NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed? 

A. Kidney disease stage II B. Obesity C. Cardiovascular disease D. Diabetes type II 

QUESTION 72 

The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)? 

A. Phentermine (Adipex-P) dose can be increased safely when taken with an anticonvulsant. B. Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts by inhibiting appetite. C. Topiramate (Topamax) potentiates appetite suppression achieved by phentermine (Adipex-P). D. Topiramate (Topamax) helps prevent the unwanted side effects of phentermine (Adipex-P). 

QUESTION 73 

The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and sees people chasing him. The PMHNP identifies these symptoms to be associated with which of the following? 

A. Barbiturate intoxication B. Marijuana intoxication C. “Bath salt” intoxication D. Cocaine intoxication 

QUESTION 74 

The PMHNP is caring for a patient who openly admitted to drinking a quart of vodka daily. Prior to prescribing this patient disulfiram (Antabuse), it is important for the PMHNP to: 

A. Evaluate the patient’s willingness to abstain from alcohol B. Counsel the patient on dietary restrictions C. Obtain liver function tests D. Assess for addiction to opioids 

QUESTION 75 An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ? 

A. The patient’s speech is slurred, and he is in and out of sleep. B. The patient’s appetite has decreased from eating 100% of his meal to 50% of his meal. C. The patient complains of not having a bowel movement for 4 days. D. The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations. 

QUESTION 76 

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? 

Yes No

  

                         NURS 6630 Midterm Exam (2018): Walden University

QUESTION 1

1.      A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).

A.

“You have to take your medication to become stable.”

B.

“Most medications will increase the number of neurotransmitters that you already have in the brain.”

C.

“Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has.”

D.

“Why do you believe that your medication is poison?” 

QUESTION 2

1.      Which statement about neurotransmitters and medications is true?

A.

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

B.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

C.

Neurotransmitters receive messages from most medications.

D.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points  

QUESTION 3

1.      When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

A.

“In an extreme case such as yours, more than one medication is often needed.”

B.

“Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

C.

“Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms.”

D.

“I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms.”

1 points  

QUESTION 4 ?

1.      During gene expression, what must occur prior to a gene being expressed?

A.

Transcription factor must bind to the regulatory region within the cell’s nucleus.

B.

RNA must be converted to mRNA.

C.

The coding region must separate from the regulatory region. This is wrong

D.

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points  

QUESTION 5

1.      While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

A.

Genes impact neuron functioning directly.

B.

Changes made to proteins lead to changes in behavior.

C.

Neurons are able to impact protein synthesis.

D.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points  

QUESTION 6

1.      Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

A.

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

B.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

C.

Neurotransmitters can spread by diffusion.

D.

The postsynaptic neuron can release the neurotransmitter.

1 points  

QUESTION 7

1.      Why is the cytochrome P450 enzyme system of significance to the PMHNP?

A.

The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective.

B.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

C.

The medication’s chemical composition changes when it comes in contact with the acid in the stomach.

D.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points  

QUESTION 8

1.      It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true?

A.

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

B.

The term polymorphic refers to the body’s ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics.

C.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

D.

Most enzyme pathways do not have interactions between the newer medications.

1 points  

QUESTION 9

1.      As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

A.

Most medications that act on G-protein linked receptors have antagonistic traits.

B.

The majority of medications used in practice are full agonists and are used to stimulate the body’s natural neurotransmitters.

C.

Most medications act as partial agonists because they allow the body to use only what is needed.

D.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points  

QUESTION 10

1.      The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition:

A.

The patient smokes cigarettes. 

B.

The patient has hypertension.

C.

The patient has chronic kidney disease, stage 2.

D.

The patient drinks a cup of coffee a day.

1 points  

QUESTION 11

1.      A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to:

A.

Alert staff to possible seizures

B.

Write an order for a different moodstabilizer 

C.

Decrease the amount prescribed for aripiprazole (Abilify)

D.

Explain to the patient that it will be more difficult to control his temper

1 points  

QUESTION 12

1.      A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). Which is the best action for the PMHNP to take for this patient?

A.

Review Amitriptyline (Elavil) level 

B.

Order a liver function test

C.

Check the patient’s blood pressure and pulse

D.

Order a stat platelet count

1 points  

QUESTION 13

1.      A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this?

A.

To promote the availability of serotonin

B.

To decrease serotonin

C.

To indirectly increase the amount of dopamine in the body

D.

To help decrease the amount of serotonin and dopamine

1 points  

QUESTION 14

1.      The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

A.

“I have trouble staying asleep in the middle of the night.”

B.

