After taking orlistat for one week, a female patient tells the home health nurse that she is experiencing increasingly frequent oily stools and gas.
What action should the nurse take?

The correct answer is A:

Choice A reason: Notifying the healthcare provider is crucial because the patient’s carbamazepine level is significantly above the therapeutic range, which is 4-12 mcg/mL. A level of 84 mcg/mL indicates a high risk of toxicity, and the healthcare provider must be informed to take appropriate action, which may include adjusting the dose or discontinuing the medication.

Choice B reason: Administering the carbamazepine as prescribed would not be safe without addressing the elevated drug level. Continuing to administer the medication could increase the risk of severe side effects and toxicity due to the already high serum level.

Choice C reason: Withholding the dose may be a necessary immediate action, but it does not address the need for medical intervention to manage the patient’s elevated drug level. Therefore, while withholding the dose might be part of the response, it should follow notifying the healthcare provider.

Choice D reason: Assessing the patient for side effects is important, but it is not the most immediate action required. The priority is to notify the healthcare provider because of the potential for serious toxicity given the high carbamazepine level.

Choice A rationale

Codeine is an opioid medication that can cause drowsiness and dizziness. This can increase the risk of falls, particularly in older adults or those with balance or mobility issues. Therefore, it is important to instruct the client to request assistance when ambulating to prevent falls.

Choice B rationale

While constipation is a common side effect of opioid medications like codeine, and a stool softener or laxative may be helpful in managing this side effect, it is not the highest priority nursing action. The risk of falls due to drowsiness or dizziness is a more immediate safety concern.

Choice C rationale

While it is important for the client to notify the nurse if the pain is not relieved, this is not the highest priority nursing action. The safety of the client is the primary concern, and preventing falls by providing assistance with ambulation is a more immediate need.

Choice D rationale

Advising the client that the medication should start to work in about 30 minutes is an important part of patient education, but it is not the highest priority nursing action. The safety of the client is the primary concern, and preventing falls by providing assistance with ambulation is a more immediate need.