Author Question: An adult patient reports feeling unfocused all the time, loses things, and has difficulty completing ... (Read 107 times)

jparksx · **on:** Jul 24, 2018

An adult patient reports feeling unfocused all the time, loses things, and has difficulty completing tasks and says that this is interfering with family relations and work.

The symptoms have been present as long as the patient can remember, although there is no previous documentation of attention-deficit/hyperactivity disorder (AD/HD) in this patient's medical history. The primary care nurse practitioner (NP) should: a. tell the patient that a diagnosis of AD/HD as a child is a prerequisite for diagnosing this in adults.
b. conduct a thorough evaluation to document behaviors associated with AD/HD and begin treatment if indicated.
c. suggest that the patient may have a major depressive disorder and refer the patient for psychiatric evaluation and treatment.
d. prescribe a methylphenidate trial, ask the patient to keep a diary of behaviors and feelings, and reevaluate in 1 to 2 months.

Question 2

A patient has acute low back pain caused by lifting a heavy object. The patient reports having one or two drinks with meals each day. The primary care NP should prescribe:

a. an NSAID.
b. diazepam (Valium).
c. metaxalone (Skelaxin).
d. acetaminophen (Tylenol).

ynlevi · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

B
Although childhood AD/HD is a prerequisite for diagnosis in an adult, it is increasingly recognized that many adults have the disorder without having been diagnosed as children. The NP should evaluate the patient's symptoms and treat if indicated. The patient does not have symptoms of depression. Methylphenidate should not be given unless the patient meets the diagnostic criteria.

Answer to Question 2

A
Skeletal muscle relaxants should not be taken with alcohol because effects are additive. Acetaminophen has toxic effects on the liver, and patients who consume alcohol regularly should avoid acetaminophen and diazepam.