The nurse has reviewed the Provider Prescriptions at 1355, Laboratory Results at 1450, and Diagnostic Results at 1525.

Exhibits

Complete the following sentence by using the lists of options.

The client is most likely experiencing

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as evidenced by 

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and

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.

Rationale for correct choices

• Blurred vision: Amitriptyline is a tricyclic antidepressant that has anticholinergic effects, which can reduce the ability of the eyes to focus and cause blurred vision. Clients should be warned about potential difficulty with reading or driving until they know how the medication affects their vision. This adverse effect is common and may persist throughout therapy.

• Orthostatic hypotension Amitriptyline can block alpha-adrenergic receptors, leading to vasodilation and a drop in blood pressure upon standing. Clients may experience dizziness, lightheadedness, or fainting, especially when moving from sitting to standing. Monitoring blood pressure and educating the client to rise slowly are important preventive strategies.

• Urinary retention Anticholinergic effects of amitriptyline can impair bladder contraction, causing difficulty initiating urination or incomplete emptying. This is particularly important in older adults or clients with preexisting urinary issues. Teaching clients to report urinary hesitancy or discomfort helps prevent complications such as infection.

• Constipation Amitriptyline slows gastrointestinal motility due to its anticholinergic properties, making constipation a common adverse effect. Clients may need dietary adjustments, increased fluid intake, or stool softeners. Early teaching on prevention is important to reduce discomfort and maintain regular bowel habits.

Rationale for incorrect choices

• Tinnitus: Tinnitus is not commonly associated with amitriptyline therapy. While some medications can cause ringing in the ears, this is not a primary concern with tricyclic antidepressants. It is less likely to be observed or require teaching.

• Sore throat: Sore throat is not a known adverse effect of amitriptyline. Upper respiratory symptoms are unrelated to the anticholinergic and adrenergic effects of this medication, making this an inappropriate teaching point.

• Bradycardia: Amitriptyline does not typically cause bradycardia; it may instead affect conduction and potentially lead to arrhythmias in susceptible clients, but slowing the heart rate is uncommon. Monitoring focuses on blood pressure rather than heart rate reduction.

• Peripheral edema: Peripheral edema is not a common effect of amitriptyline. Fluid retention is not typically induced by tricyclic antidepressants, so this is not a relevant teaching point.

• Increased urination: Amitriptyline generally causes urinary retention rather than increased urination due to anticholinergic effects. Increased urination is not expected and is not a priority to include in client teaching.

• Dysuria: While urinary retention can cause discomfort, dysuria (painful urination) is not a direct effect of amitriptyline. Any urinary pain would likely be secondary to infection, not the medication itself.

• Diarrhea: Amitriptyline slows gastrointestinal motility, so diarrhea is not a common effect. Constipation is far more likely due to anticholinergic activity.

• Nausea with vomiting: Although some clients may experience mild nausea initially, constipation is more directly linked to the anticholinergic mechanism and is more consistent as a common teaching point. Nausea is less frequent and usually transient.

Rationale:

A. Reinforce orientation to time, place, and person: Regularly providing cues about the current time, location, and people helps reduce confusion and anxiety in clients with dementia. Orientation reinforcement supports cognitive functioning and promotes a sense of safety.

B. Refute the client’s delusions using logic: Arguing or attempting to correct delusions can increase agitation and distress. Therapeutic communication focuses on validation and redirection rather than confrontation, making this approach inappropriate for dementia care.

C. Establish eye contact when communicating with the client: Maintaining eye contact helps ensure the client’s attention and conveys engagement and respect. It enhances understanding and supports effective communication, especially when verbal comprehension may be impaired.

D. Give the client one simple direction at a time: Breaking tasks into single, clear instructions reduces cognitive overload and frustration. This approach increases the likelihood that the client can follow directions and participate successfully in activities of daily living.

E. Allow the client to choose among a variety of activities each day: While offering choices promotes autonomy, offering a large variety can be overwhelming for a client with dementia, leading to confusion, anxiety, and decision paralysis. The nurse should offer limited choices