A 76-year-old patient who is determined to be a poor 2D6 metabolizer is being prescribed vortioxetine for his depression. What does the PMHNP need to remember when prescribing this drug?

Correct Answer: C

Rationale: The correct answer is C: The dosage should not exceed ½ of the usual recommended dose. Vortioxetine is primarily metabolized by the CYP2D6 enzyme. In poor 2D6 metabolizers, the metabolism of vortioxetine is significantly reduced, leading to higher drug levels in the body. Therefore, to prevent potential adverse effects or toxicity, the dosage should be reduced to avoid exceeding the usual recommended dose. A: The dosage of the drug will need to be increased - Incorrect. Due to reduced metabolism in poor 2D6 metabolizers, increasing the dosage would lead to higher drug levels and increased risk of adverse effects. B: The dosage needs to begin at half then increase over a 2-week period - Incorrect. Starting at half the dose is not sufficient for poor metabolizers as they may still experience increased drug levels. D: An adjunct medication will need to be prescribed until the dosage can be reduced - Incorrect. Adding another medication is not necessary

Correct Answer: B

Rationale: The correct answer is C: Dopamine. An increase in dopamine levels can lead to hallucinations and psychosis. Dopamine is involved in regulating mood, emotions, and perception. Excess dopamine can disrupt these functions, leading to psychotic symptoms. Serotonin (A) is primarily associated with mood regulation, not hallucinations. Acetylcholine (B) is involved in memory and muscle control, not typically linked to hallucinations. GABA (D) is an inhibitory neurotransmitter that helps regulate neuronal excitability, not associated with hallucinations or psychosis.

Correct Answer: D

Rationale: An overactive mesolimbic pathway is associated with excess dopamine activity, leading to hallucinations and psychosis. Dopamine dysregulation in this pathway can cause positive symptoms like hallucinations. Choices A, B, and C are incorrect because they are not directly linked to mesolimbic pathway dysfunction. Dystonia and akathisia (A) are motor side effects often associated with antipsychotic medications. Sexual dysfunction (B) may be caused by medications or psychological factors. Negative symptoms (C) are associated with hypoactivity in the mesocortical pathway, not the mesolimbic pathway.

Correct Answer: B

Rationale: The correct answer is B: Clozapine. Clozapine is known to cause agranulocytosis, a serious condition characterized by a low absolute neutrophil count. Monitoring of absolute neutrophil count is required to detect this potentially life-threatening side effect. Brexpiprazole, Risperidone, and Olanzapine are not associated with the same risk of agranulocytosis, so routine monitoring of absolute neutrophil count is not necessary for these medications.

Correct Answer: B

Rationale: The correct answer is B because it promotes a patient-centered approach by respecting the patient's cultural beliefs and fostering collaboration. This approach acknowledges the importance of the patient's beliefs while working towards integrating both traditional and alternative treatments when possible. This approach enhances patient trust and compliance. Explanation of other choices: A: This choice disregards the patient's autonomy and cultural beliefs, potentially leading to mistrust and non-adherence to treatment. C: Ignoring the patient's beliefs can result in a breakdown of communication and trust, hindering the therapeutic relationship. D: Referring the patient solely to another provider for alternative medicine disregards the nurse's role in promoting holistic care and collaboration.