An 18-year-old pregnant college student presented at the prenatal clinic for an initial visit at 14 weeks' gestation. the client's history revealed that when she was 12, she and her mother survived a plane crash that killed her father and sister. since that time, she has taken fluoxetine 20 mg orally daily for posttraumatic stress disorder (ptsd) and depression. her medication was recently increased to 40 mg daily because of reports of increased stress and suicide ideation. which side effect of fluoxetine would the nurse judge to be the greatest risk for the client and her developing fetus at this stage in her pregnancy?

The answer is nausea or anorexia. Development of the fetus is important, so nausea and anorexia that would inhibit with the young woman’s nutrition would root the most damage to the developing fetus. It could also lead to electrolyte disproportion if she did not take in sufficient fluid. While sleeplessness could cause difficulties long term, this side effect could be alleviated through adjustment of the dosing time (earlier in the day), by reducing the dosage to her former 20 mg daily, or by altering to every other day dosing of 40 mg, since fluoxetine has a long half-life. Headaches are painful but can be treated with mild painkillers or other actions, such as cold cloths, that would not damage the fetus.