Week 6 midterm

Question 1

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

Question 2

Which statement about neurotransmitters and medications is
true?

Question 3

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

Question 4

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

Question 5

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

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:

Question 7

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

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?

Question 9

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

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:

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:

Question 12

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?

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?

Question 14

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

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?

Question 16

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

Question 17

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?

Question 18

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

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?

Question 20

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

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?

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?

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?

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?

Question 25

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

Question 26

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

Question 27

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

Question 28

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

Question 29

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

Question 30

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?

Question 31

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

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?

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?

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?

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 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?

Question 36

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

Question 37

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

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?

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?

Question 40

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

Question 41

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

Question 42

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

Question 43

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

Question 44

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

Question 45

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

Question 46

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?

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:

Question 48

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

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?

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?

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?

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 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?

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?

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?

Question 55

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

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?

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?

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?

Question 59

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

Question 60

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?

Question 61

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?

Question 62

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?

Question 63

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

Question 64

A 39-year old female patient presently on lithium would like
to try a new medication to treat her bipolar disorder. She has had concerns
about side effects from lithium and wants to learn more about Lamotrigine
(Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects
of this agent, including which of the following?

Question 65

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?

Question 66

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

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?

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?

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:

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:

Question 71

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

Question 72

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

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:

Question 74

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

Question 75

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

Question 76

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

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