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: Clomipramine, a tricyclic antidepressant, targets serotonin and norepinephrine reuptake for depression, not bipolar mood stabilization. It risks triggering mania by overstimulating monoamine pathways, making it unsuitable for rapid-cycling bipolar disorder, which requires mood-stabilizing anticonvulsants.

Choice B reason: Risperidone, an antipsychotic, blocks dopamine and serotonin receptors, managing acute mania but not rapid cycling. Anticonvulsants like carbamazepine stabilize mood by modulating sodium channels, making risperidone less effective for long-term control of bipolar mood fluctuations.

Choice C reason: Clonidine, an alpha-2 agonist, reduces norepinephrine release for hypertension or ADHD, not bipolar disorder. It lacks mood-stabilizing properties, unlike anticonvulsants, which modulate neuronal excitability, making it inappropriate for managing rapid-cycling bipolar mood changes.

Choice D reason: Carbamazepine, an anticonvulsant, stabilizes mood in rapid-cycling bipolar disorder by inhibiting voltage-gated sodium channels, reducing neuronal excitability in the limbic system. This prevents manic and depressive episodes, making it a first-line choice for stabilizing rapid mood cycles.

A. A 25-year-old woman who is not experiencing symptoms of delusions and hallucinations. B. A 20-year-old man who is exhibiting a decrease in his ability to concentrate and function in daily activities. C. A 30-year-old man who is experiencing an exacerbation of symptoms after stopping his antipsychotic. D. A 28-year-old woman who is exhibiting bizarre and disruptive behavior.

Correct Answer is B

Explanation

Choice A reason: Absence of symptoms does not indicate the prodromal phase of schizophrenia, which involves subtle cognitive and functional declines driven by early dopamine dysregulation in the prefrontal cortex. This woman shows no signs of prodromal neural changes, making this choice incorrect.

Choice B reason: The prodromal phase of schizophrenia includes decreased concentration and functioning, reflecting early dopamine and glutamate dysregulation in the prefrontal cortex and hippocampus. These subtle neurocognitive changes precede overt psychosis, accurately describing the 20-year-old’s symptoms as prodromal.

Choice C reason: Exacerbation after stopping antipsychotics indicates active schizophrenia, not the prodromal phase. Dopamine receptor hypersensitivity from medication withdrawal causes symptom relapse, not the subtle, pre-psychotic cognitive decline characteristic of the prodromal period, making this incorrect.

Choice D reason: Bizarre and disruptive behavior indicates active schizophrenia, not the prodromal phase. Overt psychosis reflects advanced mesolimbic dopamine hyperactivity, unlike the prodromal period’s subtle cognitive and functional impairments driven by early prefrontal and hippocampal changes.

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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?

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Naxlex Comprehensive Predictor Exams

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. Which drug should the nurse anticipate will be prescribed?

Correct Answer is D

Explanation

Which client best exhibits the characteristics that are typical of the prodromal period of schizophrenia?

Correct Answer is B

Explanation

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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?

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