The nurse admits a patient from the emergency department who is suspected of having influenza.
The nurse prepares equipment and anticipates placing the patient on which type of precaution?

Choice A rationale

Reassuring the patient these are expected effects dismisses potentially serious anticholinergic side effects associated with ipratropium, a muscarinic antagonist. Difficulty urinating (urinary retention) and blurred vision, especially in an elderly patient, could indicate significant systemic absorption, necessitating dosage adjustment or alternative therapy to prevent complications.

Choice B rationale

Increasing fluid intake is insufficient and potentially harmful if severe urinary retention is the cause of the difficulty, as it could exacerbate bladder distension. Ipratropium acts by blocking muscarinic receptors, relaxing detrusor muscle tone and potentially causing retention, which is a significant adverse effect requiring medical evaluation.

Choice C rationale

Notifying the healthcare provider is the priority because these symptoms (urinary retention, blurred vision) are significant anticholinergic side effects of ipratropium, particularly concerning in a 70-year-old with potential prostatic hypertrophy or glaucoma. These adverse effects may require dose reduction or a change in medication to prevent serious harm.

Choice D rationale

While ipratropium is a maintenance treatment, not a rescue inhaler, instructing the patient to only use it when wheezing does not address the current adverse drug effects. Systemic side effects indicate the need for medical assessment and potential drug modification, not just a change in usage pattern.

Choice A rationale

Pseudoephedrine is a sympathomimetic drug that acts primarily as an alpha and beta agonist, stimulating the central nervous system (CNS). This stimulation usually leads to wakefulness, nervousness, and insomnia, rather than excessive sleepiness, which is a CNS depressant effect. Drowsiness can occur but is less common than CNS stimulation effects, as the drug promotes adrenergic activity.

Choice B rationale

Pseudoephedrine stimulates beta-1 adrenergic receptors in the heart, leading to an increase in heart rate (tachycardia) and force of contraction. This enhanced cardiac activity can be perceived by the patient as palpitations (irregular or rapid heartbeat). The normal adult heart rate is 60 to 100 beats per minute, and this drug can push it toward the upper limit or beyond.

Choice C rationale

Pseudoephedrine acts as a vasoconstrictor by stimulating alpha-1 adrenergic receptors on blood vessels, leading to an increase in systemic vascular resistance. This increase in resistance and cardiac stimulation typically results in a rise in blood pressure (hypertension), not hypotension. The normal adult blood pressure is less than 120/80 mm Hg.

Choice D rationale

Pseudoephedrine is generally a bronchodilator due to its beta-2 adrenergic receptor stimulation, which relaxes bronchial smooth muscles and improves (not worsens) respiration. Shallow respirations are a sign of respiratory depression or distress, which is not a common adverse effect of this sympathomimetic, which tends to increase the respiratory drive.