A nurse in the respiratory unit is caring for client who has a past medical history of heart failure and is currently admitted for asthma exacerbation. When reviewing the provider's orders further clarification is needed for which of the following medications?

A) Jaundice:
Carbidopa-levodopa works by increasing dopamine levels in the brain to help alleviate symptoms of Parkinson's disease, but it is not typically associated with liver dysfunction that would lead to jaundice. If jaundice were to occur, it could indicate liver problems, which would need to be evaluated further, but this is not a typical side effect of Sinemet.

B) Hyperglycemia:
Sinemet primarily affects dopamine levels in the brain and does not have a direct impact on blood sugar regulation. However, long-term use of certain medications, especially corticosteroids or other specific treatments, can affect glucose levels, but carbidopa-levodopa is not typically linked to hyperglycemia.

C) Hypertension:

Carbidopa-levodopa may lead to fluctuations in blood pressure, including lowering blood pressure, especially when the patient is changing positions. However, hypertension is not a typical response to this medication. Instead, patients may experience orthostatic hypotension, which is more common with carbidopa-levodopa.

D) Orthostatic hypotension:
Orthostatic hypotension is a well-recognized and common side effect of carbidopa-levodopa. This occurs because Sinemet affects the autonomic nervous system, which can cause a decrease in blood pressure when moving from a sitting or lying position to standing. Patients on carbidopa-levodopa should be advised to rise slowly to minimize the risk of dizziness or fainting due to orthostatic hypotension.

A) Obtain blood specimen for a BMP test:
Although obtaining laboratory tests like a BMP (Basic Metabolic Panel) can be important in evaluating the client’s electrolyte balance and kidney function, it is not the priority intervention in this acute situation. The client is exhibiting a potentially dangerous rhythm and the immediate intervention to stabilize the rhythm is necessary before ordering lab tests.

B) Prepare for synchronized cardioversion:
The priority intervention for a client exhibiting this cardiac rhythm with accompanying signs of hemodynamic instability (low blood pressure, tachycardia, respiratory distress) is synchronized cardioversion. This is especially the case if the rhythm is atrial fibrillation, atrial flutter, or supraventricular tachycardia (SVT), which can be life-threatening if not treated promptly. Synchronized cardioversion is indicated when the patient is symptomatic and hemodynamically unstable.

C) Start CPR:
While starting CPR is critical for a patient who is unresponsive and in a pulseless rhythm (such as ventricular fibrillation or asystole), this client is still responsive with a pulse of 130 bpm. Although the client is in a high-risk rhythm with signs of hemodynamic instability, CPR is not indicated at this moment because the client is not in cardiac arrest.

D) Prepare for defibrillation:
Defibrillation is indicated for life-threatening arrhythmias such as ventricular fibrillation or pulseless ventricular tachycardia. In this case, the client has a pulse, indicating that defibrillation is not appropriate.