# Clinical context A 45-year-old with Huntington chorea is being evaluated before tetrabenazine is started and titrated; the nurse reviews mood history, current medicines, and the proposed target dose. Which findings require clarification before starting or escalating tetrabenazine for Huntington chorea? Select exactly 3 responses.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=603006&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
A 45-year-old with Huntington chorea is being evaluated before tetrabenazine is started and titrated; the nurse reviews mood history, current medicines, and the proposed target dose.

Which findings require clarification before starting or escalating tetrabenazine for Huntington chorea? Select exactly 3 responses.

Select exactly 3 responses.

1

Planned dose above 50 mg/day without CYP2D6 genotyping

2

Untreated major depression

3

Active suicidal thoughts

4

A past depressive episode is in full remission with scheduled mood monitoring.

5

Paroxetine is prescribed and the plan limits tetrabenazine to 50 mg/day.

6

CYP2D6 genotype is documented before a planned dose above 50 mg/day.

## Explanation

Tetrabenazine can increase depression and suicidality and is contraindicated in actively suicidal clients or those with untreated or inadequately treated depression. CYP2D6 genotyping is required before doses above 50 mg/day.

## In-depth explanation

Quick answer
Screen suicide risk, depression treatment, and CYP2D6 before high-dose tetrabenazine.

Why this is correct
Chorea improvement must be balanced against mood, parkinsonism, sedation, akathisia, and QT-related risks.

Easy analogy or mental picture
Build a medication-safety chain: identify the new cue, connect it to the drug mechanism or labeled limitation, stop preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, substitute an unauthorized dose, or delay escalation leave the client at risk.References
1DailyMed: Tetrabenazine TabletsDepression and suicidality contraindications plus CYP2D6 dose threshold

## Clinical scenario

Clinical context
A 45-year-old with Huntington chorea is being evaluated before tetrabenazine is started and titrated; the nurse reviews mood history, current medicines, and the proposed target dose.

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