A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting to take immediate-release exenatide. Which of the following client statements indicates an understanding of the teaching?

Choice A rationale
Peripheral edema is a common adverse effect of verapamil. It occurs due to the vasodilatory effects of the medication, which can cause fluid retention in the extremities.
Choice B rationale
Bradycardia is an adverse effect of verapamil. It occurs because verapamil slows down the heart rate by blocking calcium channels in the heart.
Choice C rationale
Constipation is a common adverse effect of verapamil. It occurs due to the medication’s effect on smooth muscle relaxation, which can slow down gastrointestinal motility.
Choice D rationale
Reports of blurred vision are not a common adverse effect of verapamil. Blurred vision is not typically associated with this medication.
Choice E rationale
Reports of insomnia are not a common adverse effect of verapamil. Insomnia is not typically associated with this medication.

The nurse should first address the client’s oxygen saturation, followed by the client’s blood pressure.

Addressing the oxygen saturation is crucial because the client’s level has dropped significantly to 86%, indicating potential respiratory distress or hypoxia. Following that, the nurse should address the blood pressure, which has also dropped, indicating possible hemodynamic instability.

Let’s break down the case notes to understand why addressing the client’s oxygen saturation and blood pressure is critical:

Oxygen Saturation

• Initial Vital Signs (1200): The client’s oxygen saturation was 100% on 2 L oxygen via nasal cannula.
• Current Vital Signs (1220): The oxygen saturation has dropped to 86% on the same oxygen support.

This significant drop in oxygen saturation indicates that the client is not receiving adequate oxygen, which can lead to hypoxia. Hypoxia can cause severe complications, including organ damage. Therefore, improving oxygenation is the top priority.

Blood Pressure

• Initial Vital Signs (1200): The client’s blood pressure was 110/75 mm Hg.
• Current Vital Signs (1220): The blood pressure has decreased to 90/60 mm Hg.

The drop in blood pressure suggests that the client is experiencing hemodynamic instability, which could be due to several factors, including dehydration, blood loss, or a reaction to anesthesia. Low blood pressure can lead to inadequate perfusion of vital organs, which is why it needs to be addressed promptly after stabilizing the oxygen saturation.

Other Symptoms

• Muscle Rigidity: The client is experiencing painful muscle rigidity, which could be a sign of a serious condition like malignant hyperthermia, especially given the elevated temperature.
• Temperature: The client’s temperature has spiked to 40.2°C (104.4°F), indicating a possible infection or reaction.
• Heart Rate: The heart rate has increased to 125/min, which could be a compensatory response to low blood pressure and hypoxia.
• Nausea and Vomiting: The client has vomited twice, which could contribute to dehydration and electrolyte imbalance.

Conclusion

By addressing the oxygen saturation first, the nurse ensures that the client is receiving adequate oxygen, which is essential for all bodily functions. Following that, stabilizing the blood pressure is crucial to ensure proper perfusion and prevent further complications.