A nurse is assessing a client who is taking gentamicin. For which of the following findings should the nurse withhold the medication?

A. Weight gain: Opioid withdrawal typically causes weight loss due to decreased appetite and gastrointestinal upset, rather than weight gain.

B. Yawning: Frequent yawning is a common early manifestation of opioid withdrawal, reflecting autonomic hyperactivity and central nervous system changes as the body adjusts to the absence of the opioid.

C. Constipation: Opioid withdrawal usually causes diarrhea rather than constipation, as opioid-induced bowel hypomotility resolves when the drug is discontinued.

D. Somnolence: Withdrawal is associated with hyperactivity, anxiety, and insomnia rather than excessive sleepiness. Somnolence is more characteristic of opioid intoxication.

Rationale for Correct Choices:

• Diltiazem: Diltiazem is a calcium channel blocker commonly used to control ventricular rate in atrial fibrillation. The client’s ECG confirms atrial fibrillation with rapid ventricular response, making rate control a priority to prevent hemodynamic instability.
• Cardiac rhythm: The rapid, irregular heart rate documented on ECG is the primary finding necessitating medication intervention to prevent further complications such as decreased cardiac output or thromboembolism.

Rationale for Incorrect Choices:

• Dopamine: Dopamine is a vasopressor used to support blood pressure in hypotension or shock. While the client’s BP is mildly decreased, the immediate concern is rapid atrial fibrillation rather than hypotensive crisis.
• Furosemide: Furosemide treats fluid overload and edema but does not directly address the acute arrhythmia causing tachycardia and hemodynamic compromise.
• Albuterol nebulizer: Albuterol is used for bronchospasm and respiratory distress related to airway constriction. The client has clear lung sounds, so this is not indicated.
• Alprazolam: Alprazolam can reduce anxiety but does not manage the underlying atrial fibrillation or prevent cardiovascular complications.
• Edema, blood pressure, anxiety, dyspnea: While these are relevant assessments, they are secondary to the urgent need to control the cardiac rhythm in acute atrial fibrillation.