A nurse is caring for a client who is 6 hr postoperative following an open reduction internal fixation to the left hip. The nurse should use which of the following routes to administer pain medication?

Ferrous gluconate is an iron supplementused to treat or prevent iron-deficiency anemia. Iron is best absorbed in an acidic environmentand is known for causing significant gastrointestinal irritation. Patient education focuses on enhancing absorption while minimizing common side effects like constipation, nausea, and esophageal irritation.

Rationale:

A.Black stools are a common and harmless side effect of iron supplementation, resulting from unabsorbed iron in the gastrointestinal tract. The client does not need to notify the provider unless the stools are also tarry or accompanied by abdominal pain, which could indicate bleeding. Misinterpreting this as a danger sign could lead to unnecessary anxiety or discontinuation of therapy.

B.Taking the medication with milk is incorrect because calcium and phosphates in dairy products significantly inhibit iron absorption. The client should avoid consuming dairy, eggs, coffee, or tea within 2 hours of taking ferrous gluconate. To maximize absorption, the medication should ideally be taken with a source of vitamin C, such as orange juice, or on an empty stomach.

C.Staying upright for at least 15 minutes after taking ferrous gluconate is a correct measure to prevent esophageal irritation. Iron supplements can be caustic to the mucosal lining if they reflux or lodge in the esophagus. Remaining in an upright position helps ensure the tablet or liquid moves efficiently into the stomach, reducing the risk of erosive esophagitis.

D.Taking an antacid with iron is contraindicated because antacids neutralize gastric acid, which is required for optimal iron absorption. If the client experiences significant stomach upset, the nurse should suggest taking the medication with a small amount of non-dairy food. However, the client must be aware that taking it with food or antacids reduces the overall percentage of iron absorbed.

Disulfiram is an aldehyde dehydrogenase inhibitorused as an aversion therapy for alcohol use disorder. It causes the accumulation of acetaldehydein the blood if ethanol is consumed, leading to a highly unpleasant and dangerous disulfiram-ethanol reaction. This reaction can escalate from mild discomfort to cardiovascular collapse and respiratory failure.

Rationale:

A.A headache is a distressing part of the disulfiram-ethanol reaction, but it is not the most life-threatening symptom. While the client may experience significant throbbing and pain, the nurse must prioritize the assessment of ABCs (airway, breathing, and circulation). A headache does not signal the immediate hemodynamic instability that requires the highest level of emergency medical intervention.

B.Flushing of the face and neck occurs due to acetaldehyde-induced vasodilation and is one of the first signs of the reaction. While visually prominent, flushing itself does not pose an immediate threat to the client’s life. The nurse should document the finding but focus on identifying more severe symptoms that indicate the client is entering a stage of cardiovascular shock.

C.Hypotension is the priority finding because it indicates severe cardiovascular collapse resulting from profound vasodilation and increased capillary permeability. Significant drops in blood pressure during a disulfiram reaction can lead to shock, myocardial infarction, or death. The nurse must report this immediately so that emergency resuscitation, including intravenous fluids and vasopressors, can be initiated to stabilize the client.

D.Nausea and vomiting are very common during the disulfiram-ethanol reaction and serve as the primary "aversion" mechanism of the drug. Although these symptoms are highly uncomfortable and can lead to dehydration, they are not as immediately fatal as profound hypotension. The nurse should manage the vomiting but prioritize reporting the signs of circulatory failure to the healthcare provider.