A nurse is caring for a client who has right-sided hemiplegia following a recent stroke. Which of the following questions should the nurse ask to determine the client's ability to cope?

Choice A reason:
St. John's wort is known to interact adversely with fluoxetine. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and other conditions. St. John's wort also has effects on serotonin, and when taken with fluoxetine, it can increase the risk of serotonin syndrome, a potentially life-threatening condition. Symptoms of serotonin syndrome include confusion, rapid heart rate, dilated pupils, loss of muscle coordination, heavy sweating, and muscle rigidity³. Therefore, it is crucial for patients on fluoxetine to avoid taking St. John's wort to prevent any serious complications.

Choice B reason:
Soy protein is not known to have a significant interaction with fluoxetine. Soy products are commonly consumed foods and are generally considered safe. However, patients should always consult with their healthcare provider before starting any new supplement to ensure it does not interfere with their medication regimen.

Choice C reason:
Echinacea is commonly used to support the immune system, especially for colds and other respiratory infections. There is no well-documented interaction between echinacea and fluoxetine, but as with any supplement, it is advisable to consult with a healthcare provider before combining it with prescription medications.

Choice D reason:
Ginkgo biloba is often used for memory enhancement or to improve circulation. While there are some concerns about ginkgo's potential to affect bleeding due to its blood-thinning properties, there is no direct adverse interaction with fluoxetine. However, patients taking fluoxetine should be cautious with any supplements that can affect bleeding, especially if they are also taking other medications with similar effects.

Choice A reason:
Electroconvulsive therapy (ECT) is not typically used to reduce the frequency of seizures. In fact, ECT induces controlled seizures as part of its therapeutic process. Therefore, a reduction in seizure frequency is not an indicator of ECT's effectiveness.

Choice B reason:
While ECT can be used to treat various psychiatric conditions, it is most commonly and effectively used for severe depression. It is not primarily indicated for reducing the frequency of panic attacks. Therefore, a reduction in panic attacks is not a primary measure of ECT's effectiveness.

Choice C reason:
Improvement in manifestations of depression is a key indicator of ECT's effectiveness. ECT is often used when other treatments for major depressive disorder have failed. Patients typically show significant improvement in mood, energy levels, and overall functioning after a series of ECT treatments.

Choice D reason:
Decreased fear of heights, or acrophobia, is not a condition typically treated with ECT. Phobias are usually addressed through therapies such as cognitive-behavioral therapy (CBT) rather than ECT. Therefore, a decrease in the fear of heights is not an indicator of ECT's effectiveness.