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NURS 6630 FINAL EXAM QUESTIONS &
CORRECT ANSWERS GRADED A WALDEN
UNIVERSITY
What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs QUESTION 2 The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics QUESTION 3 The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above.
QUESTION 4
Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. QUESTION 5 The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5 – 7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy QUESTION 6 The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax)
A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. QUESTION 11 A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” QUESTION 12 A 14 - year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. QUESTION 13 The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10 – 40 mg, daily.
QUESTION 14
A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. QUESTION 15 Which patient will receive a lower dose of guanfacine? A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease QUESTION 16 An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain QUESTION 17 The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose?
A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg QUESTION 21 The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. QUESTION 22 An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do?
A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. QUESTION 23 The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. QUESTION 24 The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID
A. It will bind to the alpha- 2 - delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. QUESTION 28 Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above QUESTION 29 The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin QUESTION 30 The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) QUESTION 31
A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C QUESTION 32 The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above QUESTION 33 The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” QUESTION 34
A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. QUESTION 38 Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” QUESTION 39 Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. QUESTION 40
The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine QUESTION 41 The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above QUESTION 42 The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives
A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) QUESTION 46 A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” QUESTION 47 A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above QUESTION 48 The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?
A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” QUESTION 49 Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. QUESTION 50 An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) QUESTION 51 An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) QUESTION 52
advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. QUESTION 55 A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. QUESTION 56 Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD.
QUESTION 57
The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only QUESTION 58 A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia QUESTION 59 The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency,
