Which statement by a patient who is taking lamotrigine would receive the nurse's priority attention?
I bumped into a table yesterday and got a bruise on my elbow.
I have a new rash on my chest and abdomen.
I have not had a bowel movement in 2 days.
Last night I slept for only 7.5 hours.
The Correct Answer is B
Choice A rationale
Bruising from a minor trauma like bumping into a table is common and not typically a priority concern with lamotrigine. While some anticonvulsants can rarely affect clotting factors, a single bruise is usually insignificant. The priority lies with recognizing life-threatening hypersensitivity reactions over minor, common occurrences like bruising, unless severe or widespread.
Choice B rationale
Lamotrigine carries a significant Black Box Warning for serious, life-threatening rashes, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). A new rash on the chest and abdomen is a potential initial manifestation of these dermatological emergencies, requiring immediate cessation of the drug and medical evaluation to prevent potentially fatal systemic complications.
Choice C rationale
Constipation is a common and often manageable side effect of many medications, sometimes including lamotrigine, but it is not life-threatening. Although it should be addressed with appropriate interventions, it does not pose the same immediate, severe risk as a potentially fatal hypersensitivity rash, so it does not take priority over the reported new rash.
Choice D rationale
Insomnia or mild changes in sleep patterns can be side effects of lamotrigine or reflective of the underlying mood disorder being treated. While important to assess, sleeping for 7.5 hours is within the normal range for many adults and is not an acute, life-threatening side effect that requires the same priority attention as the possible early signs of SJS or TEN.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
The Patient Protection and Affordable Care Act (PPACA) of 2010 strengthened mental health and substance use disorder parity requirements by integrating them into the Essential Health Benefits (EHBs). This legislation effectively mandated that most individual and small-group health plans cover mental health and substance use disorder services with benefits and cost-sharing equivalent to those for medical and surgical care.
Choice B rationale
The Health Care and Education Reconciliation Act (HCERA) of 2010 was an amendment to the PPACA. Although its primary focus was on student loans and Medicare, it is integral to the overall structure of the PPACA and contributes to the legislative foundation that mandates parity for mental health benefits within the expanded health coverage system.
Choice C rationale
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 primarily addresses the continuation of health insurance coverage, simplification of administrative processes, and the establishment of standards for the electronic transmission and security of health information (patient privacy rules). It does not specifically address or mandate parity in benefit levels between mental health and medical/surgical services.
Choice D rationale
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 significantly strengthened previous parity laws. It required group health plans that offer mental health or substance use disorder benefits to provide benefits that are no more restrictive than those for medical and surgical benefits, particularly concerning financial requirements and treatment limitations.
Choice E rationale
The Mental Health Parity Act (MHPA) of 1996 was the precursor to MHPAEA. It initially required parity for annual and lifetime dollar limits for mental health benefits compared to medical/surgical benefits. Although limited in scope, it was the first federal law to require some level of equality in mental health coverage.
Correct Answer is B
Explanation
Choice A rationale
Anticholinergic medications primarily block acetylcholine receptors, commonly leading to side effects like dry mouth, blurred vision, constipation, and urinary retention. They do not typically cause hyperprolactinemia-related effects such as gynecomastia (male breast enlargement), amenorrhea (absence of menstruation), or galactorrhea (milky discharge).
Choice B rationale
First-generation (conventional) antipsychotics, like haloperidol, exert a potent Dopamine-2 receptor antagonism in the tuberoinfundibular pathway. This blockade lifts the dopaminergic inhibition on prolactin release from the anterior pituitary, resulting in hyperprolactinemia, which is the direct cause of gynecomastia, amenorrhea, and galactorrhea.
Choice C rationale
Second-generation (atypical) antipsychotics also block D2 receptors but often have a broader receptor profile. While some (like risperidone) can cause hyperprolactinemia, others are prolactin-sparing or cause it less frequently or severely than the first-generation agents.
Choice D rationale
Third-generation antipsychotics, such as aripiprazole, are often dopamine system stabilizers (partial agonists). They are less likely to cause significant D2 blockade and often have a lower risk of inducing hyperprolactinemia and the associated endocrine side effects compared to both first- and some second-generation agents.
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