Nclexpn Quiz: Medication Interactions And Contraindications

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Medication Interactions And ContraindicationsQuestion 1 of 20

A 65-year-old client is being treated for a severe bacterial infection and is prescribed a course of oral ciprofloxacin. While reviewing the client's current medication list, the nurse notes the client also takes a daily calcium supplement for osteoporosis.

Which action should the nurse take to prevent a medication interaction?

Administer both the antibiotic and the calcium supplement together with a full meal.

Document that the client should avoid all dairy products for the duration of the antibiotic therapy.

Notify the PHCP that the calcium supplement is a direct contraindication for ciprofloxacin.

Instruct the client to take the calcium supplement at least 6 hours after the ciprofloxacin.

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Nclexpn Quiz

Nclexpn Quiz: Medication Interactions And Contraindications

Practice Medication Interactions And Contraindications in Nclexpn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Medication Interactions And Contraindications, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexpn.

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Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

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Question 1

Which action should the nurse take to prevent a medication interaction?

Administer both the antibiotic and the calcium supplement together with a full meal.
Document that the client should avoid all dairy products for the duration of the antibiotic therapy.
Notify the PHCP that the calcium supplement is a direct contraindication for ciprofloxacin.
Instruct the client to take the calcium supplement at least 6 hours after the ciprofloxacin. (correct answer)

Explanation: Calcium and other divalent and trivalent cations (magnesium, aluminum, iron, zinc) bind with fluoroquinolone antibiotics like ciprofloxacin in the gastrointestinal tract to form insoluble chelation complexes. This significantly reduces the antibiotic's oral absorption and may result in inadequate blood levels, jeopardizing treatment of a severe infection. The solution is to separate administration: a minimum of 2 hours is recommended, with 6 hours being the more conservative and safer interval. The supplement need not be permanently discontinued (C) — it is a timing, not a true contraindication. Taking them together with food (A) does not prevent the chelation reaction; food does not interrupt cation binding to the antibiotic. Avoiding all dairy for the entire duration (B) is unnecessarily restrictive — dairy should simply not be consumed within the recommended separation window around the antibiotic dose.

Question 2

The nurse is reinforcing discharge teaching with a client who has been prescribed simvastatin for high cholesterol. The client mentions they usually have a glass of grapefruit juice every morning with breakfast.

Which information should the nurse reinforce with the client regarding this dietary habit?

"You should avoid grapefruit juice because it can increase the level of this medication in your blood." (correct answer)
"Grapefruit juice is encouraged because it helps the medication lower your cholesterol faster."
"It is safe to drink grapefruit juice as long as you take your medication in the evening."
"Grapefruit juice will cause the medication to be eliminated from your body too quickly."

Explanation: Grapefruit juice contains furanocoumarins that inhibit cytochrome P450 3A4 (CYP3A4) enzymes in the intestinal wall, which are responsible for the first-pass metabolism of simvastatin. When CYP3A4 is inhibited, more simvastatin is absorbed intact into the bloodstream, significantly increasing plasma drug levels. This raises the risk of dose-dependent toxicity, most critically statin-induced myopathy and potentially rhabdomyolysis. The client should be instructed to avoid grapefruit and grapefruit juice entirely while taking simvastatin. Grapefruit juice does not enhance cholesterol lowering (B). Choice C is incorrect and dangerously misleading: grapefruit juice inhibits CYP3A4 for 24 to 72 hours after consumption, so the timing of the dose relative to juice intake has no practical protective effect. The interaction involves decreased metabolism and increased drug levels, not accelerated elimination (D).

Question 3

A nurse is caring for a client with type 2 diabetes who has just been prescribed a beta-blocker for hypertension. The client also takes insulin glargine daily to manage their blood glucose levels.

Which potential interaction should the nurse monitor for in this client?

The beta-blocker will cause the client to experience frequent episodes of hyperglycemia.
The beta-blocker may mask common symptoms of hypoglycemia, such as tachycardia. (correct answer)
Taking both medications together will cause the client's blood pressure to drop dangerously low.
The insulin will prevent the beta-blocker from effectively lowering the heart rate.

