The nurse is caring for a patient with ulcerative colitis and severe diarrhea.
Which nursing assessment is the highest priority?

Choice A rationale

Gradually decreasing the dose of diphenhydramine once tolerance to sedation is reached is not a recommended strategy. Tolerance to the antihistamine effects, including sedation, may develop over time, but abruptly or gradually changing the dose without provider guidance is not advisable and could lead to a return of pruritus.

Choice B rationale

Taking diphenhydramine with meals may slightly delay its absorption but is unlikely to significantly reduce daytime sedation. While taking some medications with food can affect their pharmacokinetics, the primary cause of daytime sedation with diphenhydramine is its antihistaminic effect on the central nervous system, which is not directly mitigated by food intake.

Choice C rationale

Distributing the doses of diphenhydramine evenly throughout the day is likely to worsen daytime sedation. Diphenhydramine is a first-generation antihistamine known for its sedating properties due to its ability to cross the blood-brain barrier and block histamine receptors in the central nervous system. Evenly spaced doses would maintain a more consistent level of the drug in the system, leading to continued sedation.

Choice D rationale

Taking most of the daily dose of diphenhydramine at bedtime can help minimize daytime sedation. By concentrating the medication administration closer to the client's sleep period, the sedative effects are more likely to occur during sleep, and the residual sedation during the day may be reduced. This allows for symptom relief while minimizing interference with daytime activities. .

Choice A rationale

Maintaining a recommended body weight is crucial for managing osteoarthritis as excess weight places additional stress on weight-bearing joints like the hips and knees, accelerating cartilage breakdown and increasing pain. Reducing this mechanical stress can slow the progression of the disease and alleviate symptoms. A healthy Body Mass Index (BMI) is generally considered to be between 18.5 and 24.9 kg/m².

Choice B rationale

Applying ice to the joint before exercising is generally not recommended for osteoarthritis. While ice can help reduce inflammation and pain after exercise or during acute flares, applying it before exercise can stiffen the joint and potentially hinder movement, increasing the risk of injury. Heat application is often preferred before exercise to warm up the muscles and tissues around the joint, improving flexibility.

Choice C rationale

Reducing the amount of purine in the diet is a primary recommendation for managing gout, a type of arthritis caused by the buildup of uric acid crystals in the joints. Purines are substances found in certain foods that break down into uric acid. Osteoarthritis, however, is a degenerative joint disease not directly related to purine metabolism or uric acid levels.

Choice D rationale

There is insufficient scientific evidence to support the use of Echinacea for managing joint pain associated with osteoarthritis. Echinacea is an herb primarily known for its potential immune-boosting properties and is often used for colds and flu. Its efficacy in treating the underlying mechanisms or symptoms of osteoarthritis has not been established through rigorous clinical trials.