Clinical Practicum I Final Exam: Multiple Choice Questions and Answers, Exams of Nursing

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CLINICAL PRACTICUM I FINAL EXAM 100%

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Which of the following is true regarding psychostimulants? - ✔✔First line treatment for ADHD All of the following are changes that were made to the DSM V regarding ADHD diagnoses EXCEPT: - ✔✔ODD is included as an exclusionary diagnosis (meaning with the DSM V you CANNOT have a comorbid diagnosis of ODD and ADHD) ADHD treatment is associated with: - ✔✔Decrease in accidental injury and medical utilization due to accidents and trauma Non-stimulant medications should be used first-line in adults with ADHD. - ✔✔** True Tyler is an 8 - year-old male who presents with ADHD and ODD on a referral from his pediatrician who has been having difficulty managing his medication side effects. Per mom, Tyler is doing well on his 20 mg dose of Focalin XR (extended release), which he takes at 6:30 am before mom leaves for work. He has reported appetite suppression, and consequently does not eat breakfast and eats very minimally for lunch at school. The pediatrician and mom are concerned as Tyler previously was at the 50% percentile on his growth charts for both height and weight, but has recently dropped to the 25th percentile for weight. What is the BEST strategy to consider to mitigate this medication side effect? - ✔✔Switch his stimulant to a short acting stimulant twice a day (morning and lunch) and instruct him to eat meals then take the short-acting stimulant. Stimulants have a black box warning for: - ✔✔Drug Dependence Which of the following is true regarding cortical brain development in children with ADHD compared to healthy controls? - ✔✔The timing of cortical maturation is different ***Peak thickness of cortex delayed (typically occurs around 7, may not happen until 10 for kids with ADHD) A 32-year old patient with major depressive disorder has been treated successfully with paroxetine (Paxil) for 4 years. He also has a history of ADHD, but is not currently being treated for it. In addition, he

has a history of stimulant abuse, but has been clean for several years. He presents now stating that he is

having significant work impairment due to inattention and disorganization and is in danger of losing his job. Full evaluation reveals that he does meet criteria for current ADHD. Because of his history of substance abuse, atomoxetine (Strattera) is chosen as a treatment. What pharmacokinetic interaction, if any, would you expect between atomoxetine and paroxetine? - ✔✔Paroxetine is an inhibitor of CYP 2D6 and atomoxetine is metabolized by CYP450 2D6, so the dose of atomoxetine should be decreased. ***In the presence of paroxetine, the dose of atomoxetine should be decreased. Which of the following is a risk factor for the development of Conduct Disorder? - ✔✔Poor family functioning Which of the following symptom is the MOST frequent reason for referral in child psychiatry clinics? - ✔✔Disruptive behavior Autism Spectrum Disorder, Severity Level 2, only requires substantial support. - ✔✔True Deficits in social-emotional reciprocity in someone with ASD: - ✔✔Are clearly evident in young children with the disorder (DSM 5 p. 53, within diagnostic features) All of the following are differences between Schizophrenia and Autism EXCEPT: - ✔✔Only children with schizophrenia appear aloof, socially isolated or verbally uncommunicative (The big difference is that Autism is usually diagnosed before age 3 whereas schizophrenia occurs in adolescence or adulthood, not extremely early childhood and importantly children with autism, but not schizophrenia have an increased risk of having ID. Schizophrenia develops after a period of normal behavior. It's more of a regression. The prodromal period of schizophrenia can have some symptoms that are similar to ASD, problems with social communication which on the inside may be due to hallucinations but on the outside just looks strange.) The only two FDA approved atypical antipsychotics for irritability associated with Autism are: - ✔✔Aripiprazole (Abilify) and Risperidone (Risperdal) There are many types of psychosocial interventions for Autism, but many use principles from

• ✔✔Applied Behavior Analysis

Families of children with Autism are unlikely to use complementary and alternative medications when treating their child, therefore you do not need to ask about them during your initial evaluation. - ✔✔False (Families use CAM more often in Autism than other disorders, so it is important to ask about them during your assessment.) There are two major categories of disturbances in Autism Spectrum Disorders, which are: - ✔✔(1) Deficits in social communication/social interaction and (2) restricted, repetitive patterns of behavior, interests, or activities In Separation Anxiety, the fear, anxiety, or avoidance is persistent, lasting at least weeks in children and adolescents. - ✔✔ 4 If a child is experiencing Selective Mutism, they are usually able to speak at school amongst their friends.