Explanation: Beta-blockers suppress the sympathetically mediated warning symptoms of hypoglycemia — most notably tachycardia, tremors, and palpitations — by blocking beta-1 adrenergic receptors. This means a client taking both insulin and a beta-blocker may experience a severe hypoglycemic episode without the usual autonomic warning signs that would prompt them to eat or seek help. Importantly, diaphoresis (sweating) is cholinergically mediated and is NOT masked by beta-blockers, so clients should be taught to monitor for sweating as their remaining warning sign. The beta-blocker does not itself cause hyperglycemia (A) — it may slightly impair glycogenolysis, but this is not the priority monitoring concern. Dangerous hypotension from this combination (C) is not a standard expected interaction. Insulin does not reduce the heart rate-lowering effect of beta-blockers (D).

Question 4

Client: 74-year-old female admitted for management of chronic heart failure (CHF) and osteoarthritis. History: Hypertension, Type 2 Diabetes, Stage 3 Chronic Kidney Disease (CKD). Current Medications: Furosemide 40 mg PO daily, Metformin 500 mg PO twice daily, Lisinopril 10 mg PO daily. New Complaint: The client reports severe knee pain and states she has been taking over-the-counter ibuprofen 400 mg every 6 hours for the past three days at home.

The nurse recognizes that taking ibuprofen while also taking lisinopril and furosemide increases the risk for which complication?

Acute kidney injury and decreased effectiveness of the diuretic. (correct answer)
Severe hypoglycemic episodes related to the use of metformin.
Paradoxical hypertension and a sudden increase in heart rate.
Vitamin B12 deficiency resulting from poor medication absorption.

Explanation: The combination of an NSAID with an ACE inhibitor and a diuretic is a well-described pharmacological triple threat to renal function. NSAIDs reduce prostaglandin-mediated afferent arteriolar dilation, decreasing glomerular filtration. ACE inhibitors dilate the efferent arteriole, further reducing intraglomerular pressure. Diuretics reduce circulating volume, decreasing renal perfusion pressure. Together, these three mechanisms converge to dramatically reduce renal blood flow, precipitating acute kidney injury in a client who already has Stage 3 CKD. NSAIDs also cause sodium and water retention via prostaglandin inhibition, which directly antagonizes the therapeutic effects of both furosemide and lisinopril. Hypoglycemic episodes (B) are not a consequence of this drug combination. Paradoxical hypertension (C) partially reflects the BP-raising effect of NSAIDs, but the primary and most dangerous complication is acute kidney injury. Vitamin B12 deficiency (D) is unrelated to this drug combination.

Question 5

Based on the client's recent use of ibuprofen, which nursing hypothesis should the nurse prioritize?

Risk for imbalanced nutrition related to long-term metformin use.
Risk for falls related to uncontrolled osteoarthritis pain.
Risk for ineffective medication management related to the use of OTC drugs. (correct answer)
Knowledge deficit regarding a low-sodium diet for chronic heart failure.

Explanation: The client has been self-medicating with an OTC NSAID that is contraindicated given her CKD, CHF, and current prescription medications — without awareness of the serious potential for harm. Risk for ineffective medication management related to OTC drug use is the priority nursing hypothesis because it directly addresses the active, potentially life-threatening safety issue presented by the ibuprofen. This hypothesis drives the most urgent nursing actions: stopping the ibuprofen, notifying the PHCP, and providing targeted education. Risk for imbalanced nutrition from metformin (A) is a long-term chronic concern, not acutely relevant to this admission. Risk for falls (B) addresses pain management indirectly but is not the most clinically urgent hypothesis given the renal and cardiovascular risks of current NSAID use. Low-sodium diet education (D) is appropriate for CHF management but is not the priority hypothesis triggered by the ibuprofen.

Question 6

The nurse is preparing to administer the scheduled morning medications. The client asks, "Can I have one more ibuprofen before you give me those other pills?" What is the most appropriate response by the nurse?

"Yes, you can have it as long as you take it with a full glass of water."
"I need to check with your doctor first because ibuprofen can affect your kidney function." (correct answer)
"You should wait at least two hours after your other pills to take the ibuprofen."
"I will give you the ibuprofen now, but I must skip your blood pressure pill today."

Explanation: The nurse must withhold the ibuprofen and notify the PHCP before administering it, because it is contraindicated for this client given her CKD and the dangerous triple-whammy interaction with her current prescriptions. Choice B correctly reflects the nurse's responsibility: refuse the medication, provide a brief, honest explanation that respects the client without being alarming, and loop in the provider before any further action. Simply approving the ibuprofen with water (A) disregards the known contraindication. Suggesting a 2-hour wait (C) implies that timing can resolve a pharmacokinetic interaction that is not time-dependent in this way — the nephrotoxic risk from NSAIDs is cumulative and not mitigated by separating from other medications. Giving ibuprofen while skipping the blood pressure pill (D) is both clinically dangerous and outside the LPN/VN's scope of independent decision-making.

