A 70-year-old patient is prescribed ipratropium bromide via inhaler for the management of asthma. During a follow-up visit, the patient reports difficulty urinating and blurred vision. Which action should the nurse take first?

Choice A rationale Reassuring the patient these are expected effects dismisses potentially serious anticholinergic side effects associated with ipratropium, a muscarinic antagonist. Difficulty urinating (urinary retention) and blurred vision, especially in an elderly patient, could indicate significant systemic absorption, necessitating dosage adjustment or alternative therapy to prevent complications. Choice B rationale Increasing fluid intake is insufficient and potentially harmful if severe urinary retention is the cause of the difficulty, as it could exacerbate bladder distension. Ipratropium acts by blocking muscarinic receptors, relaxing detrusor muscle tone and potentially causing retention, which is a significant adverse effect requiring medical evaluation. Choice C rationale Notifying the healthcare provider is the priority because these symptoms (urinary retention, blurred vision) are significant anticholinergic side effects of ipratropium, particularly concerning in a 70-year-old with potential prostatic hypertrophy or glaucoma. These adverse effects may require dose reduction or a change in medication to prevent serious harm. Choice D rationale While ipratropium is a maintenance treatment, not a rescue inhaler, instructing the patient to only use it when wheezing does not address the current adverse drug effects. Systemic side effects indicate the need for medical assessment and potential drug modification, not just a change in usage pattern.