A nurse is teaching a client who is being treated for depression with escitalopram. Which of the following statements by the client should the nurse identify as an adverse effect?

A. "I have vomited several times.": Vomiting can be a side effect of penicillin, but it is usually manageable and not immediately life-threatening unless severe dehydration occurs.

B. "I am having diarrhea.": Mild diarrhea is a common side effect of antibiotics. It is important to monitor for signs of C. difficile infection, but occasional loose stools are not immediately critical.

C. "I am having trouble swallowing.": Difficulty swallowing may indicate oropharyngeal edema, which can be a sign of a severe allergic reaction to penicillin. This requires immediate attention as it can progress to airway obstruction.

D. "My skin feels itchy all over.": Generalized itching may indicate a mild allergic reaction. While it should be monitored, it is less urgent than symptoms suggesting airway compromise.

Rationales for Correct Choices

• Not take the antacid within 30 min of the sucralfate: Antacids can interfere with the absorption and adherence of sucralfate to the gastric mucosa. Spacing administration by at least 30 minutes ensures optimal therapeutic action of both medications.
• Shake the suspension thoroughly before administration: Sucralfate is a suspension, meaning its medication particles are dispersed in a liquid. To ensure the client receives the correct, full dose and therapeutic effect, the medication must be shaken well immediately before measuring and administering.

Rationale for Incorrect Choices:

• Discontinue the sucralfate as soon as ulcer manifestations subside: Stopping sucralfate too early can prevent complete healing of the ulcer. Full courses should be completed as prescribed.
• Take the sucralfate with meals: Sucralfate should be taken on an empty stomach (at least 1hour before meals and at bedtime) to allow it to form the protective barrier on the ulcer before food and acid production increase.