Question 7

A nurse is caring for a client who is taking warfarin for a mechanical heart valve. The client reports they have been taking aspirin for a mild headache for the past two days.

The nurse should recognize that taking aspirin with warfarin is a contraindication because it:

Increases the client's risk for significant bleeding. (correct answer)
Prevents the warfarin from effectively thinning the blood.
Causes the warfarin to be eliminated too quickly by the kidneys.
Leads to a high risk of developing a severe allergic reaction.

Explanation: Warfarin and aspirin affect the coagulation cascade through different but additive mechanisms. Warfarin inhibits the hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, X), reducing the ability to form clots via the coagulation cascade. Aspirin irreversibly inhibits platelet cyclooxygenase, impairing platelet aggregation — the primary cellular mechanism of clot formation. Using both together produces an additive anticoagulant and antiplatelet effect that significantly elevates the risk of serious or life-threatening hemorrhage, including gastrointestinal bleeding and intracranial hemorrhage. The combination does not reduce warfarin's effectiveness (B) — on the contrary, the overall anticoagulation effect is increased. Warfarin is not eliminated by aspirin (C). An allergic reaction (D) is not an expected pharmacological interaction between these agents.

Question 8

The nurse is preparing to administer spironolactone (a potassium-sparing diuretic) to a client with heart failure. The nurse notes the client is also prescribed a daily potassium supplement.

Which action should the nurse take next?

Administer both medications as prescribed by the PHCP.
Withhold both medications and notify the PHCP of the potential interaction. (correct answer)
Give the spironolactone but tell the client to skip the potassium supplement.
Advise the client to increase their intake of bananas and orange juice today.

Explanation: Spironolactone is a potassium-sparing diuretic that works by blocking aldosterone receptors, causing the kidney to retain potassium while excreting sodium and water. When combined with a potassium supplement, the additive potassium load creates a high risk for life-threatening hyperkalemia, which can cause fatal cardiac arrhythmias. The nurse must withhold both medications and notify the PHCP so an informed decision can be made about the regimen — the nurse should not independently determine which medication to give or omit. Administering both as prescribed (A) puts the client at immediate risk. Independently deciding to give spironolactone while withholding the supplement (C) bypasses the PHCP and makes an unilateral clinical judgment outside LPN/VN scope. Recommending additional dietary potassium sources (D) would further worsen the risk of hyperkalemia in this already dangerous combination.

Question 9

A client with a history of severe bronchial asthma is newly diagnosed with hypertension. The PHCP prescribes propranolol (a non-selective beta-blocker).

The nurse should identify that this medication is a contraindication for this client because it can cause:

Severe hypertension and a rapid heart rate.
Bronchoconstriction and an acute asthma attack. (correct answer)
A significant increase in the client's blood glucose levels.
Excessive fluid retention and peripheral edema.

Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1 receptors (cardiac) and beta-2 receptors (smooth muscle, including bronchial smooth muscle). In clients with asthma, beta-2 receptor activation causes bronchodilation — blocking these receptors with propranolol removes this bronchodilatory tone and can trigger bronchoconstriction and acute bronchospasm, precipitating a potentially life-threatening asthma attack. The nurse must withhold this medication and notify the PHCP before administration. Cardioselective beta-1 blockers (such as metoprolol or atenolol) have less beta-2 activity and are generally preferred when a beta-blocker is required for a client with asthma, though they are not entirely risk-free. Propranolol causes bradycardia and hypotension (not hypertension or tachycardia as in A). While beta-blockers can modestly impair glucose recovery from hypoglycemia, hyperglycemia (C) is not the primary contraindication concern. Fluid retention (D) is not a characteristic adverse effect of beta-blockers.

Question 10

A nurse is caring for a client who is taking digoxin and furosemide. The nurse notes the client's most recent potassium level is 3.1 mEq/L (Normal: 3.5 to 5.0 mEq/L).

The nurse should recognize that this electrolyte imbalance increases the client's risk for:

Digoxin toxicity and cardiac arrhythmias. (correct answer)
Decreased therapeutic effect of the furosemide.
A severe allergic reaction to the digoxin.
Significant fluid volume excess and edema.

