A nurse is administering medications to a client and mistakenly gives hydroxyzine instead of hydralazine. For which of the following adverse effects should the nurse monitor the client?

Pioglitazone is a thiazolidinedioneantidiabetic agent that enhances insulin sensitivityby activating the peroxisome proliferator-activated receptor-gamma. It primarily addresses insulin resistancein peripheral tissues, but its use is restricted in patients with established heart failure due to risk of volume overload.

Rationale:

A.Fluid retention is a significant adverse effect of pioglitazone because the medication promotes sodium reabsorption in the renal distal tubules. This expanded plasma volume can lead to peripheral edema and potentially precipitate or worsen heart failure in susceptible individuals. The nurse must monitor the client for rapid weight gain, dyspnea, and bilateral lower extremity swelling during the course of therapy.

B.Tinnitus is not a recognized adverse effect associated with the use of thiazolidinediones like pioglitazone. It is more commonly linked to ototoxic medications such as aminoglycosides or high-dose salicylates. A client reporting ringing in the ears while taking pioglitazone should be evaluated for other pharmacological or physiological causes unrelated to their antidiabetic regimen.

C.Insomnia is not a typical side effect of pioglitazone therapy, as the medication does not exert stimulatory effects on the central nervous system. Patients with diabetes may experience sleep disturbances due to nocturnal hyperglycemia or hypoglycemia, but pioglitazone itself does not disrupt the sleep-wake cycle. The nurse should investigate alternative causes if the client reports difficulty sleeping.

D.Orthostatic hypotension is not associated with pioglitazone; in fact, the fluid retention caused by the drug would be more likely to support or slightly increase blood pressure. Amlodipine or nitrates are more likely to cause postural drops in pressure. Monitoring for dizziness upon standing is not a priority specific to the safety profile of thiazolidinedione medications.

Safe medication administration relies on the elimination of transcription errorsand adherence to established safety guidelines, such as avoiding trailing zeros. The Joint Commission mandates specific labeling standards to prevent dosing inaccuracies that could lead to toxicity or subtherapeutic treatment. Clarifying ambiguous or non-standard prescriptions is a fundamental responsibility of the nurse in maintaining patient safetyand preventing adverse events.

Rationale:

A.The prescription for Clozapine 12.50 mg must be clarified because it contains a trailing zero, which is a prohibited notation according to safety standards. A trailing zero can be misread as 125 mg if the decimal point is missed, leading to a ten-fold dosing error and potential toxicity. Standard practice requires writing the dose as 12.5 mg to ensure clear communication.

B.Lamotrigine 200 mg PO daily is a standard maintenance dose for the treatment of epilepsy or bipolar disorder and does not require clarification. This dosage falls within the typical therapeutic range and the notation is clear and free of dangerous abbreviations or zeros. The nurse should simply continue to monitor the patient for adverse effects like Stevens-Johnson syndrome.

C.Donepezil 23 mg PO daily is an approved dosage for the treatment of moderate-to-severe Alzheimer's disease and is not inherently incorrect. While higher than the starting dose, this specific strength was developed to provide additional cognitive benefits for patients with advanced disease. The notation is clear and follows standard pharmaceutical guidelines, so no clarification is needed based on the dosage.

D.Fluoxetine oral solution 20 mg/5 mL administered via a gastrostomy tube is an appropriate route and dose for a patient who cannot swallow. Liquid formulations are the preferred method for tube administration to prevent clogging and ensure the full dose of the selective serotonin reuptake inhibitor is delivered. This prescription follows clear clinical logic and standard safety practices for enteral medication.