The nurse caring for a patient with a productive cough would anticipate an order for the following medication:

Choice A reason: This is correct. Hypertension is a contraindication for taking pseudoephedrine. Pseudoephedrine is a decongestant that shrinks the blood vessels in the nasal passages and relieves congestion. However, it can also increase the blood pressure and the heart rate, which can worsen hypertension and increase the risk of stroke, heart attack, or kidney damage. The nurse should advise the client to avoid pseudoephedrine and use other methods to relieve sinus congestion, such as saline nasal spray, steam inhalation, or humidifier.

Choice B reason: This is incorrect. Diverticulitis is not a contraindication for taking pseudoephedrine. Diverticulitis is a condition where small pouches in the colon become inflamed and infected. It can cause symptoms such as abdominal pain, fever, nausea, or constipation. Pseudoephedrine does not affect the colon or the inflammation directly, but it can cause dehydration, which can worsen constipation and diverticulitis. The nurse should advise the client to drink plenty of fluids and eat a highfiber diet to prevent constipation and diverticulitis.

Choice C reason: This is incorrect. Migraines are not a contraindication for taking pseudoephedrine. Migraines are severe headaches that are often accompanied by nausea, vomiting, or sensitivity to light and sound. They can be triggered by various factors, such as stress, hormones, or food. Pseudoephedrine does not cause migraines directly, but it can interact with some migraine medications, such as triptans, which are used to treat acute migraine attacks. The combination of pseudoephedrine and triptans can increase the blood pressure and the risk of serotonin syndrome, a serious condition that causes agitation, confusion, tremors, or seizures. The nurse should advise the client to check with their doctor before taking pseudoephedrine and triptans together.

Choice D reason: This is incorrect. Eczema is not a contraindication for taking pseudoephedrine. Eczema is a skin condition that causes dry, itchy, and inflamed skin. It can be caused by various factors, such as allergies, irritants, or genetics. Pseudoephedrine does not affect the skin or the inflammation directly, but it can cause dryness of the mucous membranes, such as the mouth, nose, or eyes. The nurse should advise the client to use a moisturizer, a lip balm, and artificial tears to prevent dryness and irritation of the skin and the mucous membranes.

Choice A reason: This is incorrect. Distributing the doses evenly throughout the day may increase the risk of daytime sedation and impair the client's ability to perform daily activities. Diphenhydramine is a sedating antihistamine that causes drowsiness and reduces alertness.

Choice B reason: This is correct. Taking most of the daily dose at bedtime may minimize daytime sedation and help the client sleep better at night. Diphenhydramine is often used as a short-term treatment for insomnia.

Choice C reason: This is incorrect. Taking the medication with meals does not affect the sedative effect of diphenhydramine. It may only reduce the risk of stomach upset, which is not a common side effect of diphenhydramine.

Choice D reason: This is incorrect. Gradually decreasing the dose once tolerance to the effect is reached may not be advisable, as it may reduce the effectiveness of the medication for relieving pruritus. Diphenhydramine is an antihistamine that blocks the action of histamine, a chemical that causes itching and inflammation in allergic reactions.