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1. 1. Question
Chuck is a 20-year-old student diagnosed with obsessive-compulsive
behavior. A psychiatrist prescribes clomipramine (Anafranil) to treat his
condition. Nurse Nicolette understands the rationale for this treatment
is that the clomipramine:
o A. Increases dopamine levels
o B. Increases serotonin levels
o C. Decreases norepinephrine levels
o D. Decreases GABA levels
Incorrect
Correct Answer: B. Increases serotonin levels
According to the psychobiological theory, dysregulation of the
neurotransmitter serotonin is thought to contribute to obsessive-
compulsive behavior. Clomipramine (Anafranil) is used to increase
serotonin levels, thereby decreasing the need for obsessive-
compulsive behaviors. The only FDA-approved use for clomipramine is
for the treatment of the obsessive-compulsive disorder (OCD) in ages
10 and older. Clomipramine was the first FDA-approved medication for
OCD in 1989. For the treatment of OCD, a meta-analysis found
clomipramine was more effective than sertraline, fluoxetine, and
fluvoxamine.
Option A: Clomipramine is a tertiary amine belonging to the
class of medications known as tricyclic antidepressants (TCA). It
is a dibenzazepine TCA. Clomipramine is a serotonin reuptake
inhibitor (S-RI) with a stronger affinity for the serotonin
transporter (SERT), compared to other TCAs and S-RIs. The
resulting action of clomipramine increases serotonergic and
noradrenergic transmission.
Option C: Metabolism of clomipramine is primarily through the
liver via oxidation by CYP450 2D6. The half-life of clomipramine is
17 to 28 hours. Clomipramine is then metabolized to the steady-
state active metabolite desmethyl clomipramine by CYP450 1A2.
Desmethyl clomipramine has more noradrenergic activity than
serotonergic.
Option D: Experts often use fluvoxamine, a CYP450 1A2
inhibitor, with clomipramine in treatment-resistant OCD. By
, adding the CYP450 1A2 inhibitor, the conversion from
clomipramine to desmethyl clomipramine is blocked, resulting in
increased serotonergic activity. The onset of action of
clomipramine is usually between 6 to 12 weeks for OCD; it may
treat anxiety or insomnia immediately. If the patient achieves
OCD remission with clomipramine, treatment should continue
indefinitely.
2. 2. Question
A nurse at Nurseslabs Medical Center is developing a care plan for a
female client with post-traumatic stress disorder. Which of the
following would she do initially?
A. Instruct the client to use distraction techniques to cope with
flashbacks.
B. Encourage the client to put the past in proper perspective.
C. Encourage the client to verbalize thoughts and feelings
about the trauma.
D. Avoid discussing the traumatic event with the client.
Incorrect
Correct Answer: C. Encourage the client to verbalize thoughts
and feelings about the trauma.
Planning care for a client with post-traumatic stress disorder would
involve helping the client to verbalize thoughts and feelings about the
trauma. This will help the client work through the strong emotions
connected with the trauma and, therefore foster the belief that she is
able to cope. Maintain a calm, non-threatening manner while working
with the client. Anxiety is contagious and may be transferred from
health care provider to client or vice versa. The client develops a
feeling of security in presence of a calm staff person.
Option A: Encourage the client’s participation in relaxation
exercises such as deep breathing, progressive muscle. Relaxation
exercises are effective nonchemical ways to reduce anxiety.
relaxation, guided imagery, meditation and so forth. Maintain
calmness in your approach to the client. The client will feel more
secure if you are calm and if the client feels you are in control of
the situation.
, Option B: This may be possible later after the client is able to
verbalize strong emotions. Present and discuss the reality of the
situation with client in order to recognize aspects that can be
changed and those that cannot. The client must accept the
reality of the situation before the work of reducing the fear can
progress.
Option D: Avoiding discussion would be inappropriate.
Encourage the client to explore underlying feelings that may be
contributing to irrational fears. Help the client to understand how
facing these feelings, rather than suppressing them, can result in
more adaptive coping abilities. Verbalization of feelings in a non-
threatening environment may help the client come to terms with
unresolved issues.
3. 3. Question
A group of community nurses sees and plans care for various clients
with different types of problems. Which of the following clients would
they consider the most vulnerable to post-traumatic stress disorder?
A. An eight (8)-year-old boy with asthma who has recently failed a
grade in school.
B. A 20-year-old college student with DM who experienced
date rape.
C. A 40-year-old widower who has recently lost his wife to cancer.
D. A wife of an individual with a severe substance abuse problem.
Incorrect
Correct Answer: B. A 20-year-old college student with DM who
experienced date rape
Post-traumatic stress disorder is caused by the experience of severe,
specific trauma. Rape is a severely traumatic event. Posttraumatic
stress disorder (PTSD) is a syndrome that results from exposure to real
or threatened death, serious injury, or sexual assault. Following the
traumatic event, PTSD is common and is one of the serious health
concerns that is associated with comorbidity, functional impairment,
and increased mortality with suicidal ideations and attempts.
Option A: The development of posttraumatic stress disorder in
individuals is linked to a large number of factors. These include
, experiencing a traumatic event such as a severe threat or a
physical injury, a near-death experience, combat-related trauma,
sexual assault, interpersonal conflicts, child abuse, or after a
medical illness. Chronic PTSD occurs in patients who are unable
to recover from the trauma due to maladaptive responses.
Option C: The risk factors for the development of PTSD include
biological and psychological factors such as gender (more
prevalent in women), childhood adversities, pre-existing mental
illness, low socioeconomic status, less education, lack of social
support. Nature and the severity of the trauma are also
accountable while determining the risk factors for PTSD.
Option D: Although this situation is certainly stressful, they are
not at the level of severe trauma. The symptoms of PTSD include
persistently re-experiencing the traumatic event, intrusive
thoughts, nightmares, flashbacks, dissociation(detachment from
oneself or reality), and intense negative emotional (sadness,
guilt) and physiological reaction on being exposed to the
traumatic reminder.[1] Furthermore, problems with sleep and
concentration, irritability, increased reactivity, increased startle
response, hypervigilance, avoidance of traumatic triggers also
occur.
4. 4. Question
Which outcome is most appropriate for Francis who has a dissociative
disorder?
A. Francis will deal with uncomfortable emotions on a
conscious level.
B. Francis will modify stress with the use of relaxation techniques.
C. Francis will identify his anxiety responses.
D. Francis will use problem-solving strategies when feeling
stressed.
Incorrect
Correct Answer: A. Francis will deal with uncomfortable
emotions on a conscious level.
Dissociative disorders occur when traumatic events are beyond an
individual’s recall because these memories have been “blocked” from
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