A nurse is caring for a client who has hydromorphone toxicity.
The nurse should anticipate a prescription for which of the following medications?

Choice A rationale

Ethinyl estradiol and norethindrone, a common oral contraceptive combination, can sometimes lead to weight gain rather than weight loss. This is often attributed to fluid retention and changes in appetite or metabolism, rather than a catabolic effect causing weight reduction.

Choice B rationale

Easy bruising is not a typical manifestation of ethinyl estradiol and norethindrone use. While some hormonal contraceptives can affect coagulation factors, leading to an increased risk of thrombosis, they do not generally cause increased capillary fragility or platelet dysfunction manifesting as easy bruising.

Choice C rationale

Oral contraceptives containing estrogen, such as ethinyl estradiol, can actually cause a slight increase in blood pressure in some individuals due to their effects on the renin-angiotensin-aldosterone system, leading to sodium and water retention. Low blood pressure is not a common adverse effect.

Choice D rationale

Breakthrough bleeding, or irregular uterine bleeding that occurs during hormone therapy, is a common adverse effect of combined oral contraceptives like ethinyl estradiol and norethindrone, especially during the initial cycles of use. It results from an imbalance in the hormonal effects on the endometrium.

Choice A rationale

Beclomethasone is an inhaled corticosteroid. Gargling with water after use is essential to reduce the local deposition of the medication in the oropharynx. This minimizes the risk of developing oral candidiasis, commonly known as thrush, and hoarseness, which are common local side effects associated with inhaled corticosteroid use.

Choice B rationale

Beclomethasone, like most inhaled suspensions, requires shaking prior to use. Shaking ensures that the medication is evenly dispersed within the propellant or solution. This uniform dispersion is critical for delivering an accurate and consistent dose with each actuation, maximizing therapeutic efficacy and minimizing variability.

Choice C rationale

Beclomethasone is a long-acting inhaled corticosteroid used for the *maintenance* and *preventive* treatment of asthma. It works by reducing airway inflammation over time, not by providing immediate bronchodilation. Therefore, it is ineffective for and should not be used during an acute asthma attack, which requires a rapid-acting bronchodilator.

Choice D rationale

For optimal benefit, the short-acting bronchodilator, albuterol, should be used *before* beclomethasone. Albuterol opens the airways, allowing for better penetration of the inhaled corticosteroid into the lower respiratory tract. This sequential administration enhances the delivery and absorption of beclomethasone, improving its anti-inflammatory effects.