A client is brought to the emergency department after exhibiting vital sign instability, diaphoresis, shivering, incoordination, hyperreflexia, hyperpyrexia, and diarrhea. The client is taking paroxetine (Paxil) for depression. Which condition should the nurse most likely suspect?

Neuroleptic malignant syndrome.

Agranulocytosis.

Acute dystonic reaction.

Serotonin syndrome.

Answer and Explanation

The Correct Answer is D

Choice A reason: Neuroleptic malignant syndrome is associated with antipsychotics, not SSRIs like paroxetine, causing muscle rigidity and hyperthermia via dopamine blockade. The client’s symptoms, including hyperreflexia and diarrhea, align with serotonin excess, not dopamine-related issues, making this condition unlikely.

Choice B reason: Agranulocytosis, a severe reduction in white blood cells, is unrelated to paroxetine’s mechanism. SSRIs increase serotonin, not affecting hematopoiesis. The client’s symptoms like hyperpyrexia and hyperreflexia indicate serotonin toxicity, not an immunological or bone marrow disorder.

Choice C reason: Acute dystonic reactions involve muscle spasms from antipsychotics’ dopamine antagonism, not SSRIs. Paroxetine’s serotonin increase causes hyperreflexia and hyperpyrexia, consistent with serotonin syndrome, not extrapyramidal symptoms, making this diagnosis inappropriate for the described clinical presentation.

Choice D reason: Serotonin syndrome results from excessive serotonin due to paroxetine, an SSRI, overstimulating 5-HT receptors, causing hyperreflexia, hyperpyrexia, and autonomic instability. These symptoms reflect serotonin-driven neural excitation, particularly in the brainstem and spinal cord, matching the client’s clinical presentation accurately.

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Correct Answer is D

Explanation

Choice A reason: Divorce represents distress, not eustress, as it triggers negative emotional responses via heightened cortisol and amygdala activity, disrupting serotonin and dopamine balance. This chronic stress impairs prefrontal cortex function, leading to emotional dysregulation, unlike eustress, which promotes positive motivation and growth.

Choice B reason: Job loss threat is distress, activating the HPA axis to release cortisol, increasing amygdala-driven anxiety. This disrupts serotonin signaling, impairing mood regulation, and does not foster positive motivation or growth, unlike eustress, which involves beneficial stress enhancing performance without overwhelming neural systems.

Choice C reason: Financial strain is distress, elevating cortisol via HPA axis activation, increasing amygdala activity, and reducing prefrontal control, leading to anxiety. Unlike eustress, which promotes motivation through manageable challenges, this scenario causes negative emotional responses, disrupting serotonin and dopamine balance, impairing coping mechanisms.

Choice D reason: Learning new skills for a promotion is eustress, activating moderate HPA axis responses and dopamine release in the reward system, enhancing motivation and prefrontal cortex function. This positive stress promotes neuroplasticity, improving cognitive adaptability and emotional resilience, unlike distress, which overwhelms neural regulatory systems.

A. Do you have any positive therapeutic relationships? B. Have you recently lost your job? C. Do you ever use alcohol to help you feel better? D. Have you ever been the victim of bullying?

Correct Answer is A

Explanation

Choice A reason: Positive therapeutic relationships are protective against suicide, enhancing serotonin-mediated emotional regulation and prefrontal cortex coping mechanisms. Social support reduces amygdala-driven despair, lowering suicide risk by fostering resilience and emotional stability in depressed clients.

Choice B reason: Job loss is a risk factor, not a protective factor, for suicide, increasing stress and cortisol levels, which exacerbate serotonin deficits and amygdala hyperactivity. This question does not identify protective elements that mitigate suicide risk in depression.

Choice C reason: Alcohol use is a risk factor, not protective, as it depresses serotonin and impairs prefrontal cortex judgment, increasing impulsivity and suicide risk. This question does not assess protective factors but rather identifies behaviors that heighten vulnerability.

Choice D reason: Bullying history is a risk factor, contributing to trauma and serotonin dysregulation, increasing suicide risk via amygdala hyperactivity. This question does not identify protective factors like social support that reduce suicide risk in depressed clients.

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A client is brought to the emergency department after exhibiting vital sign instability, diaphoresis, shivering, incoordination, hyperreflexia, hyperpyrexia, and diarrhea. The client is taking paroxetine (Paxil) for depression. Which condition should the nurse most likely suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which scenario best demonstrates an example of eustress?

Correct Answer is D

Explanation

The nurse conducts a health history assessment for a client who is depressed. Which question should the nurse include to determine the client’s protective factors for suicide?

Correct Answer is A

Explanation

A primary intervention strategy for coping with a maturational crisis includes:

During lunch, a patient cuts herself with a plastic eating utensil. The patient refuses redirection and continues to attempt to cut herself. The patient is safely secured in a restraint chair. What is the next priority action for the nurse?

A nurse is reviewing the medical record of a client diagnosed with depression and notes that the client has been prescribed bupropion (Wellbutrin). The client asks, "What kind of medication is this anyway?" The nurse would inform the client this agent is a:

When assessing a patient's plan for suicide, what aspect has priority?

The plan of care for a patient in the manic state of bipolar disorder should include which intervention?

As part of the stress response, the HPA axis is stimulated. Which structures make up this system?

A client with bipolar disorder has advanced lithium toxicity with a lithium level of 1.7 mEq/L. Which symptom would the nurse expect to assess?

A client with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg daily. The client asks the nurse how this medicine minimizes hallucinations. The nurse explains that the mechanism by which olanzapine controls the client's psychotic symptoms is believed to be what?