NURS6630N Week 6 Midterm Exam

Wladen_NURS6630N_Week_6_Midterm_Exam.docx (41.26 KB)

• 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
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?
• Question
3
Which
statement about neurotransmitters and medications is true?
• Question
4
When an
unstable patient asks why it is necessary to add medications to his current
regimen, the PMHNP’s best response would be:
• Question
5
During
gene expression, what must occur prior to a gene being expressed?
• Question
6
While
genes have potential to modify behavior, behavior can also modify genes. How do
genes impact this process?
• Question
7
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:
• Question
8
Why is
the cytochrome P450 enzyme system of significance to the PMHNP?
• Question
9
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
10 As it relates to G-protein
linked receptors, what does the PMHNP understand about medications that are
used in practice?
• Question
11
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
12
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
13
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?
• Question
14
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
15
The
PMHNP is caring for four patients. Which patient statement indicates that
benzodiazepines would be beneficial?
• Question
16
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
17
A
patient is seeking pharmacological treatment for smoking cessation. Which drug
class does the PMHNP prescribe to the patient?
• Question
18
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
19
A
patient presents with frequent episodes of mania. Which statement describes an
appropriate treatment approach for this patient?
• Question
20
What
characteristics do the nicotinic, cholinergic, serotonin 3, and glycine
receptors all have in common?
• Question
21
Which
statement made by the patient suggests the patient will need to be treated with
antipsychotics that target paranoid psychosis?
• 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
What is
accurate about the clinical description of psychosis?
• Question
27
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?
• Question
28
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?
• 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
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?
• 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
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?
• 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
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:
• 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
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?
• 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
Fluoxetine
(Prozac) has been prescribed for a client with depression. Which of the
following statements is true regarding the action of this medication?
• Question
44
The
nurse education knows that teaching was effective when one of the students
compares fluvoxamine to sertraline and notes which of the following
similarities?
• Question
45
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?
• 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
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.
• 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
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?
• 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
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?
• Question
64
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?
• 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
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?
• 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 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?
• 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
There
are a number of endocrine reactions that accompany fear. A quick boost of
cortisol may enhance survival when encountering a real but short-term threat.
However, chronic elevations in cortisol can lead to increased medical
comorbidities. Which of the following medical conditions may be related to
these persistent cortisol elevations?
• Question
72
The
PMHNP understands that the potential of alcohol abuse in the anxious client is
higher for the following reasons:
• Question
73
After
ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which
possible effect?
• 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?