The practical nurse (PN) is caring for a client receiving a prescription for paroxetine who suddenly exhibits restlessness, tachycardia, fever, and elevated blood pressure. Which action should the PN implement first?

Choice A reason: Observing ulcer healing is important in diabetic neuropathy but not a direct measure of pregabalin’s effectiveness. Pregabalin reduces neuropathic pain, not primarily promoting tissue repair. Ulcer healing depends on glycemic control and wound care, making this choice secondary.

Choice B reason: Measuring pain and sensation assesses pregabalin’s effectiveness, as it modulates calcium channels in neurons, reducing neuropathic pain and abnormal sensations in diabetic neuropathy. Decreased pain or paresthesia in the feet indicates therapeutic success, making this the most relevant assessment for the drug’s action.

Choice C reason: Palpating skin temperature evaluates circulation or infection, not pregabalin’s effect. While neuropathy may affect perfusion, pregabalin targets pain signaling, not temperature regulation. This assessment is unrelated to the drug’s primary role in pain management, making it irrelevant.

Choice D reason: Checking swelling monitors edema, which may occur in diabetes but is not pregabalin’s target. The drug reduces neuropathic pain, not fluid accumulation. Swelling assessment is secondary to pain and sensation, which directly reflect the medication’s efficacy in neuropathy management.

Choice A reason: Instructing the UAP to bring a breakfast tray ensures nutritional support but is not the highest priority. Regular insulin peaks within 2–4 hours, risking hypoglycemia if not monitored. Observing for hypoglycemic symptoms takes precedence to ensure immediate safety post-administration.

Choice B reason: Observing for pallor, diaphoresis, or fatigue is critical, as these indicate hypoglycemia, a serious risk after regular insulin administration. Insulin lowers blood glucose, and rapid drops can impair brain function or cause seizures. Monitoring for these signs ensures timely intervention, prioritizing client safety.

Choice C reason: Measuring vital signs and oxygen saturation provides general data but is less specific than monitoring for hypoglycemia symptoms. Regular insulin’s rapid action increases hypoglycemic risk, and symptoms like diaphoresis are more direct indicators, making this choice secondary to targeted observation.

Choice D reason: Notifying the charge nurse of the insulin dose is routine but not urgent. The priority is monitoring for hypoglycemia, as regular insulin can cause rapid glucose drops, leading to serious complications. Immediate client observation outweighs administrative tasks in ensuring safety.