A nurse is preparing to administer diclofenac to a client who has chronic bursitis.
Which of the following actions should the nurse take?

Choice A rationale

Ocular erythema, or redness of the eye, is not a typical adverse effect associated with spironolactone. Spironolactone is a potassium-sparing diuretic that primarily acts on the renal tubules to inhibit aldosterone, affecting electrolyte balance and fluid excretion, not directly impacting ocular tissues or causing inflammatory responses in the eye.

Choice B rationale

Diarrhea is not a common or expected adverse effect of spironolactone. While gastrointestinal disturbances can occur with many medications, spironolactone is more commonly associated with effects related to its diuretic and anti-androgenic properties, such as electrolyte imbalances (hyperkalemia) or endocrine-related symptoms, rather than increased bowel motility.

Choice C rationale

Muscle weakness can occur as an adverse effect of spironolactone, particularly due to its potential to cause hyperkalemia. Spironolactone's mechanism of action involves conserving potassium, and elevated serum potassium levels (normal range 3.5-5.0 mEq/L) can impair the excitability of muscle cells, leading to symptoms like muscle weakness, fatigue, and in severe cases, cardiac dysrhythmias.

Choice D rationale

Depression is not a recognized or common adverse effect of spironolactone. Spironolactone's primary pharmacological actions are on the kidney and endocrine system, and it is not known to directly affect neurotransmitter systems in the brain in a way that would commonly induce depressive symptoms. Psychotropic effects are not typically associated with this medication.

Choice A rationale

Blood glucose monitoring accuracy is generally not directly affected by hydrochlorothiazide. The medication's impact is on glucose metabolism itself, not the accuracy of the measurement device. Hydrochlorothiazide affects the pancreatic beta cells or peripheral insulin sensitivity, leading to altered glucose homeostasis, not erroneous readings from a glucometer.

Choice B rationale

Decreasing insulin dosage is generally not appropriate when taking hydrochlorothiazide. Hydrochlorothiazide, a thiazide diuretic, can induce hyperglycemia by impairing insulin secretion from the pancreatic beta cells or by reducing peripheral glucose utilization, thereby requiring an *increase* in insulin dosage to maintain glycemic control, not a decrease.

Choice C rationale

Hydrochlorothiazide therapy can elevate blood glucose levels in clients who have diabetes. This effect is attributed to the medication's ability to impair insulin secretion from pancreatic beta cells or to decrease peripheral glucose utilization, leading to insulin resistance. This necessitates careful blood glucose monitoring (normal fasting glucose <100 mg/dL).

Choice D rationale

Reducing sodium in the diet while taking hydrochlorothiazide is beneficial for blood pressure control by augmenting the diuretic's effects, but it does not directly control blood glucose levels. While a healthy diet supports overall health, the primary mechanism of glucose elevation from hydrochlorothiazide is metabolic, not sodium-related.