Editing Pharmacology – RN Practice Questions (section)

==Question 9==
A client taking sertraline is started on tramadol for acute back pain. Two days later the client presents with agitation, diaphoresis, a temperature of 38.9 degrees Celsius, tremor, hyperreflexia, and inducible ankle clonus. Which condition should the nurse suspect, and what is the priority action?
# Neuroleptic malignant syndrome; administer an additional dose of sertraline
# Anticholinergic toxicity; administer physostigmine
# Serotonin syndrome; stop the serotonergic agents and notify the provider
# Acute dystonic reaction; administer diphenhydramine and continue both drugs

'''Answer:''' 3 (C) Serotonin syndrome; stop the serotonergic agents and notify the provider.

''Rationale:'' The combination of an SSRI and tramadol, both serotonergic, with hyperthermia, autonomic instability, and neuromuscular hyperactivity, especially clonus and hyperreflexia, is characteristic of serotonin syndrome. The priority is to discontinue the offending agents and provide supportive care including cooling and benzodiazepines as ordered. Option 1 is wrong on both counts: neuroleptic malignant syndrome features lead-pipe rigidity and hyporeflexia rather than clonus, and adding sertraline would worsen the syndrome. Option 2 does not fit, since anticholinergic toxicity produces dry skin rather than diaphoresis and normal reflexes. Option 4 misidentifies the syndrome and continues the causative drugs.