Two weeks ago, the PMHNP prescribed the antidepressant escitalopram (Lexapro) for a 28-year-old female client with generalized anxiety disorder. At her initial appointment, she scored 28 on the Hamilton Anxiety Rating Scale (HAM-A). At today’s follow-up visit, she scored 26. She reports no side effects from the Lexapro. Which of the following is the next step for the PMHNP?
Discontinue treatment with Lexapro
Make no changes
Add an augmenting agent
Switch to a different antidepressant
The Correct Answer is B
Choice A reason: Discontinuing an antidepressant after only two weeks with minimal improvement is premature; SSRIs often require 4–6 weeks for full efficacy.
Choice B reason: Making no changes is appropriate at this stage, as early treatment response is modest. The clinician should continue monitoring and reassess after sufficient treatment duration.
Choice C reason: Adding an augmenting agent is not indicated yet, given the patient has only had two weeks of therapy and lacks significant side effects.
Choice D reason: Switching antidepressants is premature at this early stage of treatment; efficacy assessment requires adequate duration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Bradypnea and bradycardia are not typical for fat embolism; the hallmark is respiratory distress with tachypnea and hypoxemia.
Choice B reason: Confusion may occur, but bradycardia and bradypnea are inconsistent with fat embolism syndrome.
Choice C reason: Tachypnea and tachycardia reflect the respiratory compromise and systemic inflammatory response. Restlessness is due to hypoxia, and petechial rash is a classic manifestation, often appearing on the upper body, conjunctiva, or axilla. This combination is highly suggestive of fat embolism syndrome.
Choice D reason: Decreased temperature is not characteristic; patients typically have normal or slightly elevated temperatures. While tachypnea, tachycardia, and petechiae are correct, the inclusion of hypothermia makes this choice inaccurate.
Correct Answer is D
Explanation
Choice A reason: Specific phobia involves intense fear of a specific object or situation, often leading to avoidance. While situational fears exist here, the patient’s avoidance is broad and involves multiple public environments, exceeding a single situational phobia.
Choice B reason: Adjustment disorder is characterized by emotional or behavioral symptoms in response to an identifiable stressor, typically appearing within 3 months. While COVID-19 is a stressor, the patient’s persistent, specific avoidance pattern fits a more defined anxiety disorder.
Choice C reason: PTSD involves re-experiencing trauma, avoidance of trauma-related stimuli, hyperarousal, and negative mood. The patient does not have re-experiencing or trauma-related cues in this scenario.
Choice D reason: This is correct. Agoraphobia is characterized by fear and avoidance of situations where escape may be difficult, often involving public spaces, transportation, or crowds. The patient’s inability to leave home, avoidance of stores, and fear of public situations align with the diagnostic criteria for agoraphobia.
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