The nurse is about to administer the combination medication chlorthalidone and atenolol to a client diagnosed with chronic hypertension. Which interventions should the nurse include in the plan of care? (Select all that apply)

Choice A reason: This is not a correct answer. A decrease in urination is not a common side effect of amlodipine. Amlodipine is a calcium channel blocker that lowers the blood pressure and relaxes the blood vessels. Amlodipine does not affect the kidney function or the urine output, unless there is an underlying renal problem or a drug interaction. The client should monitor their urination, but not expect a decrease.

Choice B reason: This is the correct answer. An increase in lower extremity edema is a common side effect of amlodipine. Amlodipine can cause fluid retention and swelling in the legs, ankles, or feet. This is due to the dilation of the blood vessels and the leakage of fluid into the tissues. The client should monitor their weight and the size of their lower extremities, and report any significant changes to their health care provider. The client may also elevate their legs, wear compression stockings, or take diuretics to reduce the edema.

Choice C reason: This is not a correct answer. Tachycardia during exercise is not a common side effect of amlodipine. Amlodipine can lower the heart rate and the cardiac output, which can reduce the oxygen demand of the heart. Amlodipine does not cause an increase in the heart rate, unless there is an underlying cardiac problem or a drug interaction. The client should monitor their pulse and blood pressure, but not expect tachycardia.

Choice D reason: This is not a correct answer. An increase in bowel motility is not a common side effect of amlodipine. Amlodipine does not affect the gastrointestinal system or the digestion, unless there is an allergic reaction or a drug interaction. Amlodipine can cause some gastrointestinal side effects, such as nausea, abdominal pain, or constipation, but not an increase in bowel motility. The client should monitor their bowel movements, but not expect an increase.

Choice A reason: This is not a correct answer. A decrease in urination is not a common side effect of amlodipine. Amlodipine is a calcium channel blocker that lowers the blood pressure and relaxes the blood vessels. Amlodipine does not affect the kidney function or the urine output, unless there is an underlying renal problem or a drug interaction. The client should monitor their urination, but not expect a decrease.

Choice B reason: This is the correct answer. An increase in lower extremity edema is a common side effect of amlodipine. Amlodipine can cause fluid retention and swelling in the legs, ankles, or feet. This is due to the dilation of the blood vessels and the leakage of fluid into the tissues. The client should monitor their weight and the size of their lower extremities, and report any significant changes to their health care provider. The client may also elevate their legs, wear compression stockings, or take diuretics to reduce the edema.

Choice C reason: This is not a correct answer. Tachycardia during exercise is not a common side effect of amlodipine. Amlodipine can lower the heart rate and the cardiac output, which can reduce the oxygen demand of the heart. Amlodipine does not cause an increase in the heart rate, unless there is an underlying cardiac problem or a drug interaction. The client should monitor their pulse and blood pressure, but not expect tachycardia.

Choice D reason: This is not a correct answer. An increase in bowel motility is not a common side effect of amlodipine. Amlodipine does not affect the gastrointestinal system or the digestion, unless there is an allergic reaction or a drug interaction. Amlodipine can cause some gastrointestinal side effects, such as nausea, abdominal pain, or constipation, but not an increase in bowel motility. The client should monitor their bowel movements, but not expect an increase.

Choice A reason: The nurse should not encourage vigorous tooth brushing with a soft bristle toothbrush. Thrombocytopenia is a condition where the blood has a low number of platelets, which are cells that help with clotting. ¹ Vigorous tooth brushing can cause bleeding of the gums, which can be hard to stop in a client with thrombocytopenia. The nurse should advise the client to use a soft sponge or swab to clean the teeth and mouth gently.

Choice B reason: The nurse should avoid needle sticks or other invasive procedures as much as possible. Needle sticks and other invasive procedures can cause bleeding, bruising, or infection in a client with thrombocytopenia. ¹ The nurse should use the smallest gauge needle possible, apply pressure for at least 10 minutes after the procedure, and monitor the site for any signs of bleeding or infection. The nurse should also avoid unnecessary blood draws or injections, and use non-invasive methods whenever possible.

Choice C reason: The nurse should not hold all stool softeners and laxatives until otherwise ordered. Stool softeners and laxatives can help prevent constipation and straining, which can cause hemorrhoids or anal fissures in a client with thrombocytopenia. ¹ The nurse should encourage the client to take stool softeners and laxatives as prescribed, drink plenty of fluids, and eat high-fiber foods to promote regular bowel movements.

Choice D reason: The nurse should not obtain a low temperature every 8 hours. A low temperature is not a relevant or accurate measurement for a client with thrombocytopenia. The nurse should obtain a normal temperature, which is around 98.6°F (37°C), using a non-invasive method, such as an oral or tympanic thermometer. ² The nurse should avoid using a rectal thermometer, as it can cause bleeding or infection in a client with thrombocytopenia.