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 C
Explanation
Choice A reason: Emotional cutoffs refer to the act of distancing oneself emotionally from others, often to manage unresolved issues. This does not reflect a healthy or stable sense of self-worth, but rather a defensive strategy.
Choice B reason: Transactional patterns describe repetitive interpersonal exchanges, often rooted in learned behaviors. These patterns do not inherently reflect self-worth or independence from external validation.
Choice C reason: Differentiation is the ability to maintain one's sense of self while remaining emotionally connected to others. It reflects a mature psychological state where self-worth is internally regulated and not dependent on external factors.
Choice D reason: Enmeshment involves blurred boundaries in relationships, where individuals lose their sense of self in others. This is the opposite of differentiation and indicates dependence on external validation for self-worth.
Correct Answer is C
Explanation
Choice A reason: This choice is incorrect because the client endorsed four out of six core symptoms in Part A of the Adult ADHD Self-Report Scale, which is a validated screening tool. This pattern suggests the presence of ADHD symptoms, not their absence.
Choice B reason: Adult ADHD can be diagnosed even if the individual was not formally diagnosed in childhood. The DSM-5 criteria allow for retrospective identification of childhood symptoms, and many adults are diagnosed later in life due to increased awareness or functional impairment.
Choice C reason: Endorsing "sometimes, often, or very often" to four of the six Part A questions meets the threshold for further evaluation. This section screens for inattentive and hyperactive-impulsive symptoms. A positive screen warrants a comprehensive clinical assessment to confirm diagnosis and rule out other causes.
Choice D reason: Malingering implies intentional feigning of symptoms for secondary gain, which cannot be concluded based solely on a screening tool. Such a determination requires a thorough clinical evaluation and consideration of context, which is not provided here.
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