The scope of practice for an advanced nurse practitioner would include which intervention?

Choice A rationale

Glutamate is the primary excitatory neurotransmitter in the central nervous system. Its facilitation would increase neuronal activity, which is generally contrary to the desired calming and sedative effects of anxiolytic medications, which typically aim to reduce nervous system overactivity to manage anxiety.

Choice B rationale

Dopamine is a monoamine neurotransmitter involved in reward, motivation, and motor control. While involved in various psychiatric conditions, decreasing excess dopamine is the primary mechanism of action for some antipsychotic medications, not the typical mechanism for anxiolytics, which primarily target anxiety symptoms.

Choice C rationale

Serotonin, a monoamine, modulates mood, sleep, and appetite. Increasing its release or effects is the primary mechanism for some classes of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), which are also used for anxiety, but is not the defining or typical mechanism of benzodiazepine anxiolytics.

Choice D rationale

γ-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the brain. Anxiolytic drugs, particularly the benzodiazepine class, exert their effect by binding to the GABA_A receptor. This binding enhances GABA's inhibitory effects, leading to hyperpolarization of the neuron, thereby reducing overall neuronal excitability and promoting an anxiolytic (calming) effect.

Choice A rationale

Aversion therapy is a behavioral therapy that uses the principles of classical conditioning to help a client reduce or stop an undesirable behavior, such as alcohol consumption. It pairs the unwanted behavior with a noxious stimulus, which, in the case of disulfiram, is the unpleasant physical reaction (nausea, vomiting) caused by acetaldehyde accumulation from alcohol metabolism blockade. This creates a conditioned aversion to alcohol.

Choice B rationale

Biofeedback is a technique that teaches a client to control involuntary physiological responses, such as heart rate or muscle tension, by providing real-time visual or auditory feedback about these functions. It operates on the basis of operant conditioning, allowing the client to modify their responses to achieve a desired physical state, and it is not typically used to directly treat substance use disorder in this manner.

Choice C rationale

Flooding is an exposure-based behavioral therapy used primarily for anxiety disorders, such as phobias. It involves exposing the client to a maximally anxiety-provoking stimulus (the feared object or situation) for a prolonged period, preventing escape, which allows habituation and extinction of the conditioned fear response to occur. This is not the mechanism of action for disulfiram.

Choice D rationale

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based psychotherapy originally developed for clients with borderline personality disorder. It combines cognitive-behavioral techniques with mindfulness and emotional regulation strategies. DBT is a structured, long-term approach focusing on skills training and is distinct from the pharmacologically-induced classical conditioning of aversion therapy.