A nurse is reinforcing teaching with a client who has schizophrenia and a new prescription for haloperidol. The nurse should instruct the client to avoid taking 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. "This is an expected adverse effect of the medication." Rifampin commonly causes red-orange discoloration of bodily fluids, including saliva, tears, urine, and sweat. This occurs due to the drug's excretion and is harmless. It does not indicate internal bleeding or organ dysfunction. Clients should be educated about this side effect in advance to prevent alarm and unnecessary discontinuation of the medication, as adherence to tuberculosis treatment is crucial.

B. "Stop taking the medication. You are having an allergic reaction." The red discoloration caused by rifampin is a known side effect, not an allergic reaction. A true allergic response would include symptoms such as rash, itching, swelling, or difficulty breathing. Stopping rifampin without medical advice could disrupt tuberculosis treatment, leading to drug resistance or treatment failure, making this an inappropriate recommendation.

C. "This condition will only last a couple of days." The discoloration of bodily fluids persists throughout the duration of rifampin therapy. Tuberculosis treatment can last several months, so the client should expect this effect to continue as long as they are taking the medication. Providing incorrect information may cause the client to worry unnecessarily when the discoloration does not resolve quickly.

D. "Taking the medication with red meat will cause this adverse effect." The discoloration is due to rifampin’s chemical properties and metabolism, not dietary intake. Red-colored foods, such as red meat or berries, do not influence this effect. Providing inaccurate dietary information may lead to unnecessary dietary restrictions, which are not needed for managing this side effect.