A 24-year-old woman with a history of major depressive disorder treated with sertraline is brought to the emergency department by her partner for evaluation of fever, vomiting, and weakness. In the emergency department, her temperature is 103°F, her heart rate is 129 beats per minute, she is agitated and restless, and she displays hyperactive reflexes. Her symptoms began several hours after she used a new medication prescribed by her primary care provider. Which of the following is most likely to be the new medication?
Propranolol
Topiramate
Sumatriptan
Naproxen
The Correct Answer is C
Choice A reason: Propranolol is a beta-blocker used for anxiety, hypertension, and migraine prophylaxis. It does not increase serotonin levels and is not associated with serotonin syndrome, making it an unlikely cause of the described symptoms.
Choice B reason: Topiramate is an anticonvulsant and mood stabilizer used for epilepsy and migraine prevention. It does not significantly affect serotonin pathways and is not known to cause serotonin syndrome.
Choice C reason: Sumatriptan is a serotonin receptor agonist used for acute migraine treatment. When combined with SSRIs like sertraline, it can precipitate serotonin syndrome—a potentially life-threatening condition characterized by hyperthermia, autonomic instability, neuromuscular abnormalities, and altered mental status. The timing and symptoms strongly suggest this interaction.
Choice D reason: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. It does not interact with serotonergic systems and is not associated with serotonin syndrome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Reporting to the state board is not appropriate unless there is a breach of professional conduct. Countertransference is a clinical issue best managed internally.
Choice B reason: Supervisory consultation is the standard and most effective method for addressing countertransference. It allows for reflection, guidance, and professional development without compromising client care.
Choice C reason: While individual therapy may help clinicians explore personal issues contributing to countertransference, it is not the primary method for managing it in clinical practice.
Choice D reason: Discharging the client prematurely due to countertransference may harm the therapeutic alliance and is not considered best practice unless absolutely necessary.
Correct Answer is B
Explanation
Choice A reason: Belladonna is considered psychoactive due to its anticholinergic properties. It can cause hallucinations, confusion, and delirium, especially in high doses. It affects the central nervous system and is not classified as nonpsychoactive.
Choice B reason: Black cohosh is primarily used for menopausal symptoms and hormonal regulation. It does not exert direct effects on the central nervous system and is not associated with mood or cognitive alterations, making it nonpsychoactive.
Choice C reason: Ginseng has stimulant-like effects and can influence mood, energy levels, and cognitive function. It interacts with neurotransmitter systems and is considered psychoactive.
Choice D reason: Melatonin is a hormone that regulates sleep-wake cycles. Although it is naturally occurring, its supplementation affects circadian rhythms and has sedative properties, classifying it as psychoactive.
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