Which medication would be considered a first-line medication therapy for generalized anxiety disorder (GAD)?

Paroxetine (Paxil)

Imipramine (Tofranil)

Hydroxyzine (Vistaril)

Alprazolam (Xanax)

Answer and Explanation

The Correct Answer is A

Choice A reason: Paroxetine, an SSRI, is first-line for GAD, enhancing serotonin in the amygdala and prefrontal cortex, reducing excessive worry. Its efficacy and tolerability, with minimal dependence risk, align with evidence-based guidelines for long-term anxiety management, making it the preferred choice.

Choice B reason: Imipramine, a tricyclic antidepressant, affects serotonin and norepinephrine but has significant anticholinergic side effects, reducing tolerability. It is not first-line for GAD due to slower onset and side effect profile compared to SSRIs, which better target anxiety’s neurobiological basis.

Choice C reason: Hydroxyzine, an antihistamine, reduces anxiety via histamine receptor blockade, causing sedation. It is used as needed, not for chronic GAD management. SSRIs, like paroxetine, offer sustained serotonin modulation, making hydroxyzine a less effective, non-first-line option for long-term treatment.

Choice D reason: Alprazolam, a benzodiazepine, enhances GABA activity, providing rapid anxiety relief but carries high dependence risk. It is not first-line for GAD, as SSRIs offer safer, long-term serotonin-based treatment, making alprazolam unsuitable for chronic management due to addiction potential.

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Correct Answer is B

Explanation

Choice A reason: Intervening in self-harm prioritizes beneficence, ensuring safety, over autonomy. Self-mutilation, often linked to dysregulated serotonin or impulsivity, requires immediate action to prevent harm, overriding patient choice. Autonomy is secondary when safety is at risk, making this an incorrect application of the principle.

Choice B reason: Exploring medication options respects autonomy by involving patients in decisions, aligning with their values. This considers individual neurobiological responses (e.g., serotonin reuptake variations) and preferences, empowering informed choice. Autonomy emphasizes patient control over treatment, making this the correct approach for ethical psychiatric care.

Choice C reason: Restricting patients for fighting prioritizes safety and unit order, not autonomy. Conflict may stem from emotional dysregulation or neurotransmitter imbalances, but restricting movement limits patient choice. This action reflects beneficence or justice, not autonomy, making it an incorrect choice for this ethical principle.

Choice D reason: Staying with an anxious patient supports emotional regulation, possibly linked to GABA deficits, but emphasizes beneficence over autonomy. While supportive, it does not involve patient decision-making. Autonomy requires empowering patient choice, not just presence, making this an incorrect application of the ethical principle.

A. “Can you give me an example of what you mean by pusillanimous?” B. “I understand what you’re saying. Bad dreams leave me feeling tired, too.” C. “It sounds as though you were uncomfortable with the content of your dream.” D. “So, all in all, you feel as though you had a rather poor night’s sleep?”

Correct Answer is A

Explanation

Choice A reason: Clarifying “pusillanimous” seeks specific meaning, ensuring accurate understanding of the patient’s emotional state. Dreams reflecting fear or inadequacy may involve amygdala hyperactivity or serotonin imbalances. This promotes therapeutic communication, addressing emotional distress linked to neurobiological stress responses, making it the most appropriate response.

Choice B reason: Relating personal experience shifts focus from the patient, reducing therapeutic effectiveness. Emotional drainage, possibly tied to REM sleep disruptions or cortisol spikes, requires exploration, not nurse self-disclosure. This risks dismissing the patient’s unique neurobiological experience, making it inappropriate for clarification.

Choice C reason: Assuming discomfort generalizes the dream’s impact without clarifying “pusillanimous.” Emotional drainage may reflect amygdala-driven stress responses, but this response lacks specificity. Clarification requires direct exploration of the term to understand its emotional and neurobiological significance, making this less effective.

Choice D reason: Summarizing poor sleep oversimplifies the emotional drainage, potentially linked to serotonin dysregulation or heightened stress responses. It fails to explore “pusillanimous,” missing the dream’s specific emotional content. Clarification requires detailed inquiry into the term’s meaning, making this response inadequate.

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Which medication would be considered a first-line medication therapy for generalized anxiety disorder (GAD)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

How does a psychiatric nurse best implement the ethical principle of autonomy?

Correct Answer is B

Explanation

A patient says to the nurse, “I dreamed I was pusillanimous. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification?

Correct Answer is A

Explanation

Which patient would a nurse refer to partial hospitalization?

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Which medication would be considered a first-line medication therapy for generalized anxiety disorder (GAD)?

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Which of the following speech patterns is an example of tangential thinking?