A nurse is caring for a client who is febrile. To reduce the client's fever, the nurse applies a cooling blanket. Which of the following findings indicates the client is having an adverse reaction to the cooling?

Rationale:

Serotonin syndrome is a serious drug reaction that results from having too much serotonin in the body. Serotonin is a chemical that plays a role in mood, sleep, appetite and other functions. Some medications, especially antidepressants, can increase serotonin levels and cause serotonin syndrome. The client is taking paroxetine, which is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). SSRIs work by blocking the reabsorption of serotonin in the brain, making more serotonin available.

Paroxetine can cause serotonin syndrome if taken at high doses, in combination with other serotonergic drugs, or if abruptly stopped. The client’s symptoms of restlessness, abdominal pain, disorientation and fever are consistent with serotonin syndrome. Other possible symptoms include agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle twitching, rigidity, sweating and shivering. Severe serotonin syndrome can lead to seizures, coma and death. The client should stop taking paroxetine and seek immediate medical attention. Serotonin syndrome can be treated with supportive care and medications that reduce serotonin levels or block its effects. The client may need to switch to a different antidepressant or adjust the dosage under the guidance of their provider.

A. Directing statements to the interpreter rather than the client can create a communication barrier and undermine the client's autonomy and involvement in the conversation.
B. Speaking in a normal voice at a natural pace allows the interpreter to accurately convey the message to the client without feeling rushed or overwhelmed, facilitating effective communication.
C. Pausing in the middle of sentences can disrupt the flow of communication and make it difficult for the interpreter to accurately translate the message.
D. While gestures can complement verbal communication, relying solely on gestures may lead to misinterpretation or misunderstanding, especially if cultural differences exist between the nurse, client, and interpreter.