A nurse is teaching a client who is starting to take methotrexate to treat rheumatoid arthritis.
Which of the following instructions should the nurse include in the teaching?

Choice A rationale

Informing a patient with impaired memory about socially appropriate behavior is generally ineffective as their cognitive deficits hinder their ability to process, retain, and apply this information. Their behavioral challenges often stem from neurological changes rather than a lack of understanding of social norms, leading to frustration for both parties.

Choice B rationale

Assisting with all self-care for a patient with dementia can inadvertently foster dependence and diminish their remaining abilities. Encouraging independence in activities of daily living, even with supervision or partial assistance, is crucial to maintain existing cognitive and functional skills and promote a sense of autonomy and dignity.

Choice C rationale

Maintaining familiar routines of sleep, meals, drug administration, and activities provides a sense of predictability and security for individuals with dementia. This consistency minimizes confusion and agitation by reducing the need to process new information and adapting to changes, thereby supporting cognitive function and emotional well-being.

Choice D rationale

While promoting orientation is important, frequent and repetitive questioning about the day, time, and place can be frustrating and agitating for a patient with significant memory impairment from dementia. Instead, providing subtle environmental cues, consistent verbal reminders, and engaging in reality orientation techniques when appropriate is more beneficial.

Choice A rationale

Nitroglycerin is a vasodilator used for angina and does not directly interact with contrast media to cause acute kidney injury. Its primary mechanism involves nitric oxide release, leading to smooth muscle relaxation and improved blood flow, unrelated to renal clearance of contrast.

Choice B rationale

Carvedilol is a beta-blocker that primarily affects heart rate and blood pressure. It does not have a direct interaction with iodinated contrast material that specifically increases the risk of acute kidney injury; its metabolism and excretion pathways do not significantly involve competitive renal mechanisms.

Choice C rationale

Metformin, an oral hypoglycemic agent, interacts with iodinated contrast material. In the presence of acute kidney injury induced by the contrast, metformin can accumulate, leading to lactic acidosis. This risk is due to its renal excretion and interference with mitochondrial respiration.

Choice D rationale

Atorvastatin is a statin used for lipid lowering. It primarily undergoes hepatic metabolism and does not have a known significant interaction with iodinated contrast media that predisposes clients to acute kidney injury. Its mechanism of action is unrelated to renal elimination or nephrotoxicity with contrast.