A nurse is caring for a client.

Select the 3 statements the nurse should make.

Citalopram is a selective serotonin reuptake inhibitor(SSRI) used to manage major depressive disorder by increasing serotonin levelsin the synaptic cleft. While generally well-tolerated, SSRIs can cause serotonin syndrome, a potentially fatal condition characterized by altered mental status, autonomic instability, and neuromuscular hyperactivity. Early detection of neurological changes is vital.

Rationale:

A.Bruxism, or involuntary teeth grinding, is a known side effect of SSRIs that typically occurs during sleep. While it can cause dental wear and jaw pain, it is not a life-threatening emergency requiring immediate reporting. The nurse can suggest a mouth guard or a dosage adjustment during a routine follow-up with the provider to manage this specific discomfort.

B.Insomnia is a frequent side effect of citalopram due to the stimulating effects of increased serotonin in certain brain pathways. While significant for the client's quality of life, it is an expected reaction that often subsides after several weeks of therapy. It does not carry the same degree of clinical urgency as symptoms indicating acute toxicity or systemic physiological distress.

C.Weight loss can occur during the initial phase of citalopram therapy due to decreased appetite or nausea. While the nurse should monitor the client's nutritional intake and weight over time, it is a gradual process rather than an acute crisis. It is considered a manageable side effect that rarely requires immediate medical intervention unless the weight loss becomes extreme.

D.Confusion is a priority finding because it may indicate the onset of serotonin syndromeor significant hyponatremia, which are serious complications of SSRI therapy. Altered mental status is a "red flag" symptom that suggests systemic toxicity rather than a benign side effect. The nurse must report confusion immediately to ensure the client is evaluated for potentially life-threatening drug reactions.

Anaphylaxis is a severe type I hypersensitivityreaction characterized by systemic mast cell degranulation and bronchoconstriction. While epinephrine is the first-line treatment for its vasopressorand bronchodilatory effects, refractory respiratory distress requires secondary interventions to stabilize the airway. Targeted beta-2 agonists are used to provide localized relief of bronchospasm.

Rationale:

A.Selegiline is a monoamine oxidase inhibitor (MAOI) used primarily in the management of Parkinson's disease. It has no role in the acute treatment of anaphylaxis or respiratory distress. Administering an MAOI in an emergency setting could actually lead to dangerous drug interactions with the epinephrine already given, potentially triggering a hypertensive crisis or cardiac arrhythmia.

B.Abatacept is a selective costimulation modulator used for the treatment of rheumatoid arthritis by inhibiting T-cell activation. It is a maintenance medication for chronic autoimmune conditions and does not provide the rapid bronchodilation required for an acute allergic emergency. Its onset of action is far too slow to address the immediate threat of airway occlusion following a bee sting.

C.Sucralfate is a gastroprotective agent that forms a complex over ulcer sites in the stomach. It is administered orally and has no systemic effect on the respiratory or cardiovascular systems. Using sucralfate in a client with severe dyspnea is inappropriate and dangerous, as the patient is at high risk for aspiration and requires immediate parenteral or inhaled interventions.

D.Albuterol is a rapid-acting beta-2 adrenergic agonist that provides direct bronchodilation to relieve the wheezing and airway constriction associated with anaphylaxis. When a client has a suboptimal response to epinephrine, inhaled albuterol helps to further relax the smooth muscles of the bronchioles. This is a critical secondary intervention to improve ventilation and reduce the work of breathing.