# A male client taking trazodone 100 mg PO at bedtime calls the clinic to report a painful erection lasting 3 hours. Which is the nurse's most appropriate response?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391734&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A male client taking trazodone 100 mg PO at bedtime calls the clinic to report a painful erection lasting 3 hours. Which is the nurse's most appropriate response?

## Option

1. "This is a known side effect of trazodone; you can wait and see if it resolves on its own."
2. "Apply an ice pack to the area and lie down; the erection should resolve on its own in a few hours."
3. "Go to the emergency department now — this could be priapism, which is a urologic emergency." **✔ Correct answer**
4. "Take an extra dose of trazodone to help you fall asleep; the erection will subside with rest."

**Correct answer: 3**

## Explanation

Correct (2): Priapism (erection >4 hours) is a rare but serious adverse effect of trazodone caused by alpha-1 blockade. The 3-hour threshold demands emergency evaluation — irreversible ischemic tissue damage and erectile dysfunction can occur after ~4 hours. ED management may include cavernosal aspiration, intracavernous phenylephrine, or surgical decompression. (1) Watchful waiting risks permanent damage. (3) Additional trazodone worsens the problem. (4) NOT a normal effect — it is a urologic emergency.

## In-depth explanation

Memory Tip Trazodone = "TRA-ZZZ-Done" for sleep, but watch for priapism (4-hour rule). Caution All male clients starting trazodone must receive priapism teaching — emphasize ED visit BEFORE 4 hours, not after.

## Clinical scenario

Scenario 38-year-old male on trazodone 100 mg PO HS for insomnia × 6 weeks. He calls the after-hours line: "I've had a painful erection for 3 hours and it won't go away."

## Key concepts

- **Priapism** — Persistent (>4 hours), often painful erection unrelated to sexual stimulation; a urologic emergency that can cause permanent erectile dysfunction if untreated.
- **Alpha-1 blockade** — Trazodone's mechanism for both sedation and priapism risk; reduces sympathetic vasoconstriction in penile vasculature.
- **Off-label sleep use** — Trazodone is widely used off-label for insomnia at sub-antidepressant doses (25-100 mg HS); less Beers-flagged than benzodiazepines in some scenarios but still requires priapism counseling in males.

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