A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery?

Choice A reason: Constipation is not an adverse effect of tamoxifen. Tamoxifen does not affect the gastrointestinal motility or function. Constipation may be caused by other factors such as dehydration, low-fiber diet, or lack of exercise.

Choice B reason: Clotting is an adverse effect of tamoxifen. Tamoxifen can increase the risk of thromboembolic events such as deep vein thrombosis, pulmonary embolism, or stroke. Clotting can cause serious complications such as pain, swelling, shortness of breath, chest pain, or neurological deficits.

Choice C reason: Tinnitus is not an adverse effect of tamoxifen. Tamoxifen does not affect the auditory system or cause hearing loss. Tinnitus may be caused by other factors such as noise exposure, ear infection, or medication toxicity.

Choice D reason: Urinary retention is not an adverse effect of tamoxifen. Tamoxifen does not affect the urinary system or cause bladder dysfunction. Urinary retention may be caused by other factors such as prostate enlargement, nerve damage, or medication side effects.

Choice A reason: This is incorrect because NPH insulin is normally cloudy and should be gently mixed before use. However, the nurse should discard the solution if it has clumps, flakes, or crystals.

Choice B reason: This is correct because NPH insulin is an intermediate-acting insulin that has a slower onset and longer duration than short-acting or rapid-acting insulins. The nurse should explain to the client that NPH insulin provides basal coverage and may need to be combined with other types of insulin to control blood glucose levels.

Choice C reason: This is incorrect because freezing insulin can damage its potency and effectiveness. The nurse should instruct the client to store unopened insulin vials in the refrigerator and opened vials at room temperature.

Choice D reason: This is incorrect because shaking insulin can cause air bubbles and frothing, which can affect the accuracy of the dose. The nurse should instruct the client to roll the insulin vial between the palms of the hands to mix it gently.