A 31-year-old male client has come to the PMHNP for a medication follow-up. He tells the prescriber he is feeling "very good" on escitalopram (Lexapro). He feels so good, in fact, that he has decided to add the supplement tryptophan to his medication regimen to "boost" its effect. What is the most appropriate response by the PMHNP?
"I'm proud to see you are taking control of your health."
"That sounds very positive, and there is some evidence tryptophan does help with depression."
"I'm pleased you are doing well on your medication, but it could be dangerous to combine the supplement with the antidepressant."
"That was not a very smart thing to do. You should have talked to me before you started any new over-the-counter product."
The Correct Answer is C
Choice A reason: While encouraging autonomy is important, this response overlooks the potential danger of combining serotonergic agents. It may inadvertently reinforce unsafe behavior.
Choice B reason: Although tryptophan has been studied for its role in mood regulation, combining it with SSRIs like escitalopram increases the risk of serotonin syndrome—a potentially life-threatening condition. This response fails to address the safety concern.
Choice C reason: This response acknowledges the client’s progress while appropriately warning about the risk of serotonin syndrome. It maintains therapeutic rapport and provides necessary education about drug interactions.
Choice D reason: This response is overly critical and may damage the therapeutic relationship. It does not validate the client’s intent or provide constructive guidance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The id is the primitive part of the psyche driven by instinctual desires and operates on the pleasure principle. It does not express future-oriented or moralistic statements like "I shall." Instead, it demands immediate gratification.
Choice B reason: The ego mediates between the id, superego, and reality. It operates on the reality principle and is associated with rational thought and decision-making. "I think" accurately reflects the ego’s role in conscious reasoning and problem-solving.
Choice C reason: The superego represents internalized moral standards and ideals. It is more likely to say "I should" or "I must" rather than "I want," which reflects desire and is more aligned with the id.
Choice D reason: "I am" is a statement of existence and identity, not typically associated with any specific Freudian structure. It lacks the motivational or regulatory tone characteristic of the id, ego, or superego.
Correct Answer is C
Explanation
Choice A reason: This choice is incorrect because the client endorsed four out of six core symptoms in Part A of the Adult ADHD Self-Report Scale, which is a validated screening tool. This pattern suggests the presence of ADHD symptoms, not their absence.
Choice B reason: Adult ADHD can be diagnosed even if the individual was not formally diagnosed in childhood. The DSM-5 criteria allow for retrospective identification of childhood symptoms, and many adults are diagnosed later in life due to increased awareness or functional impairment.
Choice C reason: Endorsing "sometimes, often, or very often" to four of the six Part A questions meets the threshold for further evaluation. This section screens for inattentive and hyperactive-impulsive symptoms. A positive screen warrants a comprehensive clinical assessment to confirm diagnosis and rule out other causes.
Choice D reason: Malingering implies intentional feigning of symptoms for secondary gain, which cannot be concluded based solely on a screening tool. Such a determination requires a thorough clinical evaluation and consideration of context, which is not provided here.
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