The nurse is caring for a client who has been prescribed prednisone. The nurse checks the patient’s medical history knowing that this therapy is contraindicated in which disorder?

Choice A reason: Aspirin inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1, reducing thromboxane A2 production, which increases bleeding risk. This is critical in patients with bleeding disorders, as it can exacerbate conditions like hemophilia or cause gastrointestinal bleeding, necessitating caution and monitoring during therapy.

Choice B reason: Taking aspirin on an empty stomach does not maximize effectiveness and may increase gastrointestinal irritation. Aspirin’s antiplatelet and analgesic effects are independent of food intake, but taking it with food reduces gastric mucosal damage, making this statement incorrect for patient safety.

Choice C reason: Aspirin is not safe with all medications, as it interacts with anticoagulants, NSAIDs, or corticosteroids, increasing bleeding risk. It also affects drugs like methotrexate by altering renal clearance. Drug interactions are common, requiring careful review of concurrent medications, making this statement misleading and unsafe.

Choice D reason: Moderate alcohol consumption with aspirin is not safe, as both irritate the gastric mucosa, increasing the risk of gastrointestinal bleeding. Aspirin’s antiplatelet effect combined with alcohol’s mucosal damage heightens this risk, making this statement incorrect and potentially harmful for patient education.

Choice A reason: Stopping antitubercular medication due to dark orange urine is incorrect, as this is an expected effect of rifampin. Discontinuing therapy prematurely risks treatment failure and resistance development. Patient education about harmless discoloration is needed, not cessation, unless serious adverse effects like hepatotoxicity occur.

Choice B reason: Dark orange urine does not indicate worsening tuberculosis. It is a benign effect of rifampin’s red-orange metabolite excreted in urine. Worsening tuberculosis would present with increased symptoms like cough or fever, not urine discoloration, making this response inaccurate and alarming to the patient.

Choice C reason: Dark orange urine is a common, expected effect of rifampin, not an unusual finding requiring clinic evaluation. Rifampin’s metabolites cause harmless discoloration of bodily fluids. Only symptoms like jaundice or abdominal pain would warrant further investigation, not this benign side effect.

Choice D reason: Dark orange urine is an expected side effect of rifampin, a first-line antitubercular drug. Its red-orange metabolite discolors urine, sweat, and tears, which is harmless. Educating the patient about this effect reassures them, ensures adherence, and prevents unnecessary concern, focusing on other potential serious side effects.