A nurse is assessing a client who has a prescription for oral albuterol for the long-term management of asthma.
For which of the following adverse effects should the nurse monitor?

Choice A rationale

Ipratropium is an anticholinergic bronchodilator that blocks muscarinic receptors in the bronchial smooth muscle, leading to bronchodilation. A common adverse effect of anticholinergic medications is reduced salivary gland secretion, resulting in xerostomia, or dry mouth, due to inhibition of parasympathetic stimulation.

Choice B rationale

Periorbital edema is not a typical adverse effect of ipratropium. This medication primarily targets muscarinic receptors in the respiratory tract. Edema, particularly around the eyes, is more commonly associated with allergic reactions or fluid retention from other medications.

Choice C rationale

Ipratropium, being an anticholinergic, primarily acts on M3 receptors in the lungs and has minimal systemic absorption, thus rarely causing bradycardia. In fact, anticholinergics can sometimes cause a mild increase in heart rate due to blockade of M2 receptors in the heart, but clinically significant changes are uncommon.

Choice D rationale

While xerostomia can contribute to dental issues over time due to reduced saliva's protective effects, dental caries is not a direct, acute adverse effect of ipratropium itself. It is a potential long-term complication of prolonged dry mouth, rather than a direct drug-induced effect to monitor immediately.

Choice A rationale

Dry mouth can be an anticholinergic effect of some medications or a symptom of dehydration, but it is not a direct, priority adverse effect associated with ketorolac, which is an NSAID. While uncomfortable, it does not indicate immediate life-threatening organ dysfunction.

Choice B rationale

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, which can lead to adverse renal effects. Prostaglandins play a crucial role in maintaining renal blood flow and glomerular filtration rate. Oliguria (urine output < 0.5 mL/kg/hr or < 400 mL/24 hr) indicates potential acute kidney injury, a serious and life-threatening complication that requires immediate reporting to the provider.

Choice C rationale

Nausea is a common gastrointestinal adverse effect of NSAIDs, including ketorolac, due to direct irritation of the gastric mucosa or central effects. While it can cause discomfort and impact client well-being, it is generally not a life-threatening symptom and does not take priority over signs of organ damage.

Choice D rationale

Altered taste, or dysgeusia, can be an idiosyncratic drug reaction but is not a common or priority adverse effect of ketorolac. While it can affect appetite and client satisfaction, it does not signify acute organ damage or a life-threatening condition requiring urgent intervention.