The PMHNP is treating a 46-year-old woman who has been taking paroxetine (Paxil) for 10 years. She has been trying to discontinue the medication for several weeks but is struggling with withdrawal symptoms. The PMHNP understands this is due to which of the following reasons?
A short half-life
A long half-life
Other medications the patient is taking
Paroxetine metabolism via CYP450 pathway
The Correct Answer is A
Choice A reason: Paroxetine has a relatively short half-life of approximately 21 hours, which contributes to rapid fluctuations in plasma levels when the drug is discontinued. This abrupt drop in serotonin levels can lead to significant withdrawal symptoms such as dizziness, nausea, irritability, and "brain zaps." The short half-life makes it one of the SSRIs most associated with severe discontinuation syndrome.
Choice B reason: A long half-life, such as that of fluoxetine, tends to result in a more gradual decline in drug levels, reducing the severity of withdrawal symptoms. Paroxetine’s short half-life makes this choice incorrect.
Choice C reason: While concomitant medications can influence withdrawal experiences, the primary reason for paroxetine’s withdrawal symptoms is its pharmacokinetic profile, not drug interactions.
Choice D reason: Although paroxetine is metabolized via the CYP450 system, this pathway does not directly explain the intensity of withdrawal symptoms. The metabolism route is more relevant to drug interactions than to withdrawal severity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This describes empathy from the nurse practitioner, which is a normal and therapeutic response. It does not reflect transference, which originates from the patient.
Choice B reason: This is a classic example of transference, where the patient projects feelings or associations from a past relationship (with her sister) onto the therapist. It affects the therapeutic dynamic and may influence the patient’s responses and expectations.
Choice C reason: This describes countertransference, where the clinician develops personal emotional involvement with the patient. It is not transference.
Choice D reason: While this may reflect resistance or frustration, it does not clearly indicate transference. Transference involves displacement of feelings from past relationships onto the therapist.
Correct Answer is C
Explanation
Choice A reason: This is a miracle question, used in solution-focused therapy to help clients envision a future without their current problems. It is not an exception-finding question.
Choice B reason: This question explores the impact of the problem but does not identify exceptions or times when the problem was absent.
Choice C reason: Exception-finding questions aim to identify times when the problem did not occur or was less severe. This helps clients recognize their strengths and build on successful coping strategies. Asking about a time when the problem was not present is a classic example.
Choice D reason: This question explores emotional responses and is more aligned with psychodynamic or humanistic approaches than solution-focused therapy.
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