A nurse is assisting with the care of four clients who have peptic ulcer disease. The nurse should identify that misoprostol (Cytotec) is contraindicated for which of the following clients?

To calculate the rate of administration in milliliters per hour (mL/hr):

First, find the total volume to be infused: 1000 mL

Next, divide the total volume by the total time in hours: 1000 mL ÷ 5 hours = 200 mL/hr

Therefore, you will administer the solution at a rate of 200 mL/hr.

To calculate the rate of administration in drops per minute (drops/min):

First, find the total drops: 1000 mL × 15 drops/mL = 15,000 drops

Next, divide the total drops by the total time in minutes: 15,000 drops ÷ (5 hours × 60 minutes/hour) = 50 drops/min

Therefore, you will administer the solution at a rate of 200 mL/hr and 50 drops/min.

A) Increase dosing with a large meal:
Increasing the dosing with a large meal may not be appropriate as it could lead to overdosing and potential side effects. The dosage of pancrelipase should be determined by the healthcare provider based on the individual's needs and response to treatment. There's no evidence to support the need for increased dosing with larger meals.

B) Take the medication at least 2 hours prior to meals:
Taking the medication prior to meals may not be effective as the enzymes will not be available when food is consumed, which defeats the purpose of enzyme replacement therapy. The enzymes need to be present simultaneously with the food to aid in digestion. Waiting 2 hours before meals would mean the enzymes are not available when needed.

C) Take the medication with meals.
Pancrelipase, such as Cotazym, is a pancreatic enzyme replacement therapy used to aid in the digestion of fats, proteins, and carbohydrates in individuals with pancreatic insufficiency. Taking the medication with meals is crucial because it helps ensure that the enzymes are available to aid in the digestion of food. Without proper enzyme supplementation during meals, individuals with pancreatic insufficiency may experience malabsorption, leading to nutritional deficiencies and gastrointestinal symptoms.

D) Decrease fluid intake:
Decreasing fluid intake is not appropriate as it could lead to dehydration and may not have any significant impact on the efficacy of pancrelipase. In fact, adequate fluid intake is important for digestion and overall health. There's no indication that fluid intake needs to be decreased when taking pancrelipase.