A nurse is caring for a client who has a ventricular dysrhythmia and a new prescription for amiodarone.
Which of the following interventions should the nurse include in the client's plan of care?

Choice A rationale

Gingival hyperplasia is an overgrowth of gum tissue, often associated with certain medications like phenytoin or cyclosporine. It is caused by an increase in the number of fibroblasts and collagen deposition in the gingiva. Haloperidol, an antipsychotic, primarily affects dopamine receptors in the brain and does not cause gingival hyperplasia.

Choice B rationale

Haloperidol is a first-generation antipsychotic that blocks D2 dopamine receptors in the brain. This blockade, particularly in the nigrostriatal pathway, can lead to extrapyramidal symptoms (EPS) such as acute dystonia, parkinsonism (including muscle rigidity, bradykinesia, and tremor), and akathisia. Muscle rigidity is a common manifestation of drug-induced parkinsonism.

Choice C rationale

Polyuria is the excessive production of urine, often a symptom of diabetes mellitus or insipidus. It results from impaired water reabsorption in the kidneys. While some medications can affect fluid balance, haloperidol's primary pharmacological action on dopamine receptors does not directly induce polyuria as a typical adverse effect.

Choice D rationale

Bruising, or ecchymosis, results from bleeding under the skin, often due to trauma or coagulation disorders. It is caused by extravasation of blood from capillaries into surrounding tissues. Haloperidol does not affect coagulation factors or platelet function and is not associated with increased bruising as a direct adverse effect.

The client is at risk for developing hallucinations and weight loss.

Rationale for correct answers:
Bupropion is an atypical antidepressant used for smoking cessation that acts by inhibiting the reuptake of norepinephrine and dopamine. It is known to potentially cause neuropsychiatric side effects, including hallucinations, especially in patients with a history of psychiatric disorders such as bipolar disorder. Weight loss is a common adverse effect due to bupropion’s appetite suppression and increased metabolism. Normal weight is assessed by BMI, and this client has a normal BMI, but bupropion may exacerbate weight loss. Hallucinations indicate serious CNS involvement and require close monitoring.

Rationale for incorrect Response 1 options:
Dependence is not typically associated with bupropion; it has a low abuse potential. Somnolence or drowsiness is not a prominent side effect; bupropion is generally stimulating rather than sedating. Hypotension is also not a common effect; bupropion may actually increase heart rate and blood pressure slightly.

Rationale for incorrect Response 2 options:
Somnolence is not common; patients may experience insomnia rather than sedation. Hallucinations are already selected as a correct response. Hypotension is rare; instead, bupropion can cause hypertension in some cases. Weight loss is a known side effect and thus the correct choice.

Take home points:

• Bupropion can cause neuropsychiatric side effects, especially in clients with bipolar disorder.
• Weight loss may occur due to appetite suppression and increased metabolism.
• Monitor closely for CNS symptoms such as hallucinations during therapy.
• Smoking cessation pharmacotherapy must be tailored considering psychiatric history to avoid adverse effects.