A nurse is monitoring a client who is receiving a unit of packed red blood cells (RBCs) following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload?

Choice A reason: Bradycardia is not an adverse effect of diphenhydramine. Bradycardia is a slow heart rate, usually below 60 beats per minute. Diphenhydramine is an antihistamine that blocks the effects of histamine, a chemical that causes allergic reactions. Diphenhydramine does not affect the heart rate, although it may cause palpitations or irregular heartbeat in some cases.

Choice B reason: Constipation is an adverse effect of diphenhydramine. Constipation is a condition in which the bowel movements are infrequent, hard, or difficult to pass. Diphenhydramine has anticholinergic properties, which means it inhibits the activity of acetylcholine, a neurotransmitter that regulates the smooth muscle contraction in the gastrointestinal tract. Diphenhydramine can reduce the intestinal motility and cause constipation, as well as dry mouth, blurred vision, and urinary retention.

Choice C reason: Hypertension is not an adverse effect of diphenhydramine. Hypertension is a condition in which the blood pressure is abnormally high, usually above 140/90 mmHg. Diphenhydramine does not affect the blood pressure, although it may cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions from lying to standing. This can cause dizziness, fainting, or falls.

Choice D reason: Sedation is an adverse effect of diphenhydramine. Sedation is a state of reduced alertness, awareness, or responsiveness. Diphenhydramine can cross the blood-brain barrier and affect the central nervous system, causing drowsiness, fatigue, impaired coordination, and reduced mental performance. Diphenhydramine can also potentiate the effects of alcohol and other sedatives, such as benzodiazepines, opioids, or barbiturates. The nurse should advise the client to avoid driving, operating machinery, or performing other tasks that require attention and concentration while taking diphenhydramine.

Choice A reason: Bleeding gums is a possible adverse effect of taking gingko biloba, as it may increase the risk of bleeding by inhibiting platelet aggregation and interfering with clotting factors. Gingko biloba may also interact with other medications that affect bleeding, such as anticoagulants, antiplatelets, or NSAIDs. The nurse should advise the client to monitor for signs of bleeding, such as bruising, nosebleeds, or hematuria, and report them to the provider.

Choice B reason: Decreased alertness is not a likely adverse effect of taking gingko biloba, as it may have the opposite effect of enhancing cognitive function and memory. Gingko biloba may improve blood flow to the brain and protect against oxidative stress and neuronal damage. The nurse should inform the client that gingko biloba may take several weeks to show its benefits and that the evidence for its effectiveness is inconclusive.

Choice C reason: Breast enlargement is not a known adverse effect of taking gingko biloba, as it does not affect the hormonal levels or the breast tissue. Gingko biloba may have some estrogenic activity, but it is not significant enough to cause gynecomastia or breast tenderness. The nurse should assess the client for other possible causes of breast enlargement, such as medications, liver disease, or tumors.

Choice D reason: Bad breath is not a common adverse effect of taking gingko biloba, as it does not affect the oral hygiene or the digestive system. Gingko biloba may have a mild odor, but it is not unpleasant or persistent. The nurse should advise the client to maintain good oral care and to check for other possible causes of bad breath, such as infections, dental problems, or dietary factors.