NR606 Diagnosis Management in Psychiatric Mental Health Practicum II
Request for Actual Exam
For which client would breastfeeding most likely be contraindicated?
Answer
Breastfeeding would most likely be contraindicated for A. a client who takes clozapine.
Explanation
The decision to breastfeed while taking psychotropic medication is based on balancing
the medication's potential risk to the infant (drug concentration in breast milk, half-life,
active metabolites) against the risk of untreated maternal illness.
, Clozapine is generally considered a high-risk medication during breastfeeding and is often cited
as a contraindication.
• Clozapine (Atypical Antipsychotic): Clozapine and its active metabolites are secreted
into breast milk at potentially significant levels. Due to the risk of serious adverse
effects in the infant, including agranulocytosis (though rare), sedation, seizures, and
neutropenia, it is generally recommended that mothers taking clozapine do not
breastfeed.
• Quetiapine (Atypical Antipsychotic): Generally considered to be of low risk. It is
excreted in very small amounts into breast milk, and limited data suggests it's likely
safe, though infant monitoring is recommended.
• Alprazolam (Benzodiazepine): Generally considered to be of moderate to high risk
with caution, especially with chronic use. While it is excreted into breast milk, its use
is usually discouraged due to the risk of sedation and potential withdrawal symptoms
in the infant. However, it is often seen as less of an absolute contraindication than
clozapine, especially if short-term use is necessary.
• Fluoxetine (SSRI Antidepressant): Generally considered to be of moderate risk. It
has a long half-life and active metabolites. While often used cautiously, some other
SSRIs (like sertraline or paroxetine) are generally preferred due to lower excretion
levels. However, it is not an absolute contraindication like clozapine.
Conclusion: Among the options provided, clozapine (A) represents the most definitive and
widely accepted contraindication for breastfeeding due to the risk of serious infant hematological
and central nervous system effects.
Request for Actual Exam
For which client would breastfeeding most likely be contraindicated?
Answer
Breastfeeding would most likely be contraindicated for A. a client who takes clozapine.
Explanation
The decision to breastfeed while taking psychotropic medication is based on balancing
the medication's potential risk to the infant (drug concentration in breast milk, half-life,
active metabolites) against the risk of untreated maternal illness.
, Clozapine is generally considered a high-risk medication during breastfeeding and is often cited
as a contraindication.
• Clozapine (Atypical Antipsychotic): Clozapine and its active metabolites are secreted
into breast milk at potentially significant levels. Due to the risk of serious adverse
effects in the infant, including agranulocytosis (though rare), sedation, seizures, and
neutropenia, it is generally recommended that mothers taking clozapine do not
breastfeed.
• Quetiapine (Atypical Antipsychotic): Generally considered to be of low risk. It is
excreted in very small amounts into breast milk, and limited data suggests it's likely
safe, though infant monitoring is recommended.
• Alprazolam (Benzodiazepine): Generally considered to be of moderate to high risk
with caution, especially with chronic use. While it is excreted into breast milk, its use
is usually discouraged due to the risk of sedation and potential withdrawal symptoms
in the infant. However, it is often seen as less of an absolute contraindication than
clozapine, especially if short-term use is necessary.
• Fluoxetine (SSRI Antidepressant): Generally considered to be of moderate risk. It
has a long half-life and active metabolites. While often used cautiously, some other
SSRIs (like sertraline or paroxetine) are generally preferred due to lower excretion
levels. However, it is not an absolute contraindication like clozapine.
Conclusion: Among the options provided, clozapine (A) represents the most definitive and
widely accepted contraindication for breastfeeding due to the risk of serious infant hematological
and central nervous system effects.
