Questions: A nurse is teaching a client who has Alzheimer's disease and their caregiver about memantine. Which of the following instructions should the nurse include? Increase fluid intake to improve renal excretion. Report memory loss or confusion. Watch for manifestations of liver impairment, such as jaundice and abdominal pain. Avoid taking over-the-counter antacids.

The answer is the fourth one: Avoid taking over-the-counter antacids.

Explanation for each option:

1. Increase fluid intake to improve renal excretion.

   • This is not a standard instruction for memantine. While staying hydrated is generally good advice, it is not specifically related to the use of memantine.

2. Report memory loss or confusion.

   • Memory loss and confusion are symptoms of Alzheimer's disease itself, and while any sudden changes should be reported, this is not a specific instruction related to memantine use.

3. Watch for manifestations of liver impairment, such as jaundice and abdominal pain.

   • Memantine is not primarily associated with liver impairment. This instruction is more relevant for medications that are hepatotoxic.

4. Avoid taking over-the-counter antacids.

   • This is the correct instruction. Memantine's excretion can be affected by changes in urine pH, and some antacids can alter urine pH, potentially affecting the drug's elimination.

In summary, the nurse should instruct the client and caregiver to avoid taking over-the-counter antacids while on memantine.