or medications can significantly decrease its absorption. Therefore, administering it before breakfast on an empty stomach is crucial to optimize its effectiveness and reduce the potential for adverse gastrointestinal effects.

A. Maintain the head of the bed in a flat position for 30 min following medication administration: This option is incorrect because after administering medications through an NG tube, it's crucial to elevate the head of the bed to at least 30 to 45 degrees to minimize the risk of aspiration. Keeping the head of the bed flat increases the likelihood of reflux and aspiration of medication.
B. Mix the three medications together prior to administering: This option is incorrect because mixing medications without specific instructions from the healthcare provider can lead to potential interactions or alterations in the effectiveness of the drugs. Each medication should be administered separately to ensure accurate dosing and prevent potential adverse effects.
C. Rush the NG feeding tube with 30 mL of water immediately: This option is incorrect because while flushing the NG tube with water after medication administration is necessary to ensure that the medications reach the stomach and to prevent tube occlusion, the recommended volume for flushing is typically 30 to 60 mL, not just 30 mL. Using a larger volume of water helps ensure thorough flushing of the tube.
D. Dilute each medication with 10 mL of tap water: This is the correct action. Diluting each medication with 10 mL of tap water is a standard practice to ensure proper administration through an NG tube. Dilution helps prevent tube occlusion and irritation of the gastric mucosa, reducing the risk of complications such as clogging of the tube or local irritation. Additionally, diluting the medications facilitates their passage through the tube and into the stomach, optimizing absorption and effectiveness while minimizing the risk of adverse effects.