A nurse is caring for a client in a clinic. For each body system below, click to specify the adverse effect that the nurse should include in the teaching. Choose the most likely response for the dropdown(s) in the table below by choosing from the lists of options. Body System Common Adverse Effects Head, eyes, ears, nose, and throat (HEENT) dropdown Cardiovascular dropdown Genitourinary dropdown Gastrointestinal dropdown

Rationale for correct choices Dry mouth (HEENT): Amitriptyline blocks muscarinic (acetylcholine) receptors, leading to decreased salivary gland secretion. This results in xerostomia (dry mouth), which can increase risk for dental caries, oral infections, and difficulty swallowing. Patients should be taught to increase fluid intake, chew sugarless gum, or use saliva substitutes. Tachycardia (Cardiovascular): TCAs inhibit norepinephrine reuptake and also have anticholinergic effects, both of which can increase heart rate. Additionally, TCAs can affect cardiac conduction (prolonged PR, QRS, QT intervals), making tachycardia and dysrhythmias important adverse effects to monitor, especially in older adults or those with cardiac disease. Urinary retention (Genitourinary): Anticholinergic effects reduce detrusor muscle contraction in the bladder, making it difficult to initiate urination and fully empty the bladder. This can lead to bladder distention and discomfort, particularly in older adults or those with prostate enlargement. Constipation (Gastrointestinal): TCAs decrease gastrointestinal motility due to their anticholinergic properties. This slows peristalsis, leading to constipation. Patients should be encouraged to increase fiber intake, fluid intake, and physical activity to prevent complications like fecal impaction. Rationale for incorrect choices: Double vision: Although TCAs can cause blurred vision due to anticholinergic effects, dry mouth is a more common and expected finding emphasized in teaching. Sore throat: Not associated with TCA use; may indicate infection rather than medication effect. Chest pain: Not a typical expected side effect; could indicate a serious cardiac issue and requires immediate evaluation. Hypertension: TCAs are more likely to cause orthostatic hypotension due to alpha-1 blockade, not hypertension. Hematuria: No mechanism linking TCAs to blood in urine. Urinary incontinence: Opposite of expected effect; TCAs cause retention, not leakage. Weight loss: TCAs often cause weight gain due to increased appetite and metabolic effects. Diarrhea: Due to decreased GI motility, constipation—not diarrhea—is expected.