A nurse is caring for a client who has major depression and a new prescription for citalopram. Which of the following adverse effects is the priority for the nurse to report to the provider?

Desmopressin is a synthetic analogue of antidiuretic hormone(ADH) that increases water reabsorption in the collecting ductsof the kidney. It is the primary treatment for central diabetes insipidus, effectively concentrating urine and reducing excessive thirst and polyuria. Monitoring for water intoxication is the priority nursing intervention.

Rationale:

A.Bradycardia is not a direct adverse effect associated with desmopressin administration. While significant fluid overload could theoretically stress the cardiovascular system, a slow heart rate is not the specific parameter used to monitor for desmopressin toxicity. The nurse should focus instead on signs of volume expansion and electrolyte shifts, particularly those affecting the neurological system and sodium balance.

B.Fluid retention is a primary adverse effect of desmopressin because the drug effectively stops the kidneys from excreting water. If the client continues to drink large amounts of fluid while taking the drug, they are at risk for water intoxication and dilutional hyponatremia. The nurse must monitor for headache, confusion, and edema, which indicate that the body is retaining too much free water.

C.Blurred vision is not a common or direct side effect of desmopressin therapy. Visual changes are more often linked to medications that affect the autonomic nervous system or those with anticholinergic properties. However, if blurred vision occurs in the context of a severe headache while on desmopressin, it could be a sign of increased intracranial pressure from severe water intoxication.

D.Hypernatremia is the condition desmopressin is meant to treat in a patient with diabetes insipidus, not an adverse effect of the drug. Desmopressin causes water retention, which dilutes the blood and lowers the sodium concentration. Therefore, the nurse should monitor for the opposite effect, hyponatremia, which occurs if the medication works too effectively or if fluid intake is excessive.

Insulin therapy management involves the precise coordination of short-actingand intermediate-actingagents to mimic physiological glucose regulation. Regular insulinacts rapidly, whereas NPH insulincontains protamine to delay absorption and extend the duration of action. Proper mixing technique is vital to maintain the integrity of each medication and ensure accurate glycaemic control without causing cross-contamination.

Rationale:

A.Injecting air into both vials is the correct first step when mixing insulins to prevent the creation of a vacuum. The nurse must teach the client to inject air equal to the dose into the NPH vial first, followed by air into the regular vial. This equalization of pressure allows for the smooth withdrawal of the liquid medication without contaminating the regular insulin with NPH.

B.Shaking insulin vials vigorously is contraindicated as it creates air bubbles that interfere with accurate dose measurement and can denature the protein molecules. Instead, NPH insulin, which is a suspension, should be gently rolled between the palms to redistribute the particles. Regular insulin is a clear solution and does not require any agitation or rolling before withdrawal from the vial.

C.Drawing up NPH insulin first is an incorrect technique that risks contaminating the clear regular insulin vial with the cloudy protamine from the NPH. The standard protocol is to draw the "clear before cloudy" (regular before NPH) to ensure the fast-acting insulin remains pure. Contamination of the regular vial with NPH would inadvertently alter the onset and peak characteristics of the short-acting dose.

D.Inserting the needle at a 15° angle is incorrect for subcutaneous insulin administration and is more appropriate for intradermal injections. Insulin must be deposited into the fatty subcutaneous tissue, typically at a 45° to 90° angle depending on the patient's body mass and needle length. A 15° angle would likely result in an ineffective intradermal delivery, leading to unpredictable absorption rates.