A 29-year-old pregnant woman is referred to the psychiatric-mental health nurse practitioner for medication-assisted treatment (MAT) for opioid use disorder (OUD). Which of the following will the PMHNP prescribe?
Naloxone
Naltrexone
Buprenorphine
Buprenorphine/Naloxone
The Correct Answer is C
Choice A reason: Naloxone is an opioid antagonist used primarily for emergency reversal of opioid overdose. It is not used as a maintenance medication in MAT, especially not during pregnancy, as it does not address withdrawal or cravings.
Choice B reason: Naltrexone is also an opioid antagonist used in MAT, but it is contraindicated during pregnancy due to insufficient safety data and the risk of precipitating withdrawal. It requires complete detoxification before initiation, which is not ideal for pregnant patients.
Choice C reason: Buprenorphine is a partial opioid agonist and is considered safe and effective for use during pregnancy. It reduces cravings and withdrawal symptoms without producing the same level of euphoria as full agonists. It is preferred over methadone in many cases due to lower risk of neonatal abstinence syndrome and better maternal outcomes.
Choice D reason: Buprenorphine/Naloxone combination is generally avoided during pregnancy because naloxone can precipitate withdrawal in the fetus. Monotherapy with buprenorphine is the recommended approach for pregnant women with OUD.
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Correct Answer is B
Explanation
Choice A reason: Selecting a screening tool is an important step in the implementation process, but it is not the first. Without understanding the clinic’s current capabilities, workflows, and barriers, choosing a tool may result in poor integration or resistance from staff.
Choice B reason: Conducting a systemic needs assessment is the foundational first step in any change process. It allows the PMHNP to evaluate the clinic’s readiness, identify gaps in current practices, assess staff training needs, and determine logistical constraints. This ensures that the change is tailored to the organization’s specific context and increases the likelihood of successful implementation.
Choice C reason: A chart review analysis can provide insight into past documentation and suicide risk patterns, but it is a retrospective tool. It does not address the broader organizational needs or readiness for change.
Choice D reason: A root cause analysis is typically used to investigate adverse events or system failures. While it may be useful in understanding why suicide screening has not been previously implemented, it is not the appropriate first step in a proactive change process.
Correct Answer is C
Explanation
Choice A reason: While involving a trusted family member may be helpful later, it does not fulfill the legal and ethical obligation to report suspected abuse. It delays appropriate intervention.
Choice B reason: Telling the mother to cease contact with the boyfriend may be necessary, but it is not the PMHNP’s role to enforce protective measures without proper reporting. This action alone does not initiate an investigation or ensure the child’s safety.
Choice C reason: Mandatory reporting laws require healthcare professionals to report suspected child abuse immediately to the appropriate child protection agency. This ensures that trained professionals can investigate and intervene to protect the child.
Choice D reason: Delegating the responsibility to the school is inappropriate. The PMHNP is the mandated reporter and must act directly to notify child protective services.
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