A nurse states, "I evaluated a new patient using the modified SAD PERSONS scale and got a score of 10. Should I send the patient home?" Select the best reply.

A score over 8 requires immediate hospitalization.

Give the patient a follow-up appointment. Hospitalization may be needed soon.

That action would seem to be appropriate based on the score.

I think you should strongly consider a benzodiazepine for this patient.

Answer and Explanation

The Correct Answer is A

Choice A reason: A SAD PERSONS score over 8 indicates high suicide risk, driven by serotonin dysregulation and amygdala hyperactivity, necessitating hospitalization to prevent self-harm. Immediate intervention stabilizes neurochemical imbalances and ensures safety, addressing the acute risk effectively.

Choice B reason: A follow-up appointment is inadequate for a score of 10, indicating high suicide risk. Serotonin and dopamine dysregulation heighten impulsivity, and delaying hospitalization risks self-harm, as outpatient care cannot address acute amygdala-driven suicidal ideation effectively.

Choice C reason: Sending the patient home with a score of 10 is unsafe, as high suicide risk involves serotonin deficits and amygdala hyperactivity. This disregards the need for immediate intervention to stabilize neurochemical imbalances and ensure safety, making it inappropriate.

Choice D reason: Benzodiazepines address anxiety but not suicide risk directly. A score of 10 indicates severe serotonin dysregulation and amygdala-driven impulsivity, requiring hospitalization, not anxiolytics, which may mask symptoms without addressing the underlying neurochemical suicide risk.

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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.

A. Atypical antidepressant. B. Tricyclic antidepressant. C. Selective serotonin reuptake inhibitor. D. Monoamine oxidase inhibitor.

Correct Answer is A

Explanation

Choice A reason: Bupropion is an atypical antidepressant, inhibiting dopamine and norepinephrine reuptake, enhancing prefrontal cortex and reward system activity. Unlike SSRIs or MAOIs, it minimally affects serotonin, targeting catecholamines to improve mood and energy, aligning with its unique mechanism in treating depression.

Choice B reason: Tricyclic antidepressants block serotonin and norepinephrine reuptake and have anticholinergic effects, unlike bupropion, which targets dopamine and norepinephrine without significant anticholinergic activity. This distinct pharmacological profile excludes bupropion from the tricyclic class, making this choice incorrect.

Choice C reason: Selective serotonin reuptake inhibitors like fluoxetine target serotonin exclusively, increasing 5-HT levels. Bupropion primarily inhibits dopamine and norepinephrine reuptake, with minimal serotonin effects, making it an atypical antidepressant, not an SSRI, due to its distinct neurochemical action.

Choice D reason: Monoamine oxidase inhibitors like phenelzine prevent monoamine breakdown, increasing serotonin, dopamine, and norepinephrine. Bupropion’s selective reuptake inhibition of dopamine and norepinephrine, without MAO inhibition, distinguishes it as an atypical antidepressant, not an MAOI, due to its specific mechanism.

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A nurse states, "I evaluated a new patient using the modified SAD PERSONS scale and got a score of 10. Should I send the patient home?" Select the best reply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

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:

Correct Answer is A

Explanation

A nurse is preparing to administer acetaminophen 320 mg PO every four hours as needed for pain. The amount available from the pharmacy is acetaminophen liquid 160 mg/5 mL. How many mL should the nurse administer per dose? (Round to the nearest whole number.)

The nurse preparing to teach a patient diagnosed with post-traumatic stress disorder (PTSD) about recommended psychotherapy and psychopharmacology will discuss:

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

The most appropriate response by the nurse when a despondent patient says "Nothing matters anymore" would be:

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?

A victim of intimate partner violence comes to the crisis center seeking help. The nurse uses crisis intervention strategies that focus on what?

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

A nurse is conducting a visit to a client who is receiving palliative care at home for dying. The client’s husband tells the nurse, "I know she needs to be with God. That is the best place for her now." The client is experiencing which stage of Kubler-Ross’ stages of grieving?