What should the practical nurse (PN) do first when a client receiving paroxetine exhibits restlessness, tachycardia, fever, and elevated blood pressure?

Withholding the next dose of paroxetine and contacting the health care provider is the appropriate action in this scenario. The symptoms displayed by the client—restlessness, tachycardia, fever, and elevated blood pressure—can indicate potential serious conditions such as serotonin syndrome or a hypertensive crisis, both of which require immediate medical attention.

By withholding the medication, the nurse prevents further exacerbation of the client's condition while allowing time for assessment and intervention by the healthcare provider. This step ensures patient safety, as continuing the medication could worsen the symptoms or lead to serious complications. Prompt communication with the healthcare provider also facilitates timely evaluation and management of the adverse effects.

Monitoring vital signs more frequently and documenting findings are important tasks in nursing care; however, they are secondary to stopping a potentially harmful medication that could be contributing to the client's symptoms. Administering antihypertensive medication may become necessary in this situation, but it should be done under the direction of the healthcare provider and after further evaluation of the client's condition.