A client with overactive bladder starts a new prescription for oxybutynin. When assessing the client prior to medication administration, which finding should the practical nurse (PN) report to the charge nurse?

Choice A reason: Eating aged cheeses, high in tyramine, is relevant for monoamine oxidase inhibitors, not TCAs, which do not interact with tyramine. This dietary habit does not affect TCA-related sleep disturbances, making it irrelevant for addressing the client’s early morning awakening.

Choice B reason: Taking a warm bath at night may promote relaxation but does not directly address TCA-related sleep issues. While helpful for general sleep hygiene, it is less critical than medication timing, which directly influences TCA’s stimulatory effects on sleep patterns.

Choice C reason: Dry mouth is a common TCA side effect due to anticholinergic properties but is not directly linked to sleep disturbances. It may cause discomfort but does not explain or address early morning awakening, making this information less relevant for sleep improvement.

Choice D reason: Taking TCAs upon rising can cause insomnia, as their stimulatory effects peak during sleep hours. TCAs increase norepinephrine, disrupting sleep architecture. Adjusting to bedtime dosing may reduce early morning awakening, making this information critical for optimizing sleep and therapeutic outcomes.

Choice A reason: The cost of medications, while a practical concern, does not indicate a need to assess the prescription’s safety or appropriateness. It reflects financial issues, not a clinical discrepancy. The PN should address cost concerns separately, but this does not warrant immediate prescription review.

Choice B reason: Frustration with daily pill-taking reflects emotional fatigue, not a clinical issue requiring prescription assessment. It may prompt adherence counseling, but it does not suggest errors in the prescription itself, such as incorrect medication or dosage, making this choice incorrect.

Choice C reason: Taking pills at 8:00 am at home versus 9:00 am in the hospital is a minor timing difference, not necessitating prescription review. Hospital schedules often differ, and this does not indicate a safety concern or error in the medication order.

Choice D reason: A new, unfamiliar pill raises concerns about potential prescription errors, allergies, or inappropriate medication. The PN must verify the prescription against the client’s history and medical record to ensure safety, as unfamiliarity may indicate a mistake or new therapy requiring confirmation.