A nurse is caring for a client who has been taking oxymetazoline (Afrin) nasal spray for the past 10 days for allergic rhinitis. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication?

A. Decreased cardiac output: Inotropic medications are intended to improve cardiac function and increase cardiac output, so monitoring for signs of decreased cardiac output would be contrary to the expected therapeutic effect of these medications.

B. Increased afterload: Inotropic medications primarily affect the contractility of the heart muscle and do not typically have a direct effect on afterload (the force against which the heart must pump blood). While changes in afterload can occur as a secondary consequence of altered cardiac function, monitoring for signs of increased afterload would not be the primary focus after administering an inotropic medication.

C. Increased cardiac output.
Inotropic medications are drugs that affect the contractility of the heart muscle. They are often used in the management of shock to improve cardiac function and increase cardiac output. Therefore, after administering an inotropic medication, the nurse would monitor the patient for signs of increased cardiac output, such as improved peripheral perfusion, increased blood pressure, and resolution of signs and symptoms of shock.

D. Slowing of the heart rate: Inotropic medications can affect heart rate indirectly by altering cardiac output, but their primary effect is on contractility rather than heart rate. Monitoring for signs of bradycardia (slowing of the heart rate) may be appropriate in certain clinical situations, but it is not the primary consideration after administering an inotropic medication for shock.

A) Treatment with PPIs to decrease stomach acid:
Pancreatic insufficiency is not primarily related to excess stomach acid production, so treatment with proton pump inhibitors (PPIs) to decrease stomach acid would not address the underlying cause of the condition.

B) Treatment with stimulant laxatives:
Pancreatic insufficiency is not typically associated with constipation or the need for stimulant laxatives. While malabsorption of fats due to pancreatic insufficiency can lead to loose stools or diarrhea, treatment with laxatives is not indicated for this condition.

C) Replacement therapy with pancreatic enzymes.
Pancreatic insufficiency is a condition where the pancreas does not produce enough digestive enzymes to properly digest food. Replacement therapy with pancreatic enzymes is the mainstay of treatment for pancreatic insufficiency. These pancreatic enzyme supplements help in the digestion and absorption of nutrients from food by compensating for the deficient enzymes produced by the pancreas. By taking pancreatic enzyme supplements with meals, the client can improve digestion and prevent malnutrition associated with pancreatic insufficiency.

D) Decrease food intake:
Decreasing food intake would not address the underlying cause of pancreatic insufficiency, which is the deficiency of pancreatic enzymes needed for proper digestion. In fact, decreasing food intake could exacerbate malnutrition and nutrient deficiencies in individuals with pancreatic insufficiency. The primary goal of treatment is to improve digestion and nutrient absorption by providing supplemental pancreatic enzymes with meals.