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NRNP 6675 Week 11 Final Exam: Questions and Answers on Medication and Mental Health, Exams of Nursing

A comprehensive set of questions and answers related to medication and mental health, focusing on topics such as antipsychotics, antidepressants, and mood stabilizers. It covers various aspects of medication management, including half-life, withdrawal syndromes, and drug interactions. Particularly useful for students studying psychiatric nursing or related fields.

Typology: Exams

2024/2025

Available from 12/23/2024

Examiner2025
Examiner2025 🇺🇸

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Download NRNP 6675 Week 11 Final Exam: Questions and Answers on Medication and Mental Health and more Exams Nursing in PDF only on Docsity!

NRNP 6675 WEEK 11 FINAL EXAM LATEST UPDATE

2024 - 2025 QUESTONS WITH CORRECT DETAILED

ANSWERS ALREADY GRADED A+

_________induces it's own metabolism, hastening excretion and shortening it's half life A. Carbamazepine (Tegretol) *this effect begins to "rev up" after 2-4 weeks--which is why a carbamazepine level is so important on obtaining 1-2 months after starting Tegretol. Carbamazepine (Tegretol) level should be checked how soon after starting to take this med? 1 - 2 months due to Tegretol inducing it's own metabolism, hastening excretion and shortening it's half life. The treatment of others equitably and distribution of benefits/burdens fairly is known as which of the following? B. Justice a fair an equitable distribution of health resources Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics of which of the following PD? C. Dependent PD

According to Sullivan, which of the following are consistent with a mentor/mentee relationship? C. Goals for the mentoring are set mutually The need for NPs to practice to the full extent of their education and training is necessary for which of the following reasons? B, C & D The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A. Diet Trifluphenazine is also known as? Stelazine first generation antipsychotic Lillipucin hallucinations are what? "little people or kids" hallucinations What is a red flag that indicates Lewy Body? Lillipucin hallucinations hallucinations of little people or kids What is a key question to ask someone with dementia when performing an evaluation of mental status to show confabulation?

"You look familiar, didn't we meet before?" will show confabulation How to test for lewy body dementia? (question to ask?) Q: how do you think they are getting in the house? Q: where in the home are they hiding? *Individuals are typically paranoid What is not used in tx of lewy body dementia for antispcyhotics? D. Risperidone and haldol WHY?

  • Individuals with lewy body dementia have increased sensitivity to antipsychotics
  • increased risk of EPS, confusion, sedation and falls
  • typical or traditional antipsychotics should be avoided Why is haldol contraindicated in lewy body? first generation antipsychotic meds should not be used to tx lewy body due to increased confusion, severe parkinsonism/EPS, sedation and even death 1st gen antipsychotics should be prescribed ______ term for older adults with lewy body dementia? SHORT TERM at a lose dose but only if the benefits outweigh the risks What are the preferred tx of antipsychotics in lewy body? Seroquel, Clozaril and Zyprexa

**they don't make you stiff Possible indications of lewy body dementia? increased falls, delirium, pneumonia/recent infections What hallucination indicates paranoia? bugs scratching/itching/picking, talking about bugs in their skin? meth Bugs, animals, snakes, spiders, creepy crawlies indicate what? A. NOT psychosis look into medication/medical options The smaller the dose of Geodon, the more? A. Activating *to sedate patients will need LARGE geodon doses Charles Bonat was no a psychiatrist- but believed that the brain creates things it wants that humans cannot see due to this it is important to assess hearing and sight prior to making a diagnosis of schizophrenia/ect for older adultsa Red flags for older adults to indicate infection?

UTI, PNA, any infection Delirium, fatty liver Abilify in bipolar mania? NOT used, does not work well what antipsychotics are used at baby doses with older adults? C. A&B Seroquel in older adults? increases risk of falls and lowers BP--adding to increased falls *be cautious with all older adults Topamax is also known as? Dopamax--- increased brain fog/foggy/makes you feel stupid _________ is known to reduce appetite in individuals with weight gain related to antipsychotics? Topamax what is the gold standard/preferred treatment of bipolar? always start with an anticonvulsant for bipolar disorders-- preferred option for mood disorder What anticonvulsant medications increase the risk of hyponatremia? Tegretol and Trileptal high association with increased risk of

