A nurse is preparing to administer methylphenidate to a child who has ADHD. The child asks, “Why do I have to take this pill?” What should the nurse say?

“I will take this medication in the morning to avoid insomnia.” Fluoxetine is a type of antidepressant that belongs to the class of selective serotonin reuptake inhibitors (SSRIs). It works by increasing the level of serotonin, a neurotransmitter that regulates mood, sleep, and appetite, in the brain.Fluoxetine can cause insomnia as a side effect, so it is recommended to take it in the morning.

Some of the other choices are wrong because:

• Choice B. “I will stop taking this medication if I have sexual dysfunction.” Fluoxetine can also cause sexual dysfunction as a side effect, such as reduced libido, difficulty with orgasm, or erectile dysfunction.

However, stopping the medication abruptly can cause withdrawal symptoms, such as nausea, headache, dizziness, and anxiety.Therefore, it is important to consult with the doctor before stopping or changing the dose of fluoxetine.

• Choice C. “I will increase my intake of cheese and red wine while taking this medication.” Fluoxetine can interact with foods that contain high levels of tyramine, a compound that can affect blood pressure and cause headaches.

Tyramine is found in aged cheeses, red wine, beer, cured meats, soy sauce, and other fermented or pickled foods.Consuming these foods while taking fluoxetine can increase the risk of a hypertensive crisis, which is a medical emergency that requires immediate attention.

• Choice D. “I will taper off this medication slowly when I feel better.” Fluoxetine should not be stopped or tapered off without the doctor’s guidance.

Although fluoxetine has a long half-life and is less likely to cause withdrawal symptoms than other SSRIs, some people may still experience them if they stop taking it too quickly.Withdrawal symptoms can include mood changes, irritability, agitation, confusion, insomnia, fatigue, flu-like symptoms, and electric shock sensations.

The doctor will advise on how to gradually reduce the dose of fluoxetine over several weeks or months to avoid these effects.

Thyroid function tests, serum electrolytes and serum creatinine levels should be monitored for a client who is taking lithium carbonate.This is because lithium can affect the thyroid gland, causing hypothyroidism or goiter.Lithium can also cause dehydration and electrolyte imbalance, which can increase the risk of toxicity.Lithium can also impair renal function, leading to increased serum creatinine levels.

Choice B is wrong because blood glucose levels are not affected by lithium.Choice D is wrong because liver function tests are not indicated for lithium therapy.

Normal ranges for thyroid function tests vary depending on the method and laboratory used, but generally include:

• Thyroid-stimulating hormone (TSH): 0.4 to 4.0 mIU/L

• Free thyroxine (FT4): 0.8 to 2.8 ng/dL

• Total triiodothyronine (T3): 80 to 200 ng/dL

Normal ranges for serum electrolytes include:

• Sodium: 135 to 145 mEq/L

• Potassium: 3.5 to 5.0 mEq/L

• Chloride: 98 to 106 mEq/L

• Bicarbonate: 22 to 26 mEq/L

Normal range for serum creatinine is 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women.