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?

A. Add the medications to the enteral feeding bag. Medications should not be mixed with enteral feeding formula as this can alter drug absorption, cause tube clogging, or result in medication interactions. Each medication should be administered separately to ensure proper effectiveness.

B. Check for gastric residual 15 min after administering the medications. Gastric residual volume (GRV) should be checked before medication administration to assess delayed gastric emptying. Checking it after administration is unnecessary and may disrupt medication absorption without clinical benefit.

C. Keep the client's head elevated 15° while administering the medications. The head of the bed should be elevated at least 30–45 degrees, not 15 degrees, to reduce aspiration risk and promote medication passage. Insufficient elevation increases the likelihood of regurgitation and aspiration pneumonia.

D. Flush the tube with 30 ml of water between each medication. Flushing with 30 mL of water between medications prevents tube clogging and ensures each drug is properly delivered. It also minimizes drug interactions by preventing medications from mixing within the tube.

A. Levothyroxine. Levothyroxine is used to treat hypothyroidism and does not have a significant interaction with furosemide. However, both medications require careful monitoring, as hypothyroidism can affect fluid balance, but they are not contraindicated together.

B. Cetirizine. Cetirizine is an antihistamine used to treat allergies and does not interfere with furosemide’s effects. While some antihistamines can cause mild fluid retention, this does not significantly impact furosemide therapy, making them safe to use together.

C. Lithium carbonate. Furosemide is a loop diuretic that increases sodium excretion. Since lithium is excreted through the kidneys in a sodium-dependent manner, a loss of sodium due to diuretic use can lead to reduced lithium excretion and toxic accumulation. Clients taking lithium should avoid diuretics unless absolutely necessary, and their lithium levels must be carefully monitored if diuretics are required.

D. Albuterol. Albuterol is a bronchodilator used for conditions like asthma and COPD. While both furosemide and albuterol can cause hypokalemia, this does not make them absolutely contraindicated. Instead, potassium levels should be regularly monitored, and supplementation may be needed if hypokalemia develops.