A 43-year-old man with a BMI of 33 presents to the PMHNP with complaints of being depressed, difficulty falling asleep, loss of motivation, diminished concentration, and decreased sexual desire. Based on this scenario, which of the following medications would be most appropriate as an initial treatment?
Mirtazapine
Fluoxetine
Bupropion
Nortriptyline
The Correct Answer is C
Choice A reason: Mirtazapine is a sedating antidepressant that can cause significant weight gain and increased appetite. Given the patient’s elevated BMI, this side effect profile may worsen his metabolic status and is not ideal as a first-line option.
Choice B reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and is generally weight-neutral or mildly weight-reducing. However, it can cause sexual dysfunction, which is already a concern for this patient. It may also exacerbate insomnia in some individuals.
Choice C reason: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that is activating and can improve energy, motivation, and concentration. It is associated with weight loss and has a lower risk of sexual side effects compared to SSRIs, making it the most appropriate initial choice for this patient’s symptom profile and BMI.
Choice D reason: Nortriptyline is a tricyclic antidepressant with anticholinergic side effects and potential for weight gain. It is not typically used as a first-line agent due to its side effect burden and cardiovascular risks, especially in patients with metabolic concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Empathy is a core component of therapeutic relationships and does not indicate countertransference. It reflects appropriate emotional attunement and professional compassion.
Choice B reason: This behavior reflects transference, where the patient projects feelings or associations from past relationships onto the therapist. It is not countertransference, which originates from the clinician.
Choice C reason: Countertransference occurs when the clinician projects personal feelings onto the patient, often unconsciously. Spending excessive time and thinking about the patient outside of clinical hours suggests that the nurse practitioner’s emotional boundaries are compromised, indicating countertransference.
Choice D reason: A patient giving a gift may reflect transference or an attempt to build rapport. It does not necessarily indicate countertransference unless the clinician responds inappropriately or emotionally.
Correct Answer is B
Explanation
Choice A reason: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that can be used for depression and pain. However, it has moderate CYP2D6 inhibition, which may interfere with tamoxifen metabolism and reduce its efficacy.
Choice B reason: Venlafaxine is an SNRI with minimal CYP2D6 inhibition. It is effective for depression and also helps alleviate hot flashes, making it the most appropriate choice for this patient.
Choice C reason: Bupropion is a norepinephrine-dopamine reuptake inhibitor and a strong CYP2D6 inhibitor. It can significantly reduce the conversion of tamoxifen to its active metabolite, endoxifen, thereby compromising its therapeutic effect.
Choice D reason: Fluoxetine is a potent CYP2D6 inhibitor and should be avoided in patients taking tamoxifen due to the risk of reducing its efficacy in preventing breast cancer recurrence.
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