NURS104 FINAL EXAM WEEK 11 FINAL, Exams of Nursing

Download NURS104 FINAL EXAM WEEK 11 FINAL and more Exams Nursing in PDF only on Docsity! • Question 4 NURS104 FINAL EXAM WEEK 11 FINAL  Question FILL IN THE BLANK: is the main neurotransmitter behind reward systems in the brain, which usually leads to addiction when altered in any way. DOPAMINE Respons e Feedbac k: “Distribution of the endogenous reward systems in the brain is a common feature of drug abuse; most addictive drugs act by disrupting central nervous system (CNS) dopamine circuits.” - Table 16-1 as well all the drug types show alterations of dopamine pathways in some way • Question 2 L. J. is a 55-year-old male who attended a funeral and found himself laughing during the service, but later that evening he was irritated with himself for what he had done. His wife said this was abnormal behavior and took him to his doctor to be evaluated. After L. J.’s MRI was reviewed, he was diagnosed with frontotemporal dementia. Which medication is recommended to help L. J. with his emotional outbursts? ESCITALOPRAM Respons e Feedbac k: under Treatment subtitle: “The behavioral features are sometimes helped by SSRIs, and these are the best-studied treatments for these disorders.” • Question 3 In the pathophysiology of Alzheimer’s Disease, there are certain proteins that lead to the plaques and tangles that result in this progressive, irreversible brain disorder. Choose the appropriate protein with its corresponding pathology. I and IV I. Tau – tangles II. Beta-amyloid – tangles III. Tau – plaques IV. Beta-amyloid – plaques Patient is a 75-year-old female with a confirmed diagnosis of Alzheimer’s Disease. She is currently on Donepezil 10 mg daily. She is accompanied to your clinic today by her daughter, who informs you that her mother has recently had an increase in depressive symptoms. She has no history of mood disorders. She has a history of hypertension and tonic-clonic seizures, but both are controlled. Assuming this patient will be thoroughly evaluated for the diagnosis of depression, what would you recommend as initial therapy? FLUOXETINE Respons e Feedbac k: SSRIs are effective in treating depressive symptoms. Answer choices A & B are both TCAs and are advised against due to side effect profile and the fact this person is treatment naive (learned from previous exam) and answer choice D is contraindicated in a patient with seizures. • Question 5 The experience of pain is ALWAYS subjective YES IT IS ALWAYS SUBJECTIVE Respons e Feedbac k: “The experience of pain is always subjective.” • Question 6 Of the following neurotransmitters, which ones play a critical role in modulating attention in ADHD? C . I and IV I. Dopamine II. Epinephrine III. GABA IV. Norepinephrine V. Glutamate Respons e Feedbac k: "Stimulants increase intra-synaptic concentrations of dopamine (DA) and norepinephrine (NE)” • Question 7 There are many different types of dementia. Which dementia is NOT a direct result of disrupted neurotransmitters, but a result of degeneration of different regions in the brain? Onset of the disease is typically before the age of 60, and very rare after the age of 75. Alzheimer Disease Respons e Feedbac k: under subtitle “Epidemiology and genetic risk factors” • Question 8 This medication cannot be used for more than 5 days, it is a non-steroidal, anti- inflammatory drug, and it is often substituted for morphine due to its rapid onset and high potency. What is this medication? KETOROLAC, DUH Respons e Feedbac k: under non-steroidal, anti- inflammatory drugs V. Norepinephrine Response under pathophysiology subtitle: “It is clear that both the cholinergic and dopaminergic neurotransmitter systems are severely disrupted.” • Question 13 • Question 14 Feedback: Which of the following drugs in the treatment of Alzheimer’s Disease helps normalize glutamate by antagonizing the NMDA receptor? MEMANTINE A new patient presents to your clinic today. The patient is a 13-year-old boy who complains that he has no interest in anything. The patient states, “I just want to sleep more than I normally do, and I don’t care much for playing my video games anymore.” His mother states he cannot focus on anything for more than a few minutes at a time, and that he often gets in trouble at school because he cannot sit still. What would you recommend at this time? RECOMMEND A FULL EVALUATION FOR ADHD Respon se Feedbac k : under Attention-Deficit/Hyperactivity Disorder Plus Depression subtitle: “In ADHD patients, depression is not an artifact, and it must be distinguished from demoralization.” Page 99 under overview also mentions, “Before using medications, clinicians should complete a thorough clinical evaluation that includes a complete history of symptoms, a differential diagnosis, a review of prior assessments/treatments, a medical history, and a description of current physical symptoms.” • Question 15 E. B., a 55-year-old female, is a patient at your clinic today who has a past medical history significant for breast cancer, hypertension, hepatic cirrhosis, type 