The nurse makes a home care visit to a client with a diagnosis of right sided stroke. The client's spouse reports that she was recently diagnosed with gastroenteritis and is having frequent loose stools. The nurse is most concerned with which observation?

A. While changes in breathing patterns can indicate airway obstruction, snoring alone is not the most specific indicator of a complication after tonsillectomy. It could indicate swelling or an obstructed airway but does not specifically indicate bleeding.

B. Checking the mucous membranes for moisture is important in general nursing care to assess hydration status. However, it is not the most immediate priority in the post-tonsillectomy setting, where the primary concern is to monitor for bleeding.
C. Assessing pain is important for overall patient comfort and to evaluate the effectiveness of pain management strategies. However, pain alone does not directly indicate a complication like bleeding, which is a critical concern in this scenario.
D. Continuous swallowing can be an early sign of bleeding after tonsillectomy, as patients may swallow frequently to clear blood from the throat. If a patient is swallowing more often than normal, it could indicate that they are swallowing blood, which would require immediate intervention.

A. While using an incentive spirometer is important in promoting lung expansion and preventing respiratory complications, it is not directly related to the administration of acyclovir. This intervention is typically more relevant for patients at risk of respiratory issues.
B. A high-carbohydrate diet is not a specific recommendation related to acyclovir administration. While nutrition is important for overall health, this intervention does not address the key concerns associated with the use of acyclovir.
C. While activity levels may need to be monitored based on the patient's overall condition, limiting activity is not a primary concern with acyclovir. The medication itself does not usually require significant restrictions on physical activity unless the patient has other conditions that warrant it.
D. Acyclovir can be nephrotoxic, especially when given intravenously, and maintaining adequate hydration helps prevent kidney damage. Encouraging fluids ensures that the kidneys can effectively excrete the medication and reduces the risk of crystallization in the renal tubules.