• ✔✔False Diagnostic Criteria for Agoraphobia include which of the following: - ✔✔** Marked anxiety or fear of using public transportation ** Marked anxiety or fear of standing in line First-line medication treatment for GAD in children and adolescents are: - ✔✔** SSRI In Generalized Anxiety Disorder, Children are required to meet the FULL set of core symptoms. - ✔✔False When evaluating for anxiety, it is prudent to wonder/ask "Is this something you should be worried about?" while minimizing the intensity of worries. - ✔✔False (Slide 4 in "Anxiety Disorders in Children and Adolescents". The intensity of worries and how they can impact functioning should be considered in your diagnostic evaluation.)

A primary care providers refers a 17 year old, high school senior to your practice due to concerns of excessive worries. When the client sits down, they report being worried about their grades and their ability to obtain scholarships for university. As you are listening, you should be considering - ✔✔** These concerns are developmentally normal. ** Any steps/actions that the client has taken to alleviate the worries. ** How these worries are impacting the client. NAC dosing may vary between pediatric and adult populations. Which dose did Vonda say she typically started in the pediatric population? - ✔✔300mg one cap PO qD Which of the following may be an appropriate form of therapy for a pediatric client with a h/o trauma or PTSD - ✔✔** Trauma-focused CBT ** EMDR ** DBT Clomipramine/Anafranil is a TCA and, thus, has serotonergic and noradrenergic actions. - ✔✔** True A 34 - year-old woman presents with symptoms of generalized anxiety disorder (GAD) that have been present for the past 8 weeks. How long must the symptoms of GAD be present in order to make the diagnosis? - ✔✔6 months A selective serotonin reuptake inhibitor targets which part of the brain? - ✔✔Frontal cortex A patient who is admitted to the psychiatric unit with a diagnosis of obsessive - compulsive disorder spends a significant amount of time during the day and night washing his or her hands. On the third hospital day, the patient reports feeling better and more comfortable with the staff and other patients. The psychiatric and mental health nurse knows that the most appropriate nursing intervention is to: - ✔✔collaborate with the patient to reduce the amount of time he or she engages in ritualistic behavior.

Which factors are associated with the development of post-traumatic stress disorder? - ✔✔Severity of the stressor and availability of support systems After taking an antidepressant for about a week, a patient reports constipation and blurred vision, with no improvement in mood. The psychiatric and mental health nurse informs the patient: - ✔✔"It takes approximately two to four weeks for depression to lessen, and side effects usually diminish over time." Which characteristic of fluoxetine (Prozac) provides the greatest degree of safety for patients who have severe anxiety and panic attacks? - ✔✔Less potential for injury with intentional overdose Symptoms of anxiety and panic are associated with a low level of which neurotransmitter? - ✔✔Gamma- aminobutyric acid Alprazolam is thought to exert its anxiolytic effects by acting on and inhibiting activity in the

. - ✔✔GABA-A, amygdala You are seeing a follow-up patient, Clarice, who is 37 - years-old and of Hispanic descent. You suspect that she is abusing the alprazolam that you're prescribing to her for an Unspecified Anxiety Disorder. What are some steps you could take to help confirm or dismiss this suspicion? - ✔✔Contact her PCP's office and any specialists to review with them prescribed medications. Order a urine drug screen to see if she possibly diverting this product and/or abusing any other substances. Directly and firmly ask Clarice if she is abusing her prescriptions or any other substances. Assess OARRS. Which of the following statements are correct? - ✔✔Symptoms of panic attacks may include cardiac related, dysphagia, diaphoresis, & neurological symptoms

