A 48-year-old man with a new diagnosis of chronic low back pain requests a prescription for opioids. Which of the following is the most appropriate response?
“Guidelines recommend nonpharmacologic therapies as first-line treatments for chronic low back pain.”
“Opioids are only recommended when other treatments are ineffective.”
“As a nurse practitioner, I cannot prescribe opioid medications.”
“I can prescribe opioids only after you have completed a comprehensive screening for addiction.”
The Correct Answer is A
Choice A reason: Clinical guidelines from organizations such as the CDC and American College of Physicians recommend nonpharmacologic therapies (e.g., physical therapy, exercise, cognitive behavioral therapy) as first-line treatments for chronic low back pain. This response aligns with evidence-based practice and promotes safer, more sustainable pain management.
Choice B reason: While technically accurate, this response lacks the emphasis on guideline-based care and may imply that opioids are a likely next step. It does not promote the preferred initial approach.
Choice C reason: This statement may be factually incorrect depending on the PMHNP’s scope of practice and state regulations. It also avoids addressing the clinical appropriateness of opioids.
Choice D reason: Although screening for addiction is important, this response implies that opioids are a viable option pending screening, which may not be appropriate as a first-line treatment. It also lacks the broader context of guideline-based care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Pearson's r correlation measures the strength and direction of a linear relationship between two variables. It does not directly indicate the probability of a result occurring by chance, although it may be used alongside inferential statistics to assess significance.
Choice B reason: The p-value is a statistical measure that indicates the probability of obtaining the observed results, or more extreme ones, assuming the null hypothesis is true. It is the primary tool used to determine statistical significance and assess whether findings are likely due to chance. A low p-value suggests that the observed effect is unlikely to be due to random variation alone.
Choice C reason: Probability is a general concept in statistics that refers to the likelihood of an event occurring. While foundational, it is not a specific inferential statistic used to test hypotheses or determine significance in research findings.
Choice D reason: The t-test is a statistical test used to compare the means of two groups. It helps determine whether differences between groups are statistically significant. However, the t-test produces a p-value, which is the actual statistic that describes the probability of the result occurring by chance.
Correct Answer is A
Explanation
Choice A reason: Carbamazepine is a known inducer of the cytochrome P450 3A4 enzyme, which metabolizes buprenorphine. Its induction leads to increased metabolism and reduced plasma levels of buprenorphine, thereby decreasing its efficacy. This interaction can result in withdrawal symptoms or reduced control of opioid use disorder.
Choice B reason: Amitriptyline is a tricyclic antidepressant that does not significantly affect buprenorphine metabolism. While it may have sedative effects or interact with other CNS depressants, it is not known to reduce buprenorphine efficacy.
Choice C reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and a CYP2D6 inhibitor. It does not significantly impact buprenorphine levels or efficacy. Its interaction profile is more relevant to serotonergic drugs than opioids.
Choice D reason: Erythromycin is a macrolide antibiotic and a CYP3A4 inhibitor. It can increase buprenorphine levels rather than decrease them. Therefore, it would not contribute to reduced efficacy but might increase side effects.
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