The psychiatric-mental health nurse practitioner is treating a 26-year-old woman diagnosed with bipolar I disorder who has exhibited a partial response to Lamictal 200 mg PO BID. The PMHNP wants to augment the Lamictal with valproate (Depakote). To do so, how must she change the dose of Lamictal?
She does not need to change the dose of Lamictal
She must double the dose
She must decrease the dose by half
She must discontinue the dose of Lamictal because the two medications are contraindicated
The Correct Answer is C
Choice A reason: Lamictal metabolism is affected by valproate; failing to adjust the dose increases the risk of toxicity.
Choice B reason: Doubling the dose would increase the risk of serious adverse effects, including life-threatening rash.
Choice C reason: Valproate inhibits Lamictal metabolism, so the dose of Lamictal must be reduced to avoid toxic accumulation.
Choice D reason: The two medications are not contraindicated; they can be used together with proper dose adjustment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Guided imagery is a mind-body intervention using mental visualization techniques and does not involve direct manipulation of the body.
Choice B reason: Meditation focuses on mindfulness and relaxation techniques without physical manipulation of muscles or joints.
Choice C reason: Reflexology is a manipulative body-based therapy that involves applying pressure to specific points on the feet, hands, or ears to stimulate healing and relaxation in corresponding body parts.
Choice D reason: Yoga combines physical postures, breathing, and meditation. While it involves the body, it is primarily classified as movement-based or mind-body therapy rather than strictly manipulative body-based therapy.
Correct Answer is B
Explanation
Choice A reason: Bipolar disorder involves mood swings between mania and depression, but frequent temper outbursts that are persistent and disproportionate are more characteristic of disruptive mood dysregulation disorder than classic bipolar episodes.
Choice B reason: Disruptive mood dysregulation disorder is defined by severe, recurrent temper outbursts that are inconsistent with developmental level, occurring frequently over time. This diagnosis accounts for chronic irritability and is appropriate for this patient’s presentation.
Choice C reason: Schizophrenia involves psychotic symptoms such as delusions and hallucinations and does not typically present with recurrent temper outbursts alone.
Choice D reason: Brief psychotic disorder involves sudden onset of psychotic symptoms that last less than one month, which does not align with chronic temper outbursts.
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