A client has been admitted in withdrawal delirium. He is dehydrated and has a bruised, swollen tongue. He is experiencing illusions and auditory hallucinations and is confused. In developing a care plan for this client, what measure should the nurse include to ensure physiologic stability?

ideation, as some clients express relief anticipating death. While concerning, it is less specific than other indicators, as it may not always reflect serotonin-driven despair or intent, requiring further assessment to confirm risk.

Choice B reason: Feeling overwhelmed by simple tasks indicates severe depression, linked to serotonin and prefrontal cortex dysfunction, impairing executive function. This heightens suicidal risk, as cognitive overload and hopelessness increase impulsivity and despair, making it a critical neurobiological marker requiring immediate intervention to prevent self-harm.

Choice C reason: Calling family to make amends signals high suicidal risk, often reflecting intent to resolve relationships before death, driven by serotonin dysregulation and prefrontal cortex deficits. This behavior indicates advanced planning, a neurobiological marker of serious ideation, necessitating urgent safety measures to prevent completion.

Choice D reason: An abrupt mood improvement can indicate suicidal risk, as it may reflect relief from deciding to end life, linked to serotonin and dopamine shifts. This neurobiological change reduces despair temporarily, increasing energy for action, making it a critical warning sign requiring immediate assessment and intervention.

Choice A reason: Echinacea is used for immune support and has no significant interaction with paroxetine, an SSRI that increases serotonin by inhibiting reuptake. Echinacea’s effects on cytokine production do not alter serotonin metabolism or CYP450 enzymes, which paroxetine relies on for clearance, making it a safe supplement in this context.

Choice B reason: Ginkgo enhances cerebral blood flow but has minimal interaction with paroxetine. It may affect platelet aggregation, but paroxetine’s serotonin reuptake inhibition is primarily metabolized via CYP2D6, unaffected by ginkgo’s mechanisms. No significant pharmacodynamic or pharmacokinetic interactions occur, making this supplement safe for concurrent use with paroxetine.

Choice C reason: St. John’s Wort induces CYP3A4 and P-glycoprotein, accelerating paroxetine metabolism, an SSRI reliant on CYP2D6. This reduces paroxetine’s efficacy, lowering serotonin levels and risking treatment failure for depression. It also increases serotonin syndrome risk due to additive serotonergic effects, making it a critical interaction to avoid.

Choice D reason: Saw palmetto, used for prostate health, has no significant interaction with paroxetine. It primarily affects androgen pathways, not serotonin metabolism or CYP2D6, which paroxetine uses for clearance. No pharmacodynamic or pharmacokinetic conflicts arise, making saw palmetto a safe supplement for clients taking paroxetine for depression.