The nurse is caring for a client with a new diagnosis of epilepsy who is prescribed phenytoin. Which teaching point should the nurse emphasize?

Choice A reason: Hydromorphone, an opioid, poses a significant risk of respiratory depression by suppressing the brainstem’s respiratory centers. After four days, cumulative effects increase this risk, especially in opioid-naïve patients. Monitoring respiratory rate and depth is critical to prevent life-threatening hypoxia, making it the priority assessment.

Choice B reason: Constipation is a common hydromorphone side effect due to opioid-induced reduced gastrointestinal motility. While important, it is not life-threatening like respiratory depression. Monitoring bowel function is secondary, as respiratory compromise poses an immediate risk requiring urgent intervention in opioid therapy.

Choice C reason: Skin rash is a rare allergic reaction to hydromorphone, not a primary concern after four days of use. Respiratory depression is far more critical, as opioids directly depress respiratory drive, risking hypoxia, making rash assessment secondary to monitoring respiratory function.

Choice D reason: Nausea is a frequent hydromorphone side effect, often diminishing with continued use. While bothersome, it is not life-threatening compared to respiratory depression, which can cause rapid hypoxia. Monitoring respiratory status is the priority to ensure patient safety during opioid administration.

Choice A reason: Delegating oral care to UAP is appropriate for routine hygiene in AIDS patients with candidiasis. Leaving oral care solely to the nurse is unnecessary unless complex treatments are required. A soft-bristled toothbrush ensures safe, effective cleaning, supporting UAP involvement in standard oral hygiene.

Choice B reason: A soft-bristled toothbrush is ideal for oral care in candidiasis, as it gently cleans without traumatizing painful ulcers. In AIDS, oral hygiene reduces fungal load and discomfort. This instruction ensures safe, effective care by UAP, aligning with standard hygiene practices for mucosal infections.

Choice C reason: Sterile gloves are unnecessary for routine oral care, as candidiasis is not highly contagious in this context. Standard precautions, including clean gloves, suffice for UAP performing hygiene. Requiring sterile gloves is excessive, complicating care without added benefit compared to using a soft toothbrush.

Choice D reason: Mouthwash may irritate candidiasis ulcers, especially if alcohol-based, and is not the priority. Brushing with a soft-bristled toothbrush effectively cleans the mouth without causing trauma. Mouthwash is secondary and requires nurse oversight to ensure compatibility with the client’s condition, unlike brushing.