NURS 6630 Midterm Exam Test Bank-with 100% verified solutions-2024.docx, Exams of Nursing

Download NURS 6630 Midterm Exam Test Bank-with 100% verified solutions-2024.docx and more Exams Nursing in PDF only on Docsity! lOMoAR cPSD| 17616083 NURS 6630 Midterm Exam Test Bank-with 100% verified solutions-2024 NURS 6630 Midterm Exam Test Bank Question 1 1 out of 1 points 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). Answer: C. “Most medications that work in the brain will result in restoring an imbalance of one or more neurotransmitters that your body already produces helping to alleviate your symptoms .” Question 2 1 out of 1 points Ms. Hill is currently being treated for schizophrenia but has stopped taking her medications due to some side effects she claims she was experiencing. She presents to the clinic today with worsening symptoms. She is experiencing anhedonia, agitation, attentional impairment, and affective blunting. Which one of the symptoms mentioned is considered a positive symptom of schizophrenia? Answer: B. Agitation Question 3 0 out of 1 points Which statement about neurotransmitters and medications is true? Answer: D. An imbalance of serotonin has been directly linked to depression. Following the discovery of this neurotransmitter, pharmacologists were able to develop a well- onin.known drug- Prozac as the first medication used to restore the balance of serot lOMoAR cPSD| 17616083 Question 4 1 out of 1 points When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: Answer: C. “Many psychiatric illnesses involve several dys-functioning neurotransmitter systems in the brain. Often, a single medication may only effect one or two of the dys-functioning systems. The addition of another medication can work with the current medication in stabilizing multiple neurotransmitter systems and help to alleviate your symptoms.” Question 5 1 out of 1 points During gene expression, what must occur prior to a gene being expressed? Answers: A. Transcription factor must bind to the regulatory region within the cell’s nucleus. Question 6 1 out of 1 points While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? Answer: Question 7 1 out of 1 points Though medications have the ability to target neurotransmitter release into the synapse by the presynaptic neuron it is not always necessary. The PMHNP understands that this is because: Answer: C. Neurotransmitters can spread by diffusion. B. Changes made to proteins lead to changes in behavior. lOMoAR cPSD| 17616083 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? Answer: A. “The drug will have an almost immediate effect.” Question 17 1 out of 1 points A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? Answer: D. Varenicline (Chantix) Question 18 1 out of 1 points 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? Answer: C. Partial agonists Question 19 1 out of 1 points A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient? Answer: B. “The patient could benefit from an anticonvulsant.” Question 20 1 out of 1 points What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in common? lOMoAR cPSD| 17616083 Answer: A. Ligand-gated ion channels with a pentameric structure Question 44 1 out of 1 points A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do? Answer: B. Prescribe short-acting benzodiazepine for 2 weeks, then discontinue. Question 45 1 out of 1 points 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? Answer: 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 Question 46 1 out of 1 points The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial? Answer: D. “I feel nervous to go outside and be in large crowds.” Question 47 1 out of 1 points Ms. Boeckh is a 42-year-old client who is taking an antidepressant therapy. The PMHNP understands that this medication can have substantial food interactions that can cause Ms. Boeckh to develop a hypertensive crisis. Which antidepressant class is Ms. Boeckh’s medication in? Answer: B. MAO inhibitors lOMoAR cPSD| 17616083 Question 48 0 out of 1 points A client is prescribed fluoxetine but is concerned about side effects. Which statement demonstrates accurate client teaching when discussing the side effects associated with fluoxetine? Answer: Question 49 1 out of 1 points The PMHNP spends a session with a client and notices behaviors correlating with a potential manic episode. All of the following are possible manic symptoms the PMHNP could observe except: Answer: D. A low self esteem Question 50 1 out of 1 points The PMNHP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This client has begun to develop a common side effect of this medication. What is this side effect? Answer: D. Tardive dyskinesia Question 51 1 out of 1 points 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? Answer: D. D2 receptors are the primary binding site for dopamine agonists. Question 52 0 out of 1 points A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease? Answer: B. Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex C. Sedation is unusual lOMoAR cPSD| 17616083 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? Answer: D. The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia. Question 25 0 out of 1 points A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease? Answer: B. Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex Question 26 1 out of 1 points What is accurate about the clinical description of psychosis? Answer: C. It is a syndrome that can be associated with a number of psychiatric disorders. Question 27 1 out of 1 points The PMNHP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This client has begun to develop a common side effect of this medication. What is this side effect? Answer: D. Tardive dyskinesia Question 28 1 out of 1 points lOMoAR cPSD| 17616083 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 called an atypical antipsychotic. What neurotransmitters will this new medication work on? Answer: A. dopamine and serotonin Question 29 1 out of 1 points Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body? Answer: D. D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia. Question 30 1 out of 1 points 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? Answer: B. The recent change of a 2nd generation antipsychotic to a conventional one Question 31 1 out of 1 points Mrs. Schwartzman is a 52-year-old client 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 since starting her new medication. What does the PMHNP infer from this encounter with the client? Answer C. The new medication is blocking D2 receptors in the mesolimbic system : Question 32 0 out of 1 points lOMoAR cPSD| 17616083 The student inquires about antipsychotic medications. Which response by the PMHNP describes the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics? Answer: C. D2 receptors that are blocked in the nigrostriatal pathway Question 33 0 out of 1 points 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? Answer: Question 34 0 out of 1 points Mr. Gordon is a middle-aged client who was started on antidepressant monotherapy for depression. After beginning this medication, the PMHNP noticed that this client seemed to swing into a hypomanic episode. What can the PMHNP infer from this behavior change? Answer: D. A and C Question 35 1 out of 1 points 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? Answer A. The patient has an unsustained response to antidepressants. : A. 5HT2 antagonism lOMoAR cPSD| 17616083 A. Full agonists B. Antagonists C. Partial agonists D. Inverse agonists Question 18 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." Question 19 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 Question 20 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." Question 21 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 lOMoAR cPSD| 17616083 Question 22 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. Question 23 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."Question 24 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. Question 44 1 out of 1 points The nurse education knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities? Answer: D. Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic effects. lOMoAR cPSD| 17616083 Question 45 1 out of 1 points A 45 year old female client with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed when considering phenelzine in treating her depression? Answer: B. The client will need to minimize dietary intake of foods that are high in tyramine. Question 46 1 out of 1 points 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? Answer: D. A and C Question 47 1 out of 1 points 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: Answer: B. SSRI/SNRI plus NDRI Question 48 1 out of 1 points A nurse overhears that a client has failed monotherapy with an SSRI and an SNRI. She also learns that the client has failed dual SSRI + SNRI therapy. The nurse approaches the PMHNP and asks what treatment options should be considered in this treatment resistant client. The PMHNP tells the nurse that she will treat the client with the following regimen. Answer: B. SSRI + NDRI lOMoAR cPSD| 17616083 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? Answer: D. “Decongestants should be avoided due to risk of hypertensive crisis.” Question 58 1 out of 1 points 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? Answer: C. Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses. Question 59 1 out of 1 points The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)? Answer B. Patient with partial seizures : Question 60 1 out of 1 points 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? Answer A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily. : Question 61 1 out of 1 points 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? lOMoAR cPSD| 17616083 Answer: D. trazadone (Oleptro) Question 62 1 out of 1 points 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? Answer: 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 Question 63 1 out of 1 points A client who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response? Answer: C. Mood stabilizers can treat either manic phases or depressive phases of bipolar disorder. Question 64 1 out of 1 points The PMHNP is assessing a client in the emergency room. The client shares that he has been on lithium for many years. What blood test does the PMHNP order? Answer: A. Thyroid Stimulating Hormone Question 65 1 out of 1 points 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? Answer: B. Gabapentin (Neurontin) Question 66 1 out of 1 points lOMoAR cPSD| 17616083 A nursing student is seeking clarification on the use of anticonvulsants to treat bipolar depression and is unclear about which anticonvulsants have the most effective outcomes in treating bipolar depression. Which of the following anticonvulsants is NOT used for treating bipolar depression? Answer: B. Gabapentin (Neurontin) Question 67 0 out of 1 points 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? Answer: C. Lithium (Lithobid) Question 68 1 out of 1 points 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 client? Answer: C. Lithium (Lithobid) Question 69 1 out of 1 points 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: Answer: C. Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa) Question 70 0 out of 1 points 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: lOMoAR cPSD| 17616083 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." Question 4 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. Question 5 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. Question 6 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. Question 7 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. C. The medication's chemical composition changes when it comes in contact with the acid in the stomach. lOMoAR cPSD| 17616083 D. The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively. Question 8 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. Question 9 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. Question 10 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 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 mood stabilizer lOMoAR cPSD| 17616083 C. Decrease the amount prescribed for aripiprazole (Abilify) D. Explain to the patient that it will be more difficult to control his temper1 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 Question 13 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 Question 14 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." Question 15 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." lOMoAR cPSD| 17616083 D. A and C E. All of the above Question 32 The student inquires about antipsychotic medications. Which response by the PMHNP describes the 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 Question 33 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 Question 34 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 Question 1 1 out of 1 points When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: Answer: C. “Many psychiatric illnesses involve several dys-functioning neurotransmitter systems in the brain. Often, a single medication may only effect one or two of the dys- functioning systems. The addition of another medication can work with the current lOMoAR cPSD| 17616083 medication in stabilizing multiple neurotransmitter systems and help to alleviate your symptoms.” Question 2 0 out of 1 points 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? Answer: C. Lithium (Lithobid) Question 3 1 out of 1 points Mr. Gordon is a middle-aged client who was started on antidepressant monotherapy for depression. After beginning this medication, the PMHNP noticed that this client seemed to swing into a hypomanic episode. What can the PMHNP infer from this behavior change? Answer : A. This client may have Bipolar III disorder Question 4 1 out of 1 points A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient? Answer: B. “The patient could benefit from an anticonvulsant.” Question 5 1 out of 1 points The student inquires about antipsychotic medications. Which response by the PMHNP describes the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics? Answer B. Those that are potent D2 antagonists with 5HT2A antagonism properties : Question 35 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 lOMoAR cPSD| 17616083 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. Question 36 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 Question 37 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. Question 38 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. Question 39 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. lOMoAR cPSD| 17616083 Question 47 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 Question 48 Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advice 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. Question 49 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. Question 50 