After reviewing the client's Nurses' Notes, the nurse initiates the client's plan of care.
Complete the following sentence by using the list of options.
The nurse should first address the client's

dropdown

, due to the client's

dropdown

.

Choice A reason: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is commonly associated with sexual dysfunction, including decreased libido, delayed orgasm, or erectile difficulties. This is an important teaching point because it can affect adherence to therapy if the client is not prepared for this side effect.

Choice B reason: Drooling is not a typical side effect of fluoxetine. Excessive salivation is more commonly seen with antipsychotics such as clozapine, not SSRIs.

Choice C reason: Improvement in depressive symptoms with fluoxetine usually takes 2 to 4 weeks, not 2 to 3 days. Clients should be counseled to continue taking the medication consistently and not expect immediate relief.

Choice D reason: Appetite changes can occur with SSRIs, but decreased appetite is not a primary or consistent side effect of fluoxetine. Some clients may experience weight changes, but sexual dysfunction is more characteristic.

Rationale for correct condition

Neuroleptic malignant syndrome is the correct condition because the client is on high-dose haloperidol, a dopamine antagonist strongly associated with NMS. The clinical presentation includes hyperthermia, diaphoresis, muscle rigidity, autonomic instability, and altered mental status. The elevated blood pressure, tachycardia, and high fever are hallmark signs of NMS. The rigidity and sluggish response further support this diagnosis. Other listed conditions do not explain the acute life-threatening combination of hyperthermia, rigidity, and autonomic dysfunction.

Rationale for the two correct actions

Apply a cooling blanket:This is correct because hyperthermia is a critical symptom of NMS, and external cooling helps reduce body temperature and prevent organ damage.

Administer medications as prescribed by the provider:This is correct because pharmacologic interventions such as dantrolene or bromocriptine are essential to reverse muscle rigidity and dopamine blockade.

Rationale for parameters to monitor

Temperature:Monitoring temperature is vital because hyperthermia is life-threatening in NMS, and treatment effectiveness is gauged by reduction in fever.

Cardiac rhythm:Autonomic instability in NMS can cause arrhythmias, so continuous cardiac monitoring ensures early detection and intervention.

Rationale for incorrect conditions

Extrapyramidal effects:These involve tremors and dystonia but do not cause hyperthermia or autonomic instability.

Agranulocytosis:This is linked to clozapine, not haloperidol, and presents with infection risk, not rigidity or fever.

Metabolic syndrome:This is a chronic complication of antipsychotics, not an acute emergency with fever and rigidity.

Tardive dyskinesia:This involves involuntary movements but does not present with diaphoresis, hyperthermia, or autonomic instability.

Rationale for incorrect actions to take

Annotate a transfer to TCU:This delays urgent treatment and does not address the acute crisis.

Initiate an exercise plan in the unit:Exercise worsens hyperthermia and rigidity, making it unsafe.

Initiate reverse isolation:This is used for infection control, not for NMS management.

Rationale for incorrect parameters to monitor

Presence of rhabdomyolysis:While rhabdomyolysis can occur, it is secondary and not the primary parameter to monitor for immediate stabilization.

Absolute neutrophil count:This is relevant for agranulocytosis, not NMS.

Tardive dyskinesia:Monitoring abnormal movements is irrelevant in the acute management of NMS.