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NURS 6630 MIDTERM EXAM QUESTIONS &
CORRECT ANSWERS GRADED A WALDEN
UNIVERSITY
Question1 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: Selected C. Answer: (^) “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 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? Selected 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? Selected 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? Selected 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? Selected Answer: B. Those that are potent D2 antagonists with 5HT2A antagonism properties - Question 6 1 out of 1 points After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect? Selected 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 that the patient would be placed on a different antipsychotic agent called an atypical antipsychotic. What neurotransmitters will this new medication work on? Selected Answer: A. dopamine and serotonin - Question 8 1 out of 1 points While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? Selected Answer: B. Changes made to proteins lead to changes in behavior. - Question 9 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
Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.
- Question 14 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: Selected Answer: C. Neurotransmitters can spread by diffusion. - Question 15 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? Selected Answer: D. trazadone (Oleptro) - Question 16 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)? Selected Answer: B. Patient with partial seizures - Question 17 1 out of 1 points Which statement about neurotransmitters and medications is true? Selected Answer: B. Several psychiatric medications have been developed after discoveries of endogenous neurotransmitters and defining their function in the brain. - 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? Selected 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? Selected 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? Selected 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: Selected 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? Selected Answer: A. Patient with a bipolar I designation
“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? Selected Answer: C. “Amphetamines can cause hallucinations, so I would advise against this type of prescription.” - 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: Selected 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? Selected Answer: D. Weight gain is unusual. - Question 31 What is accurate about the clinical description of psychosis? 1 out of 1 points Selected 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? Selected Answer: D. Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic effects. - 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: Selected 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? Selected Answer: A. The PMHNP will prescribe less than 2 - 6 mg for Mr. Gutier to take daily. - Question 35 1 out of 1 points A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose: Selected Answer: B. Beta blockers are linked to reconsolidation. - Question 36 1 out of 1 points A patient recently transferred following a suicide attempt has a
Selected Answer: C. Lithium (Lithobid)
- Question 41 1 out of 1 points 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? Selected Answer: B. Gabapentin (Neurontin) - Question 42 1 out of 1 points 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? Selected Answer: D. All of the above - Question 43 1 out of 1 points 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? Selected Answer: A. “The drug will have an almost immediate effect.” - 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? Selected 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? Selected 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? Selected 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? Selected Answer: B. MAO inhibitors - 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? Selected Answer: C. Sedation is unusual - 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: Selected Answer: D. A low self esteem
drug-drug interactions? Selected Answer: D. “Decongestants should be avoided due to risk of hypertensive crisis.”
- Question 55 1 out of 1 points 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? Selected Answer: D. A and C - Question 56 1 out of 1 points 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? Selected Answer: D. The patient may be less responsive or tolerant to the treatment. - Question 57 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? Selected Answer: B. Agitation - Question 58
1 out of 1 points The PMHNP understands that the potential of alcohol abuse in the anxious client is higher for the following reasons: Selected Answer: a. Alcohol exerts an effect on GABAA receptors.
- Question 59 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: Selected Answer: B. SSRI/SNRI plus NDRI - Question 60 1 out of 1 points During gene expression, what must occur prior to a gene being expressed? Selected Answers: 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? Selected 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? Selected Answer: B. The client will need to minimize dietary intake of foods that are high in tyramine. - Question 63
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: Selected Answer: C. Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)
- Question 68 It is important for the PMHNP to recognize differences in 1 out of 1 points pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true? Selected 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? Selected Answer: C. Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses. - 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? Selected 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. Selected 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? Selected 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? Selected Answer: A. The patient has an unsustained response to antidepressants. - Question 74 A 51 - year-old female patient presents with symptoms of 1 out of 1 points depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression? Selected Answer: D. A and C - Question 75 1 out of 1 points