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% lOMoAR cPSD| 17616083 Question 51 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. Question 52 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 4050 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. Question 53 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. Question 54 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. lOMoAR cPSD| 17616083 Question 55 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. Question 56 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." Question 57 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.” Question 58 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. lOMoAR cPSD| 17616083 Question 67 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) Question 68 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. Question 33 1 out of 1 points 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: Answer: A. The patient smokes cigarettes. Question 34 1 out of 1 points 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? Answer: A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily. Question 35 A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose: 1 out of 1 points Answer B. Beta blockers are linked to reconsolidation. : lOMoAR cPSD| 17616083 Question 69 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 Question 70 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." Question 71 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 Question 72 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 lOMoAR cPSD| 17616083 Question 73 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." Question 74 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? Question 75 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. Question 6 1 out of 1 points After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect? Answer: D. All of the above Question 7 1 out of 1 points The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient lOMoAR cPSD| 17616083 Question 18 1 out of 1 points 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? Answer: C. The patient has severe renal impairment. Question 19 0 out of 1 points 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? Answer: A. To promote the availability of serotonin Question 20 1 out of 1 points 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? Answer: A. “You must avoid soy products, such as tofu.” Question 21 1 out of 1 points The PMHNP evaluates the patient for “fear conditioning” when he asks: Answer A. Have you ever experienced any type of trauma? : Question 22 0 out of 1 points The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? Answer: A. Patient with a bipolar I designation Question 23 0 out of 0 points When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Answer Yes : lOMoAR cPSD| 17616083 Question 24 0 out of 1 points 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? Answer: D. D2 partial agonist Question 25 1 out of 1 points The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)? Answer: B. Muscarinic M1 receptor blockade causes blurred vision. Question 26 1 out of 1 points The PMHNP is assessing a client in the emergency room. The client shares that he has been on lithium for many years. What blood test does the PMHNP order? Answer A. Thyroid Stimulating Hormone : Question 27 1 out of 1 points 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). Answer: C. “Most medications that work in the brain will result in restoring an imbalance of one or more neurotransmitters that your body already produces helping to alleviate your symptoms .” Question 28 1 out of 1 points 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? Answer: C. “Amphetamines can cause hallucinations, so I would advise against this type of prescription.” lOMoAR cPSD| 17616083 Question 29 1 out of 1 points 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: Answer C. Decrease the amount prescribed for aripiprazole (Abilify) : Question 30 1 out of 1 points 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? Answer D. Weight gain is unusual. : Question 31 1 out of 1 points What is accurate about the clinical description of psychosis? Answer C. It is a syndrome that can be associated with a number of psychiatric disorders. : Question 32 1 out of 1 points The nurse education knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities? Answer: D. Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic effects. Question 36 1 out of 1 points 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). When assessing the psychiatric medications and the reason for admission, what would be the best course of action for the PMHNP with this client? lOMoAR cPSD| 17616083 Answer A. Transcription factor must bind to the regulatory region within the cell’s nucleus. : Question 61 1 out of 1 points Fluoxetine (Prozac) has been prescribed for a client with depression. Which of the following statements is true regarding the action of this medication? Answer: B. Fluoxetine inhibits the serotonin transporter (SERT). Question 62 1 out of 1 points A 45 year old female client with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed when considering phenelzine in treating her depression? Answer B. The client will need to minimize dietary intake of foods that are high in tyramine. : Question 63 1 out of 1 points Why is the cytochrome P450 enzyme system of significance to the PMHNP? Answer: B. The bioavailability of the medication after it passes through the stomach and liver can be altered. Question 64 1 out of 1 points 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? Answer C. He uses alcohol. : Question 65 1 out of 1 points 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? lOMoAR cPSD| 17616083 Answer B. Norepinephrine inhibits 5HT release through a2 receptors. : Question 66 1 out of 1 points Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis? Answer: B. “I have to talk to the President because I’m the only one who can help him.” Question 67 1 out of 1 points 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: Answer: C. Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa) Question 68 1 out of 1 points 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? Answer: A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics. Question 69 1 out of 1 points 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? Answer: C. Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses. lOMoAR cPSD| 17616083 Question 70 1 out of 1 points A client who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response? Answer: C. Mood stabilizers can treat either manic phases or depressive phases of bipolar disorder. Question 71 1 out of 1 points A nurse overhears that a client has failed monotherapy with an SSRI and an SNRI. She also learns that the client has failed dual SSRI + SNRI therapy. The nurse approaches the PMHNP and asks what treatment options should be considered in this treatment resistant client. The PMHNP tells the nurse that she will treat the client with the following regimen. Answer: B. SSRI + NDRI Question 72 1 out of 1 points What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in common? Answer A. Ligand-gated ion channels with a pentameric structure : Question 73 1 out of 1 points 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? Answer: A. The patient has an unsustained response to antidepressants. Question 74 1 out of 1 points 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? Answer D. A and C :