The nurse is preparing to administer Reglan to a patient. She is most concerned by the following information in the patient's medical record?

Choice A reason: Increased respiratory rate is not a sign of adverse reaction to metoprolol, but rather a normal response to hypoxia or distress. Metoprolol is a betablocker that can lower the heart rate and blood pressure, but it does not affect the respiratory rate directly.

Choice B reason: Bronchodilation is not a sign of adverse reaction to metoprolol, but rather a desired effect of asthma medications such as betaagonists or anticholinergics. Metoprolol is a betablocker that can block the beta receptors in the lungs, which can cause bronchoconstriction or narrowing of the airways. This is why metoprolol is contraindicated or used with caution in clients with asthma.

Choice C reason: Decreased sputum production is not a sign of adverse reaction to metoprolol, but rather a result of effective asthma management. Metoprolol is a betablocker that does not have any direct effect on the mucus secretion or inflammation in the lungs.

Choice D reason: Wheezing is a sign of adverse reaction to metoprolol, as it indicates bronchoconstriction or narrowing of the airways. Metoprolol is a betablocker that can block the beta receptors in the lungs, which can reduce the bronchodilation effect of beta agonists or other asthma medications. This can worsen the asthma symptoms and cause wheezing, coughing, dyspnea, or chest tightness. The nurse should monitor the client for these signs and report them to the prescriber immediately.

Choice A reason: Bradycardia is not an adverse effect of diphenhydramine. Diphenhydramine is a medication that blocks the action of histamine, a chemical that causes allergic reactions and inflammation. Diphenhydramine can also block the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Diphenhydramine does not affect the heart rate or blood pressure significantly, and it is not associated with bradycardia, which is a slow heart rate that can cause dizziness, fatigue, or fainting. The nurse should monitor the vital signs of the client after administering diphenhydramine, but bradycardia is not a common or expected outcome.

Choice B reason: Sedation is an adverse effect of diphenhydramine. Diphenhydramine is a medication that blocks the action of histamine, a chemical that causes allergic reactions and inflammation. Diphenhydramine can also block the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Diphenhydramine can cross the bloodbrain barrier and block the histamine receptors in the brain, which are involved in regulating the sleepwake cycle and alertness. Diphenhydramine can cause sedation, sleepiness, drowsiness, dizziness, and impaired coordination, which can affect the performance and safety of the client. The nurse should instruct the client to avoid driving, operating machinery, or performing other tasks that require mental alertness after taking diphenhydramine, and to take the medication at bedtime or as needed for sleep.

Choice C reason: Constipation is not an adverse effect of diphenhydramine. Diphenhydramine is a medication that blocks the action of histamine, a chemical that causes allergic reactions and inflammation. Diphenhydramine can also block the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Diphenhydramine does not affect the gastrointestinal motility or secretion significantly, and it is not associated with constipation, which is a condition of infrequent or difficult bowel movements. The nurse should encourage the client to eat a balanced and highfiber diet, drink plenty of fluids, and exercise regularly to prevent or treat constipation, but diphenhydramine is not a contributing factor.

Choice D reason: Hypertension is not an adverse effect of diphenhydramine. Diphenhydramine is a medication that blocks the action of histamine, a chemical that causes allergic reactions and inflammation. Diphenhydramine can also block the action of acetylcholine, a neurotransmitter that stimulates the parasympathetic nervous system. Diphenhydramine does not affect the blood pressure or the vascular tone significantly, and it is not associated with hypertension, which is a condition of high blood pressure that can cause headaches, chest pain, or stroke. The nurse should monitor the blood pressure of the client after administering diphenhydramine, but hypertension is not a common or expected outcome.