A patient has been prescribed the antibiotic doxycycline.

What is the most important information for the nurse to include when educating the patient?

Choice A rationale
This choice is correct. Calcium carbonate, which is used to treat GERD, can lead to hypercalcemia, or high levels of calcium in the blood, if taken in excess or if the client has impaired kidney function. Hypercalcemia can cause various symptoms, including nausea, vomiting, constipation, and abdominal pain. It can also affect the nervous system, leading to confusion, lethargy, and fatigue. In severe cases, it can cause cardiac arrhythmias.
Choice B rationale
Metabolic alkalosis is a condition characterized by a high level of bicarbonate in the blood, leading to an increase in blood pH. While antacids like calcium carbonate can potentially cause metabolic alkalosis if taken in large amounts, it is less likely to occur in patients taking the medication for GERD, as the medication is used to neutralize stomach acid. Therefore, while it’s a potential risk, it’s less likely than hypercalcemia.
Choice C rationale
Hepatotoxicity, or liver damage, is not typically associated with the use of calcium carbonate. This medication does not have a direct effect on the liver, so it’s unlikely to cause hepatotoxicity unless the client has an underlying liver condition or is taking other medications that can cause liver damage.
Choice D rationale
Hyperphosphatemia, or high levels of phosphate in the blood, is not typically a risk associated with the use of calcium carbonate. In fact, calcium carbonate can bind to phosphate in the gut and reduce phosphate absorption, which can help manage high phosphate levels in certain conditions. Therefore, this choice is not the most likely risk for the client.

Choice A rationale
A client with a hip fracture and is on bedrest for 4 weeks may indeed experience constipation due to decreased physical activity. However, this situation would not necessarily require the nurse to question the order for psyllium. Psyllium is a bulk-forming laxative that can help relieve constipation by increasing stool bulk and improving bowel regularity.
Choice B rationale
Morphine is an opioid medication that can cause constipation as a side effect. Therefore, a client who is experiencing severe pain and is prescribed morphine may benefit from a laxative like psyllium to help manage opioid-induced constipation. This situation would not necessarily require the nurse to question the order for psyllium.
Choice C rationale
A client who is post-operative and is on a clear liquid diet may experience constipation due to the low fiber content of the diet. However, this situation would not necessarily require the nurse to question the order for psyllium. Once the client progresses to a regular diet, psyllium can help add bulk to the stool and promote regular bowel movements.
Choice D rationale
This choice is correct. A client with a recent stroke who has difficulty swallowing may be at risk for aspiration, or the inhalation of food or liquid into the lungs, when taking psyllium. Psyllium is a bulk-forming laxative that absorbs water in the intestines to form a softer, bulkier stool. If a client with swallowing difficulties were to aspirate the psyllium, it could potentially expand in the lungs when it comes into contact with moisture, leading to serious complications. Therefore, the nurse should question the order for psyllium in this situation.