A 51-year-old woman with a history of generalized anxiety disorder (GAD) has been treated with 20 mg of paroxetine (Paxil) for 6 months. The dose was increased to 40 mg at her last visit 2 weeks ago due to increased symptoms of anxiety. Now she reports “hot flashes” and significant hyperhidrosis to her psychiatric mental health nurse practitioner. Which of the following statements is NOT correct about this clinical scenario?
The client is experiencing a dose-dependent antidepressant-related hyperhidrosis.
Selective serotonin reuptake inhibitors (SSRIs) may be less effective in women over 50, especially if they are not taking estrogen.
The PMHNP should switch the client to escitalopram (Lexapro), which has a lower potential for dose-dependent hyperhidrosis.
An appropriate next step would be to reduce the dose of paroxetine back to 20 mg, add a short-term adjunctive treatment for acute anxiety, and draw labs to check her hormone levels prior to making further medication changes.
The Correct Answer is C
Choice A reason: Hyperhidrosis is a known dose-dependent side effect of SSRIs, particularly paroxetine, making this statement correct.
Choice B reason: Age-related changes in drug metabolism and hormone levels may reduce SSRI efficacy in women over 50, making this statement accurate.
Choice C reason: This statement is not correct. While escitalopram may have a slightly lower risk of hyperhidrosis, switching without first evaluating dose adjustment or other interventions is not the standard first approach. The focus should be on managing side effects while maintaining therapeutic efficacy.
Choice D reason: Reducing the dose and considering adjunctive therapies while evaluating hormonal status is an appropriate, evidence-based approach to managing SSRI-induced hyperhidrosis in this patient population.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Dialectical Behavioral Therapy (DBT) is primarily used for emotion regulation and managing self-harm behaviors, often in borderline personality disorder, rather than addressing existential questions about meaning and mortality.
Choice B reason: Rational Emotive Behavioral Therapy (REBT) focuses on challenging and changing irrational beliefs to reduce anxiety and depression. While it can address anxiety, it does not directly explore the philosophical concerns about life’s purpose that this patient presents.
Choice C reason: Existential therapy directly addresses questions about the meaning of life, death, freedom, and isolation. It helps individuals explore existential anxiety and personal responsibility, making it the most appropriate therapy for this patient’s concerns.
Choice D reason: Group therapy provides support and interpersonal feedback but may not allow for focused exploration of deep existential questions. While beneficial for social support, it is not the primary therapeutic approach for this type of existential anxiety.
Correct Answer is D
Explanation
Choice A reason: Carbamazepine is an anticonvulsant used for seizure disorders and certain mood disorders. It does not have a rapid anxiolytic effect suitable for acute preoperative anxiety.
Choice B reason: Clonidine is an alpha-2 agonist used for hypertension and sometimes off-label for anxiety, but it is not first-line for acute situational anxiety and has slower onset than benzodiazepines.
Choice C reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for chronic anxiety and depression. It does not act rapidly enough for acute preoperative anxiety.
Choice D reason: Lorazepam is a benzodiazepine with rapid onset that can effectively reduce situational anxiety before surgery. It is appropriate for short-term use in acute anxiety scenarios such as preoperative stress, with careful monitoring for sedation and respiratory effects.
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