A nurse is teaching a client about water-soluble vitamins. Which of the following vitamins should the nurse include?

Choice A reason: Anemia results from factors like iron deficiency or chronic disease, not directly from prolonged stress. Stress may elevate cortisol, affecting hematopoiesis indirectly, but anemia is not a primary manifestation. Chronic stress primarily impacts neuroendocrine and immune systems, not red blood cell production or hemoglobin levels.

Choice B reason: Prolonged stress typically increases blood pressure via sympathetic activation, releasing catecholamines (e.g., epinephrine), which cause vasoconstriction and elevated heart rate. Decreased blood pressure is not a common stress response, as the hypothalamic-pituitary-adrenal axis drives hypertension, not hypotension, in chronic stress scenarios.

Choice C reason: Prolonged stress elevates cortisol and catecholamines, suppressing immune function by inhibiting T-cell proliferation and cytokine production. This reduces the body’s ability to fight infections, increasing susceptibility to illness. Chronic activation of the hypothalamic-pituitary-adrenal axis downregulates immune responses, a well-documented effect of sustained stress.

Choice D reason: Hypoglycemia is not a typical manifestation of prolonged stress. Stress hormones (cortisol, glucagon) increase blood glucose by promoting glycogenolysis and gluconeogenesis to provide energy. While acute stress may cause transient glucose fluctuations, chronic stress typically leads to hyperglycemia, not low blood sugar, in most individuals.

Choice A reason: Cimetidine, an H2 receptor antagonist, reduces gastric acid secretion and is taken regularly to prevent ulcer recurrence, not as needed for pain. PRN dosing is ineffective for maintaining consistent acid suppression, which is necessary for ulcer healing and preventing acid-related damage to the gastric mucosa.

Choice B reason: Black stools typically indicate gastrointestinal bleeding, often due to ulcer perforation, not a normal effect of cimetidine. Cimetidine reduces acid to promote ulcer healing, preventing bleeding. Black stools require urgent evaluation, as they suggest melena, potentially from hemoglobin oxidation in the digestive tract.

Choice C reason: Cimetidine’s absorption is minimally affected by food, allowing administration with or without meals. This flexibility ensures consistent acid suppression, as it blocks histamine receptors on parietal cells, reducing hydrochloric acid production, which promotes ulcer healing and symptom relief regardless of meal timing.

Choice D reason: Eating five small meals reduces gastric acid demand and prevents stomach distension, which can exacerbate ulcers. This dietary approach minimizes acid secretion spikes, allowing cimetidine to maintain a stable gastric pH, promoting mucosal healing and reducing irritation from excessive acid exposure.

Choice E reason: Taking cimetidine with antacids can reduce its absorption, as antacids alter gastric pH, potentially decreasing bioavailability. Cimetidine’s acid suppression is sufficient alone, and concurrent antacid use may interfere with its pharmacokinetics, reducing efficacy in treating peptic ulcer disease.