A nurse is collecting data from a group of clients. Which of the following images indicates a client the nurse should identify as exhibiting clubbing of the fingers?

A. Hematuria: Hematuria is not a typical adverse effect of methylergonovine. This medication primarily affects uterine smooth muscle and vascular tone, so urinary complications are uncommon.

B. Elevated blood pressure: Methylergonovine is a potent vasoconstrictor, which can lead to hypertension. Monitoring blood pressure is essential because severe elevations can increase the risk of stroke or cardiac complications, especially in clients with preexisting hypertension.

C. Uterine relaxation: Methylergonovine promotes uterine contraction, not relaxation. Uterine relaxation would be contrary to the intended therapeutic effect of preventing or controlling postpartum hemorrhage.

D. Diarrhea: Gastrointestinal upset, including nausea, vomiting, or diarrhea, can occur but is less common and typically mild. Blood pressure changes are the primary adverse effect requiring close monitoring.

Rationale for correct choices:

• Monitor body temperature: Paliperidone, an antipsychotic, can increase the risk of neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening condition characterized by hyperthermia, muscle rigidity, and altered mental status. Teaching the client to monitor body temperature helps with early recognition of NMS and timely intervention.

• Report sore throat: Paliperidone can cause hematologic adverse effects, including leukopenia, neutropenia, and agranulocytosis. A sore throat may be an early sign of infection due to low white blood cell counts. Reinforcing the need to report symptoms like sore throat ensures prompt evaluation and prevents serious complications.

Rationale for incorrect choices:

• Anticipated increased bruising: Although some antipsychotics may rarely affect platelet function, paliperidone is not commonly associated with increased bruising. This is not a primary teaching point for the client. Monitoring for bruising is less critical than monitoring for signs of infection or NMS.

• Stop taking contraceptive medication: There is no evidence that paliperidone interacts with contraceptives in a way that requires discontinuation. Advising the client to stop contraceptive medication is unnecessary and could place the client at risk for unintended pregnancy.

• Expect weight loss: Paliperidone is more commonly associated with weight gain rather than weight loss. Counseling the client about expecting weight loss would be inaccurate and could mislead them regarding lifestyle and dietary management.

• Follow a low-sodium diet: Paliperidone does not require sodium restriction. Low-sodium diet recommendations are not indicated unless the client has a comorbid condition like hypertension or heart failure. This is unrelated to the medication’s primary safety concerns.