A client with nasal congestion receives a prescription for phenylephrine 10 mg by mouth every 4 hours. Which client condition should the nurse report to the healthcare provider before administering the medication?

Choice A reason: Notifying the healthcare provider of the carbamazepine level is the most appropriate action for the nurse to take. Carbamazepine is an anticonvulsant drug that requires close monitoring of its serum levels to ensure therapeutic and safe effects. The normal reference range for carbamazepine is 4 to 12 mcg/mL or 16.9 to 50.8 mmol/L. A level of 84 mcg/L (35.6 mmol/L) is significantly higher than the upper limit and indicates toxicity. The nurse should report this finding to the prescriber immediately and hold the dose until further instructions.

Choice B reason: Administering the carbamazepine as prescribed is not the most appropriate action for the nurse to take. Giving the evening dose of carbamazepine when the morning level is already toxic can worsen the client's condition and cause serious adverse effects, such as confusion, drowsiness, ataxia, nystagmus, or coma. The nurse should not administer the medication without consulting the prescriber.

Choice C reason: Assessing the client for side effects of carbamazepine is an important action for the nurse to take, but it is not the most appropriate one. The nurse should assess the client for signs and symptoms of carbamazepine toxicity, such as nausea, vomiting, headache, blurred vision, or seizures. However, this action alone is not sufficient to address the problem. The nurse should also notify the prescriber and withhold the dose.

Choice D reason: Withholding this dose of the carbamazepine is a necessary action for the nurse to take, but it is not the most appropriate one. The nurse should not give the evening dose of carbamazepine when the morning level is already toxic, as this can increase the risk of complications. However, this action alone is not enough to resolve the issue. The nurse should also notify the prescriber and follow the appropriate interventions.

Choice A reason: Confirming that the daughter is aware of the progressive nature of the disease is not the best response, as it does not address the daughter's misconception about the drug. The nurse should educate the daughter that rivastigmine does not cure or stop the progression of Alzheimer's disease, but only slows down the cognitive decline.

Choice B reason: Affirming the decision to use the medication when the symptoms start to worsen is not appropriate, as it contradicts the evidence-based practice. The nurse should inform the daughter that rivastigmine is most effective when used in the early stages of Alzheimer's disease, as it can delay the need for institutionalization and improve the quality of life.

Choice C reason: Explaining that the drug should be used early in the course of the disease process is the best response, as it corrects the daughter's misunderstanding and provides accurate information. The nurse should explain that rivastigmine works by inhibiting the enzyme that breaks down acetylcholine, a neurotransmitter that is involved in memory and learning. By increasing the level of acetylcholine in the brain, rivastigmine can improve the cognitive function and behavior of the client.

Choice D reason: Assessing the client's current mental status before deciding to support the decision is not relevant, as it does not address the daughter's concern or the rationale for the drug. The nurse should already have the client's baseline mental status from the initial assessment and diagnosis. The nurse should focus on educating the daughter about the benefits and risks of rivastigmine and encouraging her to follow the prescribed regimen.