A nurse is performing an assessment on a client who has been taking verapamil as prescribed for two months. Which of the following findings should the nurse identify as adverse effects of this medication? (Select all that apply.)

Choice A rationale Verapamil is a calcium channel blocker that inhibits the influx of calcium ions into smooth muscle cells. This action affects the smooth muscles of the gastrointestinal tract, reducing peristalsis and slowing the movement of stool. This decrease in bowel motility frequently leads to constipation, which is a common and dose-dependent adverse effect of the medication. Choice B rationale Reports of blurred vision are not a typical or expected adverse effect of verapamil. While some medications can cause visual disturbances, verapamil's primary actions are on the cardiovascular system. Adverse effects more related to verapamil include dizziness or lightheadedness due to its hypotensive effects, not direct ophthalmic changes. Choice C rationale Insomnia is not a recognized or common side effect of verapamil. The medication's primary effects are on the cardiovascular system, and its central nervous system effects are generally minimal. While individual responses can vary, insomnia is not a documented or clinically significant adverse effect associated with this drug. Choice D rationale Verapamil causes vasodilation, particularly in the peripheral arterioles. This leads to a decrease in systemic vascular resistance. However, this vasodilation can also cause fluid to shift from the intravascular space into the interstitial tissues, resulting in peripheral edema, especially in the lower extremities, which is a common adverse effect. Choice E rationale Verapamil decreases the influx of calcium into cardiac pacemaker cells and myocardial cells, slowing the heart rate and reducing contractility. This negative chronotropic effect on the sinoatrial (SA) node and dromotropic effect on the atrioventricular (AV) node leads to a slower heart rate, or bradycardia, which is a common and expected pharmacologic effect.