A nurse is teaching a client who has a new prescription for zolpidem. The nurse should instruct the client that which of the following is an adverse effect of zolpidem?

A) Increased blood pressure:
Fluid overload results in an increased volume of fluid in the vascular system, leading to higher blood pressure. The excess volume places additional strain on the heart and blood vessels, causing an elevation in systolic and diastolic pressure. The nurse should expect to find elevated blood pressure in a client experiencing fluid overload due to the increased blood volume.

B) Increased hematocrit:
Hematocrit is the proportion of red blood cells in the blood, and it tends to decrease, not increase, during fluid overload. This is because the excess fluid in the bloodstream dilutes the blood, lowering the hematocrit level. Therefore, an increase in hematocrit would not be expected in fluid overload.

C) Increased respiratory rate:
Fluid overload, particularly when it affects the lungs (as seen in conditions like congestive heart failure), can cause respiratory distress. The accumulation of fluid in the lungs impairs gas exchange, leading to hypoxia and the body compensating by increasing the respiratory rate. This response helps increase oxygenation and expel carbon dioxide, so the nurse should expect to see an increased respiratory rate.

D) Increased heart rate:
An elevated heart rate, or tachycardia, is a compensatory response to fluid overload. The heart tries to pump the excess fluid through the circulatory system, which increases the heart's workload. As a result, the heart rate increases in an attempt to maintain adequate cardiac output despite the increased blood volume.

E) Increased temperature:
An elevated body temperature is not typically associated with fluid overload. In fact, fluid overload is more likely to present with normal or slightly lower body temperature, especially if there is no infection or inflammatory process present. If there is an increase in temperature, the nurse should consider other possible causes, such as infection or inflammatory conditions.

A) Apply pressure to the client’s nasolacrimal duct after instillation:
Applying gentle pressure to the nasolacrimal duct after administering an ophthalmic medication is a recommended practice. This action prevents the medication from draining into the nasopharynx, reducing the risk of systemic absorption and minimizing potential side effects. It also helps ensure that the medication stays localized in the eye for maximum therapeutic effect. This technique is especially important for medications like eye drops that could otherwise be absorbed systemically, such as those for glaucoma treatment.

B) Clean the client's eye from the outer canthus to the inner canthus before instillation:
The correct procedure for cleaning the eye prior to instilling ophthalmic medication is to clean from the inner canthus (near the nose) to the outer canthus (toward the temple). This technique avoids dragging debris from the outer eye toward the sensitive inner corner and helps prevent introducing contaminants into the eye. Cleaning from outer to inner canthus could potentially push debris toward the tear ducts and further irritate the eye.

C) Ask the client to tightly squeeze their eyes shut after the instillation:
Asking the client to tightly squeeze their eyes shut after instillation is not recommended. Squeezing the eyes shut can increase intraocular pressure and may actually force the medication out of the eye, reducing its effectiveness. Instead, the client should be encouraged to gently close their eyes and avoid blinking excessively. This allows the medication to stay in contact with the eye for a longer period.

D) Instill the ophthalmic medication directly on the client's cornea:
Instilling ophthalmic medication directly on the cornea is not recommended. The correct technique is to instill the medication into the conjunctival sac, which is the space between the lower eyelid and the eyeball. Instilling the medication directly onto the cornea could lead to irritation, discomfort, or damage to the sensitive corneal surface, and it would not allow the medication to be absorbed as intended.