Before modern conceptions of depression in children, it was thought that their would prevent them from developing depression. - ✔✔Super-ego In young children, some of the most common symptoms of depression include: - ✔✔Aggression Excessive crying Anger Guilt A PHQ- 9 score of 15 would warrant. - ✔✔pharmacotherapy Clozapine has shown superior efficacy compared to other atypical antipsychotics for the treatment of psychosis. - ✔✔True In the treatment for cocaine use disorders, antabuse has robust efficacy in numerous peer reviewed articles. - ✔✔False Which SSRI may be better for clients who have intermittent/poor adherence? - ✔✔Fluoxetine The single most predictive factor for developing MDD is high family loading for the disorder. - ✔✔True When considering Metformin for antipsychotic-associated weight gain, it would be prudent to discuss the benefits of lifestyle changes along with medication management. - ✔✔True In depressed adolescents, which therapies have evidence of efficacy from RCTs? - ✔✔IPT CBT

You are a PMHNP precepting a student in your outpatient office. The student wonders why you do not typically prescribe amitriptyline/elavil for child and adolescent depression. Which is your best answer? - ✔✔RCTs and meta-analysis have shown that TCAs are no more efficacious than placebo. A 45 year old female presents to your office for an initial intake appointment with complaints of depression. She is being treated for HTN and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history and determine which of the following medications should be considered as a possibility of worsening depression? - ✔✔propranolol A 50 year old male patient has been diagnosed with MDD and placed on fluoxetine 20 mg for his depression. For the PMHNP to effectively monitor his use of the medication, which of the following actions should be part of ongoing care? - ✔✔Use of a standardized rating scale for depression Which of the following is the appropriate initial response for a patient who presents as an acute suicidal risk? - ✔✔Ask the patient what their plan of suicide is and if they have assembled the means to carry out their plan Which of the following SSRIs is highest in side effects, particularly sedation, weight gain, and sexual SE? - ✔✔paroxetine (paxil) Which of the following is the most concerning side effect needing evaluation from fluoxetine for a 24 yo patient with Major Depressive Disorder? - ✔✔Difficulty falling asleep & "over" energized during the day A 30 year old female patient presents to the PMHNP for symptoms of depression and anxiety, first episode. The PMHNP diagnoses Major depressive disorder, first episode, moderate severity with mild anxious distress. She is started on sertraline 50 mg daily and calls the office 5 days later complaining of difficulty sleeping, feeling tense and on edge, headache, and nausea. Which of the following is the best course of action? - ✔✔Instruct her to cut the dosage of sertraline in half to 25 mg and make sure she is taking in in the morning A 32 - year-old female patient informs the psychiatric-mental health nurse practitioner that she is three months pregnant. She has been stable on fluoxetine (Prozac) for the last two years. The patient asks

whether she may safely continue this medication during her pregnancy. The nurse practitioner responds:

• ✔✔"Let's review the risks and benefits of continuing or discontinuing Prozac for you and your baby." Which of the following medications is contraindicated for patients with alcohol use disorder or liver disease? - ✔✔Duloxetine (Cymbalta) Which of the following is most important to monitor when patients are on combination therapy of Venlafaxine (Effexor) and Bupropion (Wellbutrin)? - ✔✔Blood pressure A 40 year old patient comes to the PMHNP for recurrence of MDD, recurrent, severe, without psychotic features. She responded well 10 years ago to Prozac. Which of the following statements would be your most appropriate at this time in regard to your treatment plan? - ✔✔"I think it is best to restart your Prozac at 20 mg and refer you to talk therapy" How does DMDD differ from bipolar disorder? - ✔✔DMDD is chronic irritability without distinct manic episodes Nick is an 8 - year-old with silly, disinhibited behavior, who has been labeled the class clown by peers. He is very impulsive per his parents and sometimes annoys his peers by not knowing when to stop certain behaviors. He has always been a terrible sleeper, per parents, and resists going to bed each night. Based off this limited information you are more concerned for which diagnoses? - ✔✔ADHD Main findings from the Course and Outcome of Bipolar Youth (COBY) study include: (select all that apply)
• ✔✔Kids have more pole changes per year Kids spend more time in episodes than adults Kids have more mixed/racing episodes When assessing a pediatric patient's family psychiatric history, you would be most concerned with a bipolar diagnosis in their: - ✔✔Parent BIOS study found that offspring of parents with bipolar disorder were at a much higher risk of developing bipolar disorder. First-degree is key!

