Which of the following psychotropic drugs would be most appropriate to try at this stage for the 39-year-old man with chronic paranoid schizophrenia?

Correct Answer: D

Rationale: Clozapine is the most appropriate choice for this patient as he has not responded well to previous medications such as haloperidol, chlorpromazine, and risperidone. Clozapine is often used as a last resort for treatment-resistant schizophrenia and has shown to be effective in cases where other antipsychotics have failed. Additionally, the patient had a partial response to uphenazine, which indicates the need for a different medication approach, making clozapine the best option in this scenario.

Correct Answer: C

Rationale: The patient most likely exhibited akathisia, which is a common adverse effect of antipsychotic medications like haloperidol. Akathisia is characterized by restlessness, an inability to sit still, and a feeling of wanting to jump out of one's skin. This aligns with the patient's symptoms of increased agitation and confusion, as well as the fact that she had recently started therapy with uphenazine, an antipsychotic medication. The other choices are less likely to cause the specific symptoms described.

Correct Answer: C

Rationale: The patient complained of abnormal growth of his breast after receiving a psychotropic drug for 6 months. The most likely cause of this adverse effect is Amitriptyline, as it is known to cause gynecomastia (abnormal breast growth) as a side effect. Amitriptyline is a tricyclic antidepressant that can lead to hormonal imbalances and breast enlargement in males. The other options, such as Haloperidol and Risperidone, are less likely to cause this specific symptom.

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 case, the correct answer is C) Inhibition of serotonin transporter. This mechanism of action is associated with selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat obsessive-compulsive disorder (OCD), including intrusive thoughts. By inhibiting the reuptake of serotonin, these drugs increase the availability of serotonin in the synaptic cleft, which helps regulate mood and reduce obsessive thoughts. Option A) Inhibition of monoamine oxidase A is incorrect because MAOIs are not typically used as first-line treatment for OCD and can have dangerous interactions with certain foods and medications. Option B) Blockade of serotonergic receptors is incorrect because blocking serotonin receptors would not address the underlying issue of low serotonin levels contributing to OCD symptoms. Option D) Blockade of beta receptors is incorrect because beta blockers are not typically used in the treatment of OCD and intrusive thoughts. Educationally, understanding the mechanism of action of different psychiatric medications is crucial for nurses and other healthcare professionals to make appropriate clinical decisions and provide effective care for patients with mental health disorders. In this scenario, knowing how SSRIs work can help guide treatment choices for patients with OCD symptoms.