A female client starts a new prescription, oxybutynin, for symptoms of an overactive bladder. The client tells the nurse that she is training to run in a half-marathon. Which instruction should the nurse emphasize?

 

The correct answer is d. Stop taking the medication if intended effect is not immediate.

Choice A Reason:

Using relaxation techniques to reduce excessive anxiety is a beneficial practice for managing generalized anxiety disorder (GAD). Techniques such as deep breathing, meditation, and progressive muscle relaxation can complement medication therapy and help reduce anxiety symptoms1. This statement does not require additional instruction as it aligns with recommended practices.

Choice B Reason:

Avoiding alcohol and other sedatives while taking lorazepam is crucial. Lorazepam is a benzodiazepine that can cause sedation and depress the central nervous system. Combining it with alcohol or other sedatives can enhance these effects, leading to dangerous levels of sedation, respiratory depression, or even overdose2. This advice is appropriate and does not need further instruction.

Choice C Reason:

Moving slowly from a sitting position to a standing position is important to prevent dizziness or lightheadedness, which can be side effects of lorazepam3. This precaution helps reduce the risk of falls and injuries, making it a suitable recommendation that does not require additional instruction.

Choice D Reason:

Stopping the medication if the intended effect is not immediate requires additional instruction. Lorazepam, like other benzodiazepines, may not produce immediate effects, especially in the context of anxiety management. It is important for clients to understand that medication may take some time to achieve the desired therapeutic effect and that abrupt discontinuation can lead to withdrawal symptoms and a potential rebound in anxiety4. The nurse should instruct the client to follow the prescribed regimen and consult their healthcare provider before making any changes to their medication.

Choice A Reason:

Initiating cardiopulmonary resuscitation (CPR) is a critical action when a patient is in cardiac arrest or not breathing. However, in this scenario, the client is experiencing severe respiratory depression due to opioid overdose, and the first line of treatment is to administer naloxone. If the client does not respond to naloxone, then CPR may be necessary, but the immediate step is to address the opioid toxicity.

Choice B Reason:

Preparing to assist with chest tube insertion is not relevant in this context. Chest tubes are typically used to treat conditions like pneumothorax or pleural effusion. The client’s symptoms are due to opioid-induced respiratory depression, which requires naloxone administration rather than chest tube insertion.

Choice C Reason:

Administering a second dose of naloxone is the appropriate action. Naloxone is an opioid antagonist that reverses the effects of opioid overdose, including respiratory depression. Given the client’s critically low respiratory rate and oxygen saturation, a second dose of naloxone is necessary to counteract the opioid effects and restore normal breathing.

Choice D Reason:

Determining the Glasgow Coma Scale (GCS) score is useful for assessing the level of consciousness, but it does not directly address the immediate need to reverse the opioid-induced respiratory depression. The priority is to administer naloxone to improve the client’s respiratory status. Once the client is stabilized, further assessments, including the GCS score, can be conducted.