Which of the following is true regarding the pharmacologic treatment of youth with pediatric bipolar disorder? - ✔✔Pharmacology is the cornerstone of managing Bipolar Disorder, in children and adults Pharmacology is the cornerstone of managing Bipolar Disorder in children and adults. While psychoeducation and psychotherapy are important they should be seen as adjunctive treatment. Based upon available evidence, which of the following is the BEST first-line medication in the treatment of acute mania in pediatric bipolar disorder? - ✔✔Second generation antipsychotic in monotherapy 1st line: SGA, give it 3 - 8 weeks to work and then if it does not taper off over 1 - 2 weeks and simultaneously start another SGA. Try 2 - 3 SGAs before switching to another class What length of time would be considered an adequate trial of a second generation antipsychotic for the treatment of pediatric bipolar disorder to establish efficacy if no problematic side effects are present? - ✔✔At least 3 to 8 weeks give it 3 - 8 weeks to work and then if it does not taper off over 1 - 2 weeks and simultaneously start another SGA. Try 2 - 3 SGAs before switching to another class What SGA should be used first-line for a pediatric patient with moderate bipolar depression? - ✔✔Lurasidone (Latuda) Lurasidone (Latuda) is FDA approved for bipolar depression in ages 10+, side 47. Some of the other medications can be used, but should not be first-line. Nicole is a 16-year-old who has been hospitalized on a psychiatric inpatient unit for a manic episode. During this episode she presents with psychosis (auditory hallucinations) and is subsequently started on aripiprazole (abilify) and lithium. She does well with this medication regimen during her hospitalization and subsequently her manic symptoms resolve. During a meeting with her parents her mom asks how long she is going to need to take these medications. What should you tell her parents? - ✔✔We recommend continuing these two medications for at least 2 - 6 months and then could considering slowly stopping lithium while continuing abilify. If they had psychotic features and responded to combination treatment (SGA + lithium) continue both drugs for at least 2 - 6 months, but consider longer for patients who are severely ill (attempted suicide). If stable could consider tapering off lithium and continuing SGA

If a parent fills out the Young Mania Rating Scale (YMRS) and their child receives a score of 20 you can make the diagnosis of Bipolar Disorder. - ✔✔False YMRS is a screening tool not a diagnostic tool- the screening tools never replace an interview. Elevated, expansive, or irritable mood is the hallmark of a manic episode. - ✔✔True V is a 21 year old woman presenting in an outpatient office to establish care. Their husband of one year presents with them. They are three months postpartum with complaints of severe depression beginning shortly after delivery. They have a h/o depressive episodes beginning around the age of 13, which includes a period of psychotic depression around the age of 19 necessitating treatment with Aripiprazole. They were most recently treated with Sertraline 200mg, which they found initially effective (but then lost efficacy and tapered off d/t pregnancy). When discussing family hx, they endorse mother and maternal grandmother have BPAD and treated with Lithium. Their MSE is significant for depressed and irritable mood, psychomotor agitation, and racing thoughts. They deny current A/VH and do not appear to be attending to internal stimuli. What are some features in this vignette that may be considered predictive of BP - ✔✔Postpartum depression Psychotic depression before the age of 25 Family history of bipolar disorder As this is your first time meeting V, the first goal of treatment would be to: - ✔✔Guarantee the patient's safety

