A 36-year-old man is evaluated by the PMHNP for a recent incident in which he stayed up for several nights in a row, had much more energy than usual, and believed he was talking to God. He was diagnosed with bipolar disorder. In reviewing his medications, the PMHNP finds he is taking acetaminophen 500 mg BID, bupropion XL (Wellbutrin) 150 mg once daily, Sam-E for pain from an old football injury, and alprazolam 0.5 mg pm for agitation. Which of these should be discontinued immediately?
Acetaminophen (Tylenol)
Sam-E
Bupropion (Wellbutrin)
Alprazolam (Xanax)
The Correct Answer is C
Choice A reason: Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
Choice B reason: Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
Choice C reason: Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
Choice D reason: Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Ischemic stroke may present with focal neurological deficits, but the combination of unequal pupils, inability to sit up, and high blood pressure suggests a more global intracranial process rather than a localized ischemic event.
Choice B reason: This choice is correct because the patient’s altered mental status, unequal and sluggish pupils, postural instability, and elevated blood pressure are classic signs of increased intracranial pressure. These findings suggest a critical neurological emergency.
Choice C reason: Myocardial infarction typically presents with chest pain, shortness of breath, and cardiovascular symptoms rather than altered mental status and pupil abnormalities.
Choice D reason: Cerebral aneurysm rupture can cause acute neurological decline, but unequal pupils and gradually increasing blood pressure are more consistent with generalized intracranial pressure rather than the sudden presentation of a subarachnoid hemorrhage.
Correct Answer is C
Explanation
Choice A reason: Neurosyphilis can cause neuropsychiatric symptoms but typically presents with a broader spectrum including sensory deficits and gait disturbances.
Choice B reason: Kuru is a prion disease historically seen in Papua New Guinea with tremors and ataxia, not a common diagnosis elsewhere.
Choice C reason: Huntington’s disease presents with movement disorders (chorea), cognitive decline, and psychiatric symptoms such as depression, often in midlife.
Choice D reason: HIV-associated neurocognitive disorder may cause cognitive deficits but motor abnormalities are less specific and occur later in disease progression.
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