The nurse is caring for a client with a new diagnosis of epilepsy who is prescribed phenytoin. Which teaching point should the nurse emphasize?

Choice A reason: Hydromorphone, an opioid, poses a significant risk of respiratory depression by suppressing the brainstem’s respiratory centers. After four days, cumulative effects increase this risk, especially in opioid-naïve patients. Monitoring respiratory rate and depth is critical to prevent life-threatening hypoxia, making it the priority assessment.

Choice B reason: Constipation is a common hydromorphone side effect due to opioid-induced reduced gastrointestinal motility. While important, it is not life-threatening like respiratory depression. Monitoring bowel function is secondary, as respiratory compromise poses an immediate risk requiring urgent intervention in opioid therapy.

Choice C reason: Skin rash is a rare allergic reaction to hydromorphone, not a primary concern after four days of use. Respiratory depression is far more critical, as opioids directly depress respiratory drive, risking hypoxia, making rash assessment secondary to monitoring respiratory function.

Choice D reason: Nausea is a frequent hydromorphone side effect, often diminishing with continued use. While bothersome, it is not life-threatening compared to respiratory depression, which can cause rapid hypoxia. Monitoring respiratory status is the priority to ensure patient safety during opioid administration.

Choice A reason: Diclofenac, an NSAID, can cause gastrointestinal bleeding, leading to anemia. Pale appearance and fatigue suggest blood loss. Reviewing hemoglobin levels is critical to confirm anemia, as low hemoglobin impairs oxygen delivery, exacerbating fatigue and requiring immediate intervention to address potential bleeding.

Choice B reason: Glucose levels are unrelated to diclofenac’s common side effects. Fatigue may occur in hypoglycemia, but diclofenac does not typically affect glucose metabolism. Pale appearance and fatigue are more indicative of anemia from NSAID-related bleeding, making hemoglobin a more urgent lab value to review.

Choice C reason: Total protein levels reflect nutritional status or liver function but are not directly linked to diclofenac’s side effects. Fatigue and pallor suggest anemia from gastrointestinal bleeding, a known NSAID risk. Hemoglobin is more critical to assess, as it directly correlates with the client’s symptoms.

Choice D reason: Sodium levels influence fluid balance but are not typically altered by diclofenac. Fatigue and pallor point to anemia from potential bleeding, not electrolyte imbalance. Hemoglobin review is prioritized, as diclofenac’s gastrointestinal side effects are more likely to cause blood loss than sodium disturbances.