A nurse is reviewing the medical history of a client prior to medication administration and notes a history of an anaphylactic reaction to penicillin. The nurse should identify that which of the following medications is contraindicated for this client?

A. Check the client's pulse oximetry level every 6 hr: Pulse oximetry provides valuable information on oxygen saturation, but checking only every 6 hours may not detect early respiratory depression caused by opioid PCA therapy.

B. Check the client's blood pressure every 4 hr: Blood pressure monitoring is important postoperatively, but opioid-induced respiratory depression is a more immediate risk in the first 24 hours of PCA use, so respirations take priority.

C. Check the client's respirations every 2 hr: Opioids administered via PCA can cause respiratory depression, especially in the first 24 hours. Monitoring respiratory rate frequently allows for early detection and intervention if hypoventilation occurs.

D. Assess the client's apical heart rate every 8 hr: While cardiac monitoring may be indicated for some clients, the apical heart rate is not the most critical assessment for PCA therapy. Respiratory function is the priority for detecting opioid-related complications.

A. "Take the medication with an antacid if you have gastric distress.": Antacids can interfere with the absorption of phenytoin, reducing its effectiveness. It is not recommended to take phenytoin simultaneously with antacids.

B. "Dissolve the capsules in water prior to taking the medication.": Extended-release phenytoin capsules should be swallowed whole to maintain the time-release mechanism. Crushing or dissolving the capsules can cause rapid absorption and increase the risk of toxicity.

C. "Discontinue the medication if you experience a seizure.": Phenytoin should not be stopped abruptly, even if seizures occur, as this can precipitate status epilepticus. Any dosage concerns should be discussed with the healthcare provider before making changes.

D. "Use a soft-bristled toothbrush to brush your teeth.": Phenytoin can cause gingival hyperplasia, leading to swollen and bleeding gums. Using a soft-bristled toothbrush and practicing good oral hygiene helps minimize gum irritation and maintain oral health.