A 28-year-old man is seeking treatment for opioid use disorder with buprenorphine. He currently takes escitalopram for generalized anxiety disorder, prazosin for posttraumatic stress disorder-related nightmares, and alprazolam for panic attacks. Which of these medications should the psychiatric-mental health nurse practitioner consider discontinuing prior to induction of buprenorphine?
Prazosin
Escitalopram
Alprazolam
None
The Correct Answer is C
Choice A reason: Prazosin is an alpha-1 adrenergic antagonist commonly used to treat PTSD-related nightmares. It does not have significant CNS depressant effects and does not interact dangerously with buprenorphine. Therefore, it can be continued during induction.
Choice B reason: Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used for anxiety and depression. It does not pose a significant risk when combined with buprenorphine and is generally safe to continue during induction.
Choice C reason: Alprazolam is a benzodiazepine with potent CNS depressant effects. When combined with buprenorphine, it increases the risk of respiratory depression, sedation, and overdose. Discontinuation or tapering is recommended prior to buprenorphine induction to reduce these risks.
Choice D reason: This option implies that no medications need to be discontinued, which is incorrect. Alprazolam poses a significant safety concern and should be reconsidered before initiating buprenorphine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Sublimation is a mature defense mechanism where unacceptable impulses are transformed into socially acceptable actions or behaviors. For example, someone might channel aggressive impulses into competitive sports. This does not apply to the scenario, as the man is not redirecting his behavior into a constructive outlet but rather continuing harmful behavior.
Choice B reason: Denial is a primitive defense mechanism where a person refuses to accept reality or facts. In the context of substance use, denial is common among individuals with alcohol use disorder. The man’s repeated arrests and continued drinking, coupled with his insistence that he has no problem, exemplify denial. He is rejecting the reality of his condition and its consequences, which is a hallmark of this defense mechanism.
Choice C reason: Reaction formation involves behaving in a way that is opposite to one's true feelings or desires. For example, someone who feels hostility might act overly friendly. This does not fit the scenario, as the man is not displaying behavior contrary to his internal state—he is simply refusing to acknowledge the problem.
Choice D reason: Repression is an unconscious process where distressing thoughts or memories are pushed out of conscious awareness. While repression may play a role in substance use disorders, the man’s overt behavior and verbal denial suggest a conscious refusal to accept reality, which aligns more closely with denial than repression.
Correct Answer is B
Explanation
Choice A reason: A score of 12 on the AUDIT indicates hazardous or harmful alcohol use. No intervention would be inappropriate and neglectful of the clinical implications of the score.
Choice B reason: A score between 8 and 15 on the AUDIT suggests hazardous drinking. The recommended next step is a brief intervention, which involves structured advice or counseling aimed at reducing alcohol consumption and preventing escalation.
Choice C reason: Detoxification assessment is appropriate for scores above 20 or when there are signs of physical dependence and withdrawal. A score of 12 does not automatically warrant detox evaluation.
Choice D reason: PEth testing is a biomarker for alcohol use but is not a standard follow-up for an AUDIT score of 12. It may be used in legal or forensic contexts but is not necessary in routine clinical practice at this stage.
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