Clients taking an NSAID drug should be counseled that these medications can cause which side effects? Select all that apply.

Rationale: A. Oral thrush: Oral thrush is caused by overgrowth of Candida species in the mouth and is associated with immunosuppression or prolonged antibiotic or corticosteroid use. NSAIDs do not suppress the immune system or alter oral flora in a way that predisposes to fungal infections. B. Cardiovascular effects: NSAIDs inhibit cyclooxygenase enzymes, which reduces prostaglandin synthesis. Prostaglandins help maintain vasodilation and sodium excretion in the kidneys, their inhibition can lead to increased blood pressure, fluid retention, and higher risk of heart failure or myocardial infarction, particularly in patients with preexisting CVS disease. C. GI bleeds: By inhibiting COX-1, NSAIDs reduce prostaglandins that protect the gastric and intestinal mucosa. This increases gastric acid secretion, decreases bicarbonate and mucus production, and disrupts mucosal blood flow, which can result in gastritis, peptic ulcers, and gastrointestinal bleeding. D. Yellowing of the sclera: Scleral jaundice occurs due to elevated bilirubin from liver dysfunction or hemolysis. NSAIDs do not interfere with bilirubin metabolism or cause significant hepatocellular damage in standard use, yellowing of the sclera is not associated with NSAID therapy. E. Kidney damage: NSAIDs reduce renal prostaglandin production, which normally maintains afferent arteriolar dilation and glomerular filtration, especially under conditions of low renal perfusion. Inhibition can lead to reduced renal blood flow, sodium and water retention, and acute kidney injury, particularly in older adults or patients with preexisting renal impairment.