The PMHNP is treating a 76-year-old woman with an atypical antipsychotic who is exhibiting extrapyramidal symptoms (EPS). The PMHNP understands that for EPS symptoms to decrease, which neurotransmitter must be decreased?
Dopamine
Serotonin
Norepinephrine
Glutamate
The Correct Answer is A
Choice A reason: Dopamine plays a central role in the pathophysiology of extrapyramidal symptoms. EPS occurs due to dopamine receptor blockade in the nigrostriatal pathway, particularly with antipsychotic medications. Reducing dopamine activity in this pathway leads to motor disturbances similar to Parkinsonism. Therefore, managing EPS often involves balancing dopamine levels or using medications that counteract dopamine blockade.
Choice B reason: Serotonin is involved in mood regulation and other central nervous system functions, but it is not directly implicated in the development of EPS. While some antipsychotics affect serotonin receptors, EPS symptoms are primarily linked to dopamine dysregulation.
Choice C reason: Norepinephrine is associated with arousal, attention, and stress responses. It does not play a significant role in the extrapyramidal system, and altering its levels would not directly alleviate EPS.
Choice D reason: Glutamate is the primary excitatory neurotransmitter and is involved in learning and memory. Although it interacts with dopamine systems, it is not the primary neurotransmitter responsible for EPS, and decreasing glutamate would not be a targeted approach for treating these symptoms.
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Correct Answer is B
Explanation
Choice A reason: Accurate empathy involves understanding and reflecting the client’s feelings in a way that validates their experience without projecting the clinician’s own emotions. The PMHNP’s response is more emotionally loaded and personal than what accurate empathy typically entails.
Choice B reason: Sympathy refers to expressing sorrow or pity for someone else’s misfortune. The PMHNP’s statement, “Oh no! That is awful! You must be so heartbroken,” conveys emotional concern and pity, which aligns with the definition of sympathy.
Choice C reason: Confrontation in therapy involves challenging the client’s thoughts or behaviors to promote insight or change. There is no element of challenge or discrepancy in the PMHNP’s response, so this does not apply.
Choice D reason: Specificity refers to providing clear, precise feedback or communication. The PMHNP’s response is emotionally expressive but not specific in terms of therapeutic guidance or feedback.
Correct Answer is C
Explanation
Choice A reason: Dextromethorphan is a cough suppressant with NMDA antagonist properties. While it can cause dissociation or mood changes at high doses, it is not commonly associated with inducing depression.
Choice B reason: Diphenhydramine is an antihistamine that may cause sedation or cognitive dulling but is not typically linked to depressive symptoms.
Choice C reason: Isotretinoin, used for severe acne, has been associated with psychiatric side effects including depression and suicidal ideation, particularly in adolescents. Its neuropsychiatric risk profile is well-documented and warrants close monitoring.
Choice D reason: Pseudoephedrine is a decongestant that may cause agitation or insomnia but is not known to induce depression.
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