A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?

Choice A reason: Tinnitus is a rare side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Tinnitus is a ringing or buzzing sound in the ears that can be caused by various factors, such as ear infections, noise exposure, or certain medications. Flexeril does not affect the auditory system directly, but it can cause confusion or dizziness, which may worsen the perception of tinnitus.

Choice B reason: Drowsiness is the most common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Drowsiness occurs because Flexeril has sedative and anticholinergic properties, which means that it blocks the action of acetylcholine, a neurotransmitter that regulates arousal and alertness. Flexeril can impair the mental and physical abilities, especially in elderly patients or those who take other medications that cause drowsiness¹. The nurse should educate the patient about the risk of drowsiness and advise them to avoid driving or operating machinery while taking Flexeril.

Choice C reason: Diarrhea is not a common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Diarrhea is a condition that causes loose or watery stools, which can be caused by various factors, such as infections, food intolerance, or certain medications. Flexeril does not affect the gastrointestinal system directly, but it can cause dry mouth, nausea, or constipation, which may alter the bowel movements¹.

Choice D reason: Palpitations are not a common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Palpitations are a sensation of rapid or irregular heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, or certain medications. Flexeril does not affect the cardiac system directly, but it can lower the blood pressure or interact with other medications that affect the heart rate, such as betablockers or antidepressants¹.

Choice A reason: This is correct. Blood pressure is the most important vital sign to monitor after giving sublingual nitroglycerin to a client with chest pain. Nitroglycerin is a medication that dilates the blood vessels and lowers the blood pressure. This can relieve the chest pain caused by angina, which is a condition where the heart muscle does not get enough oxygen due to narrowed or blocked arteries. However, if the blood pressure drops too low, the client may experience dizziness, fainting, or shock. Therefore, the nurse should check the blood pressure before and after giving nitroglycerin and report any significant changes to the doctor.

Choice B reason: This is incorrect. Blood glucose levels are not directly affected by sublingual nitroglycerin. However, some clients with chest pain may also have diabetes, which is a risk factor for heart disease. Diabetes is a condition where the body cannot regulate the amount of sugar in the blood. High or low blood sugar levels can cause symptoms such as thirst, hunger, fatigue, blurred vision, or confusion. Therefore, the nurse should check the blood glucose levels of clients with diabetes and follow the doctor's orders for managing their blood sugar.

Choice C reason: This is incorrect. Body temperature is not directly affected by sublingual nitroglycerin. However, some clients with chest pain may also have a fever, which is a sign of infection or inflammation. Fever is a condition where the body's temperature rises above the normal range. Fever can cause symptoms such as sweating, chills, headache, or muscle ache. Therefore, the nurse should check the body temperature of clients with fever and follow the doctor's orders for treating their infection or inflammation.

Choice D reason: This is incorrect. Respiratory rate is not directly affected by sublingual nitroglycerin. However, some clients with chest pain may also have difficulty breathing, which is a sign of heart failure or lung disease. Difficulty breathing is a condition where the client cannot get enough air into or out of the lungs. Difficulty breathing can cause symptoms such as coughing, wheezing, or gasping. Therefore, the nurse should check the respiratory rate of clients with difficulty breathing and follow the doctor's orders for improving their oxygenation.