The practical nurse (PN) is providing discharge instructions to a client who had a partial thyroidectomy. When explaining the actions of the prescribed thyroid supplement levothyroxine sodium, which parameter should the PN tell the client is most important to monitor for potential side effects?

Choice A reason: Rivaroxaban, a direct oral anticoagulant, inhibits factor Xa, increasing bleeding risk. Bruising on arms and legs may indicate excessive anticoagulation, potentially leading to severe hemorrhage. Immediate reporting is critical to assess bleeding risk, adjust dosing, or initiate interventions to prevent life-threatening complications.

Choice B reason: Genital itching and burning with discharge suggest a possible infection or allergic reaction, not a direct adverse effect of rivaroxaban. These symptoms are unrelated to its anticoagulant mechanism, which primarily affects hemostasis, making this choice incorrect for immediate reporting.

Choice C reason: Diminished taste and smell are not recognized side effects of rivaroxaban. These symptoms may relate to other conditions, like neurological or infectious issues, but do not reflect the drug’s anticoagulant effects. This choice is irrelevant to rivaroxaban’s adverse effect profile.

Choice D reason: Hard, dry stools indicate constipation, a non-urgent side effect not typically associated with rivaroxaban. While gastrointestinal issues may occur, bleeding risks are more critical. This symptom does not warrant immediate reporting compared to bruising, which signals potential hemorrhage.

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.