Smaller doses of antipsychotics and anticonvulsants should be used with what population(s)? Young and elderly Chosen favorite anticonvulsants to combine to treat a mood disorder? A. Lithium and depakote How often do you need a creatinine clearance done if on Lithium and/or depakote? yearly What antipsychotic is used to treat psychosis? A&B Parkinson like s/s--what meds should be avoided as they can cause increased stiffness? Haldol or risperidone ^makes patients stiff What antipsychotic is preferred in parkinson's disease? D All of the above

  • Seroquel #1 choice
  • then clozaril and zyprexa Older adults and risperidone? small doses of risperidone are used
  • available as liquid/ODT/ect other forms Older adults and Zyprexa?

small doses of Zyprexa are used

  • available as liquid/ODT/ect other forms Lisinopril can do what to Lithium levels? INCREASE *always check a lithium level dizziness, electric shock sensations, ear ringing, headache, fatigue, mood s/s and anxiety s/s? Serotonin Withdrawal from SSRIs and SNRIs Mood and anxiety related symptoms may make it look like? the patient is relapsing on their depression /anxiety ect Serotonin withdrawal when severe can cause? A. increased risk of falls in relation to 1/ 2 life *ONLY EXCEPTION = Paxil due to long half life What is the only exception to severe serotonin withdrawal with a SSRI/SNRI? Paxil due to long half life The 1/2 life of lithium is about? 24 hours Fluoxetine is the SSRI with the ______ WD risk?

lowest due to long half life What antipsychotics are good for pts who miss doses of their meds? Antipsychotics with long half-lives:

  1. Cariprazine(Vrylar): (2-4 days-active metabolites up to 3 weeks)
  2. Abilify (3 days)
  3. Brexipiprazole (4 days)
  4. Pimozide (4-5 days)
  5. Pimavanserin (2 days, active metabolites 8 days) Disulfiram's alcohol interactions persist for up to how long after the medication is stopped? LONG Half life-- 2 - 3 days persist up to 2 weeks following stopping What is the only TCA with a long half life? Protriptyline (Vivactil) Most psychotropics have a medium range 1/2 life of approx? 24 hours what does "steady state" mean in relation to 1/2 life? steady state means that you are eliminating the drug at the same overall rate that you are ingesting it Lithium reaches its 'steady state' when? 5 half lives example:

Day 1: Start pt on Lithium 600 mg daily Day 2: (24 hours later) the amount left in his body is 300 mg (day 2 min) because 24 hours has passed--one 1/2 life--therefore the pt has excreted 1/2 of the initial amount. THEN the pt takes his 2nd dose of 600 mg on DAY 2-resulting in a max dose of 900 (300 mg left in body + 600 mg of 2nd dose). DAY 3: starts off with 450 mg (1/2 of the 900 mg in pt's system) and after taking the day 3 600 mg dose, the pt now has a total of 1050 mg. Due to the steady state of Lithium, when do we draw a blood level? 5 half lives if you check any earlier, the trough level will underestimate the actual level the pt is on after achieving steady state Fluoxetine has a half life of about? 2 weeks 1/2 life take 2.5 months to achieve steady state Most psychotropic medications operate in this fashion: "when you double the dose, the serum dose doubles." *minus three SRIs and three anticonvulsants (Fluoxetine, fluvoxamine, paxil, gabapentin, valproate and carbamazepine) Paxil's half life is _____ longer than effexor? 3 - 4x longer

_______ is ranked beside venlafaxine to have the most notorious WD problems? A) Paxil #1 ---ranked #1 due to half life of 24 hours Effexor # How long is venlafaxine's half life? 5 hours How does WD syndrome affect Paxil due to it's long metabolism of 24 hours? Paxil slows down it's own metabolism by inhibiting the enzyme that metabolizes it: CYP2D

  • this hastens the withdrawal due to enzyme effectively shortening the 1/2 life How does Paxil hasten it's WD syndrome? it hastens the withdrawal due to the enzyme effectively shortening the 1/2 life (CYPD26) How many half life's need to pass in order to avoid drug interactions prior to starting a MAOI from a SSRI/SNRI? FIVE half life's of the drug how long do you have to wait when taking fluoxetine and switching to a MAOI? A. wait 6 weeks how long do you have to wait when taking Vortioxetine and switching to a MAOI? A. Wait 2 weeks how long do you have to wait when taking "most other antidepressants"(outside of Prozac and Trintellix)

and switching to a MAOI? normally 3-5 days How do you manage withdrawal symptoms with? (two options)

