A nurse is providing discharge teaching to a client who has tuberculosis and is taking rifampin.
Which of the following statements by the client indicates an understanding of the teaching?

Choice A rationale

Constipation is a very common and expected adverse effect of codeine due to its opioid effects on gastrointestinal motility, specifically by decreasing propulsive contractions. While it requires management, it is generally not the highest priority unless it leads to severe complications like impaction, making other acute symptoms more immediately concerning. Normal bowel frequency varies but ranges from three times daily to three times weekly.

Choice B rationale

Dry mouth, or xerostomia, is a common anticholinergic-like effect of opioid medications like codeine. While uncomfortable, it is typically a mild, non-life-threatening side effect. It can be managed with hydration and oral hygiene measures and does not represent an acute physiological threat requiring immediate reporting as a priority.

Choice C rationale

Agitation, especially in the context of opioid use, can be a sign of central nervous system excitation or an idiosyncratic reaction. It can indicate a paradoxical effect of the medication or an emerging adverse event that could escalate to more serious neurological complications, such as seizures or respiratory compromise if not promptly addressed.

Choice D rationale

Urinary retention is a known adverse effect of opioids due to their effect on bladder detrusor muscle tone and sphincter function. While it is important to monitor and manage, potentially requiring catheterization, it is generally not as immediately life-threatening as signs of central nervous system instability or respiratory compromise, making agitation a higher priority in the acute setting.

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.