A nurse in a clinic is caring for an adolescent client who is at 24 weeks of gestation and showing signs of preeclampsia. Which of the following findings should the nurse expect?

Rationale for Correct Choices:

• Serotonin syndrome: The client presents with restlessness, fever, abdominal pain, and disorientation all classic signs of serotonin syndrome. These symptoms developed after a recent dose increase of a serotonergic medication, indicating a likely adverse drug reaction.
• Adverse effects of paroxetine: Paroxetine, an SSRI, can cause serotonin syndrome, especially when recently increased or combined with other serotonergic agents. The timing of the dose escalation aligns with the emergence of the client’s acute symptoms.

Rationale for Incorrect Choices:

• Psychosis: While disorientation is present, there is no evidence of hallucinations, delusions, or loss of reality testing, which are essential features of psychosis.
• Mania: The client does not show signs of elevated mood, grandiosity, pressured speech, or risky behavior, which are typical of mania.
• Anxiety: Although anxiety is part of the client’s history, the sudden onset of fever and autonomic instability points more clearly to a toxic reaction rather than worsening anxiety.
• Fluoxetine discontinuation: Fluoxetine has a long half-life, and discontinuation typically causes delayed withdrawal symptoms like dizziness or mood swings not the acute systemic symptoms noted here.

Rationale:

A. Acetaminophen: Acetaminophen is generally considered safe during pregnancy when used at recommended doses. It is commonly used to treat mild pain and fever without significant risk to the fetus.

B. Saline nasal spray: Saline nasal sprays are non-medicated and safe for use during pregnancy. They help relieve nasal congestion without systemic absorption or risk to fetal development.

C. Levothyroxine: Levothyroxine is a thyroid hormone replacement that is safe and essential during pregnancy for clients with hypothyroidism. Untreated hypothyroidism poses greater risks to both mother and fetus than the medication itself.

D. Ibuprofen: Ibuprofen is contraindicated, especially during the third trimester, due to risks such as premature closure of the ductus arteriosus, oligohydramnios, and delayed labor. Acetaminophen is preferred for pain relief in pregnancy.