As you are going through V's assessment, they endorse decrease in self-care (MSE is significant for disheveled appearance and malodorous), decreased appetite with reported 10 pound weight loss in a month, suicidality w/ plan to OD and varying levels of intent, and insomnia. Husband agrees with V's report and reports he has been taking time off of work to help accommodate V's decrease in function. V is resistant to the idea of hospitalization as they are concerned their newborn will be removed from the home. Is there enough information to consider compelling a psychiatric hold/pink slip/72 hour hold? - ✔✔Yes Through shared decision making with V and her partner, V agrees to a voluntary hospitalization considering the severity of their depression and decrease in self - care. While at the psychiatric hospital, the Psychiatric/Mental Health APRN diagnoses V with Bipolar II and subsequently prescribed a Lamictal taper and Aripiprazole. After a week, V was discharged to your office on Lamotrigine 25mg one tab PO qD and Aripiprazole 10mg one tab PO qD. When providing education to V about the Lamotrigine it would be prudent to discuss: - ✔✔Lamotrigine is helpful for bipolar depression and may prevent manic episodes The importance of medication adherence You and V to agree to meet on a monthly basis to monitor their mental health. Over the course of three months, V is eventually titrated to Lamictal 200mg qD and Aripiprazole 15mg qD. At four months, V's depression is considered in remission and you agree to follow-up with one another in three months Three months later, V follows up for her appointment and the first words out of her mouth are "I'm fantastic!" Over the course of the assessment, her mood is labile (from irritable to euphoric), and she has a hard time sitting still. She also reports her husband is concerned about how much money she is spending, "butIdontcarebecauseitwillallbeokayandIhavesomuchenergyanditisamazingandcanyoubelieveIredecorate dmyentirehouseOMGhowareyouyoulooklikeyougainedweightareyouokay?" At this point you should be wondering about: - ✔✔Substance use Medication nonadherence

Other medical conditions and/or changes in medication regimen With V's permission, you contact her husband to obtain collateral and discuss his concerns. He states V has been acting like this for about two weeks and is concerned about her lack of sleep and impulsivity. Based on this information, you agree to send V to the hospital for stabilization. While inpatient, Lamictal is re-started (rationale is that it worked well for client while she was taking it); Aripiprazole is replaced with Olanzapine 10mg one tab qHS. Considering V's manic state, you are considering adding Lithium. Is it possible to provide loading doses of Lithium? - ✔✔Yes V is started on Lithium sustained release 300mg one BID. During early hospitalization, V also receives Ativan, Benadryl, and Haldol infrequently for agitation. V's manic symptoms start to resolve and they wonder how lithium is beneficial for them. According to Stahl, Lithium's mechanism of action as an anti-manic agent is: - ✔✔Unknown The therapeutic window of Lithium is: - ✔✔0.6-1.2 mEq/L Valproate's hypothetical mechanisms of action include: - ✔✔Boosting GABA Regulating downstream signal transduction cascades Inhibiting voltage-sensitive sodium channel Medical conditions that may be a cause of psychosis include all of the following except: - ✔✔Huntington's Disease Hypoadrenocorticism Systemic Lupus Erythemagosus

Neurological soft signs commonly seen in individuals with Schizophrenia include: - ✔✔Impairment of motor coordination Impairment of sensory integration Left-Right confusion Approximately to % of individuals with Schizophrenia die by suicide. - ✔✔5, 6 Life expectancy of persons with Schizophrenia is reduced due to: - ✔✔Medical conditions If one is considering MDD as a differential diagnosis for Schizophrenia, one should consider the temporal relationship between mood disturbance and psychosis, as well as severity of the depressive symptoms. - ✔✔True As a category of medications, atypical antipsychotics may be used to treat: - ✔✔Off-label use, including treatment resistant anxiety Manic and depressed phases of bipolar Augmenting agents for treatment-resistant depression Psychosis Therapeutic actions of first generation antipsychotics is thought to be due to. - ✔✔blockade of D2 receptors in the mesolimbic dopamine pathway Galactorrhea (breast secretions) and amenorrhea (irregular or lack of menstrual periods) are associated with antipsychotic-induced. - ✔✔Hyperprolactinemia

