The practical nurse (PN) administers filgrastim subcutaneous to a client with neutropenia. The client becomes troubled with bone pain. Which action should the PN take?

Choice A reason: Restlessness, tachycardia, fever, and hypertension suggest serotonin syndrome, a life-threatening paroxetine side effect due to excessive serotonin. Withholding the dose and contacting the provider prevents further serotonin accumulation, allowing urgent assessment and intervention to stabilize the client’s neurological and cardiovascular status.

Choice B reason: A cooling blanket addresses fever but is not the first action for serotonin syndrome. Withholding paroxetine and consulting the provider are critical to stop the syndrome’s progression, as fever is a symptom, not the cause, making this choice secondary to halting the drug.

Choice C reason: Taking the client to a quiet area may reduce stimulation but does not address serotonin syndrome’s physiological cause. Paroxetine’s serotonin excess drives symptoms, requiring drug cessation and medical intervention, not just reassurance, as this condition can rapidly worsen, making this choice inadequate.

Choice D reason: Administering benzodiazepine and acetaminophen is premature without provider guidance, as serotonin syndrome requires specific treatments, like cyproheptadine. Paroxetine must be stopped first, and the provider consulted to confirm diagnosis and manage symptoms, making this choice unsafe and reactive.

Choice A reason: Appetite changes may occur with levothyroxine due to metabolic effects, but they are not the most critical side effect. Excessive thyroid hormone can overstimulate metabolism, but cardiovascular effects, like tachycardia, are more immediate and dangerous, making appetite monitoring less urgent.

Choice B reason: Sleep disturbances may result from levothyroxine’s stimulatory effects, but they are less severe than cardiovascular risks. Overdose can cause insomnia by increasing metabolism, but heart rate is a more direct indicator of hyperthyroidism, which poses greater health risks, making this choice secondary.

Choice C reason: Heart rate is critical to monitor, as levothyroxine increases metabolism, potentially causing tachycardia or arrhythmias if overdosed. Excess thyroid hormone mimics hyperthyroidism, stressing the cardiovascular system, which can lead to palpitations or heart failure, making this the most important parameter for side effect detection.

Choice D reason: Daily weights track fluid or metabolic changes but are less specific for levothyroxine side effects. Weight loss may occur with excess dosing, but cardiovascular effects, like increased heart rate, are more immediate and life-threatening, requiring closer monitoring than weight fluctuations.