  • option 1: taper slowly over a couple of months
  • option 2: switch to a longer half life drug, such as Prozac How do you manage withdrawal symptoms with SSRIs? A. Switch to a drug with a longer half-life ex. Fluoxetine How do you manage withdrawal syndrome with Benzodiazepines? A. Switch to a drug with a longer half life ex. diazepam Important to remember that you may still need to taper off the old med as you add in the longer 1/2 life alternative due to the new med not binding with the receptors in the same way How do you manage a modified release (MR & IR) medication withdrawal syndrome? A. You cannot prevent withdrawal, you can only change the rate of absorption (not excretion) With modified release meds, is the half life longer? MR/IR do not actually lengthen the half life Risk with short 1/2 life drugs?

Cause withdrawal symptoms as they quickly exit the body The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A. Diet In educating the patient beginning to take lithium, the ARNP explains which of the following related to diet and fluid intake? D. All of the above the goal of psychotropic tx is to eliminate all manifestations of a disorder to below the syndromal threshold i defined as which of the following? B. Remission The NP can impact health policy and healthcare by doing which of the following? D. All of the above A term used to describe individuals and familie who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following? D. A&B Which of the following is consistent with current literature regarding the epidemiology dependent personality disorder? C. Persons with chronic physical illness in childhood may be more susceptible to this disorder. patients who injure themselves by SIB but who usually do not wish to die are said to have which of the following? C. Parasuicidal behavior

The NP preceptor should have which of the following? D. All of the above Tx choice for patients with histrionic personality disorder inlcudes? D. A&B Antipsychotics which are most likely to cause neuroleptic induced parkinsonism are which of the following effects? C. High potency drugs with high levels of anticholinergic activity Tx aimed at reducing intimate partner violence and domestic violence includes which of the following? D. A&B only A patient presents with a formal tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights reluctant to confide in the ARNP; what PD? B. Paranoid PD Which of the following is consistent with current perspectives on NP competencies? A. The national organization of NP faculties have developed a list of core competencies that all students should have upon graduation from a master's program Which of the following core competencies are quality competencies? D. A&C Which of the following are criteria for a particular suicide to be considered inevitable?

D. All of the above The misuse of the charge's funds for personal gain is known as which of the following? C. Financial abuse/exploitation According to Freud, passive and dependent personality traits are associated with which stage of development? A. Oral stage the incidence of suicide is higher for what population? D. Older African American men Assumes complex and advanced leadership roles to initiate and guide change is a NP core competency for what area? C. Leadership competencies At a minimum, a psychiatric eval in an emergency should include which of the following? Select all that apply A, B & C Stage of the cycle of DV that is characterized by the abuser subconsciously implementing defense mechanisms and cognitive distortions to alleviate the ego dystonic implication of the abuse? D. Defensive phase An ARNP takes a position in which the ARNP is guaranteed a set salary but can make additional salary if he or she generates practice income over some set amount. This is known as what type of pay structure? C. Base salary plus percentage

A pt is prescribed Haldol and has a hx of schizophrenia. she appears in the ED with hyperthermia muscle rigidity, autonomic instability, and elevated phosphokinase. The ARNP recognizes these symptoms are consistent with which of the following psychiatric emergencies? D. NMS Pt with extreme sensitivity to rejection who are socially withdrawn because they consider themselves socially inept, although are not asocial, but show a great desire for companionship are demonstrating symptoms most consistent with which of the following PD? B. Avoidance PD feel uncomfortable in social situations and often feel socially inept. Despite this self-awareness, comments by others about your shyness or nervousness in a social setting may come off as criticism or rejection* Non pharmacologic tx for abuse includes all of the following EXCEPT? D. Involve the abuser in the tx planning OCD, dependent and avoidant PD are associated with which of the following personality clusters? C. Cluster C Which of the following is the therapeutic blood level range for lithium? C. 0.3 to 1.2 mEq/L The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following?

