A nurse is preparing to administer fluoxetine 40 mg PO daily.

The amount available is fluoxetine 20 mg/5mL.

How many mL should the nurse administer?

(Round the answer to the nearest whole number. Use a leading zero if it applies.Do not use a trailing zero.).

The adverse effect the nurse should report to the provider is A. Sweating and fever.

This combination of symptoms is a key indicator of Serotonin Syndrome, a potentially life-threatening condition that, while rare with buspirone alone, can occur, particularly if the client is taking other medications that increase serotonin (like SSRIs or MAOIs).

The nurse should report these signs immediately because:

• Sweating (Diaphoresis) and High Fever (Hyperthermia) are core components of the triad of symptoms for Serotonin Syndrome (autonomic instability).

• Serotonin Syndrome also involves changes in mental status (e.g., confusion, hallucinations, which is option D) and neuromuscular hyperactivity (e.g., muscle rigidity, tremors).

• This is a medical emergency that requires immediate intervention to prevent complications like rhabdomyolysis, metabolic acidosis, and renal failure.

In comparison:

• C. Decreased appetite is a common, generally mild, and manageable side effect.

• D. Hallucinations are a serious central nervous system side effect, but when presented alongside the life-threatening systemic signs of Serotonin Syndrome (A), option A represents the more urgent and dangerous adverse reaction.

• B. Discolored urine is not a standard adverse effect and would need investigation, but is not as acutely critical as signs of Serotonin Syndrome.

Rationale for Choice A:

While it is important to address the client's behavior, simply explaining that it was unacceptable is unlikely to be effective in this situation. Clients with antisocial personality disorder often have difficulty understanding and accepting responsibility for their actions. They may lack empathy for others and may not see their behavior as problematic. Confronting the client about their behavior too early in the therapeutic relationship could lead to defensiveness, hostility, or even aggression. It is important to first establish a rapport with the client and build a foundation of trust before addressing difficult topics.

Rationale for Choice B:

Setting behavioral limits is an important aspect of treatment for clients with antisocial personality disorder. However, it is not the first priority in this situation. Before setting limits, the nurse needs to establish a relationship with the client and assess their individual needs and level of functioning. Attempting to set limits without first establishing a rapport could lead to power struggles and further resistance from the client.

Rationale for Choice C:

Exploring the truth of the client's statements may be necessary at some point in the treatment process. However, it is not the first priority in this situation. The nurse's initial focus should be on establishing a relationship with the client and assessing their immediate needs. Focusing on the accuracy of the client's statements too early in the therapeutic process could derail the development of a trusting relationship.

Rationale for Choice D:

Establishing a client relationship is the first and most important step in the treatment of any client, but it is especially crucial for clients with antisocial personality disorder. These clients often have difficulty trusting others and forming close relationships. By establishing a rapport with the client, the nurse can begin to build trust and create a safe and supportive environment. This foundation is essential for any further therapeutic interventions to be successful.