When a client is on an atypical antipsychotic, what are the recommended parameters for metabolic monitoring? - ✔✔Fasting triglycerides Fasting glucose Blood pressure Weight/BMI has shown superior efficacy compared to other antipsychotics when treating psychosis, as well reducing suicidality, aggression, and severity of tardive dyskinesia. - ✔✔Clozapine The belief that an outside force has removed his or her internal organs and replaced them with someone else's organs without leaving any wounds or scars is considered: - ✔✔Bizarre delusion Brief Psychotic Disorder Diagnostic Criteria include: - ✔✔Must have duration of at least 1 day, but less than one month Include incoherent speech Can occur postpartum The distinctive difference between schizophreniform disorder and schizophrenia is: - ✔✔Duration of illness Social and Occupational Dysfunction is a functional consequence of Schizophrenia. - ✔✔True If the onset of Schizophrenia in childhood or adolescence occurs, there is failure to achieve expected level of interpersonal, academic, or occupational functioning. - ✔✔True

You are the PMHNP at a community's psychiatric crisis center. You walk into treatment team and overhear a tech talk about how a client is repeating what they are saying, mimicking their movements, maintaining "weird" postures for extended periods of time, and keeps making "weird" faces at the techs and other clients. Without any other information, which diagnosis should be at the top of your differential list: - ✔✔Catatonia You are finishing an initial assessment on a 19 year old client with first episode psychosis. They endorse hallucinations of seeing angels and appear to be attending to internal stimuli throughout the assessment. They also have difficulty maintaining conversation and frequently get derailed. Pertinent positives to their medical history include: morbid obesity (5'10"; weight before the assessment is 350#), HTN, Dyslipidemia, and DMT2 (A1C on admission is 8.5). Which medication would be the most appropriate first-line medication for this client: - ✔✔Aripiprazole Best option is Aripiprazole as it has lower metabolic risks compared to Clozapine and Olanzapine. Olanzapine is a fair option, but is higher on the metabolic risk scale and this client has poorly controlled DMT2. Clozapine is a great medication and there are some arguments that it should be used first-line; however, it is usually relegated to 3rd line d/t frequency of monitoring. Clozapine is also higher on the metabolic risk scale. Valproic acid is not used in monotherapy for psychosis, but may be used as an adjunct. You are covering for another PMHNP in an outpatient clinic when the EHR has an outage and you lose connection. A client of the other NP comes in stating they are to get their follow-up antipsychotic injection. They received their first IM injection a week ago and were told to come back in a week to receive the second injection. Out of the LAIs, which is the most likely injection this client is due to receive? - ✔✔Invega Sustenna In an integrated care office, a primary care provider asks you to consult on a case of "treatment-resistant psychosis". The client is currently treated with Quetiapine 300mg one tab qHS and has been taking this medication for approximately two weeks. During the consult, the client is attending to internal stimuli and behaving bizarrely; thus, you agree that psychosis is not well-controlled. What is your recommendation to the PCP? - ✔✔Okay to titrate Quetiapine up to 800mg/day.

A client's partner calls your office stating your client developed muscle rigidity and a fever a few days into treatment with risperidone 1mg one tab BID. What is your response? - ✔✔Recommend going to the ED for evaluation of NMS You're rounding on an inpatient substance abuse unit, and as you're interviewing a patient, you notice that she appears slightly diaphoretic on her forehead and chest, seems to have some psychomotor agitation and she continues to tell you, "I just don't feel right." She is Caucasian and 44 - years-old, and is in generally good health. What should be the first step you take toward further assessing this patient? - ✔✔Have her vital signs assessed Ask her some questions about any specific substances she has been using What signs and/or symptoms should you be mindful of when treating a patient in cocaine withdrawal? - ✔✔None of the above You are newly seeing a 39 - year-old Native American male who has a history of alcohol use disorder, severe, and he's been sober for about 48 hours, since being admitted to the detox facility over the weekend. He has diabetes, chronic pain from a disc injury, and is obese, and he abuses no other substances. He is terrified he will relapse and continue to use, even after he completes detoxification and residential rehabilitation for 14 days. He asks, "I just need a medication that will stop me from drinking." What is an appropriate response - ✔✔Process with him his expectations for sobriety and what his inpatient and aftercare plans are for same Maxine, a 21-year-old Russian girl, asks you if you have ever used marijuana as you are interviewing her for the first time during a substance abuse partial hospitalization program. What is the most therapeutic response? - ✔✔Redirect the interview back to her, and let her know that it is not appropriate to discuss your personal history with her You're treating a 61 - year-old African American male named Alfred, who is in acute alcohol withdrawal on a detoxification unit called, Higher Power. You read his most recent vital sign set as being: 169/104, 110, 18, 99.9 and CIWA as a 15 (namely for tremor and diaphoresis). He has a medical history of hypertension, diabetes, chronic pain from spinal stenosis, osteoarthritis, and grand mal seizure disorder. He has been medication adherent in the community and has continued his home medications while

