A nurse is assisting in the care of a client. For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

Check deep tendon reflexes: The client exhibits restlessness, diaphoresis, tachycardia, elevated temperature, and gastrointestinal symptoms, which are consistent with serotonin syndrome. Hyperreflexia and clonus are key neuromuscular findings associated with this condition. Assessing deep tendon reflexes helps confirm neuromuscular hyperactivity. Discontinue fluoxetine: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels and can precipitate serotonin syndrome. The client’s symptoms developed after initiating this medication, suggesting toxicity. Immediate discontinuation removes the source of excess serotonin. Administer citalopram: Citalopram is another SSRI that increases serotonin activity. Administering it while the client is experiencing serotonin toxicity would worsen the condition. Adding another serotonergic agent could intensify hyperthermia, autonomic instability, and neuromuscular symptoms. Administer phenelzine: Phenelzine is a monoamine oxidase inhibitor (MAOI) that significantly increases serotonin levels. Combining or switching to an MAOI in the setting of suspected serotonin syndrome is dangerous and can precipitate severe toxicity. MAOIs require a washout period after SSRIs due to fluoxetine’s long half-life. Administer propranolol: Propranolol may be used to manage autonomic instability such as tachycardia and hypertension associated with serotonin syndrome. The client’s elevated heart rate and blood pressure support this intervention. Controlling sympathetic overactivity reduces cardiovascular strain.