[Verified Answer]: Read the Case Study below and answer the…

Read the Case Study below and answer the questions that follow them. Answering all of the questions will earn you TWO (2) points on Proctored Test 2. For example: A grade of 76% will become 78%. Case Study HPI (History of Present Illness): Miss R is an 18 year-old white female college student who was recently hospitalized for major depression. Her mother calls the primary care office where the nurse is employed and shares concerns about her daughter’s agitation and hostility telling the nurse that her daughter is “pacing the halls at night and doesn’t sleep much. She isn’t eating. The mother says, “When I ask her what’s wrong, she shuts her door, telling me she doesn’t want to talk now. The few people she’ll talk to are suspicious characters, not her usual group of friends. I think they’re using drugs.” Miss R’s mother then tells you that her daughter’s condition has deteriorated since the brief hospitalization 4 days ago, when she was started on her medications. The nurse has seen Miss R in the past and has a good relationship with her. The nurse convinces her come to the clinic to be evaluated. Miss R arrives at the clinic appearing agitated. She admits that she has been “nerved up” and “full of energy,” but she can’t understand why her mom is so concerned. She tells the nurse: “My depression is starting to lift. I’m actually starting to see the world in vivid color. Yeah, I have new friends, because I’m starting to live again. No, I’m not using drugs. I drink once in a while, sometimes more than I should.” When questioned further about her mood, Miss R. admits that “Sometimes at night, I get nervous and start to get those dark thoughts that made me miserable this past year, but I no longer want to hurt myself. I want to live.” Past Medical History: Anorexia/Bulimia Possible ADHD (poor school performance, never fully worked up) Depression (several episodes since age 14, most serious 2 weeks ago, when she considered suicide following break-up with boyfriend) Seasonal allergic rhinitis Medications: Imipramine (Tofranil), 150 mg, PO, qhs Cimetidine (Tagamet), 800 mg, PO, bid, for indigestion/heartburn, obtained OTC, started 1 week ago Loratadine, 10 mg, PO, daily Loestrin 21 (1.5/30), tablet PO, daily Allergies: Sulfa drugs cause hives Physical Exam: Vital signs: BP: 125/78, HR: 108, RR: 20, T: 37.5 Hypervigilant, anxious, thin female, pacing the room Dressed casually, appropriate for setting Speech: somewhat pressured, loud Neuro: Attention poor- starts out window instead of answering some questions Thought content logical and relevant Oriented x3, no focal neurological signs Q1: Should the nurse be concerned about this patient’s behavioral changes? What might be going on with this patient? Q2: Are insomnia and increased energy likely side effects of this patient’s antidepressant medication? Q3: Are there drug interactions between this patient’s medications that are concerning? If so, list them. Hint: cimetidine is a CYP450 inhibitor Q4: Is there anything that should get the nurse’s attention on the physical exam? Q5: Given her history and the findings on today’s examination, are there safer medications for this patient?