A 49-year-old female client presents to the PMHNP for a medication evaluation prior to beginning treatment for rheumatoid arthritis. As they are reviewing her psychiatric medications, the client says, "I also take melatonin, but that probably doesn't matter." What is the most appropriate response from the PMHNP?
"You're right, melatonin is a safe drug with few side effects or interactions."
"Actually, melatonin is contraindicated with immunosuppressants."
"You should probably discuss this with your primary care provider."
"Why don't I switch you to a benzodiazepine instead?"
The Correct Answer is B
Choice A reason: While melatonin is generally considered safe for short-term use, it has clinically significant interactions with several medications, including immunosuppressants. It can stimulate immune function, which may counteract the effects of immunosuppressive therapy. Therefore, this response is overly dismissive and potentially unsafe.
Choice B reason: Melatonin can interfere with immunosuppressive therapy by enhancing immune activity, which is counterproductive in conditions like rheumatoid arthritis where immunosuppression is often necessary. This makes it contraindicated or at least a cautionary supplement in such contexts. The PMHNP should recognize this and advise accordingly.
Choice C reason: While deferring to the primary care provider may seem prudent, the PMHNP is qualified to assess drug interactions and should take responsibility for evaluating the safety of melatonin in this context. This response lacks clinical assertiveness.
Choice D reason: Suggesting a benzodiazepine as a replacement for melatonin without assessing the client’s full psychiatric and medical profile is inappropriate. Benzodiazepines carry risks of dependence and sedation and are not a direct substitute for melatonin in most cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The anal stage, occurring around ages 1 to 3, is associated with issues of control, orderliness, and autonomy. Fixation at this stage may result in traits such as obsessiveness or rigidity, not substance use or oral behaviors.
Choice B reason: The oral stage is the first stage in Freud’s psychosexual development (birth to 1 year). It centers on pleasure derived from oral activities such as sucking and eating. Fixation at this stage is linked to behaviors such as smoking, overeating, nail-biting, and alcohol use—making it the most appropriate answer.
Choice C reason: The phallic stage (ages 3 to 6) involves the Oedipus and Electra complexes and focuses on genital awareness. Fixation here may lead to issues with authority or sexual identity, not oral behaviors.
Choice D reason: The latent stage (ages 6 to puberty) is a period of relative calm in psychosexual development, where sexual impulses are repressed. Fixation here is not typically associated with substance use or oral behaviors.
Correct Answer is A
Explanation
Choice A reason: Dopamine plays a central role in the pathophysiology of extrapyramidal symptoms. EPS occurs due to dopamine receptor blockade in the nigrostriatal pathway, particularly with antipsychotic medications. Reducing dopamine activity in this pathway leads to motor disturbances similar to Parkinsonism. Therefore, managing EPS often involves balancing dopamine levels or using medications that counteract dopamine blockade.
Choice B reason: Serotonin is involved in mood regulation and other central nervous system functions, but it is not directly implicated in the development of EPS. While some antipsychotics affect serotonin receptors, EPS symptoms are primarily linked to dopamine dysregulation.
Choice C reason: Norepinephrine is associated with arousal, attention, and stress responses. It does not play a significant role in the extrapyramidal system, and altering its levels would not directly alleviate EPS.
Choice D reason: Glutamate is the primary excitatory neurotransmitter and is involved in learning and memory. Although it interacts with dopamine systems, it is not the primary neurotransmitter responsible for EPS, and decreasing glutamate would not be a targeted approach for treating these symptoms.
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