2 diabetes, and a recent diagnosis of alcohol use disorder. She has no known drug allergies. She states she is ready to quit drinking but fears the cravings that it may bring. Which medication would you recommend for E. B. to begin? Evaluate HTN and HLD. Take ACAMPROSATE Respon se Feedbac k : “It is preferred for patients with liver damage since acamprosate is metabolized through the kidneys and not the liver” & Table 15- 3 shows it reduces alcohol cravings; benzodiazepines are used in the acute setting if a patient is experiencing severe alcohol withdrawal that leads to seizures; thiamine is if a patient is admitted for alcohol intoxication. • Question 16 Daytrana is the MPH transdermal system of methylphenidate approved for the treatment of ADHD in children aged 6 years and older. What is the difference in terms of the metabolism compared to the other formulations in this class? It does not undergo first-pass metabolism by the enzyme carboxylesteraase Respons e Feedbac k: referring to MPH transdermal system (MTS; Daytrana): “Since the MPH is absorbed through the skin, it does not undergo first- pass metabolism by CES-1 in the liver, resulting in higher plasma MPH levels” • Question 17 What is the difference between Ritalin and Focalin? Focalin is a D-isomer Respons e Feedbac k: “The primarily active form of MPH appears to be the d-threo isomer, which is available in both immediate-release tablets (Focalin 2.5, 5, and 10 mg)” • Question 18 Which neurotransmitters are likely involved in the pathophysiology of withdrawal seizures? III and IV I. Serotonin II. Endorphin s III. Glutamate IV. GABA V. Dopamine Respons e Feedbac k: “Thus when an individual suddenly ceases alcohol use, the decrease in inhibitory effects in combination with fewer GABA receptors and increased glutamatergic discharge contributes to over-excitation and possible withdrawal seizures.” • Question 19 When can buprenorphine be initiated in a patient who is suffering from an opioid overdose? Mild to moderate Respons e Feedbac k: “To avoid this problem, the initial buprenorphine dose should not be administered until the patient demonstrates mild-to- moderate symptoms of withdrawal.” • Question 20 Patient is a 10-year-old female with diagnosed ADHD who was started on Ritalin 5 mg twice a day over 2 months ago. She is still experiencing the triad of symptoms associated with ADHD (impaired attention, impulsivity, and excessive motor activity). Her mother reports that she is now having difficulty in falling asleep since starting the medication. She has been on no other anti- ADHD medications and the mother reports full compliance with medication • Question 24 The patient is a 16-year-old girl with a past history of substance use disorder. She has been known to abuse prescription opioids and smokes one pack of cigarettes every day. She has been in and out of recovery for the past year. During her last admission into a recovery center, she was diagnosed with ADHD, which may have contributed to her addictive personality. She presents to your clinic today to initiate pharmacotherapy for her new diagnosis. What would you recommend in this patient? Her current weight is 55 kg. Atomoxetine 60 mg once daily Respon se Feedbac k : Ritalin and Focalin have abuse potential due to their short half- lives and multiple times a day dosing. Daytrana has the wrong instructions for the patch and still has an abuse potential due to being a stimulant (See table 10-1 for dosing instruction of the patch being worn for 9 hours but lasts 12 hours). Atomoxetine has the least abuse potential and appropriately dosed for patient’s weight. Page 110 in upper right column: “In these populations use of extended delivery stimulant preparations, which are more difficult to misuse, or non-stimulants should be considered.” • Question 25 What should our treatment goal be with our patients when it comes to managing chronic pain? The goal is to improve their function and to drop their pain scale to less than 5 out of 10 Respons e Feedbac k: “In general, treatment goals are reports of pain less than 5 out of 10 and an improvement in function.” • Question 26 SSRIs can be used in alcohol use disorder and offer modest drinking reduction through an anti-craving effect. TRUE Respons e Feedbac k: “SSRIs have produced only modest drinking reductions— independent of the antidepressant effects—through an anti- craving effect” • Question 27 Which medication below should be routine for all suspected cases of alcohol intoxication and dependence? Vitamin B Respons e Feedbac k: under Treatment of Wernicke’s encephalopathy: “Administration of the B vitamin thiamine (IM or IV) should be routine for all suspected cases of alcohol intoxication and dependence.” • Question 28 Which of the following drugs is often used in the management of opioid addiction due to • Question 33 T. B. is a 55-year-old male who has diagnosed with type 2 diabetes 10+ years ago. He has since had complications from the disease and is suffering from severe neuropathy. On top of that, T. B. is struggling with his