The practical nurse (PN) is providing discharge instructions to a client who had a partial thyroidectomy. When explaining the actions of the prescribed thyroid supplement levothyroxine sodium, which parameter should the PN tell the client is most important to monitor for potential side effects?

Choice A reason: A neurological exam assesses brain function but does not directly address glipizide-related symptoms like confusion and blurred vision, which suggest hypoglycemia. Glipizide, a sulfonylurea, lowers blood glucose, and these symptoms are likely due to low glucose levels, making glucose testing more urgent than a neurological evaluation.

Choice B reason: Administering glucagon treats severe hypoglycemia but is premature without confirming low blood glucose. Glipizide increases insulin release, potentially causing hypoglycemia, but a fingerstick glucose test is needed first to verify the cause of symptoms. This choice is incorrect without diagnostic confirmation.

Choice C reason: Measuring vital signs provides general health data but does not specifically address confusion and blurred vision caused by glipizide-induced hypoglycemia. Low blood glucose is the likely cause, and testing glucose levels is more direct and urgent than monitoring vital signs, which are secondary in this context.

Choice D reason: Obtaining a fingerstick blood glucose is critical, as glipizide can cause hypoglycemia, leading to confusion and blurred vision. These symptoms result from insufficient glucose in the brain and eyes. Confirming low glucose guides immediate treatment, such as glucose administration, making this the most appropriate action.

Choice A reason: Less frequent urinary incontinence is a desired effect of oxybutynin, an antimuscarinic that relaxes bladder muscles, reducing involuntary contractions. This indicates therapeutic success in managing overactive bladder, not a concern requiring reporting, as it aligns with the drug’s intended action.

Choice B reason: Diminished urinary urgency is an expected outcome of oxybutynin, which inhibits bladder spasms by blocking acetylcholine receptors. This reduces the urge to urinate, improving overactive bladder symptoms, and does not warrant reporting, as it reflects the medication’s efficacy.

Choice C reason: Decreased urinary output is concerning, as oxybutynin’s anticholinergic effects may cause urinary retention by overly relaxing the bladder. This risks bladder distension or infection, requiring reporting to assess for obstruction or adjust dosing, making this the critical finding to address.

Choice D reason: Reduced urinary frequency is a therapeutic effect of oxybutynin, which decreases bladder contractions, allowing longer intervals between urination. This is a goal of overactive bladder treatment and does not require reporting, as it indicates the drug is working as intended.