A 36-year-old man presents to the psychiatric-mental health nurse practitioner with lethargy, confusion, and impaired judgment. He has been stable on 8 mg of buprenorphine for 2 years. Recently, his primary care provider prescribed a new medication. Which of the following medications most likely contributed to his current condition?
Gabapentin (Neurontin)
Naltrexone
Naloxone
Carbamazepine (Tegretol)
The Correct Answer is A
Choice A reason: Gabapentin is a central nervous system (CNS) depressant that, when combined with buprenorphine, can significantly increase the risk of sedation, respiratory depression, and cognitive impairment. The synergistic depressant effects on the CNS can lead to symptoms such as lethargy, confusion, and impaired judgment. Clinical studies and pharmacological data confirm that co-administration of gabapentin with opioids like buprenorphine should be approached with caution due to the heightened risk of overdose and serious adverse effects.
Choice B reason: Naltrexone is an opioid antagonist used to treat opioid and alcohol dependence. It blocks the effects of opioids and does not cause CNS depression. If administered to someone on buprenorphine, it may precipitate withdrawal but would not typically cause lethargy or confusion unless withdrawal symptoms were severe. However, the patient has been stable on buprenorphine, and naltrexone would more likely cause acute withdrawal rather than the described symptoms.
Choice C reason: Naloxone is also an opioid antagonist, primarily used in emergency settings to reverse opioid overdose. It is not typically prescribed for long-term use and would not be expected to cause lethargy or confusion unless it precipitated withdrawal. Like naltrexone, its role is more acute and would not align with the described gradual onset of symptoms.
Choice D reason: Carbamazepine is an anticonvulsant and mood stabilizer. While it has CNS effects, its interaction with buprenorphine is not as pronounced or dangerous as gabapentin. It may cause sedation or dizziness, but it is less likely to cause the level of CNS depression described unless combined with other sedatives. It is not the most likely contributor in this scenario.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Beneficence refers to the ethical obligation to do good and promote the well-being of patients. It emphasizes positive actions but does not specifically address fairness in care delivery.
Choice B reason: Justice is the ethical principle that emphasizes fairness, equity, and impartiality in healthcare. It requires that nurses treat all patients equally, distribute resources fairly, and avoid discrimination. Justice ensures that care is provided based on need and not influenced by bias or favoritism.
Choice C reason: Respect is a foundational value in nursing ethics, involving honoring the dignity, autonomy, and rights of individuals. While it supports fair treatment, it does not directly define fairness in the distribution of care.
Choice D reason: Fidelity refers to faithfulness and loyalty in professional relationships. It involves keeping promises and maintaining trust but does not specifically address fairness in care.
Correct Answer is D
Explanation
Choice A reason: Calling her mother to take her home does not address the acute psychiatric risk. The client is experiencing psychosis, has expressed paranoid delusions, and made threatening statements. Sending her home without intervention poses a danger to herself and others.
Choice B reason: Administering Geodon (ziprasidone) may help manage agitation or psychosis temporarily, but it does not resolve the underlying safety concerns. Additionally, administering medication without consent in a non-emergency outpatient setting may violate ethical and legal standards.
Choice C reason: Having the mother sign a medication contract is inappropriate in this context. The client is acutely manic and psychotic, and her capacity to consent or adhere to treatment is compromised. Delaying intervention for a week could result in harm.
Choice D reason: Involuntary commitment is warranted when a client poses a danger to themselves or others due to mental illness. The client’s delusions, threats of violence, and impaired judgment meet criteria for involuntary hospitalization. This ensures safety and allows for stabilization and treatment.
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