A nurse is caring for a client.

Select the 3 statements the nurse should make.

Pioglitazone is a thiazolidinedioneantidiabetic agent that enhances insulin sensitivityby activating the peroxisome proliferator-activated receptor-gamma. It primarily addresses insulin resistancein peripheral tissues, but its use is restricted in patients with established heart failure due to risk of volume overload.

Rationale:

A.Fluid retention is a significant adverse effect of pioglitazone because the medication promotes sodium reabsorption in the renal distal tubules. This expanded plasma volume can lead to peripheral edema and potentially precipitate or worsen heart failure in susceptible individuals. The nurse must monitor the client for rapid weight gain, dyspnea, and bilateral lower extremity swelling during the course of therapy.

B.Tinnitus is not a recognized adverse effect associated with the use of thiazolidinediones like pioglitazone. It is more commonly linked to ototoxic medications such as aminoglycosides or high-dose salicylates. A client reporting ringing in the ears while taking pioglitazone should be evaluated for other pharmacological or physiological causes unrelated to their antidiabetic regimen.

C.Insomnia is not a typical side effect of pioglitazone therapy, as the medication does not exert stimulatory effects on the central nervous system. Patients with diabetes may experience sleep disturbances due to nocturnal hyperglycemia or hypoglycemia, but pioglitazone itself does not disrupt the sleep-wake cycle. The nurse should investigate alternative causes if the client reports difficulty sleeping.

D.Orthostatic hypotension is not associated with pioglitazone; in fact, the fluid retention caused by the drug would be more likely to support or slightly increase blood pressure. Amlodipine or nitrates are more likely to cause postural drops in pressure. Monitoring for dizziness upon standing is not a priority specific to the safety profile of thiazolidinedione medications.

Stop the infusion.

Disconnect the IV tubing from the IV hub.

Aspirate the medication from the IV catheter.

Elevate the affected extremity.

Brief Introduction:

Extravasationis a severe clinical complication where a vesicantmedication leaks from the intravascular space into the surrounding dermal or subcutaneous tissue. Vesicants, such as certain chemotherapeutic agents, cause cellular necrosis, tissue sloughing, and permanent nerve damage upon contact with extravascular structures. Emergency management focuses on immediate cessation of the insult and the removal of as much residual toxin as possible to mitigate localized destruction.

Rationale:

A. Disconnecting the IV tubingfrom the IV hub is the second priority action. Once the pump is deactivated, the tubing must be removed while leaving the catheter in place to serve as a conduit for further intervention. This step prepares the site for aspirationand prevents any further residual medication within the line from being accidentally flushed into the compromised tissue.

B. Elevating the affected extremityis the final step in the immediate response sequence. Elevation utilizes gravity to promote venous returnand lymphatic drainage, which helps reduce localized edema and limits the spread of the vesicant within the interstitial spaces. This maneuver is part of supportive care and should only be performed after the chemical threat has been physically addressed.

C. Stop the infusionis the absolute first action the nurse must perform the moment extravasation is suspected. Continued administration of a vesicant exponentially increases the volume of tissue exposed to the toxin, leading to wider areas of necrosis. Halting the flow immediately limits the scope of the injury and is the highest priority for limb preservation and safety.

D. Aspirate the medicationfrom the client's IV catheter is performed after the tubing is disconnected but before the catheter is removed. Using a syringe to pull back on the hub allows the nurse to extract residual vesicant still sitting in the catheter and the immediate extravasation pocket. This critical step reduces the total concentration of the drug remaining in the tissue, potentially decreasing the severity of the subsequent chemical burn.