A nurse is planning care for a client who is receiving morphine via continuous epidural infusion. The nurse should monitor the client for which of the following adverse effects?

A. Correct Answer: St. John's Wort
Explanation: The nurse should advise the client to avoid taking St. John's Wort. St. John's Wort is an herbal supplement commonly used to treat depression and anxiety. However, it can have significant interactions with various medications, including sertraline. Sertraline is an antidepressant that belongs to the selective serotonin reuptake inhibitor (SSRI) class. St. John's Wort can increase serotonin levels in the brain, and when combined with medications that also affect serotonin levels (such as sertraline), it can lead to a potentially dangerous condition known as serotonin syndrome. Therefore, it's important to avoid St. John's Wort while taking sertraline to prevent adverse effects and interactions.
B. Incorrect Explanation: Coenzyme Q10
Explanation: Coenzyme Q10 (CoQ10) is a naturally occurring antioxidant that plays a role in energy production within cells. While CoQ10 is generally considered safe, it does not have known interactions with sertraline. Therefore, the nurse would not necessarily advise the client to avoid CoQ10 solely based on its potential interaction with sertraline.
C. Incorrect Explanation: Black Cohosh
Explanation: Black cohosh is an herbal supplement often used to manage symptoms of menopause. It is not typically known to have significant interactions with sertraline. However, it's important for the client to discuss any supplements with their healthcare provider before starting them, especially when taking prescribed medications. The nurse might not necessarily advise the client to avoid black cohosh unless there are specific concerns based on the client's medical history.
D. Incorrect Explanation: Ginger Root
Explanation: Ginger root is a commonly used spice and herbal remedy. It does not have known interactions with sertraline and is generally considered safe for most people. However, as with any supplement, it's a good practice to consult with a healthcare provider before starting it, especially when taking prescribed medications like sertraline. The nurse would not necessarily advise the client to avoid ginger root without specific reasons related to the client's health.

A. Bruxism:
Correct Answer: This adverse effect is a priority to report to the provider.
Explanation: Bruxism refers to teeth grinding or clenching, often unconsciously during sleep. It can be a potential side effect of citalopram and other selective serotonin reuptake inhibitors (SSRIs). Bruxism can lead to dental problems, jaw pain, and other discomforts. If this side effect occurs, it should be reported to the provider as it can impact the client's oral health and overall well-being.
B. Confusion:
Incorrect Explanation: While confusion is a concerning adverse effect, it's not typically associated with citalopram use.
Explanation: Confusion is more commonly associated with other medications or medical conditions. If a client experiences confusion, a thorough assessment is warranted, but it may not be directly attributed to citalopram.
C. Weight loss:
Incorrect Explanation: Weight loss can be a side effect of citalopram, but it's not the highest priority in this scenario.
Explanation: Weight loss is a possible side effect of many antidepressants, including citalopram. However, it is generally not as immediately concerning as other adverse effects that can impact a client's health and well-being.
D. Insomnia:
Incorrect Explanation: Insomnia is a common side effect of citalopram and other antidepressants, but it's not the highest priority in this context.
Explanation: Insomnia can be a transient side effect when starting an antidepressant-like citalopram. While it can affect the client's quality of life, it is not as urgent as potential dental issues caused by bruxism.