The practical nurse (PN) is checking the insulin dose drawn up by another PN and notes that the amount of insulin is 2 units more than the amount indicated for the glucose level written on the client’s medication record. Which action should the PN take?

Choice A reason: Palpitations may indicate electrolyte imbalances, like hypokalemia, a serious side effect of hydrochlorothiazide, a thiazide diuretic. It increases potassium excretion, disrupting cardiac electrical activity, potentially causing arrhythmias. Withholding the dose and notifying the provider is critical to prevent life-threatening cardiac complications, requiring urgent electrolyte assessment.

Choice B reason: Nervousness is a vague symptom not typically linked to hydrochlorothiazide’s side effects. It may reflect anxiety or other unrelated issues, not necessitating immediate drug cessation. Electrolyte imbalances or hypotension are more concerning, making this choice less urgent for withholding the medication.

Choice C reason: Nausea is a common, non-specific side effect of many medications, including hydrochlorothiazide, but is not severe enough to warrant withholding the dose. It may resolve or be managed symptomatically. More critical side effects, like electrolyte imbalances, take precedence, making this choice incorrect.

Choice D reason: Anorexia is not a primary concern with hydrochlorothiazide. While it may occur with diuretic-induced dehydration, it is less urgent than cardiac symptoms like palpitations. This symptom does not directly indicate a life-threatening side effect, so withholding the drug is not immediately necessary.

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.