A client on an inpatient psychiatric unit yells "My roommate is Satan's crafty minion" and attempts to strangle him. The patient is refusing redirection. What medication should the nurse expect the on-call provider to order?

Haloperidol (Haldol).

Hydroxyzine (Vistaril).

Valproate (Depakote).

Lithium carbonate (Lithobid).

Answer and Explanation

The Correct Answer is A

Choice A reason: Haloperidol, a typical antipsychotic, blocks dopamine D2 receptors in the mesolimbic pathway, rapidly reducing agitation and psychosis-driven aggression in schizophrenia. This addresses the acute delusional behavior and amygdala hyperactivity, making it the preferred choice for immediate control.

Choice B reason: Hydroxyzine, an antihistamine, reduces anxiety via histamine and mild anticholinergic effects but lacks antipsychotic properties. It cannot address dopamine-driven delusions or aggression in schizophrenia, making it ineffective for controlling acute psychotic agitation.

Choice C reason: Valproate stabilizes mood in bipolar disorder via GABA enhancement but is not indicated for acute psychotic aggression. Schizophrenia’s dopamine excess requires rapid receptor blockade, which valproate cannot provide, making it unsuitable for this scenario.

Choice D reason: Lithium stabilizes mood in bipolar disorder by modulating sodium channels and inositol, not acute psychosis. Schizophrenia’s mesolimbic dopamine hyperactivity requires antipsychotic intervention, making lithium ineffective for controlling delusional aggression in this acute situation.

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Correct Answer is B

Explanation

Choice A reason: Persistent depressive disorder responds better to SSRIs or psychotherapy, as MAOIs’ risk of hypertensive crises due to monoamine buildup limits their use. MAOIs increase serotonin, dopamine, and norepinephrine, but are reserved for severe cases due to complex neural interactions.

Choice B reason: MAOIs like phenelzine are used for treatment-resistant depression, where SSRIs fail, by increasing serotonin, dopamine, and norepinephrine via enzyme inhibition. This broad monoamine enhancement alters prefrontal-amygdala circuits, addressing severe depressive symptoms unresponsive to other treatments, making it the primary indication.

Choice C reason: Moderate depression is typically treated with SSRIs or SNRIs, which have safer profiles. MAOIs’ risk of serotonin and norepinephrine overload, causing hypertensive crises, makes them unsuitable for moderate cases, where less aggressive neural modulation is effective.

Choice D reason: Mild depression is managed with psychotherapy or SSRIs, not MAOIs, which risk serious side effects like tyramine-induced hypertensive crises due to excessive monoamine levels. MAOIs are reserved for severe, resistant cases, not mild neural dysregulation.

A. Neuroleptic malignant syndrome. B. Agranulocytosis. C. Acute dystonic reaction. D. Serotonin syndrome.

Correct Answer is D

Explanation

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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A client on an inpatient psychiatric unit yells "My roommate is Satan's crafty minion" and attempts to strangle him. The patient is refusing redirection. What medication should the nurse expect the on-call provider to order?

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Naxlex Comprehensive Predictor Exams

Monoamine oxidase inhibitors are used to treat which of the following?

Correct Answer is B

Explanation

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?

Correct Answer is D

Explanation

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A client on an inpatient psychiatric unit yells "My roommate is Satan's crafty minion" and attempts to strangle him. The patient is refusing redirection. What medication should the nurse expect the on-call provider to order?