Explanation: Furosemide is a loop diuretic that causes potassium wasting, and this client's potassium of 3.1 mEq/L reflects hypokalemia. This is a critical safety concern in a client receiving digoxin because potassium and digoxin compete for the same binding site on the Na-K-ATPase pump in cardiac cells. When potassium is low, digoxin has less competition for these receptor sites and binds more avidly, producing a toxic effect — causing dangerous cardiac arrhythmias — even when the digoxin serum level itself appears within a therapeutic range. The nurse must withhold the digoxin and notify the PHCP to address the hypokalemia before continuing the medication. Hypokalemia does not decrease furosemide's diuretic effect (B). An allergic reaction (C) is unrelated to electrolyte status. Hypokalemia causes fluid shifts but does not produce fluid volume excess (D).

Question 11

A nurse is reinforcing teaching with a client who is taking a broad-spectrum antibiotic and an oral contraceptive.

Which information should the nurse reinforce to ensure the client's safety?

"The antibiotic will make your birth control pill more effective."
"You should use a backup method of contraception while taking the antibiotic." (correct answer)
"The birth control pill will prevent the antibiotic from treating your infection."
"There are no known interactions between these two medications."

Explanation: The standard nursing education for a client taking both an antibiotic and an oral contraceptive is to recommend a backup method of contraception during the antibiotic course and for the remainder of that menstrual cycle. While current evidence supporting a clinically significant reduction in OCP effectiveness from most broad-spectrum antibiotics (other than rifampin) is debated, recommending backup contraception remains the universally accepted conservative safety practice. The potential for reduced effectiveness from altered gut flora affecting enterohepatic circulation of hormones provides a plausible mechanism, and the consequence of unintended pregnancy is too significant to dismiss. The antibiotic does not enhance contraceptive effectiveness (A). The birth control pill does not interfere with antibiotic efficacy (C). Stating there are no known interactions (D) dismisses a well-established clinical caution.

Question 12

The nurse is reviewing the medication administration record (MAR) for a client who is taking a monoamine oxidase inhibitor (MAOI) for depression. The client is newly prescribed an over-the-counter cold medication containing pseudoephedrine.

Which potential complication should the nurse identify?

Severe hypotension and bradycardia.
A significant decrease in the client's respiratory rate.
Hypertensive crisis and potential stroke. (correct answer)
Acute liver failure and jaundice.

Explanation: MAOIs inhibit monoamine oxidase, the enzyme responsible for breaking down catecholamines including norepinephrine, dopamine, and serotonin. When a sympathomimetic agent such as pseudoephedrine is taken concurrently, the catecholamine surge it causes cannot be metabolized normally, resulting in a massive accumulation of norepinephrine. This produces a potentially life-threatening hypertensive crisis characterized by sudden severe headache, extremely elevated blood pressure, and risk of intracranial hemorrhage or stroke. The nurse must immediately withhold the pseudoephedrine and notify the PHCP — this is one of the most dangerous drug interactions in clinical pharmacology. The combination does not cause hypotension or bradycardia (A). Respiratory depression (B) is associated with opioid or sedative interactions, not sympathomimetics. Liver failure (D) is not a feature of this interaction.

Question 13

A nurse is preparing to administer the first dose of a prescribed intravenous antibiotic to a client. The client's record indicates a severe allergy to penicillin, resulting in hives and difficulty breathing. The new prescription is for a cephalosporin.

Which action is a priority for the nurse?

Administer the medication and monitor the client closely for 30 minutes.
Withhold the medication and notify the PHCP of the potential cross-sensitivity. (correct answer)
Give the medication along with a dose of diphenhydramine to prevent a reaction.
Document that the client is now also allergic to all cephalosporin medications.

Explanation: There is a recognized cross-reactivity between penicillins and cephalosporins due to their shared beta-lactam ring structure. While the true cross-reactivity rate is estimated at approximately 1 to 2%, a history of a severe penicillin reaction — hives combined with difficulty breathing represents an anaphylaxis-spectrum response — warrants withholding the cephalosporin and obtaining explicit PHCP guidance before proceeding. The severity of the prior reaction, not its statistical probability of recurrence, drives this action. Administering and monitoring (A) exposes the client to an anaphylactic risk without PHCP awareness or a prepared response plan. Pre-medicating with diphenhydramine (C) may partially blunt an allergic response but does not prevent anaphylaxis and circumvents the required PHCP notification. Documenting a blanket cephalosporin allergy (D) without a confirmed reaction exceeds the nurse's scope and may unnecessarily limit future antibiotic options.