C. Non-maleficence *do not harm Acknowledging a person's right to make choices, to hold views and to take actions based on personal value is known as which of the following? D. Respect for autonomy Narcissistic, borderline, antisocial and histrionic subtypes belong to which PD cluster? B. Cluster B Using the LIAASE: A general cultural competence tool---the ARNP would do which of the following? D. ALl of the above Being knowledgeable about one's own thoughts, feelings and sensations as well as the ability to reflect on how these can affect one's interactions with others is known as which of the following? A. Cultural Awareness the ARNP recognizes which of the following long term effects of sex trafficking on victims?? D. All of the above Which of the following is used for treating alcohol dependent individuals seeking to continue to remain alcohol free after they have stopped drinking? D. Acamprosate All of the following are risk factors for sexual assault EXCEPT? A. Religion

Characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness and a pervasive pattern of perfectionism and inflexibility is known as which PD? D. Obsessive compulsive PD Pt with hx of alcohol use presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. The ARNP recognizes these symptoms as consistent with which of the following psych emergencies? D. Idiosyncratic alcohol A patient on lithium with a hx of alcohol use disorder presents with dry mouth, ataxia, dizziness, abdominal pain and slurred speech. The NP should do? ***** B. The ARNP recognizes these symptoms as mild to moderate lithium toxicity, decreases the Lithium by half and encourages the pt to drink more as mild Lithium is toxic above?

1.5 mEq *close to therapeutic range of 0.4 to 1. Mild s/s of lithium toxicity? Fine tremor, lightheadedness lack of coordination, and weakness Walking on eggshells and appeasement and avoidance behaviors by the victim is characteristic of which phase of the cycle of DV? D. Refractory phase

First phase of the DV cycle? Phase 1 is? A. Tension Building victims report their partner becoming increasingly irritated/unable to cope with daily stressors. If abuser lashes out here, they will generally stop and become apologetic Phase 2 of the Dv cycle is? A. A battering incident This is where the abuser teaches the victim a lesson/only the abuser can end phase 2---a victim needs to go to a safe place during this phase What is stage 3 of the DV cycle? A. Honeymoon phase after cycles of violence, the abuser exhibits kind and loving behavior towards the victim -- apologetic and charming Which of the following is inconsistent with current literature about victims of sexual abuse? A. All victims of sexual abuse are aware they are in an abusive relationship Self-care strategies for the ARNP to prepare for the certification exam includes all of the following EXCEPT? C. Drink lot of caffeine and high concentrated sugar foods What phase of the cycle of DV is characterized by overt aggressive behavior towards the victim?

B. Abusive incident/ battering incident Term that defines a person who has distress with clinical symptomology because their gender identify is not consistent with their gender assigned at birth? D. Gender dysphoria Pt with the inability to conform to the social norms that ordinarily govern many aspects of a person's behavior is consistent with which PD? B. Antisocial PD Tx of choice for pt's with paranoid PD includes? D. B&C In about 1/2 the cases in which suicide occurs while patients are on a psych unit, a lawsuit results. Which of the following is NOT consistent with what court expects related to inpatient psychiatric unit suicide events? B. Court requires suicide rates to be zero in an inpatient setting According to the AANP process of care standards, performing or ordering preventative and diagnostic procedures based on the patients age and hx is part of which of the following components? A. Assessment of health status A pt on Lithium and Quetiapine presents to the ER with anorexia, persistant nausea and vomiting, blurred vision, choreoathetoid movements, muscle fasciculations, and hyperactive deep tendon reflexes. The ARNP should do all of the following EXCEPT? A. Discontinue the lithium

Pt currently on risperidone presents to the ED with increased agitation, restlessness, muscle discomfort, and dysphoria. The ARNP recognizes these symptoms of akathisia and recommends which of the following? Select all that apply D. B&C only In order to qualify for the the ANCC board certification testing, you must have a minimum of how many supervised clinical settings in the respective specialty for which you are seeking certifiication? B. 500 hours In a judicial system one organization may publish one standard of care and an expert may testify to an alternative version of the standard of care. In this scenario, who is the final arbiter of the standard of care A. The organization where the NP worked at the time Low health literacy has been linked with which of the following? D. All of the above Pt appears with odd, pervasive history of magical thinking, ideas of reference, illusions and derealization. This is consistent with which PD? C. Schizotypal PD Ebstein's anomaly Lithium Which of the following symptoms of BPD assist in differentiating BPD from schizophrenia? D. A&C only

