A nurse is assessing a client who is receiving gemfibrozil. The nurse should identify which of the following findings as an adverse effect of this medication?

Choice A rationale Dependent edema is often associated with conditions like heart failure or deep vein thrombosis due to increased hydrostatic pressure in the capillaries, which forces fluid into the interstitial spaces. Gemfibrozil primarily works in the liver and bloodstream to decrease triglyceride and VLDL production, and does not typically cause fluid retention or edema as a primary adverse effect. Choice B rationale Gemfibrozil is a fibric acid derivative that can cause myopathy, which presents as muscle tenderness, pain, or weakness. This is thought to be due to an alteration in muscle metabolism, potentially through an effect on the enzymes involved in lipid processing within muscle cells. This adverse effect is more likely when the medication is combined with statins. Choice C rationale Tremors are involuntary muscle contractions that can be caused by various neurological conditions, medication side effects, or electrolyte imbalances. Gemfibrozil's mechanism of action is primarily on lipid metabolism and gene expression in the liver. It does not directly affect the central or peripheral nervous system in a way that typically induces tremors. Choice D rationale Hyperkalemia, an elevated serum potassium level (normal range 3.5-5.0 mEq/L), is typically caused by impaired kidney function, certain medications like ACE inhibitors or spironolactone, or cellular damage. Gemfibrozil does not directly interfere with the body's potassium regulation or renal excretion and is not known to cause hyperkalemia as a common adverse effect.