Nokea
An outpatient mental health clinic-based adult psychiatric and mental health nurse practitioner treats a 32-year-old patient who has diabetes and a major depressive disorder. The patient reports an improved and stable mood on a trial of duloxetine (Cymbalta), but experiences continued neuropathic pain. The nurse practitioner's initial intervention is to:
- A. add gabapentin (Neurontin) to the treatment regimen.
- B. conduct additional diagnostic tests.
- C. contact the patient's endocrinologist.
- D. increase the dosage of duloxetine (Cymbalta).
Correct Answer: A
Rationale: Gabapentin is effective for neuropathic pain and complements duloxetine's antidepressant effect, making it a practical initial step. Tests or consultation may follow if needed, and increasing duloxetine risks side effects without guaranteed pain relief.
You may also like to solve these questions
For 12 years, a 65-year-old patient with bipolar affective disorder has been treated with lithium (Eskalith) 900 mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is $2.0 \mathrm{mEq} / \mathrm{L}$. The interaction of the lithium and the thiazide diuretic has induced:
- A. hypokalemia.
- B. hyponatremia.
- C. increased renal clearance of lithium.
- D. reduced renal clearance of lithium.
Correct Answer: D
Rationale: Thiazide diuretics reduce renal clearance of lithium, leading to accumulation and toxicity (level >1.5 mEq/L), as evidenced by the symptoms and elevated level. Hypokalemia and hyponatremia are not directly caused by this interaction, and clearance is not increased .
Which of the following actions would NOT be helpful when dealing with Paranoid Hallucinations?
- A. Help the client relate with real persons
- B. Avoid giving attention to the content of hallucination or delusion after an initial investigation
- C. Acknowledge the clients belief in the perception but also indicate that is not shared by others
- D. Listen carefully to the content of hallucinations and delusion and encourage the client to describe them.
Correct Answer: D
Rationale: Even if you don't agree that they are under threat or at risk, try to understand how they are feeling. It's important to recognise that their feelings are very real, even if you feel the beliefs they are based on are unfounded. Focus on the level of distress they are feeling and offer comfort. It's possible to recognise their alarm and acknowledge their feelings without agreeing with the reason they feel that way.
Which of the following outcome criteria is appropriate for the client with dementia?
- A. The client will return to an adequate level of self-functioning.
- B. The client will learn new coping mechanisms to handle anxiety.
- C. The client will seek out resources in the community for support.
- D. The client will follow an establishing schedule for activities of daily living.
Correct Answer: D
Rationale: Following established activity schedules is a realistic expectation for clients with dementia. All of the remaining outcome statements require a higher level of cognitive ability than can be realistically expected of clients with this disorder.
A mother telephones an adult psychiatric and mental health nurse practitioner to report that her 13-year-old son has been unusually active, irritable, and unable to sleep for more than a few hours each night. The adolescent has been diagnosed with a major depressive disorder and has been taking fluoxetine (Prozac) for six weeks. The nurse practitioner is most concerned about the possibility that:
- A. a therapeutic level of the drug has not been reached.
- B. an addition of hypnotic medication is warranted.
- C. the adolescent has been misdiagnosed.
- D. the adolescent is experiencing side effects.
Correct Answer: C
Rationale: Symptoms of hyperactivity, irritability, and sleeplessness suggest mania, indicating a possible bipolar disorder misdiagnosed as depression. Fluoxetine can trigger mania in bipolar patients, making misdiagnosis the primary concern over levels , hypnotics , or side effects .
Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become increasingly dependent. Her husband is very concerned and takes her to the local mental health center. What is this type of crisis called?
- A. dispositional crisis
- B. crisis of anticipated life transitions
- C. psychiatric emergency
- D. crisis resulting from traumatic stress
Correct Answer: B
Rationale: This is an anticipated life transition crisis, as Marie faces the expected yet challenging empty nest phase.