Question 14

The nurse has identified a potential interaction between a client's prescribed antidepressant and a newly ordered cough suppressant.

What is the most appropriate way for the nurse to document this occurrence?

Record that the PHCP was notified and the cough suppressant was withheld. (correct answer)
Document that the client refused the cough suppressant for no specific reason.
Note in the record that the pharmacy made an error by sending the medication.
Record that the interaction will be monitored during the next nursing shift.

Explanation: When the nurse identifies a potential medication interaction and takes action to protect the client, documentation must accurately reflect the clinical situation, the nurse's assessment, the action taken, and the communication with the PHCP. Recording that the PHCP was notified and the medication withheld is complete, timely, and legally defensible — it creates an accurate record of the nurse's professional judgment and the coordinated response. Documenting the client as refusing without cause (B) is inaccurate and misrepresents the reason for non-administration, which could create legal liability and miscommunicate important clinical information to future providers. Attributing the issue to a pharmacy error (C) may or may not be accurate and should not be stated in the chart unless specifically confirmed — clinical documentation is not the place for blame attribution. Deferring to the next shift (D) creates an unacceptable gap in documentation and care accountability.

Question 15

The PHCP discontinues the ibuprofen and prescribes a topical analgesic. Two days later, the serum creatinine is stable and peripheral edema has not worsened. The nurse determines the intervention was successful because:

The client is now able to walk without any reports of pain in her knees.
The client's kidney function and fluid status have been protected from further injury. (correct answer)
The client no longer requires her daily doses of furosemide.
The client's blood pressure has remained at her baseline level of 120/80 mmHg.

Explanation: The primary clinical goals of discontinuing ibuprofen in this client were to prevent further nephrotoxic injury and to eliminate the pharmacological antagonism of her diuretic and ACE inhibitor. Stable serum creatinine confirms that GFR has been maintained and acute kidney injury has been avoided. Non-worsening peripheral edema confirms that the diuretic (furosemide) is again able to exert its intended effect without NSAID interference. These are the direct, objective, measurable outcomes that evaluate the safety intervention. Complete resolution of knee pain (A) is not a realistic short-term expectation and was not the goal of this specific intervention. The client continuing to require furosemide (C is its inverse) is expected — CHF does not resolve because ibuprofen was stopped; the diuretic remains necessary. Blood pressure at baseline (D) is a supportive finding but does not specifically measure the outcomes targeted by the ibuprofen discontinuation.

Question 16

An 80-year-old client with chronic atrial fibrillation has been taking warfarin for stroke prevention for several years. During a home health visit, the nurse notes a new bottle of St. John's Wort on the counter. The client states, 'I started taking this daily to help with my low mood and energy levels.'

Which action is a priority for the nurse to take regarding this new supplement?

Encourage the client to take the supplement at least four hours after the warfarin dose to ensure absorption.
Advise the client to increase their intake of green leafy vegetables to balance the effects of the supplement.
Document the use of the herbal supplement in the record as a normal lifestyle choice for the client.
Instruct the client to stop taking the supplement and immediately notify the primary health care provider (PHCP). (correct answer)

Explanation: St. John's Wort is a potent inducer of cytochrome P450 enzymes (particularly CYP2C9) and P-glycoprotein. When taken concurrently with warfarin, it accelerates warfarin's metabolism, decreasing plasma warfarin levels and reducing its anticoagulant effect. For a client with atrial fibrillation taking warfarin for stroke prevention, this interaction significantly increases the risk of clot formation and stroke. The nurse must instruct the client to stop the supplement immediately and notify the PHCP so the warfarin dose and INR can be reassessed. Timing separation (A) does not prevent enzyme induction, which is a sustained pharmacokinetic effect independent of administration timing. Documenting as a normal lifestyle choice (C) fails to address a clinically dangerous interaction. Increasing green leafy vegetables (B) would introduce additional vitamin K, further reducing warfarin effectiveness — this is additionally harmful.

Question 17

A nurse is preparing to administer morning medications to a client with a history of hypertension and active gastric ulcers. The client is currently prescribed lisinopril and has a new order for an over-the-counter aluminum-hydroxide antacid to help with indigestion.

Which information should the nurse identify as a potential drug-drug interaction for this client?

Antacids can decrease the absorption and therapeutic effectiveness of ACE inhibitors like lisinopril. (correct answer)
Lisinopril will cause the antacid to have a toxic effect on the client's liver function.
Taking both medications together will cause a severe, immediate allergic reaction.
The antacid will increase the client's risk for developing hyperkalemia from the lisinopril.