Pt presents and is unapproachable, poor eye contact and reports a lifelong pattern of isolation, uncomfortable with human interaction, and constricted affect A. Schizoid PD NP preceptors should have at least how much experience as a NP in the specialty prior to precepting? D. A minimum of 2 years experience in the specialty Pt has a heightened sense of self-importance, grandiose feelings of uniqueness. Pt also lacks empathy, although is very sensitive to minor criticism. Consistent with what PD? C. Narcissistic PD The emotional burnout and lack of empathy towards clients that healthcare providers experience after treating victims of trauma is known as? A. Compassion fatigue The ARNP recongizes which of the following short term effects of sex trafficking on the victims? D. A&C only According to Freud, stubborn, parsimonious and highly conscientious traits are associated with which stage of development? C. Phallic stage Affirmatively acting to benefit another or others, going beyond what is required by law is known as? C. Beneficence

Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply A& C In Canterbury vs Spence the US court of appeals for the DC circuit listed physician responsibilities for disclosure. which of the following is not listed as a responsibility? D. Inform the patient about precautionary therapy that he or she should seek in the future Which should be avoided when working with practice guidelines? A. Write guidelines with minute details that everyone will follow in an exact same way Which of the folllowing is not consistent with what is known about P pschosis? D. This disorder primarily affects first time mothers and there is very little risk of PP psychosis is subsequent pregnancies The us supreme court upheld the psychotherapist-patient privilege in which of the following cases? A. Jaffee vs Redmon loyalty, fairness, truthfulness, advocacy and dedication in a professional relationship is known as? B. Fidelity A late appearing adverse effect of neuroleptic drugs? C. NMS The failure to a professional to exercise the degree of skill and learning commonly applied by the average prudent, reputable member of. a professional is known as?

B. Malpractice Somatopsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about 1 week before the onset of menses is characterized by irritability, emotional lability, HA, anxiety and depression is known as? D. Premenstrual psychosomatic disorder People who exhibiit impulisve traits also show high levels of what hormones? D. A&C only Features that point to a medical cause of a psychiatric disorder includes which of the following- select al that apply A, B & C tx of others equitability and distrubution of benefits/burdens fairly is known as? B> Justice Which of the following would constitute negligence? Select all that apply B&C Who developed a biblically based cultural compentence model for healthcare? B. campinha-Bacote pt appears with odd, pervasive hx of magical thinking, ideas of reference, illusions and derealization. What PD? C. shizotypal PD Hx of alcohol use patient presents to the ED wth occulmotor distrubances, cerebellar ataxia and confusion?

C. Wernicke's encephalopathy The only approved therapy in the US for moderate to severe Alzheimer's disease is which med? B. Memantine (Namenda) Narcissistic, BPD, antisocial and histrionic are substypes of? B. Cluster B the ARNP is tx a 27 year old female who bipolar disorder, who is obese and has kidney dysfunction- which of the following is true? C. An atypical antipsychotic should be used, such as olanzapine or risperidone emotional constriction, orderliness, perseverance, stubbornness, indecisiveness and a pervasive pattern of perfectionism and inflexibility is? D. Obsessive compulsive PD PD characterized by extraordinary unstable affect, mood, behavior, object relation and self image is? C. BPD Form of psychotherapy based on Otoo Kernberg's relation therory is known as? C. Transference-focused psychotherpay Generalized convulsions, oliguria and renal failure are s/s seen at which lithium serum level? C. 2.0 to 2.5

Study Confusion Assessment Method instrument (CAMI) is a standardized assessment tool for which of the following disorders? Delirium which of the following is a common sensory deficit of conversion disorder? check all that apply. Blindness and Deafness Delirium is an example of which type of clinical problem in psychosomatic medicine. Psychiatric symptoms secondary to a medical condition All of the following medications are used in the treatment of parkinsons disease dementia/psychosis except for: memantine Indicators of imitative dissociative identity disorder include which of the following symptoms? Confusion and Same related to symptoms Which of the following can lower a person's resistance to control impulses? All the above: Fatigue, incessant stimulation, psychic trauma Schizophrenia in a patient with end stage renal disease is an example of which type of clinical problem in psychosomatic medicine. Delirium