A nurse is administering haloperidol to a client who has schizophrenia.
For which of the following adverse effects should the nurse monitor?

Choice A rationale

Bronchospasm is a constriction of the airways, commonly seen in respiratory conditions like asthma. It is mediated by inflammatory responses and smooth muscle contraction in the bronchi. Acetazolamide, a carbonic anhydrase inhibitor, does not typically cause bronchospasm; its primary effects are on fluid and electrolyte balance and intraocular pressure.

Choice B rationale

Constipation is a common gastrointestinal symptom characterized by infrequent or difficult bowel movements. It can be caused by various factors, including dietary habits, medications, and underlying medical conditions. Acetazolamide's mechanism of action, involving inhibition of carbonic anhydrase, does not directly lead to constipation as a significant adverse effect.

Choice C rationale

Diplopia, or double vision, is a visual disturbance where a single object appears as two. It can result from ocular muscle weakness, nerve damage, or other neurological conditions. Acetazolamide's therapeutic effects are on aqueous humor production in the eye to reduce intraocular pressure, but diplopia is not a recognized adverse effect of this medication.

Choice D rationale

Acetazolamide is a carbonic anhydrase inhibitor that promotes the excretion of bicarbonate, sodium, potassium, and water. This diuretic action can lead to metabolic acidosis, hypokalemia (normal range: 3.5-5.0 mEq/L), and hyponatremia (normal range: 135-145 mEq/L) due to increased renal excretion, hence requiring close monitoring of electrolyte balance.

Choice A rationale

Acetaminophen is an analgesic and antipyretic that primarily inhibits prostaglandin synthesis in the central nervous system. It does not significantly interact with clopidogrel, an antiplatelet medication, regarding its antiplatelet activity or bleeding risk. Therefore, reporting acetaminophen use to the provider is generally not a high priority unless liver concerns exist.

Choice B rationale

Valerian is an herbal supplement commonly used for sleep and anxiety. It primarily interacts with gamma-aminobutyric acid (GABA) receptors in the brain. There is no significant scientific evidence or known pharmacokinetic interaction between valerian and clopidogrel that would necessitate reporting its use to the provider due to increased bleeding risk.

Choice C rationale

Vitamin B refers to a group of water-soluble vitamins crucial for various cellular metabolic processes. Generally, vitamin B supplements do not have a known significant interaction with clopidogrel that would alter its antiplatelet effect or increase bleeding risk. Therefore, taking vitamin B is not typically a concern to report.

Choice D rationale

Ginkgo biloba is an herbal supplement known for its antiplatelet properties due to its ability to inhibit platelet-activating factor. Concomitant use with clopidogrel, another potent antiplatelet agent, significantly increases the risk of bleeding. This synergistic effect on platelet aggregation warrants immediate reporting to the provider for assessment and potential dosage adjustments.