A nurse is reviewing the medical records for a group of clients prior to administering the clients' medications. For which of the following clients should the nurse withhold the prescribed medication and notify the provider?

Rationale for correct choices:

• Amnesia: GHB is known to cause memory loss or amnesia, particularly retrograde amnesia, which makes the client unable to recall events that occurred during intoxication. This is a common effect of GHB when it is used as a "date rape drug."
• Nausea and vomiting: GHB can cause gastrointestinal symptoms, including nausea and vomiting. This is a well-known side effect, especially when the drug is ingested in larger quantities or in combination with alcohol.
• Respiratory depression: One of the most concerning effects of GHB is respiratory depression. This can be life-threatening, as GHB has a sedative effect on the central nervous system, potentially leading to slow or shallow breathing and, in extreme cases, respiratory failure.

Rationale for incorrect choices:

• Hyperthermia: GHB typically causes sedation and hypothermia rather than hyperthermia. While stimulant drugs (e.g., methamphetamine) can lead to increased body temperature, GHB is more commonly associated with decreased body temperature.
• Tachycardia: GHB does not typically cause tachycardia. It is more likely to cause bradycardia (slower heart rate) or maintain normal heart rates due to its sedative effects.
• Combativeness: GHB is a sedative and CNS depressant, not a stimulant. Therefore, it is unlikely to cause combativeness, which is more typically associated with stimulant drugs like cocaine or methamphetamine.

Rationale:

• Heart rate: The client's heart rate has increased to 124 beats per minute, which is significantly higher than normal. This tachycardia could be a sign of neuroleptic malignant syndrome (NMS), a potentially life-threatening reaction to antipsychotic medications like haloperidol.
• Temperature: The client's elevated temperature of 39.5°C (103.1°F) is concerning and could be indicative of NMS, which often presents with hyperthermia as one of its hallmark symptoms. NMS is a medical emergency that requires immediate attention.

Rationale for incorrect choices:

• Vision report: The client's report of blurry vision may be a side effect of haloperidol, but it is not typically considered a life-threatening reaction. It should be monitored but does not indicate an immediate crisis.
• Blood pressure: While the blood pressure is slightly low, it is not as critical as the combination of elevated heart rate and temperature. The low blood pressure would require monitoring but is not immediately indicative of a life-threatening reaction.
• Mouth report: Dry mouth is a common side effect of many medications, including antipsychotics like haloperidol. While uncomfortable, it is not a life-threatening condition.
• Respiratory rate: The respiratory rate of 22/min is within normal limits and does not indicate any immediate concerns related to the medication. It should be monitored but does not raise a red flag for a life-threatening reaction.