A nurse is reviewing the plan of care with a client who has a new prescription for lovastatin. Which of the following statements by the client should indicate to the nurse a need for further assessment?

Choice A Reason:
"I should notify my provider if my stools turn black." This is the appropriate statement. Ferrous gluconate is an iron supplement commonly prescribed to treat or prevent iron deficiency anemia. When taking iron supplements, it's common for stools to become darker or even black in color. This change in stool color is due to the iron and is generally harmless. However, it's essential to inform the healthcare provider about this change because it can also indicate bleeding in the gastrointestinal tract, which requires evaluation.
Choice B Reason:
Taking an antacid with iron supplements can interfere with iron absorption. Antacids may decrease the absorption of iron in the stomach, so it's not recommended to take them together.
Choice C Reason:
While staying upright after taking certain medications can help prevent esophageal irritation or reflux, it's not specifically required with ferrous gluconate.
Choice D Reason:
Taking iron supplements with milk is also not recommended as milk and calcium-containing products can inhibit the absorption of iron. It's generally best to take iron supplements on an empty stomach or with vitamin C to enhance absorption, unless otherwise instructed by the healthcare provider.

Choice A Reason:
Decreased respiratory rate is incorrect. Heparin administration and an elevated aPTT typically do not directly cause a decrease in respiratory rate. Respiratory rate changes might occur due to other factors such as respiratory conditions, pain, or medications affecting the respiratory center, but they are not commonly linked to heparin therapy.
Choice B Reason:
Increased blood pressure is incorrect. Heparin therapy and an elevated aPTT do not typically result in increased blood pressure. Heparin's primary effect is on preventing blood clotting, and while it can indirectly affect blood pressure by preventing clot formation, it doesn't typically cause a significant increase in blood pressure.
Choice C Reason:
Decreased temperature is incorrect. Heparin therapy and an elevated aPTT do not generally cause a decrease in body temperature. Changes in body temperature might occur due to various reasons such as infection, environmental factors, or certain medications, but they are not directly linked to heparin administration.
Choice D Reason:
Increased pulse rate is correct. An increased pulse rate can be an early indicator of bleeding or a potential side effect of heparin administration. Heparin's anticoagulant effect might predispose individuals to bleeding, so an increased pulse rate could indicate a response to potential bleeding complications rather than a direct effect of heparin itself.