Explanation: Aluminum-containing antacids can interfere with the oral absorption of many medications, including ACE inhibitors such as lisinopril, by altering gastric pH and binding to the drug in the gastrointestinal tract. Reduced absorption leads to lower plasma drug levels and suboptimal blood pressure control. The nurse should instruct the client to separate these medications by at least one to two hours. Lisinopril causing antacid liver toxicity (B) is not a recognized interaction. A severe allergic reaction (C) is not an expected pharmacokinetic interaction between these agents. The antacid increasing hyperkalemia risk from lisinopril (D) is incorrect; aluminum-based antacids do not influence potassium retention — hyperkalemia from lisinopril results from ACE inhibition of aldosterone, which is unrelated to antacid co-administration.

Question 18

Which finding from the client's history is the most significant contraindication for the use of ibuprofen?

The client's age of 74 years.
The history of Stage 3 Chronic Kidney Disease. (correct answer)
The presence of osteoarthritis in the knees.
The current daily dose of Metformin.

Explanation: Stage 3 Chronic Kidney Disease is the most significant contraindication for ibuprofen and NSAIDs in this client. NSAIDs inhibit prostaglandin synthesis in the kidneys; prostaglandins are essential for maintaining afferent arteriolar dilation and glomerular filtration rate in states of compromised renal perfusion. In a client with already-reduced renal reserve from Stage 3 CKD, NSAID use can precipitate acute-on-chronic kidney injury, potentially accelerating progression to end-stage renal disease. Advanced age (A) increases susceptibility to adverse effects but is not a discrete contraindication by itself. Osteoarthritis (C) is the clinical indication for the ibuprofen, not a contraindication against it. Metformin dose (D) does not directly contraindicate ibuprofen; however, metformin itself requires dose reduction or cessation in worsening CKD, making ibuprofen-induced renal injury indirectly more dangerous.

Question 19

A client with a history of chronic alcoholism and liver cirrhosis requests over-the-counter acetaminophen for a minor headache.

The nurse should identify that acetaminophen is a contraindication for this client because of the high risk for:

Acute renal failure and urinary retention.
Severe hepatotoxicity (liver damage). (correct answer)
Significant gastrointestinal bleeding and ulcers.
An immediate and severe anaphylactic reaction.

Explanation: Acetaminophen is primarily metabolized in the liver through multiple pathways. A toxic metabolite, NAPQI (N-acetyl-p-benzoquinone imine), is normally detoxified by conjugation with glutathione. In clients with liver cirrhosis or chronic heavy alcohol use, two mechanisms increase hepatotoxicity risk: the liver's metabolic capacity and glutathione stores are depleted, allowing NAPQI to accumulate and cause hepatocellular damage; and alcohol induces CYP2E1, which converts more acetaminophen to NAPQI. Even standard or seemingly low doses of acetaminophen can cause fulminant hepatic failure in this population. The nurse must refuse to supply acetaminophen and notify the PHCP for a safer alternative. Renal failure and urinary retention (A) are not primary risks of acetaminophen. GI bleeding and ulcers (C) are associated with NSAIDs, not acetaminophen. Anaphylaxis (D) is rare and unrelated to the hepatotoxicity mechanism.

Question 20

Which action should the nurse include in the client's plan of care to address her pain while avoiding harmful interactions?

Suggest increasing the daily dose of furosemide to manage potential fluid retention.
Instruct the client to always take ibuprofen with food to prevent gastric ulcers.
Consult the PHCP for a safer alternative for pain management, such as acetaminophen. (correct answer)
Encourage the client to double her dose of metformin until the knee pain subsides.

Explanation: Consulting the PHCP for a safer pain management alternative — such as acetaminophen at appropriate doses — directly addresses the clinical problem while eliminating the harmful NSAID interactions. Acetaminophen at recommended doses is generally safe for this client and does not cause nephrotoxicity, does not antagonize diuretics or ACE inhibitors, and does not cause fluid retention. Increasing furosemide (A) addresses a potential consequence of NSAID use (fluid retention) but does not eliminate the underlying nephrotoxic interaction — it is not the correct primary intervention. Instructing the client to continue ibuprofen with food (B) reduces gastrointestinal risk but does not address the renal and cardiovascular harms, which are far more serious for this client. Doubling metformin (D) is dangerous, inappropriate, and entirely unrelated to pain management.