“My spouse told me that I seem to have trouble remembering things sometimes.”

C.

“I really want to stop smoking, but the cravings are too strong.”

D.

“I feel nervous to go outside and be in large crowds.”

1 points  

QUESTION 15

1.      Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription?

A.

“The drug will have an almost immediate effect.”

B.

“The drug can take a while to build up in your system.” 

C.

“The drug is slow to release but lasts for a long time.”  

D.

“The drug will make a subtle difference in your symptoms.” 

1 points  

QUESTION 16

1.      A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

A.

Benzodiazepine

B.

Mirtazapine (Remeron)

C.

Ketamine

D.

Varenicline (Chantix)

1 points  

QUESTION 17

1.      The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug?

A.

Full agonists

B.

Antagonists

C.

Partial agonists

D.

Inverse agonists

1 points  

QUESTION 18

1.      A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

A.

“The patient needs to have an inverse agonist.”

B.

“The patient could benefit from an anticonvulsant.”  

C.

“The patient’s calcium, sodium, chloride, and potassium levels must be regulated.” 

D.

“The patient should have a drug that acts on ligand-gated ion channels.”

1 points  

QUESTION 19

1.      The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

A.

Ligand-gated ion channels with a pentameric structure

B.

Ligand-gated ion channels with a tetrameric structure

C.

Voltage-sensitive ion channels

D.

Anticonvulsants

1 points  

QUESTION 20 ?

1.      Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

A.

“It’s my fault that all of this is happening. I don’t think I could ever forgive myself.” 

B.

“I have to talk to the President because I’m the only one who can help him.”

C.

“I’m not sure why that lady is wearing a red jacket since it’s the dogs who need food.”

D.

“I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.”

1 points  

QUESTION 21

1.      A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? I did not have this question

A.

Obtaining raw normative metrics and using them to assess functionality

B.

Having the patient report on cognitive function based on personal experiences

C.

Monitoring the patient in a controlled setting 

D.

Measuring symptoms of psychosis

1 points  

QUESTION 22

1.      Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin?

A.

Dopamine is terminated through multiple mechanisms.

B.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

C.

MAO-B presents in the mitochondria within the presynaptic neuron.

D.

D2 receptors are the primary binding site for dopamine agonists. 

1 points  

QUESTION 23

1.      Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?

A.

“Amphetamines may help you, as they can alleviate psychotic conditions.”

B.

“Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you.”

C.

“Amphetamines can cause hallucinations, so I would advise against this type of prescription.”

D.

“Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.”

1 points  

QUESTION 24

1.      The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient?

A.

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

B.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

C.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

D.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points  

QUESTION 25

1.      A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease?

A.

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

B.

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

C.

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

D.

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points  

QUESTION 26

1.      The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug?

A.

Hypersexuality

B.

Amenorrhea

C.

Dystonia

D.

Tardive dyskinesia 

A.

1 points  

QUESTION 27

1.      The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent. Which of the following requires the longest transition time for therapeutic benefit?

Olanzapine to clozapine

B.

Asenapine to Risperidone

C.

Aripripazole to ziprasidone

D.

Aripripazole to clozapine

1 points  

QUESTION 28

1.      The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient?

A.

Quetiapine

B.

Paliperidone

C.

Lurasidone

D.

Clozapine

1 points  

QUESTION 29

1.      Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

A.

Muscarinic antagonists are more likely to cause decreased prolactin levels.

B.

D2 antagonists decrease the likelihood of EPS symptoms.

C.

D2 antagonism is linked to antidepressant properties.

D.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points  

QUESTION 30

1.      Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient?

A.

An underlying depressive disorder

B.

The recent change of a 2nd generation antipsychotic to a conventional one 

C.

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

D.

All of the above

1 points  

QUESTION 31

1.      The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

A.

Long-term use of antipsychotics

B.

Genetic disposition

C.

Age

D.

A and C

E.

All of the above

1 points  

QUESTION 32

1.      The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?

A.

Those that are potent D2 antagonists

B.

Those that are potent D2 antagonists with 5HT2A antagonism properties

C.

D2 receptors that are blocked in the nigrostriatal pathway

D.

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points  

QUESTION 33

1.      Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon?

A.

5HT2 antagonism

B.

D2 antagonism

C.

Alpha-2 antagonism

D.

D2 partial agonist

1 points  

QUESTION 34

1.      A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

A.

Norepinephrine

B.

Dopamine

C.

Serotonin

D.

A and C

E.

All of the above

1 points  

QUESTION 35

1.      Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation?

A.

The patient has an unsustained response to antidepressants.

B.

