A nurse is administering a scheduled medication to a client. The client reports that the medication appears different than what they take at home. Which of the following responses should the nurse make?

A. Bradypnea: Hypermagnesemia depresses neuromuscular and central nervous system function, which can lead to slowed respiratory rate (bradypnea) and potentially respiratory failure in severe cases.

B. Personality change: Personality changes are more commonly associated with hyponatremia, hypernatremia, or other electrolyte imbalances affecting the brain, rather than hypermagnesemia.

C. Seizure: Seizures are more likely in hypomagnesemia due to increased neuromuscular excitability, not in hypermagnesemia, which generally causes neuromuscular depression.

D. Elevated hematocrit: Hypermagnesemia does not directly affect red blood cell concentration or hematocrit levels. Changes in hematocrit are usually related to fluid volume status, not magnesium levels.

Rationale for correct choices:

• Prescribed medication: The client is taking hydrochlorothiazide, a diuretic that can cause dizziness, orthostatic hypotension, and increased nighttime urination. These side effects increase the risk for falls, especially in older adults who may already have mobility limitations.
• Blood pressure readings: The client’s blood pressure dropped from sitting 138/84 mm Hg to standing 100/70 mm Hg, indicating orthostatic hypotension. This sudden decrease in blood pressure can cause lightheadedness, dizziness, or fainting, all of which increase the likelihood of falls.
• Voiding pattern: The client reports waking 2–3 times per night to void. Nocturia increases fall risk because the client must get up in low-light conditions, potentially while drowsy, making them more susceptible to tripping or losing balance.

Rationale for incorrect choices:

• Gait: The client’s gait is steady, and no abnormalities were noted during assessment. While gait disturbances can increase fall risk, in this case, the client’s mobility does not currently contribute to risk.
• Reports of home environment: The client has already removed throw rugs and increased lighting, implementing effective fall prevention strategies at home. Therefore, the home environment does not currently place the client at increased risk for falls.