The practical nurse (PN) is discharging a client who had an anaphylactic reaction following administration of ampicillin. Which instruction is most important for the PN to provide this client?

Choice A reason: Using an Amsler grid monitors macular degeneration, not sildenafil-related visual changes, which include color tinting or blurred vision due to PDE5 inhibition affecting retinal blood flow. This is not a standard monitoring tool for sildenafil side effects, making it inappropriate for this context.

Choice B reason: Instilling eye drops is irrelevant, as sildenafil’s visual changes are systemic, caused by its effect on retinal phosphodiesterase, not a local eye condition treatable with drops. No evidence supports eye drops for this side effect, making this choice incorrect and ineffective.

Choice C reason: Wearing dark glasses may reduce light sensitivity but does not address sildenafil’s visual side effects, like blue-green color distortion, caused by altered retinal signaling. This is a temporary, drug-induced effect, and glasses do not mitigate the underlying issue, making this choice inadequate.

Choice D reason: Reporting visual changes immediately is critical, as sildenafil can cause rare but serious effects like non-arteritic anterior ischemic optic neuropathy, impairing retinal blood flow. Prompt reporting allows the provider to assess severity, adjust dosing, or discontinue the drug to prevent permanent vision loss.

Choice A reason: Donepezil, a cholinesterase inhibitor, increases acetylcholine in the brain, enhancing cognitive function in early Alzheimer’s. It improves memory and daily functioning by supporting neuronal communication, particularly in mild-to-moderate stages, slowing symptom progression temporarily, making this the accurate description of its action.

Choice B reason: Donepezil does not target psychotic features, like hallucinations, which are managed with antipsychotics. It enhances cognitive function by boosting acetylcholine, not addressing behavioral symptoms. Psychotic features require different therapies, making this choice incorrect for donepezil’s primary role.

Choice C reason: Donepezil does not alter Alzheimer’s progressive course, as it cannot stop neuronal degeneration. It provides symptomatic relief by enhancing acetylcholine levels, temporarily improving cognition, but the disease’s underlying pathology continues, making this choice inaccurate for describing the drug’s effect.

Choice D reason: Donepezil does not cause sedation or reduce hostility. It enhances cognitive function, potentially increasing alertness. Sedation is a side effect of other drugs, like antipsychotics, not cholinesterase inhibitors, making this choice incorrect for donepezil’s therapeutic action.