The patient has antidepressant-induced hypomania. 

C.

The patient has a depletion of monoamine neurotransmitters.

D.

The patient has an adverse effect to atypical antipsychotics.

1 points  

QUESTION 36

1.      The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?

A.

Patient with a bipolar I designation

B.

Patient with a bipolar II designation

C.

Patient with a bipolar III designation

D.

None of the above

1 points  

QUESTION 37

1.      Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

A.

The patient may experience paranoid avoidant behavior.

B.

The patient may experience severe depression.

C.

The patient may experience auditory hallucinations.

D.

The patient may experience increased mood cycling.

1 points  

QUESTION 38

1.      The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient’s response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

A.

The patient has a higher chance of tolerating SSRI/SNRI treatment.

B.

The patient will have a positive response to SSRI/SNRI treatment.

C.

The patient will develop severe mood cycling in response to treatment.

D.

The patient may be less responsive or tolerant to the treatment.

1 points  

QUESTION 39

1.      Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh’s serotonin levels?

A.

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

B.

Norepinephrine inhibits 5HT release through a2 receptors.

C.

Norepinephrine inhibits α2 receptors on axon terminals.

D.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points  

QUESTION 40

1.      Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

A.

“Drugs inhibit the release of NE.”

B.

“Drugs can mimic the natural functioning of the NE neuron.”

C.

“Drugs are unable to simulate the effects of NE neurons.”

D.

“Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron.”

1 points  

QUESTION 41

1.      The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder?

A.

Insomnia

B.

Suicidal ideation

C.

Problems concentrating

D.

A and C

1 points  

QUESTION 42

1.      Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

A.

Neuronal firing rates are not dysregulated in depression.

B.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

C.

Upon the acute administration of a SSRI, 5HT decreases. 

D.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs. 

1 points  

QUESTION 43

1.      The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

A.

Both have a sedative-like, calming effect. 

B.

Both contribute to antipsychotic actions.

C.

Both demonstrate favorable findings in treating depression in the elderly.

D.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points  

QUESTION 44

1.      A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?

A.

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

B.

The patient cannot take any antihistamines. 

C.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

D.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu. 

1 points  

QUESTION 45

1.      After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?

A.

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient. 

B.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

C.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

D.

All of the above.

1 points  

QUESTION 46

1.      A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?

A.

First onset in puberty or early adulthood

B.

Late onset of menses  

C.

Premenstrual syndrome

D.

A and C

1 points  

QUESTION 47

1.      A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen:

A.

MAOI plus SNRI

B.

SSRI/SNRI plus NDRI 

C.

NDRI/SNRI plus mirtazapine

D.

NDRI plus modafinil

1 points  

*Q/UESTION 48

1.      Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

A.

She may experience withdrawal symptoms.

B.

She may experience increased trauma.

C.

Effects of abrupt cessation are unknown.

D.

It can lead to difficulties with concentration.

1 points  

QUESTION 49

1.      A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

A.

Weight gain can be problematic.

B.

Sedation is very common.

C.

Induction of mania is rare.

D.

Seizures are not unusual.

1 points  

QUESTION 50

1.      The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

A.

Stop the venlafaxine

B.

Lower the dose of venlafaxine by 50%

C.

Lower the dose of venlafaxine by 25-40%

D.

Increase the dose of venlafaxine by 50%

1 points  

QUESTION 51

1.      A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses concern regarding “how she will feel and look” from taking the medicine. Which statement correctly describes the side effects as a result of taking this medication?

A.

It can affect her menstruation. 

B.

Suicidality can be common among young adults.

C.

Sedation may be problematic.

D.

Weight gain is unusual.

1 points  

QUESTION 52

1.      Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40-50 hours a week as a contractor and “manages his stress” by smoking 3-4 cigarettes a day and having 8-10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby?

A.

He has fibromyalgia.

B.

He has arrhythmia.

C.

He uses alcohol.

D.

He is overweight.

1 points  

QUESTION 53

1.      A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

A.

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

B.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

C.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

D.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose. 

1 points  

QUESTION 54

1.      A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

A.

The patient has hepatic impairment.

B.

The patient has moderate renal impairment.

C.

The patient has severe renal impairment.

D.

The patient has cardiac impairment.

1 points  

QUESTION 55

1.      The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

A.

Histamine H1 receptor blockade can cause insomnia.

B.

Muscarinic M1 receptor blockade causes blurred vision.

C.

Alpha 1 adrenergic receptor blockade causes weight gain.

D.

Muscarinic M3 receptor blockade causes sedation.

1 points  

QUESTION 56

1.      A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO inhibitors?

A.

