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 D
Explanation
Choice A reason: Cognitive behavioral therapy (CBT) for parents is a valid and evidence-based intervention for managing ADHD. It helps parents develop strategies to reinforce positive behaviors and manage symptoms effectively.
Choice B reason: Family therapy and education are important components of ADHD management. Educating the family about the disorder and improving communication can enhance treatment outcomes and reduce stress.
Choice C reason: Dietary modifications, such as reducing artificial additives or exploring elimination diets, have been explored as adjunctive treatments. While evidence is mixed, they are considered valid nonpharmacologic options under clinical guidance.
Choice D reason: Treatment of learning disorders is important if comorbid conditions exist, but it is not a direct treatment for ADHD itself. Learning disorders may coexist with ADHD, but addressing them does not target core ADHD symptoms like inattention, hyperactivity, or impulsivity.
Correct Answer is B
Explanation
Choice A reason: Hyperactivity, flight of ideas, and rapid speech are more indicative of manic or hypomanic states. These symptoms are not typically associated with intimate partner violence.
Choice B reason: Withdrawal, fearfulness, and hypersensitivity to touch are classic signs of trauma and abuse. These behaviors may reflect hypervigilance, fear of physical contact, and emotional distress, all of which are consistent with a history of intimate partner violence.
Choice C reason: Defensiveness and anger may be present in various psychiatric conditions, including personality disorders or trauma responses. However, they are not as specific or telling as the signs in choice B.
Choice D reason: Disorganized thinking and labile mood may suggest psychosis or mood disorders but are not specific indicators of intimate partner violence. They lack the trauma-related behavioral cues seen in choice B.
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