A client with Parkinson's disease is prescribed carbidopa-levadopa [Sinemet]. Which of the following side effects does the nurse recognize can occur with this medication?

A) Retake the vital signs:
While taking vital signs is important, the client’s vital signs (respiratory rate of 13 bpm, oxygen saturation of 92%, and normal skin color) suggest that there is no immediate crisis, such as a sudden drop in oxygen saturation or significant hemodynamic instability. Therefore, retaking the vital signs would not address the most urgent issue at the moment, which is the client's shortness of breath while laying down.

B) Call the healthcare provider:
Calling the healthcare provider may eventually be necessary if the patient's condition worsens or remains unrelieved after interventions. However, the first priority should be to manage the client’s immediate symptoms and improve their comfort. The client’s complaint of shortness of breath when lying down suggests that the positioning may be a contributing factor to their discomfort.

C) Place the client in Fowler's position:
The most appropriate first action for a client with end-stage COPD and shortness of breath while lying down is to place the client in Fowler's position. This position (sitting upright, typically at a 45-60° angle) helps to improve lung expansion and reduce the workload of breathing by using gravity to assist in lung ventilation. It also promotes diaphragmatic breathing, which can relieve the feeling of breathlessness.

D) Increase the oxygen rate:
The client is already on 6 liters of oxygen via nasal cannula and has an oxygen saturation of 92%, which is within an acceptable range for a patient with COPD. Increasing the oxygen rate further could risk causing oxygen toxicity or lead to CO2 retention in clients with COPD, as their respiratory drive is often driven by low oxygen levels rather than high carbon dioxide levels. Thus, increasing the oxygen rate should be done cautiously and only if clinically indicated by a healthcare provider.

A) "Take one tablet every 15 minutes during an acute attack."
This is incorrect because the correct instruction is to take one tablet every 5 minutes for up to 3 doses during an acute angina attack, not every 15 minutes. If the chest pain persists after three doses, the client should seek immediate medical attention. Taking a tablet every 15 minutes would delay intervention and could be dangerous in an acute situation.

B) "Take this medication after each meal and at bedtime."
This is not the correct instruction for nitroglycerin use during an angina attack. Nitroglycerin tablets are typically used on an as-needed basis to relieve acute chest pain (angina). They are not intended for routine use after meals or at bedtime. If taken routinely for prevention of angina, the dosing regimen would be different, usually in the form of extended-release formulations.

C) "Take one tablet at the first indication of chest pain."
Nitroglycerin tablets are used to relieve chest pain (angina) by relaxing coronary arteries and improving blood flow to the heart. The client should take one tablet at the first sign of chest pain. If the pain does not resolve within 5 minutes, the client should take a second tablet, and a third if needed, with a total of 3 doses being the maximum before seeking emergency care. This allows for quick relief during an acute angina attack.

D) "Take this medication with 8 ounces of water."
Nitroglycerin tablets should not be taken with water. They are typically absorbed sublingually (under the tongue) and should not be swallowed or taken with water. Taking them with water could delay the absorption process and reduce their effectiveness.