A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction?

Choice A reason: Zolpidem is a hypnotic drug that induces sleep by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. Zolpidem is used to treat insomnia, or difficulty falling asleep or staying asleep. Zolpidem should be taken only at bedtime, when the client is ready to go to sleep and can devote at least seven to eight hours for uninterrupted sleep. Taking zolpidem during the day can cause excessive sedation, drowsiness, confusion, memory loss, and impaired coordination. Therefore, the nurse should encourage the client to wait until bedtime to take the medication and avoid daytime naps.

Choice B reason: Reminding the client to drink plenty of fluids when taking the medication is not an action that the nurse should take in this situation, but rather a general recommendation that applies to most medications. Drinking fluids can help to prevent dehydration, flush out toxins, and maintain kidney function. However, drinking fluids is not specific to zolpidem and does not affect its absorption or metabolism.

Choice C reason: Advising the client to take the medication with the noon meal is not an action that the nurse should take in this situation, but rather a harmful suggestion that can reduce the effectiveness of zolpidem and increase its side effects. Taking zolpidem with food can delay its onset of action and make it less potent. Taking zolpidem at noon can also interfere with the client's circadian rhythm, or natural sleep-wake cycle, and cause daytime sleepiness and nighttime insomnia.

Choice D reason: Explaining that the client needs to allow for sleep time of at least two hours is not an action that the nurse should take in this situation, but rather an inaccurate and insufficient information that can mislead the client and endanger their safety. Zolpidem has a half-life of about two hours, which means that half of its dose is eliminated from the body in two hours. However, this does not mean that its effects wear off in two hours. Zolpidem can still cause residual sedation and impairment for several hours after taking it. The client needs to allow for sleep time of at least seven to eight hours when taking zolpidem, not just two hours.

Choice A reason: Diarrhea is a common side effect of metoclopramide, but it is not life-threatening or indicative of a serious reaction. The nurse should monitor the client's fluid and electrolyte status and provide supportive care.

Choice B reason: Involuntary movements, such as twitching, grimacing, or spasms, are signs of a rare but serious condition called tardive dyskinesia, which can be caused by metoclopramide. This condition can be irreversible and disabling, so the nurse should report it immediately and stop the medication.

Choice C reason: Nausea is the reason why the client is receiving metoclopramide, which is an antiemetic drug. If the client still experiences nausea, the nurse should assess the effectiveness of the medication and notify the prescriber if needed.

Choice D reason: Unusual irritability is not a common or serious side effect of metoclopramide. It may be related to other factors, such as stress, pain, or fatigue. The nurse should provide emotional support and reassurance to the client.