A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is
a. nausea.
b. imbalanced nutrition (less than body requirements).
c. fluid volume deficit.
d. altered peripheral tissue perfusion.
ANS: C
Nausea and vomiting are common adverse effects of vilazodone. Persistent vomiting should be evaluated for other causes, as well as for the development of electrolyte imbalance. Fluid volume deficit can lead to life-threatening cardiac arrhythmias and therefore is the priority nursing diagnosis. The nursing diagnosis nausea is appropriate but is not the priority. Imbalanced nutrition is an appropriate nursing diagnosis but is not the priority at this time. Altered peripheral tissue perfusion does not apply to this scenario.
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