A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse identify as an adverse effect of TPN

Oxybutynin is an anticholinergic medication commonly used to treat urinary incontinence. One of the adverse effects of anticholinergic medications is the potential for bradycardia, which refers to a slower than normal heart rate. Anticholinergic medications can inhibit the effects of acetylcholine, a neurotransmitter responsible for regulating various bodily functions, including heart rate. Therefore, it is important to assess the client for signs of bradycardia after an unintended higher dose of oxybutynin.

Increased salivation (A) is not an expected adverse effect of oxybutynin. In fact, anticholinergic medications like oxybutynin often have the opposite effect, causing dry mouth and reduced salivation.

Hyperthermia (B) is not a typical adverse effect of oxybutynin. It is more commonly associated with other conditions or medications.

Urinary incontinence (C) is the condition that oxybutynin is intended to treat. It is not an adverse effect but rather the therapeutic effect of the medication.

When providing discharge teaching to a client with a prescription for enoxaparin, the nurse should include the instruction to expel the air bubble prior to injecting the medication. Enoxaparin is a type of anticoagulant medication that is administered as a subcutaneous injection.

Here's why the other options are incorrect:

A. Insert the needle at a 45 angle: Enoxaparin is typically administered as a subcutaneous injection, where the needle is inserted at a 90-degree angle (straight into the skin). A 45-degree angle is used for intramuscular injections, but it is not appropriate for enoxaparin administration.

B. Inject the medication into a muscle: Enoxaparin is not intended to be injected into a muscle. It is a low-molecular-weight heparin designed for subcutaneous administration, meaning it is injected just below the skin into the fatty tissue.

C. Rub the injection site following administration: Rubbing the injection site after administering enoxaparin or any other subcutaneous medication is not recommended. Rubbing the site can cause irritation and bruising. Instead, the nurse should apply gentle pressure with a cotton ball or gauze pad for a few seconds after the injection to help minimize bleeding.