The PMHNP diagnoses a 25-year-old woman with generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying, “I need something to control them immediately.” The patient is otherwise fit and healthy and has no history of substance abuse or dependence. Which of the following strategies would be reasonable?
Start the patient on alprazolam and refer her to cognitive-behavioral therapy
Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for the short term
Start the patient on any SSRI
Start the patient in individual psychotherapy
The Correct Answer is B
Choice A reason: Alprazolam is a short-acting benzodiazepine that carries high risk for dependence. Using it as monotherapy without long-term management is not recommended.
Choice B reason: This is the correct answer. SSRIs are first-line long-term treatment for generalized anxiety disorder, and low-dose benzodiazepines such as clonazepam can be used short-term for rapid symptom relief during initiation of SSRIs. This approach balances immediate relief with safe long-term management.
Choice C reason: While starting an SSRI alone is reasonable, it may not provide immediate symptom relief, which the patient is requesting. Short-term adjunctive therapy is often needed initially.
Choice D reason: Psychotherapy alone is effective but does not meet the patient’s request for rapid symptom control. Combining therapy with pharmacologic treatment is more appropriate in this scenario.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Gabapentin is used for neuropathic pain but is not considered first-line therapy for mild-to-moderate carpal tunnel syndrome, particularly in pregnancy.
Choice B reason: Anti-inflammatories, such as NSAIDs, may relieve symptoms but are generally avoided in pregnancy due to potential fetal risks and are not considered first-line for mechanical compression neuropathies.
Choice C reason: Corticosteroids can reduce inflammation but are not typically the initial treatment due to potential systemic effects, especially in pregnancy.
Choice D reason: Splinting of the wrist, particularly a neutral-position splint, is considered the first-line treatment for carpal tunnel syndrome during pregnancy. It helps reduce compression on the median nerve and relieve nocturnal symptoms safely.
Correct Answer is D
Explanation
Choice A reason: Conduct disorder involves more severe violations of societal rules and the rights of others, such as aggression toward people or animals, destruction of property, deceitfulness, or theft, which are not described here.
Choice B reason: Antisocial personality disorder is diagnosed only in individuals aged 18 and older; therefore, it cannot be applied to a 7-year-old child.
Choice C reason: Intermittent explosive disorder is characterized by discrete episodes of severe aggression or rage that are disproportionate to the situation, rather than ongoing patterns of defiance and blame.
Choice D reason: This is correct. ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness toward authority figures, which matches the behaviors described in this child.
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