Which of the following drugs was most likely prescribed for the 43-year-old man with major depressive disorder?

Correct Answer: C

Rationale: In this scenario, the most likely drug prescribed for the 43-year-old man with major depressive disorder is Venlafaxine (Option C). Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) commonly used to treat major depressive disorder due to its effectiveness in addressing both serotonin and norepinephrine imbalances associated with depression. Option A, Amitriptyline, is a tricyclic antidepressant that is not typically the first choice for treating major depressive disorder in current practice due to its side effect profile and the availability of newer, better-tolerated options like SSRIs and SNRIs. Option B, Citalopram, is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression. While it is effective for many individuals with major depressive disorder, in this case, the man's likely presentation of norepinephrine-related symptoms would make an SNRI like Venlafaxine a more suitable choice. Option D, Lorazepam, is a benzodiazepine primarily used for anxiety and not a first-line treatment for major depressive disorder. It may be prescribed for comorbid anxiety symptoms but would not be the primary choice for treating major depressive disorder. Educationally, understanding the rationale behind selecting specific medications for different mental health conditions is crucial for nursing practice. It is essential to consider individual patient factors, symptom presentation, pharmacological mechanisms of action, and potential side effects when making prescribing decisions to ensure optimal patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) M cholinergic receptors. Imipramine is a tricyclic antidepressant that exerts its pharmacological effects by inhibiting the reuptake of norepinephrine and serotonin. However, it also has anticholinergic properties, leading to adverse effects commonly associated with muscarinic receptor blockade. Beta-1 adrenergic receptors (option A) are not primarily involved in the adverse effects of imipramine. While imipramine can cause tachycardia, it is more related to its anticholinergic effects rather than beta-1 adrenergic stimulation. 5-HT serotonergic receptors (option B) are targeted by selective serotonin reuptake inhibitors (SSRIs) rather than tricyclic antidepressants like imipramine. Imipramine's adverse effects are not primarily mediated through 5-HT receptors. Alpha-1 adrenergic receptors (option D) are not the main mediators of imipramine's adverse effects. While imipramine can cause orthostatic hypotension due to alpha-1 adrenergic blockade, it is not the key mechanism for most adverse effects seen with this drug. Educationally, understanding the pharmacological actions of drugs like imipramine is crucial for nurses and healthcare professionals to anticipate and manage potential adverse effects in patients. Recognizing the role of different receptors in drug actions helps in safe medication administration and patient care.

Correct Answer: C

Rationale: The correct answer is C) Serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin levels in the body, often due to the use of multiple serotonergic medications. In this case, the signs and symptoms exhibited by the 37-year-old man are indicative of serotonin syndrome, such as altered mental status, hyperthermia, tremors, and muscle rigidity. Option A) Selective serotonin reuptake inhibitor (SSRI) discontinuation syndrome is characterized by flu-like symptoms, dizziness, and mood disturbances when stopping SSRIs abruptly, which do not align with the symptoms described in the case. Option B) Mirtazapine overdose would present with symptoms such as sedation, tachycardia, and confusion, which are different from those seen in serotonin syndrome. Option D) Brain glioblastoma would typically manifest with symptoms related to increased intracranial pressure, neurological deficits, and seizures, which are not consistent with the presentation of serotonin syndrome. In an educational context, understanding the distinguishing features of different drug reactions and medical conditions is crucial for healthcare professionals to make accurate assessments and provide appropriate interventions. Recognizing the signs and symptoms of serotonin syndrome is essential for nursing practice, especially when caring for patients on multiple serotonergic medications to prevent adverse outcomes.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Chlorpromazine. Chlorpromazine is a typical antipsychotic medication that acts by blocking dopamine receptors in the brain. One of the common side effects of chlorpromazine is extrapyramidal symptoms, such as muscle stiffness, tremors, and spasms. These symptoms are indicative of drug-induced movement disorders, known as extrapyramidal side effects (EPS). Hence, chlorpromazine is most likely to have caused the reported symptoms in the patient. Now, let's discuss why the other options are incorrect: A) Lithium: Lithium is primarily used to treat mood disorders like bipolar disorder. It does not typically cause extrapyramidal symptoms. B) Amitriptyline: Amitriptyline is a tricyclic antidepressant that does not commonly cause extrapyramidal symptoms. C) Fluoxetine: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for treating depression and anxiety disorders. It is not associated with extrapyramidal symptoms like those seen in the patient. In an educational context, understanding the side effect profiles of different drug classes is crucial for safe medication administration and patient care. Nurses and healthcare professionals need to be able to recognize and attribute symptoms to specific medications to ensure timely interventions and prevent complications. This knowledge also helps in monitoring patients for adverse effects and adjusting treatment plans accordingly.

Correct Answer: C

Rationale: In the context of treating major depressive disorder, the most appropriate drug among the options provided is Bupropion (option C). Bupropion is an atypical antidepressant that works by selectively inhibiting the reuptake of dopamine and norepinephrine, which are neurotransmitters associated with mood regulation. It is particularly effective for patients with major depressive disorder who may not respond well to other classes of antidepressants. Amitriptyline (option A) is a tricyclic antidepressant that is more commonly used for conditions like neuropathic pain and insomnia rather than as a first-line treatment for major depressive disorder. Clonidine (option B) is primarily used to treat hypertension and ADHD, not major depressive disorder. Mirtazapine (option D) is a tetracyclic antidepressant that is more commonly used for treating depression with associated sleep disturbances and appetite changes, but it is not typically the first choice for major depressive disorder. Educationally, understanding the mechanisms of action and indications of different classes of antidepressants is crucial for nursing students preparing for the NCLEX exam. It is important for students to be able to differentiate between these drugs to make appropriate clinical decisions based on individual patient needs and characteristics. This question assesses the student's knowledge of antidepressant pharmacology and their ability to apply that knowledge in a clinical scenario.