Exhibits The nurse receives the prescription for sertraline and prepares to give the medication. The nurse reviews the current medication prescription. Click to specify if the intervention is indicated or not indicated. Each row must have only one response selected.

Rationale: Assess for pattern of bowel movements: Sertraline, a SSRI, commonly causes gastrointestinal side effects, including diarrhea or constipation. Monitoring the client's bowel movement pattern is essential to detect and manage these potential adverse effects. Monitor suicidal ideation: Clients with PTSD and major depressive symptoms, especially those recently expressing suicidal intent, require close monitoring for suicidality when initiating SSRIs like sertraline, as energy to act on suicidal thoughts may increase before mood improves. Weigh client weekly: SSRIs, including sertraline, can lead to weight changes. Regular weight monitoring helps detect significant weight gain or loss, especially in clients with changes in appetite or nutrition due to mood disorders. Offer frequent sips of fluids: There is no current evidence of dehydration or dry mouth. SSRIs like sertraline do not routinely require fluid intake encouragement unless side effects or clinical symptoms indicate a need. Watch for hypotension: Sertraline is not commonly associated with hypotension. Orthostatic hypotension is more typical with tricyclic antidepressants or antipsychotics, not SSRIs.