A nurse is caring for a client who reports difficulty breathing during the administration of an intermittent IV bolus of nafcillin. After stopping the infusion and notifying the provider, the nurse should anticipate a prescription for which of the following medications?

• NSAID use. The client has been taking ibuprofen (an NSAID) twice daily while also receiving prednisone (a corticosteroid) for asthma exacerbation. Both NSAIDs and corticosteroids inhibit prostaglandin production, which normally protects the stomach lining. This combination increases the risk of gastric irritation, peptic ulcers, and gastrointestinal bleeding.
• Recent immunization. The client received the influenza vaccine three days ago, but this does not significantly increase the risk of infection. The flu shot contains inactivated or weakened virus, meaning it cannot cause the flu. The client’s asthma may increase their risk of complications from the flu, but the vaccine helps reduce this risk rather than increasing it.
• Weight gain. The client has gained 1.36 kg (3 lb) in one week, which is likely due to fluid retention from prednisone use. While long-term corticosteroid use can lead to Cushing syndrome, this condition develops over weeks to months of high-dose steroid therapy, not within a short period. Therefore, the client is at a higher risk of peptic ulcers rather than Cushing syndrome.
• Cushing syndrome. Cushing syndrome results from chronic corticosteroid use leading to fat redistribution, muscle weakness, skin thinning, and hyperglycemia. However, this client is on a short-term tapering dose of prednisone, making Cushing syndrome unlikely at this stage.
• Influenza. Although the client has asthma, which increases the risk of complications from respiratory infections, there is no indication that they have developed the flu. The flu shot helps prevent infection, and there are no reports of fever, body aches, or respiratory symptoms suggestive of influenza.
• Peptic ulcers. The combination of NSAIDs and corticosteroids significantly increases the risk of peptic ulcer disease by weakening the stomach lining and promoting acid production. The client should be advised to monitor for signs of gastric irritation, such as abdominal pain, black stools, or nausea, and may require a proton pump inhibitor (PPI) like omeprazole for ulcer prevention.

A. Drowsiness. Dimenhydrinate is an antihistamine that works by blocking histamine and acetylcholine receptors in the brain to prevent nausea and vomiting. A common adverse effect is drowsiness due to its sedative properties, which can impair alertness and coordination. Clients should be advised to avoid activities requiring mental alertness, such as driving, until they understand how the medication affects them.

B. Hypertension. Dimenhydrinate does not typically cause hypertension. Instead, it may lead to mild hypotension due to its sedative and anticholinergic effects. Clients with pre-existing hypertension should still monitor their blood pressure, but significant increases are uncommon.

C. Polyuria. Increased urination is not associated with dimenhydrinate use. Antihistamines, including dimenhydrinate, have anticholinergic properties, which can lead to urinary retention rather than increased urine output. Clients experiencing difficulty urinating should report this to their healthcare provider.

D. Dependent edema. Dimenhydrinate does not cause fluid retention or edema. Medications that contribute to edema typically involve hormonal, cardiovascular, or kidney-related effects, which are not mechanisms of dimenhydrinate. If a client develops unexplained edema, other underlying conditions should be investigated.