A nurse is providing discharge teaching to the family of a client who has Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?

• HEENT – Dry mouth; Amitriptyline has strong anticholinergic effects, which inhibit salivary gland secretion, commonly resulting in dry mouth. This side effect can affect oral comfort, dental health, and appetite.
• Cardiovascular – Tachycardia: Tricyclic antidepressants like amitriptyline can cause tachycardia due to their anticholinergic properties and direct effects on cardiac conduction. These drugs inhibit vagal tone, which increases heart rate, and can also affect the sodium channels in cardiac tissue.
• Genitourinary – Urinary retention: Amitriptyline’s anticholinergic activity relaxes the detrusor muscle and contracts the internal urethral sphincter, impairing normal bladder emptying. This can lead to difficulty initiating urination and incomplete bladder emptying, particularly in older adults.
• Gastrointestinal – Constipation: By inhibiting parasympathetic activity in the GI tract, amitriptyline slows peristalsis, leading to constipation. This side effect is common and can become severe without dietary adjustments or the use of stool softeners.

A. Irritability: While clients with obsessive-compulsive personality disorder (OCPD) may become frustrated when things are not done their way, persistent irritability is more characteristic of mood or anxiety disorders rather than a core feature of OCPD.
B. Impulsivity: Impulsivity is typically associated with borderline or antisocial personality disorders. Clients with OCPD are generally rigid, controlled, and rule-bound rather than impulsive.
C. Takes advantage of others: This behavior is more aligned with antisocial personality disorder. Clients with OCPD are often rule-abiding and conscientious, though they may be excessively controlling or critical.
D. Shows perfectionism: Perfectionism is a hallmark of obsessive-compulsive personality disorder. Clients often set excessively high standards for themselves and others, are preoccupied with orderliness, and may have difficulty delegating tasks.