A nurse is providing instruction to a client who has chronic asthma and a new prescription for prednisone. For which of the following adverse effects should the nurse instruct the client to monitor?

Diazepam is a long-acting benzodiazepinethat enhances the inhibitory effect of gamma-aminobutyric acid(GABA) within the central nervous system. It is utilized for procedural sedation to induce anxiolysis and amnesia. Its primary safety concern involves dose-dependent depression of the medullaryrespiratory centers.

Rationale:

A.Fever is not a recognized adverse effect of diazepam administration. Benzodiazepines typically do not interfere with the hypothalamic thermoregulatory center to cause an elevation in body temperature. If a client develops a fever during sedation, the nurse should investigate other causes such as an underlying infection or a reaction to a different pharmacological agent.

B.Respiratory depression is the most critical adverse effect to monitor during diazepam administration for moderate sedation. As a central nervous system depressant, diazepam can significantly decrease the respiratory rate and tidal volume, leading to hypoxia or apnea. The nurse must continuously monitor oxygen saturation and capnography to ensure the patient maintains adequate spontaneous ventilation and airway patency.

C.Hypertension is unlikely to occur with diazepam; rather, the drug often causes a slight decrease in blood pressure due to reduced anxiety and systemic vasodilation. Benzodiazepines do not stimulate the sympathetic nervous system. Monitoring for hypotension and bradycardia is more appropriate when assessing the hemodynamic stability of a client undergoing moderate sedation with this agent.

D.Hyperreflexia is an exaggerated reflex response that is inconsistent with the pharmacological profile of benzodiazepines. Diazepam acts as a muscle relaxant and anxiolytic, which typically results in diminished or normal reflexes. Hyperreflexia is more commonly associated with upper motor neuron lesions or certain drug withdrawal states rather than acute sedation with GABAergic medications.

Furosemide is a loop diureticthat inhibits the sodium-potassium-chloride symporter in the thick ascending limb of the loop of Henle. It effectively manages fluid overload by increasing renal excretion of water and electrolytes, though its efficacy can be significantly compromised by prostaglandin inhibition. Concurrent use of certain medications can impair renal blood flow and diminish the diuretic response.

Rationale:

A.Metoclopramide is a prokinetic agent used to enhance gastrointestinal motility and prevent nausea, and it does not have a known significant interaction with furosemide. While the nurse should monitor general fluid status, metoclopramide does not interfere with the renal mechanism of action of loop diuretics. It is considered a safe adjunct medication for patients requiring diuresis and gastric support.

B.Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, which is required for furosemide to effectively dilate renal vasculature and promote diuresis. Taking ibuprofen can lead to reduced renal perfusion and a blunted diuretic effect, potentially exacerbating fluid retention. The nurse must recognize this interaction as it can result in decreased therapeutic efficacy and increased risk of nephrotoxicity.

C.Citalopram is a selective serotonin reuptake inhibitor (SSRI) that does not directly interact with the pharmacological pathway of furosemide in the kidneys. While SSRIs can occasionally contribute to hyponatremia, they do not block the diuretic action or increase the risk of acute renal failure when combined with loop diuretics. No immediate clarification is required for this combination in a standard clinical setting.

D.Ondansetron is a serotonin 5-HT3 receptor antagonist used for the prevention of vomiting and does not pose a direct threat to the effectiveness of furosemide. It lacks the prostaglandin-inhibiting properties found in NSAIDs and does not alter renal hemodynamics. The nurse can safely administer ondansetron alongside furosemide as there is no significant competitive or antagonistic drug interaction between them.