“You must avoid soy products, such as tofu.”

B.

“You should not consume processed meats.”

C.

“You may consume fermented foods, like sauerkraut.”

D.

“You may continue to drink beers on tap.”

1 points  

QUESTION 57

1.      A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug interactions?  

A.

“Decongestants are fine to continue taking with MAO inhibitors.” 

B.

“Decongestants are okay to take with MAO inhibitors in moderation.”

C.

“Decongestants should be avoided due to risk of serotonin syndrome.” 

D.

“Decongestants should be avoided due to risk of hypertensive crisis.”  

1 points  

QUESTION 58

1.      Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP understand about this patient?

A.

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

B.

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount. 

C.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

D.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points  

QUESTION 59

1.      The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

A.

Patient with PTSD

B.

Patient with partial seizures

C.

Patient with galactose intolerance  

D.

Patient with Lapp lactase deficiency

1 points  

QUESTION 60

1.      Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

A.

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

B.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

C.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

D.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points  

QUESTION 61

1.      A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient’s concerns? 

A.

mirtazapine (Remeron)

B.

doxepin (Silenor)

C.

alprazolam (Xanax)

D.

trazadone (Oleptro)

1 points  

QUESTION 62

1.      A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

A.

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

B.

Mood stabilizers can consistently treat both mania and bipolar depression

C.

Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to target all four therapeutic actions

D.

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points  

QUESTION 63

1.      The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

A.

Thyroid Stimulating Hormone (TSH)

B.

Complete Blood Count (CBC)

C.

Erythrocyte Sedimentation Rate

D.

Platelet Count

1 points  

QUESTION 64

1.      A 39-year old female patient presently on lithium would like to try a new medication to treat her bipolar disorder. She has had concerns about side effects from lithium and wants to learn more about Lamotrigine (Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects of this agent, including which of the following?  I don’t think I had this question

A.

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer’s disease

B.

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

C.

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

D.

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points  

QUESTION 65

1.      A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear about most effective outcomes. Which of the following agents does the PMHNP convey as having uncertain outcomes?

A.

Carbamazepine (Tegretol)

B.

Gabapentin (Neurontin)

C.

Valporoic Acid (Depakene)

D.

All of the above

1 points  

QUESTION 66

1.      A 46-year old male patient mentions several alternative treatments to Carbamazepine (Tegretol) as a way to manage symptoms of his bipolar depression. Which of the following does the PMHNP indicate would not be an agent to treat bipolar depression?

A.

Omega-3-fatty-acids

B.

Soybean lecithin

C.

Inositol

D.

L-methylfolate

1 points  

QUESTION 67

1.      The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this patient?

A.

Valporic Acid (Depakene)

B.

Carbamazepine (Tegretol)

C.

Lithium (Lithobid)

D.

Lamotrigine (Lamictal)

1 points  

QUESTION 68

1.      The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

A.

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder. 

B.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

C.

Irritability, lethargy, anger; the child should be evaluated further for ADHD.  

D.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder. 

1 points  

QUESTION 69

1.      A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the Clonazepam (klonopin) the best response is:

A.

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

B.

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

C.

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

D.

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points  

QUESTION 70

1.      During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the PMHNP’s best response is:

A.

“Some medications can cause heart issues so it is necessary to rule those out before you begin medication.”

B.

“This is a part of our routine admission and it is important that you give me truthful answers.”

C.

“Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus.”

D.

“Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”

1 points  

QUESTION 71

1.      The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

B.

Alcohol works similar to benzodiazepines

C.

Up to 30% of people with anxiety use alcohol to self-medicate

D.

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points  

QUESTION 72

1.      After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

a.

Respiratory depression

b.

Sedation and restlessness

c.

Sweating and nausea (This question was marked wrong but I think the answers are different too)

d.

Bradycardia and tachypnea

1 points  

QUESTION 73

1.      A patient  is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:

A.

“SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry.”

B.

“Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases.”

C.

“Antidepressants are prescribed prophylactically to prevent symptoms of depression.”

D.

“Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety.”

1 points  

QUESTION 74 ?

1.      The PMHNP evaluates the patient for “fear conditioning” when he asks:

A.

Have you ever experienced any type of trauma?

B.

What do you do when you feel fear?

C.

Does your mother or father have a history of fear and/or worrying?

D.

What makes your fear better?

1 points  

QUESTION 75

1.      A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

A.

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

B.

Beta blockers are linked to reconsolidation.

C.

This medication will allow the patient to sleep throughout the night.

D.

This medication is linked to the increase of serotonin in the brain.

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