mental health and was recently told he could be depressed but he had refused treatment at that time. Besides getting his blood sugar under control, what medication(s) can we use that may be useful in helping T. B.? II and III I. Nortriptyline II. Venlafaxine III. Duloxetine IV. Fluoxetine Respons e Feedbac k: “Among the antidepressants these include the TCAs and SNRIs (duloxetine and venlafaxine).” - SSRIs – page 204: “There is little evidence to support the independent analgesic activity of SSRIs.” • Question 34 Which medication(s) requires a test dose to determine accurate use of the drug (i.e., how addicted the patient truly is on a certain drug) before beginning a titration schedule to withdrawal the patient? I. Butalbital II. Lorazepam III. Hydrocodone Respons e Feedbac k: “Treatment should begin with an oral test dose of 200 mg of pentobarbital, a short-acting-barbiturate.” • Question 35 Which club drug is structurally similar to GABA? γ - hydroxybutyrate Respons e Feedbac k: under club drugs; Options A & D are the same drug • Question 36 Select all the criteria for what is considered “At-Risk Drinking.”, 1 2 and 4 I. Women: > 7 drinks in any given week II. Men: > 4 drinks per day III. Women: > 4 drinks per day IV. Men: > 14 drinks per week Respons e Feedbac k: I I I is wrong because it’s > 3 drinks per day for women • Question 37 Select the correct treatment regarding drugs involved in addiction management and their corresponding mechanism of action. FLUMAzenil , GABA antagonist Respons e Feedbac k: under Overdose subtitle: “Flumazenil, a specific benzodiazepine antagonist, reverses the life-threatening effects of a benzodiazepine overdose.” • Question 38 Which of the following drugs in the treatment of Alzheimer’s Disease requires administration with food? RIVASTIGMINE Respons e Feedbac k: “Rivastigmine should be administered with meals to reduce gastrointestinal side effects.” • Question 39 Which of the following psychiatric conditions is present in both domains (i.e., core psychopathology & pain-related psychological symptoms) of chronic pain that will likely lead to an outcome of disability, pain, and poor quality of life? ANXIETY Respons e Feedbac k: Figure 17-4 and in the text on the page discussing how anxiety is present in both, therefore, a review is needed of the exact cause of the anxiety • Question 40 T. C. is an 88-year-old male who is diagnosed at your clinic with Dementia with Lewy Bodies. He currently has some debilitating gait issues, which makes his quality of life very poor. His memory is still intact with minor deficits. Which medication would likely benefit T. C. as his initial therapy? LEVODOPA/Carbidopa Respons e Feedbac k: “Low dosages of levodopa/carbidopa (dopamine replacement) are sometimes helpful for the motor symptoms of DLB, although higher dosages of dopamine replacement therapy and direct dopamine agonists may exacerbate neuropsychiatric symptoms.” - Motor symptoms = gait issues • Question 41 Which of the following drugs is structurally similar to tramadol; thus, its opioid-mediated analgesia can be reversed by naloxone in mice? VENLAFAXINE Respons e Feedbac k: “Structurally, venlafaxine is similar to tramadol, and in mice, venlafaxine demonstrates opioid- mediated analgesia that is reversed by naloxone.” Response “Amphetamines can be withdrawn abruptly” • Question 47 • Question 48 Feedback: Which medication is a selective alpha-adrenergic agonist that works by mimicking norepinephrine binding in the pre-frontal cortex, which makes it particularly useful in the treatment of ADHD? Guanfacine or Midodraine Disulfiram has been proven effective in the treatment of alcoholism, but recently it has been trialed in the management of cocaine addiction. What is the mechanism of action that likely helps produce these aversive effects? Inhibition of dopamine beta- hydroxylase Respons e Feedbac k: “These reactions are thought to be mediated by the inhibitory effect of disulfiram on dopamine beta-hydroxylase. This action will elevate depleted plasma dopamine levels in chronic users and will produce abnormally high dopamine levels if cocaine is ingested; this results in a dysphoric experience in most users.” • Question 49 Which of the following is the only Black Box Warning associated with the medication atomoxetine? Suicidal Ideation Respons e Feedbac k: “The FDA issued a public health advisory, and the manufacturer later added a black box warning regarding the development of suicidal ideation in patients treated with ATMX.” Answer A Only has to be in the medication guide regarding any ADHD medication Answer C refers to stimulants only Answer D conflicting data on but not a BBW • Question 50 Which medication below would you use in addition to benzodiazepine treatment if the patient is experiencing psychosis during alcohol withdrawal delirium? Haloperidol Respons e Feedbac k: “Haloperidol 50 to 10 mg PO or IM may be added and repeated after 1 to 2 hours when psychosis or agitation is present.” • Question 51 When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?