The practical nurse (PN) reviews instructions for use of polyethylene glycol with a client scheduled for a colonoscopy. Which instruction should the PN include?

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: Explaining the medication’s purpose is important but does not address the inappropriate bedtime dosing. Diuretics increase urination, causing nocturia and sleep disruption. Administering as scheduled without review risks client discomfort, making this choice less appropriate than verifying timing.

Choice B reason: Reviewing the prescription with the charge nurse is critical, as bedtime diuretic administration causes nocturia, disrupting sleep. Diuretics, like hydrochlorothiazide, increase urine production, and morning dosing aligns with daily activity, minimizing nighttime disturbance, ensuring safe and effective administration timing.

Choice C reason: Withholding the medication until the next day delays treatment, risking conditions like edema or hypertension. Consulting the charge nurse allows timely clarification of dosing time, ensuring therapeutic benefits without sleep disruption, making this choice overly cautious and unnecessary.

Choice D reason: Administering the diuretic early without confirmation violates protocol, as the prescription specifies bedtime. Unilateral changes risk errors, and morning dosing requires provider approval. Reviewing with the charge nurse is safer, ensuring alignment with clinical intent while addressing sleep concerns.