A nurse is completing medication reconciliation on a client.

Exhibits

For each potential provider's prescription, click to specify if the potential prescription is anticipated, or contraindicated for the client.

Intravenous phentolamine should be administered because the client is experiencing a hypertensive crisis due to the interaction between phenelzine (a monoamine oxidase inhibitor [MAOI]) and over-the-counter decongestants. MAOIs can cause severe hypertension when taken with sympathomimetic agents (such as pseudoephedrine, commonly found in decongestants). Phentolamine is an alpha-adrenergic antagonist that rapidly lowers blood pressure in hypertensive emergencies.

Apply a cooling blanket to the client because the client’s temperature is dangerously high (39.6°C/103.2°F), which may indicate autonomic dysregulation or hyperthermia associated with hypertensive crisis. Active cooling measures are necessary to prevent complications such as seizures, organ damage, or stroke.

Oral benztropine is used to treat extrapyramidal symptoms from antipsychotic medications but is not relevant to this client’s condition.

Oral valbenazine is used to treat tardive dyskinesia, a side effect of dopamine-blocking medications, but this client is experiencing a hypertensive crisis, not movement disorders.

Intravenous diphenhydramine is used for allergic reactions or dystonic reactions but does not treat hypertensive crisis or hyperthermia.

Placing the client on suicide precautions is unnecessary in this scenario, as there is no indication of suicidal ideation or self-harm.

Checking the client’s absolute neutrophil count is relevant for clients taking clozapine (due to the risk of agranulocytosis) but is unrelated to this case of hypertensive crisis from an MAOI interaction.

Educating the client to increase their salt intake is appropriate for MAOI-induced orthostatic hypotension, but this client has severe hypertension, making this recommendation inappropriate.

A. Give the client a cup of hot black tea before bed. Black tea contains caffeine, which is a stimulant that can interfere with sleep. Individuals with Alzheimer's disease are particularly sensitive to sleep disturbances, so avoiding caffeinated beverages before bedtime is recommended.
B. Wake the client at the same time each morning. Maintaining a consistent sleep schedule helps regulate the body’s internal clock and improves sleep quality. For individuals with Alzheimer's disease, a predictable routine reduces confusion and enhances overall well-being.
C. Take the client for a walk 2 hr before bedtime each night. While daytime physical activity is beneficial for sleep, exercising too close to bedtime can be stimulating rather than relaxing, making it harder for the client to fall asleep. A morning or early afternoon walk would be more appropriate.
D. Allow the client to take a 50 min nap immediately after lunch. Long or late naps can interfere with night-time sleep. If a nap is necessary, it should be brief (20–30 minutes) and earlier in the day to avoid disrupting the client’s sleep-wake cycle.