A nurse is providing teaching to a client who has a history of diabetes mellitus and a new prescription for hydrochlorothiazide to treat uncontrolled hypertension.
Which of the following information should the nurse include in the teaching?

Choice A rationale

Constipation is not a commonly associated adverse effect of ciprofloxacin. Fluoroquinolones primarily impact gastrointestinal motility through alterations in gut flora and direct irritation, often leading to diarrhea or abdominal discomfort rather than constipation. The drug's mechanism does not typically promote slowed bowel movements or decreased peristalsis.

Choice B rationale

Weight gain is not a typical adverse effect of ciprofloxacin. Fluoroquinolones do not directly influence metabolic pathways or fluid retention in a manner that would lead to increased body mass. Adverse effects are usually related to gastrointestinal disturbances, neurological effects, or musculoskeletal issues.

Choice C rationale

Phototoxicity is a significant adverse effect of ciprofloxacin, a fluoroquinolone antibiotic. This occurs due to the drug's ability to absorb ultraviolet radiation, leading to a photochemical reaction that damages skin cells. This damage can manifest as severe sunburn, blistering, or rash upon exposure to sunlight.

Choice D rationale

Bradycardia is not a recognized adverse effect of ciprofloxacin. While some antibiotics can rarely affect cardiac conduction, ciprofloxacin's primary cardiovascular concerns relate more to QT prolongation and potential arrhythmias, not typically a decrease in heart rate. Its mechanism does not directly depress sinoatrial node function.

Choice A rationale

Documenting the client's refusal and the stated reason in the nurses' notes is crucial for legal and ethical reasons. It provides a clear record of the event, ensures continuity of care by informing other healthcare providers, and allows for follow-up interventions to address the client's concerns or alternative medication strategies. It upholds the client's right to refuse treatment.

Choice B rationale

Delegating medication administration to an assistive personnel (AP) is inappropriate as medication administration is a complex nursing function requiring assessment, judgment, and patient education, which are outside the scope of practice for an AP. An AP's role is typically limited to basic care activities, and they are not trained or authorized to administer medications.

Choice C rationale

Notifying the pharmacist is not the immediate or primary action when a client refuses medication. While the pharmacist may offer insights into alternative formulations or administration routes, the nurse's initial responsibility is to understand the client's refusal, document it, and then notify the prescribing provider for a revised plan of care.

Choice D rationale

Mixing medication in juice without the client's explicit consent is considered a breach of the client's autonomy and can be construed as coercive or deceptive. It violates the client's right to self-determination and informed consent regarding their treatment. Medications should only be administered with the client's knowledge and cooperation.