A nurse is caring for a client who is taking desvenlafaxine. Which of the following findings should the nurse document as an adverse effect of this medication?

Choice A reason: Encouraging a client to gain 2.3 kg (5 lb) per week is unrealistic and unsafe. Gradual weight gain of about 0.5 to 1 kg per week is recommended to avoid complications such as refeeding syndrome and to promote sustainable recovery.

Choice B reason: Weighing the client once per week is insufficient. Clients with anorexia nervosa require close monitoring, typically daily weights, to assess progress and detect rapid changes. Weekly weighing could miss dangerous fluctuations.

Choice C reason: Monitoring the client for 1 hr after meals is correct because clients with anorexia nervosa may attempt to purge or exercise excessively after eating. Post-meal monitoring ensures food intake is retained and helps prevent compensatory behaviors. This intervention supports nutritional rehabilitation and safety.

Choice D reason: Allowing the client to choose meal times is inappropriate because it gives them control that may reinforce disordered eating patterns. Structured meal times are necessary to normalize eating habits and reduce avoidance behaviors.

Choice A reason: Folding the patch in half with the medication side touching before disposal is correct because it prevents accidental exposure to residual medication. Fentanyl patches contain potent opioids, and improper disposal can lead to accidental ingestion or misuse. This practice ensures safety for both the client and others in the household.

Choice B reason: Cutting the patch in half is unsafe. Transdermal patches are designed to deliver medication at a controlled rate. Cutting them compromises the integrity of the delivery system, leading to unpredictable dosing and risk of overdose.

Choice C reason: Applying a heating pad to the patch is contraindicated. Heat increases absorption of fentanyl through the skin, which can result in toxic levels and respiratory depression. Clients should avoid external heat sources on or near the patch.

Choice D reason: Rotating the patch to a different extremity each day is incorrect. Patches should be applied to intact, non-irritated skin on the upper torso or upper arm, not rotated daily to extremities. Rotation is important, but it should be between recommended sites every 72 hours, not daily.