A nurse is planning care for a client who has a prescription for acetazolamide.
Which of the following findings should the nurse plan to monitor for as an adverse effect of this medication?

Choice A rationale

Somatropin is a synthetic growth hormone used to treat growth hormone deficiency. The primary therapeutic effect of this medication is to promote linear growth in children. Therefore, monitoring the child's height monthly is a direct and quantifiable measure to evaluate the effectiveness of somatropin therapy and ensure that the child is achieving the expected growth velocity.

Choice B rationale

While thyroid function can influence growth, and growth hormone deficiency can sometimes coexist with or impact thyroid axis, evaluating the therapeutic effect of somatropin directly involves assessing growth. Monitoring thyroid function is important for overall endocrine health but is not the primary measure for the therapeutic effect of somatropin itself, assuming thyroid function is within normal limits (e.g., TSH 0.4-4.0 mIU/L, free T4 0.8-1.8 ng/dL).

Choice C rationale

Checking the child's sodium level regularly is not a direct measure of the therapeutic effect of somatropin. Growth hormone can influence fluid balance, but sodium levels (normal range 135-145 mEq/L) are primarily monitored for hydration status or potential adverse effects like fluid retention, not as an indicator of growth hormone's efficacy in promoting growth.

Choice D rationale

Measuring the child's abdominal girth is a measure of abdominal circumference, primarily used to assess abdominal distention, fluid accumulation, or changes in visceral fat. It is not a relevant parameter for evaluating the therapeutic effect of somatropin, which is specifically aimed at stimulating linear bone growth and overall somatic growth.

The client is at risk for hypotension due to hydrochlorothiazide.

Rationale for correct answers: Hydrochlorothiazide is a thiazide diuretic that reduces blood volume by promoting renal excretion of sodium and water, which lowers blood pressure. This mechanism can lead to hypotension, especially in postoperative patients with fluid shifts or concurrent antihypertensive therapy. Normal blood pressure is approximately 120/80 mm Hg, and this client’s current blood pressure of 92/75 mm Hg indicates mild hypotension, likely related to the diuretic effect of hydrochlorothiazide.

Rationale for incorrect Response 1 options:
Hypoglycemia is a low blood glucose state (below 70 mg/dL) often caused by excess insulin or insufficient food intake, but hydrochlorothiazide typically does not cause hypoglycemia. Instead, it can sometimes increase glucose levels due to altered insulin sensitivity. Hyperkalemia (elevated potassium >5.0 mEq/L) is unlikely because thiazides promote potassium excretion, tending toward hypokalemia rather than hyperkalemia. Infection risk is unrelated to hydrochlorothiazide use and would be influenced more by surgery or immune status.

Rationale for incorrect Response 2 options:
Insulin glargine is a long-acting insulin primarily influencing blood glucose, not blood pressure. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can cause renal impairment and fluid retention but does not directly cause hypotension. Glucose level is a lab value, not a medication or intervention that causes hypotension.

Take home points:

• Hydrochlorothiazide can cause hypotension through volume depletion and natriuresis.
• Blood pressure monitoring is essential in postoperative patients on diuretics.
• Differentiate drug-induced hypotension from other causes such as bleeding or sepsis.
• Understand that thiazides can increase blood glucose and decrease potassium levels, influencing diabetic management.