A charge nurse in a newborn nursery is providing information to a group of nurses about risk factors for hypoglycemia. Which of the following risk factors should the charge nurse include? (Select all that apply)

Choice A reason: Dry cough is not associated with sertraline, an SSRI affecting serotonin pathways. Cough is linked to ACE inhibitors via bradykinin accumulation, not SSRIs, which cause neurological or gastrointestinal side effects. Including this misinforms the client about sertraline’s actual adverse effect profile.
Choice B reason: Increased urinary frequency is not a common sertraline side effect. SSRIs may cause urinary retention due to anticholinergic effects, but frequent urination is linked to diuretics or diabetes. Sertraline’s effects focus on serotonin-mediated mood changes, not bladder function alterations.
Choice C reason: Excessive sweating is a recognized sertraline adverse effect, driven by serotonin’s influence on autonomic sweat gland regulation. This hyperhidrosis, common in SSRI therapy, affects patient comfort and adherence, requiring education to prepare clients for this side effect during depression treatment.
Choice D reason: Metallic taste is not linked to sertraline. It occurs with antibiotics or chemotherapy agents due to oral mucosa irritation. Sertraline’s side effects include nausea or insomnia, driven by serotonin modulation, not gustatory changes, making this an incorrect inclusion in teaching.

Choice A reason: Avoiding physical exercise is not recommended for multiple sclerosis, as moderate activity like walking or stretching improves muscle strength, balance, and fatigue management. Complete avoidance leads to deconditioning, worsening mobility and fatigue, which are common in MS, making this instruction counterproductive to symptom management.
Choice B reason: Taking hot baths is not advised for multiple sclerosis, as heat can exacerbate symptoms like fatigue and muscle weakness due to temperature sensitivity (Uhthoff’s phenomenon). Cool or lukewarm baths are safer, supporting symptom control, making this instruction harmful and inappropriate for MS management.
Choice C reason: Performing daily stretching exercises improves flexibility, reduces spasticity, and enhances mobility in multiple sclerosis. Stretching strengthens muscles and prevents contractures, supporting functional independence. This aligns with evidence-based MS management to mitigate symptoms and improve quality of life, making it the correct instruction.
Choice D reason: Limiting fluid intake to reduce bladder irritation is inappropriate, as adequate hydration (2-3 L/day) prevents urinary tract infections, common in MS due to bladder dysfunction. Fluid restriction can worsen symptoms and dehydration, making this instruction incorrect for managing MS-related bladder issues effectively.