The healthcare provider orders Benadryl 40 mg IM now. The available concentration is 25 mg/mL. How many mL will the patient receive?

Choice A reason: Increasing aspirin dosage without medical guidance risks toxicity, including gastrointestinal bleeding and ulceration, as aspirin inhibits COX enzymes, reducing prostaglandin production. Prostaglandins mediate pain and inflammation, but excessive inhibition can damage the stomach lining. This approach is unsafe and not recommended for managing menstrual cramps effectively, as it may exacerbate adverse effects without ensuring better pain relief.

Choice B reason: First-generation NSAIDs, like ibuprofen, are more effective for menstrual cramps due to their stronger inhibition of COX-1 and COX-2 enzymes, which reduce prostaglandin synthesis responsible for uterine contractions and pain. Unlike aspirin, ibuprofen offers better pain relief with a more favorable dosing profile, making it a suitable alternative for dysmenorrhea management in most patients.

Choice C reason: Acetaminophen lacks significant anti-inflammatory effects, as it primarily inhibits COX enzymes in the central nervous system, not peripherally. It reduces pain and fever but does not effectively target prostaglandin-mediated inflammation in menstrual cramps. Therefore, it is less effective than NSAIDs like ibuprofen for dysmenorrhea, making it an inappropriate substitute in this context.

Choice D reason: Avoiding COX inhibitors due to Reye’s syndrome risk is unwarranted here, as Reye’s syndrome is primarily associated with aspirin use in children with viral infections. Menstrual cramps are unrelated to this condition, and COX inhibitors like NSAIDs are standard treatment. This choice is overly restrictive and not clinically justified for managing dysmenorrhea.

Choice A reason: Taking antihistamines only with symptoms may reduce side effects but provides inconsistent relief, as histamine levels fluctuate. Daily use during allergy seasons prevents symptom onset, offering better control, especially for second-generation antihistamines with longer action, making this choice less effective.

Choice B reason: First-generation antihistamines (e.g., diphenhydramine) are sedating and have more side effects than second-generation (e.g., loratadine), which are equally effective for allergies but less sedating. Claiming first-generation are more effective is incorrect, as second-generation are preferred, making this choice inaccurate.

Choice C reason: Anticholinergic effects (e.g., dry mouth) are more common with first-generation antihistamines (e.g., diphenhydramine) due to non-selective receptor binding. Second-generation antihistamines (e.g., cetirizine) are more selective for H1 receptors, reducing these effects, making this choice incorrect and opposite to pharmacological profiles.

Choice D reason: Daily oral antihistamines, especially second-generation (e.g., loratadine), during allergy seasons maintain steady histamine receptor blockade, preventing symptoms like sneezing and itching. This maximizes efficacy and improves quality of life, aligning with guidelines for seasonal allergies, making this the correct nurse response.