A 27-year-old woman with bipolar I disorder presents to the PMHNP for her regular medication management appointment. She announces that she is 12 weeks pregnant with her first child. This pregnancy was unplanned, and the patient is worried about her medications causing harm to her unborn fetus. Which statement is true about bipolar disorder and pregnancy?
Divalproex (Depakote) is a safe alternative to lithium (Eskalith).
Lithium (Eskalith) is safe during the first and third trimester.
Carbamazepine (Tegretol) is a safe alternative to lithium (Eskalith).
Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations.
The Correct Answer is D
Choice A reason: Divalproex is associated with a high risk of neural tube defects and other congenital malformations when used during pregnancy, especially in the first trimester. It is not considered a safe alternative.
Choice B reason: Lithium carries a risk of cardiac malformations, particularly Ebstein’s anomaly, when used during the first trimester. Its safety profile is complex and requires careful monitoring, especially during early pregnancy.
Choice C reason: Carbamazepine is also teratogenic and associated with neural tube defects. It is not considered a safe alternative during pregnancy.
Choice D reason: Clonazepam, a benzodiazepine, has not been strongly linked to major fetal malformations. While caution is still advised due to risks of neonatal withdrawal and
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: While the son exhibits problematic behavior, family systems theory emphasizes that symptoms in one member often reflect dysfunction in the entire system. Focusing solely on him overlooks systemic dynamics.
Choice B reason: The daughter also displays concerning behavior, but isolating her as the identified patient ignores the broader family context.
Choice C reason: Labeling both children as identified patients is closer to systemic thinking but still implies that the problem lies only with them, rather than with the family unit.
Choice D reason: Family systems theory posits that the identified patient is the person whose symptoms reflect the dysfunction of the entire family system. In this case, both children’s behaviors suggest systemic issues, making the whole family the identified patient.
Correct Answer is C
Explanation
Choice A reason: This is a miracle question, used in solution-focused therapy to help clients envision a future without their current problems. It is not an exception-finding question.
Choice B reason: This question explores the impact of the problem but does not identify exceptions or times when the problem was absent.
Choice C reason: Exception-finding questions aim to identify times when the problem did not occur or was less severe. This helps clients recognize their strengths and build on successful coping strategies. Asking about a time when the problem was not present is a classic example.
Choice D reason: This question explores emotional responses and is more aligned with psychodynamic or humanistic approaches than solution-focused therapy.
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