Which laboratory value should the practical nurse (PN) monitor to determine if an antilipidemic medication is having the desired effect for the client?

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.

Choice A reason: Increasing pain before the next opioid dose suggests inadequate analgesia, possibly due to tolerance or disease progression. Consulting the charge nurse facilitates dosage adjustment or schedule changes, ensuring effective pain control in terminal cancer, where maintaining comfort is critical for quality of life.

Choice B reason: Notifying the provider that the dosage has been increased is incorrect, as the PN cannot unilaterally adjust controlled substances. Pain management requires collaboration, and premature notification without consultation risks legal and clinical errors, making this choice inappropriate.

Choice C reason: Withholding opioid doses risks uncontrolled pain, which is unethical in terminal cancer care. The client’s increasing pain indicates a need for dosage review, not cessation, as opioids are essential for palliation, making this choice harmful and contrary to care goals.

Choice D reason: Administering opioids only when pain exceeds 5 is arbitrary and delays relief. Breakthrough pain before scheduled doses requires proactive dosage or interval adjustments, not reactive thresholds, to maintain consistent analgesia, making this choice inadequate for managing terminal cancer pain.