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 B
Explanation
Choice A reason: Extrapyramidal symptoms are associated with dopamine antagonists, such as antipsychotics, and are not a concern with lamotrigine.
Choice B reason: Stevens-Johnson syndrome is a rare but serious dermatologic reaction associated with lamotrigine, especially when titrated too quickly. Slow titration reduces the risk of this potentially life-threatening condition.
Choice C reason: Neuroleptic malignant syndrome is linked to antipsychotic use and is not associated with lamotrigine.
Choice D reason: Orthostatic hypotension is a side effect of some psychotropic medications but is not a primary concern with lamotrigine.
Correct Answer is C
Explanation
Choice A reason: Sigmund Freud developed psychosexual stages of development, which primarily focus on early childhood and do not extend meaningfully into older adulthood.
Choice B reason: Jean Piaget is known for his cognitive development theory, which focuses on childhood stages of learning and does not address adult psychosocial development.
Choice C reason: Erik Erikson developed the psychosocial stages of development, which span from infancy to late adulthood. His final stage, "Integrity vs. Despair," specifically addresses the challenges of aging and finding meaning after retirement.
Choice D reason: Milton Erickson was a psychiatrist known for his work in hypnosis and brief therapy, not for a developmental theory covering the lifespan.
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