Mr. Jones is a 52-year-old man who presents as a new patient to the PMHNP because his psychiatrist recently retired. He is stable on his medications for depression and anxiety, and he says he hasn't had labs drawn in "at least 2 years." His current medication regimen is: acetaminophen (Tylenol) 500 mg PO prn for knee pain, omeprazole (Prilosec) 20 mg PO BID, escitalopram (Lexapro) 20 mg PO daily, and brexpiprazole (Rexulti) 1 mg PO daily. What screening labs are appropriate for this patient?
Complete blood count (CBC) and comprehensive metabolic panel (CMP)
Complete blood count (CBC), comprehensive metabolic panel (CMP), lipid profile, and thyroid panel
Complete blood count (CBC), comprehensive metabolic panel (CMP), lipid profile, thyroid profile, and vitamins B12 and D levels
Complete blood count (CBC), basic metabolic panel (BMP), thyroid panel, lipid profile, and vitamin D level
The Correct Answer is C
Choice A reason: While CBC and CMP are essential baseline labs, they are insufficient for a middle-aged patient on psychotropic medications and with chronic medical conditions, as they do not assess nutritional deficiencies or lipid status.
Choice B reason: Adding a lipid profile and thyroid panel increases the scope of monitoring but still omits critical nutritional labs like vitamin B12 and D, which are relevant for long-term mental health, bone health, and medication effects.
Choice C reason: This comprehensive lab panel covers blood counts, metabolic status, lipid profile, thyroid function, and essential vitamins. Vitamin B12 and D deficiencies are common in adults on chronic psychotropic medications and can impact mood, cognition, and overall health.
Choice D reason: Using a BMP instead of CMP provides less information about liver function, which is important for monitoring medication safety. Omitting vitamin B12 also leaves a gap in assessing nutritional risk factors.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Duty to patient refers to the healthcare provider’s legal obligation to provide care according to professional standards, not the harm suffered.
Choice B reason: Breach of duty refers to failure to meet the standard of care, such as not checking labs before administering gentamycin, but it does not directly represent the patient’s resulting harm.
Choice C reason: Proximate cause links the breach of duty to the harm that occurred, establishing causation but not the harm itself.
Choice D reason: Damages are the actual harm or losses suffered by the patient, including physical injury, financial loss, or loss of employment, as in this case where hearing loss led to inability to perform her job.
Correct Answer is A
Explanation
Choice A reason: Electroconvulsive therapy (ECT) is the most effective treatment for severe, treatment-resistant depression, particularly when multiple medication trials have failed. ECT can rapidly reduce suicidal ideation and depressive symptoms and is indicated in cases where there is high clinical urgency.
Choice B reason: Exposure therapy is primarily used to treat anxiety disorders, phobias, and PTSD, not major depressive disorder, and would not be effective in this context.
Choice C reason: Support groups provide emotional support and social connection but are not sufficient as a primary intervention for severe, treatment-resistant depression with suicidal ideation.
Choice D reason: Exercise can improve mood and has adjunctive benefits for mild to moderate depression, but it is not an effective treatment for severe, chronic, or treatment-resistant depression, especially with suicidal ideation.
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