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: A neurological exam assesses brain function but does not directly address glipizide-related symptoms like confusion and blurred vision, which suggest hypoglycemia. Glipizide, a sulfonylurea, lowers blood glucose, and these symptoms are likely due to low glucose levels, making glucose testing more urgent than a neurological evaluation.

Choice B reason: Administering glucagon treats severe hypoglycemia but is premature without confirming low blood glucose. Glipizide increases insulin release, potentially causing hypoglycemia, but a fingerstick glucose test is needed first to verify the cause of symptoms. This choice is incorrect without diagnostic confirmation.

Choice C reason: Measuring vital signs provides general health data but does not specifically address confusion and blurred vision caused by glipizide-induced hypoglycemia. Low blood glucose is the likely cause, and testing glucose levels is more direct and urgent than monitoring vital signs, which are secondary in this context.

Choice D reason: Obtaining a fingerstick blood glucose is critical, as glipizide can cause hypoglycemia, leading to confusion and blurred vision. These symptoms result from insufficient glucose in the brain and eyes. Confirming low glucose guides immediate treatment, such as glucose administration, making this the most appropriate action.

Choice A reason: Observing ulcer healing is important in diabetic neuropathy but not a direct measure of pregabalin’s effectiveness. Pregabalin reduces neuropathic pain, not primarily promoting tissue repair. Ulcer healing depends on glycemic control and wound care, making this choice secondary.

Choice B reason: Measuring pain and sensation assesses pregabalin’s effectiveness, as it modulates calcium channels in neurons, reducing neuropathic pain and abnormal sensations in diabetic neuropathy. Decreased pain or paresthesia in the feet indicates therapeutic success, making this the most relevant assessment for the drug’s action.

Choice C reason: Palpating skin temperature evaluates circulation or infection, not pregabalin’s effect. While neuropathy may affect perfusion, pregabalin targets pain signaling, not temperature regulation. This assessment is unrelated to the drug’s primary role in pain management, making it irrelevant.

Choice D reason: Checking swelling monitors edema, which may occur in diabetes but is not pregabalin’s target. The drug reduces neuropathic pain, not fluid accumulation. Swelling assessment is secondary to pain and sensation, which directly reflect the medication’s efficacy in neuropathy management.