A nurse is teaching a client who has a new prescription for nitroglycerin sublingual tablets for treating angina. Which of the following instructions should the nurse include in the teaching?

A) Morphine 2 mg IV: Morphine is a potent opioid analgesic commonly used to manage moderate to severe pain. However, in this scenario, the client reports pain as 5 on a scale of 0 to 10, which indicates moderate pain. Morphine 2 mg IV may be excessive for this level of pain and could result in unnecessary sedation, respiratory depression, or other opioid-related adverse effects. Therefore, it is not the most appropriate choice for managing the client's pain.

B) Amitriptyline 25 mg PO: Amitriptyline is a tricyclic antidepressant with analgesic properties, but it is not typically used as a first-line treatment for acute postoperative pain. Additionally, it is administered orally and may not provide rapid pain relief in the immediate postoperative period. Therefore, it is not the most suitable option for managing the client's pain after a total knee replacement surgery.

C) Ketorolac 15 mg IV: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that provides potent analgesic and anti-inflammatory effects. It is commonly used for the management of moderate to severe pain, including postoperative pain. In this scenario, the client reports moderate pain after total knee replacement surgery, making ketorolac an appropriate choice for pain management. Administering ketorolac 15 mg IV can provide effective pain relief without the sedative effects of opioids, making it the most suitable PRN medication for the client's pain level.

D) Acetaminophen 650 mg PO: Acetaminophen is a non-opioid analgesic commonly used for mild to moderate pain relief. While acetaminophen is generally safe and effective, it may not provide sufficient pain relief for a client who reports pain as 5 on a scale of 0 to 10 after total knee replacement surgery. Additionally, oral administration may result in delayed onset of action compared to IV medications. Therefore, acetaminophen 650 mg PO may not be the most optimal choice for managing the client's pain in this situation.

D) Calcium: Calcium supplements can interfere with the absorption of levothyroxine when taken concurrently. Levothyroxine absorption can be significantly reduced if taken with calcium-containing supplements or foods high in calcium. Therefore, clients should wait at least 4 hours after taking levothyroxine before consuming calcium supplements to ensure optimal absorption of the thyroid medication.

A) Zinc: Zinc supplements do not significantly interfere with the absorption of levothyroxine. While zinc can bind to levothyroxine and potentially decrease its absorption, the effect is minimal compared to calcium. However, it is generally recommended to take zinc supplements at least 4 hours apart from levothyroxine to avoid any potential interaction.

B) Vitamin C: Vitamin C supplements do not interfere with the absorption of levothyroxine and can be taken concurrently without significant interactions. There is no need for clients to wait a specific amount of time between taking levothyroxine and vitamin C supplements.

C) Ginkgo biloba: Ginkgo biloba supplements have not been shown to have a significant impact on the absorption of levothyroxine. However, given the variability in individual responses to supplements, it is still prudent to separate the administration of levothyroxine and ginkgo biloba by at least 4 hours to minimize any potential interactions.