under your care for the past two days. He's completely and consistently alert and oriented, just outwardly anxious. What would be an appropriate and safe next step in treating Alfred? - ✔✔Review most recent and total daily dosing of benzodiazepines he's received and determine if more is needed to be ordered Ask him about a history of seizures (and/or delirium) within the context of alcohol withdrawal Order him ibuprofen to treat his mild fever Amphetamines and amphetamine-like drugs are among the most widely used illicit substances, second only to cannabis, in the United States, Asian, Great Britain, Australia and Several other Western European countries - ✔✔True All amphetamines are rapidly absorbed orally and have a rapid onset of action, usually within 60 minutes when taken orally. - ✔✔True You are treating a 20 - year-old Caucasian male outpatient for Attention Deficit Disorder, and you would like to consider using Vyvanse. What are some considerations and points of interest when making your decision? - ✔✔Before treatment, assess for presence of cardiac illness, VS and weight (and height in children) Once converted, Vyvanse increases norepinephrine and dopamine actions by blocking their reuptake and facilitating their release If this product does not work, consider adjusting dose or switching to a different agent You know that it's a prodrug of dextroamphetamine and thus it's inactive until after it's been absorbed by the intestinal tract and converted to dextroamphetamine and l-lysine You have prescribed naltrexone (ReVia) for Anuhu, a 52 - year-old Nigerian male who suffers from Alcohol Use Disorder, Severe. He sees you for a follow-up during his Partial Hospitalization Program (PHP). He is describing some potential side effects from this product, and the following side effects grab your attention, as they are common, uncomplicated ones: - ✔✔Nausea, vomiting, decreased appetite

Jason, a 13 - year-old Caucasian male, whom you see outpatient, presents for a medication check. You prescribe him Ritalin and you notice that his mother has called the office several times since the last visit, requesting an early fill on Jason's Ritalin prescription. What would be some first steps in further assessing this case, as you're concerned that there might be misuse of this product? - ✔✔Order a urine toxicology Assess the patient's OARRS Have his mother come into the office with the patient and discuss with them separately, as well as together, your concerns about the frequent requests for early fills Contact his pediatrician to discuss your concern, as there is a release on file Which disorder is characterized by a chronic, moderately depressed mood, but has not met criteria for a major depressive disorder? - ✔✔Dysthymia Two common symptoms found in individuals with obsessive-compulsive disorder include: - ✔✔Reoccurring thought(s) that are difficult to control Checking behaviors The activity of which two neurotransmitters in the postsynaptic membrane are elevated by antidepressants? - ✔✔Serotonin Norepinephrine The compulsive behaviors seen in obsessive-compulsive disorder serve to alleviate which symptom in a client? - ✔✔Anxiety Which of the below medications utilized as mood stabilizers - ✔✔Oxcarbazepine

A patient comes to the unit with symptoms of hypotension, tachycardia, clammy skin, slow/shallow breathing, depressed levels of consciousness. This client most likely is experiencing: - ✔✔Opioid overdose/toxicity In at least some patients with PTSD, data has shown hyperactivity. - ✔✔Endogenous opiate system HPA axis Noradernergic PTSD symptom criteria can be broken down into which domains? - ✔✔Re-experiencing Intrusive symptoms Avoidance According to Kaplan & Sadock's Synopsis text, which SSRIs are considered first-line for PTSD? - ✔✔Paroxetine Sertraline After a traumatic event, psychotherapy should include: - ✔✔Education Support Development of coping skills Acceptance of the event

Crisis intervention