A client with depression who is taking a tricyclic antidepressant (TCA) reports frequent early morning awakening and difficulty going back to sleep. Which information from the client is important for the practical nurse (PN) to obtain to improve the client’s sleep pattern?

Choice A reason: Recording blood pressures is relevant, as diazepam may cause hypotension, but it is less critical than respiratory monitoring. Status epilepticus requires rapid seizure control, and diazepam’s respiratory depression risk is more immediate, as it can lead to life-threatening hypoxia if not addressed promptly.

Choice B reason: Measuring urinary output monitors renal function but is not urgent in status epilepticus. Diazepam’s primary risk is respiratory depression, not renal effects. Ensuring airway and breathing stability is more critical, as seizures and the drug both threaten respiratory function, making this choice secondary.

Choice C reason: Monitoring respiratory rate and effort is critical, as diazepam, a CNS depressant, can cause respiratory depression, especially in status epilepticus, where seizures already compromise breathing. Hypoventilation risks hypoxia, potentially leading to brain damage or death, making this the most urgent intervention to ensure airway safety.

Choice D reason: Observing eye deviation may indicate ongoing seizures but is less urgent than respiratory monitoring. Diazepam controls seizures, but its side effect of respiratory depression poses an immediate threat. Ensuring adequate ventilation is the priority to prevent hypoxia during acute seizure management.

Choice A reason: Ibuprofen, a nonsteroidal anti-inflammatory drug, inhibits prostaglandins, reducing gastric mucosal protection and increasing GI bleeding risk. Symptoms like melena or hematemesis may occur, especially with prolonged use. Monitoring for bleeding is critical to detect early complications, ensuring timely intervention to prevent severe outcomes.

Choice B reason: While ibuprofen can elevate blood pressure by affecting renal prostaglandins and sodium retention, this is less immediate than GI bleeding risk. Frequent blood pressure monitoring is relevant for long-term use but not the primary concern compared to the acute danger of GI hemorrhage.

Choice C reason: Giving ibuprofen on an empty stomach increases GI irritation, as food buffers gastric acid, reducing ulcer risk. This choice is incorrect, as it contradicts best practice, which recommends taking ibuprofen with food to minimize mucosal damage and bleeding risk.

Choice D reason: Sunblock is irrelevant to ibuprofen’s effects, as it does not cause photosensitivity. This action applies to drugs like tetracyclines, not NSAIDs. Monitoring for GI bleeding is far more critical, as ibuprofen’s primary adverse effect involves the gastrointestinal tract, not skin.