A 28-year-old U.S. Marine recruit has a history of Tourette syndrome, for which he has been taking haloperidol for the past six months. He complains that he has become very restless and that his tongue is in constant motion as if he were constantly chewing gum. Since the emergence of these symptoms, he stopped taking the drug, but the symptoms persist. Which one of the following is the correct statement with respect to the symptoms he describes?

Correct Answer: B

Rationale: The correct answer is option B: "The symptoms are consistent with haloperidol-induced akathisia and tardive dyskinesia and are due to supersensitive dopamine receptors." In this case, the individual's symptoms of restlessness and constant tongue movement are indicative of akathisia and tardive dyskinesia, both of which can be caused by the use of haloperidol, an antipsychotic medication. Akathisia is characterized by a feeling of inner restlessness and the urge to move constantly, while tardive dyskinesia involves involuntary movements, such as tongue protrusion or chewing motions. The rationale for why the other options are incorrect is as follows: - Option A is incorrect because akathisia and tardive dyskinesia are not due to blocked dopamine receptors but rather to an increased sensitivity or supersensitivity of dopamine receptors. - Option C is incorrect because haloperidol primarily acts by blocking dopamine D2 receptors, not 5-HT2C receptors. - Option D is incorrect because it mentions supersensitive D2 and 5-HT2C receptors, which is not the mechanism underlying the development of akathisia and tardive dyskinesia. From an educational perspective, understanding the side effects and mechanisms of action of psychotropic medications is crucial for healthcare professionals to effectively manage and anticipate potential adverse effects in patients. Recognizing the symptoms of akathisia and tardive dyskinesia, as well as their underlying mechanisms, is essential for providing appropriate care and ensuring patient safety.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) sertraline (Zoloft). The rationale behind this choice lies in the fact that sertraline is an antidepressant medication commonly used to treat depression, anxiety disorders, and other mood disorders. Therefore, it is a suitable medication for a patient hospitalized for severe depression. Option A) chlordiazepoxide (Librium) is a benzodiazepine primarily used to treat anxiety and alcohol withdrawal, not depression. Option B) clozapine (Clozaril) is an atypical antipsychotic used for schizophrenia and treatment-resistant bipolar disorder, not first-line for depression. Option D) tacrine (Cognex) is a medication used in the treatment of Alzheimer's disease, not depression. In an educational context, understanding the appropriate psychotropic medications for specific mental health conditions is crucial for healthcare professionals, especially nurses, to provide safe and effective care to patients. Teaching patients about their prescribed medications, including their indications, side effects, and proper administration, is a fundamental aspect of nursing practice to promote medication adherence and optimal outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Hypertensive crisis. When a patient is taking a drug that inhibits monoamine oxidase (MAO), they are at risk of a hypertensive crisis if they consume certain foods or drugs that contain tyramine. MAO inhibitors prevent the breakdown of tyramine, leading to an excess accumulation of this substance in the body. Tyramine can cause a sudden and dangerous increase in blood pressure, resulting in a hypertensive crisis. Option A) Cardiac dysrhythmia is incorrect because MAO inhibitors are not directly linked to causing abnormal heart rhythms. Option B) Hypotensive shock is incorrect because MAO inhibitors are more commonly associated with causing high blood pressure rather than dangerously low blood pressure. Option D) Hypoglycemia is incorrect because MAO inhibitors do not typically affect blood sugar levels in a way that would lead to hypoglycemia. Educationally, understanding the interactions between MAO inhibitors and tyramine-containing foods/drugs is crucial for nurses and healthcare providers to ensure patient safety. Teaching patients about dietary restrictions while on MAO inhibitors can prevent potentially life-threatening complications like hypertensive crises. This knowledge is vital in psychiatric and medical settings where these medications are commonly prescribed for conditions like depression and anxiety.

Correct Answer: B

Rationale: In this question, the correct answer is B) Valproate (Depakote). The educational rationale for this choice lies in understanding the pharmacological classification of psychotropic medications. Carbamazepine, lamotrigine, gabapentin, and valproate all belong to the anticonvulsant class of medications commonly used in the treatment of various psychiatric disorders, such as bipolar disorder, epilepsy, and neuropathic pain. Valproate, like carbamazepine, lamotrigine, and gabapentin, acts on neurotransmitters in the brain to help stabilize mood, prevent seizures, and alleviate neuropathic pain. This makes it the appropriate choice among the options provided. Analyzing the incorrect options: A) Galantamine (Reminyl): This medication is an acetylcholinesterase inhibitor used in the treatment of Alzheimer's disease. It does not belong to the same pharmacological class as carbamazepine, lamotrigine, and gabapentin. C) Buspirone (BuSpar): Buspirone is an anxiolytic medication used primarily for the treatment of generalized anxiety disorder. It does not share the same pharmacological properties as the anticonvulsants mentioned. D) Tacrine (Cognex): Tacrine is a cholinesterase inhibitor used in the treatment of Alzheimer's disease, similar to galantamine. It does not belong to the same class as the medications in the group mentioned. Educational Context: Understanding the pharmacological properties of psychotropic medications is crucial for healthcare professionals, especially when prescribing and managing patients with psychiatric conditions. This knowledge helps in making informed decisions regarding treatment options, potential drug interactions, and monitoring for side effects. By recognizing the similarities and differences between medication classes, healthcare providers can optimize patient care and outcomes.

Correct Answer: D

Rationale: The correct answer is D) All of the above. Individuals experiencing an MDMA hangover can indeed exhibit symptoms such as insomnia, fatigue, and drowsiness. It is crucial to understand these effects as part of the broader context of substance use and its consequences. Insomnia can occur due to the disruption of the sleep-wake cycle caused by MDMA. Fatigue is a common symptom as the body recovers from the drug's stimulant effects, leading to a feeling of exhaustion. Drowsiness may also be present as the body attempts to regulate its systems post-MDMA use. Options A, B, and C are incorrect because they do not capture the comprehensive range of symptoms associated with an MDMA hangover. Understanding these effects is important in harm reduction strategies and in providing adequate support to individuals struggling with substance use disorders. Educating individuals about the potential consequences of drug use can empower them to make informed decisions about their health and well-being.