A genetics report for a patient with bipolar disorder shows lamotrigine (Lamictal) should be an effective treatment for them. The PMHNP will slowly titrate the dose of lamotrigine for which of the following reasons?
Extrapyramidal symptoms
Stevens-Johnson syndrome
Neuroleptic malignant syndrome
Orthostatic hypotension
The Correct Answer is B
Choice A reason: Extrapyramidal symptoms are associated with dopamine antagonists, such as antipsychotics, and are not a concern with lamotrigine.
Choice B reason: Stevens-Johnson syndrome is a rare but serious dermatologic reaction associated with lamotrigine, especially when titrated too quickly. Slow titration reduces the risk of this potentially life-threatening condition.
Choice C reason: Neuroleptic malignant syndrome is linked to antipsychotic use and is not associated with lamotrigine.
Choice D reason: Orthostatic hypotension is a side effect of some psychotropic medications but is not a primary concern with lamotrigine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Bupropion is a norepinephrine-dopamine reuptake inhibitor and does not significantly increase serotonin levels. While it can cause seizures in overdose, it is not typically associated with serotonin syndrome.
Choice B reason: Phenelzine is a monoamine oxidase inhibitor (MAOI) that prevents the breakdown of serotonin. When combined with venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), it can lead to dangerously elevated serotonin levels and trigger serotonin syndrome. The symptoms described—tachycardia, diaphoresis, and myoclonic jerks—are classic signs.
Choice C reason: Lorazepam is a benzodiazepine and acts on GABA receptors. It does not affect serotonin levels and is not implicated in serotonin syndrome.
Choice D reason: Hydroxyzine is an antihistamine with anxiolytic properties. It does not influence serotonin metabolism and is not associated with serotonin syndrome.
Correct Answer is B
Explanation
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.
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