A nurse is expressing concern about his assignment with the charge nurse. The nurse states that he has more work to do than anyone else. Which of the following statements by the charge nurse demonstrates the conflict resolution strategy of competing?

A. Document the client's respiratory rate in 1 hr: Measuring and recording vital signs, including respiratory rate, is within the scope of practice for an assistive personnel (AP). After the nurse administers a PRN pain medication, the AP can safely monitor and document routine parameters, providing the nurse with data to evaluate the client’s response.

B. Monitor the client for an allergic reaction for 30 min: Observing for adverse or allergic reactions requires nursing assessment skills, clinical judgment, and the ability to intervene immediately if a severe reaction occurs. This task is outside the AP’s scope of practice.

C. Check the client's response to the medication in 1 hr: Evaluating a client’s pain relief or therapeutic response involves subjective assessment and interpretation, which require nursing judgment. This responsibility cannot be delegated to an AP.

D. Evaluate the client for therapeutic effects in 30 min: Assessing the effectiveness of medication, such as pain relief or sedation, requires clinical judgment and decision-making to determine if further interventions are needed. This is a nursing responsibility and should not be assigned to an AP.

• Check deep tendon reflexes: The client exhibits restlessness, diaphoresis, tachycardia, elevated temperature, and gastrointestinal symptoms, which are consistent with serotonin syndrome. Hyperreflexia and clonus are key neuromuscular findings associated with this condition. Assessing deep tendon reflexes helps confirm neuromuscular hyperactivity.
• Discontinue fluoxetine: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels and can precipitate serotonin syndrome. The client’s symptoms developed after initiating this medication, suggesting toxicity. Immediate discontinuation removes the source of excess serotonin.
• Administer citalopram: Citalopram is another SSRI that increases serotonin activity. Administering it while the client is experiencing serotonin toxicity would worsen the condition. Adding another serotonergic agent could intensify hyperthermia, autonomic instability, and neuromuscular symptoms.
• Administer phenelzine: Phenelzine is a monoamine oxidase inhibitor (MAOI) that significantly increases serotonin levels. Combining or switching to an MAOI in the setting of suspected serotonin syndrome is dangerous and can precipitate severe toxicity. MAOIs require a washout period after SSRIs due to fluoxetine’s long half-life.
• Administer propranolol: Propranolol may be used to manage autonomic instability such as tachycardia and hypertension associated with serotonin syndrome. The client’s elevated heart rate and blood pressure support this intervention. Controlling sympathetic overactivity reduces cardiovascular strain.