A nurse is planning to apply a transdermal analgesic cream prior to inserting an IV for a preschool-age child. Which of the following actions should the nurse plan to take? (Select all that apply)

A. Divalproex: Divalproex is typically administered with food to minimize gastrointestinal side effects and enhance absorption. Administering it after breakfast or with a meal is recommended to reduce the risk of stomach upset and improve its bioavailability. Taking divalproex with food also helps to slow its absorption, which can decrease the incidence of adverse effects such as nausea and vomiting.
B. Mycostatin mouthwash: Mycostatin mouthwash is a topical antifungal medication used to treat oral candidiasis. Unlike systemic medications, its efficacy is not significantly influenced by food intake. Therefore, it can be administered before or after meals as prescribed, depending on the convenience of the patient. However, if the patient has oral lesions or discomfort, administering it after meals may be preferable to provide relief and ensure maximum contact time with affected areas.
C. Digoxin: Digoxin is a cardiac glycoside commonly used to treat heart failure and atrial fibrillation. It is typically administered on an empty stomach to facilitate optimal absorption. Giving digoxin before breakfast allows for consistent drug levels and reduces the risk of food interfering with its absorption. By administering it before meals, the nurse ensures that the medication is absorbed efficiently and its therapeutic effects are maximized.
D. Alendronate: Alendronate is a bisphosphonate medication used in the treatment of osteoporosis to prevent bone loss and reduce the risk of fractures. It requires administration on an empty stomach in the morning, usually at least 30 minutes before the first meal or beverage of the day, with a full glass of water. This timing ensures adequate absorption and minimizes the risk of esophageal irritation and ulceration. Alendronate has poor oral bioavailability, and taking it with food, beverages, or medications can significantly decrease its absorption. Therefore, administering it before breakfast on an empty stomach is crucial to optimize its effectiveness and reduce the potential for adverse gastrointestinal effects.

A. Inverted P wave: An inverted P wave may indicate atrial depolarization abnormalities but is not typically associated with hypokalemia. It can be seen in conditions such as atrial enlargement or atrial ischemia. However, in hypokalemia, the P wave may become flattened or have a decreased amplitude, but it is less likely to be inverted.
B. Wide QRS: A wide QRS complex may indicate conduction abnormalities or bundle branch blocks, but it is not specifically associated with hypokalemia. Wide QRS complexes are more commonly seen in conditions such as bundle branch blocks or electrolyte imbalances like hyperkalemia. Hypokalemia tends to cause a prolongation of the QT interval rather than widening of the QRS complex.
C. Elevated ST segment: An elevated ST segment is typically associated with myocardial injury or infarction, not hypokalemia. It can be indicative of conditions such as myocardial ischemia or pericarditis. In hypokalemia, ST segment changes are more likely to be flattened or depressed rather than elevated.
D. Abnormally prominent U wave: An abnormally prominent U wave is a classic EKG finding in hypokalemia. Hypokalemia prolongs the repolarization phase of the cardiac action potential, leading to the appearance of U waves following the T wave. These U waves can become more pronounced as potassium levels decrease. Therefore, an abnormally prominent U wave is a significant indicator of hypokalemia on an EKG, especially in a patient with prolonged vomiting, which can lead to potassium depletion. Thus, it is the most pertinent abnormality to interpret in this context.