NR 546/ NR 546 MIDTERM EXAM NEWEST ACTUAL EXAM WITH COMPLETE 300 QUESTIONS AND ANSWERS | GRADED A+ | NEW VERSION 2026/2027!!

NR 546/ NR 546 MIDTERM EXAM NEWEST ACTUAL EXAM WITH COMPLETE 300 QUESTIONS AND ANSWERS | GRADED A+ | NEW VERSION 2026/2027!! Sofia presents to the PMHNP with a report of being overwhelmed with stress and worry. Sofia reports she has always dealt with these feelings, but it has been worse since she has taken a more advanced role in her work with significant responsibility. She has difficulty relaxing and is often fatigued. The PMHNP diagnoses Sofia with generalized anxiety disorder. sertraline 25 mg po once daily. Rationale: Anxiety can often be treated with antidepressants. The best choice for Sofia is the SSRI, sertraline because it is half the recommended dose for depression. The duloxetine dosage listed is an appropriate dose for depression. When treating anxiety, the dosage should start at 30 mg and be titrated up. Buspirone is not the first drug of choice and it is typically used short-term. A benzodiazepine should not be the first drug of choice. Many persons with schizophrenia are treated successfully in an ______________, though some clients may require ________________ for initial treatment and subsequent treatment of psychotic episodes outpatient setting, inpatient hospitalizations Why begin with monotherapy? (antipsychotics) The use of multiple antipsychotics can increase the risk of QT prolongation. -Combinations considered only after single med have provided inadequate response. Clients are more likely to experience side effects when changing from a medication in one ___________ to a medication in another ____________ subcategory, subcategory (ex: pine to done) special considerations: Pregnancy (antipsychotics) -Risk of withdrawal symptoms in the newborn: extrapyramidal symptoms may be present at delivery. -atypical antipsychotics appear more harmful than typical antipsychotics due to increased risk of gestational metabolic complications, increased gestational age weight, and increased birth weight. -Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and quetiapine, especially in the third trimester Sofia was prescribed sertraline 25 mg po once daily. Sofia's dosage was increased to 50 mg after week 1, increased to 100 mg after week 2, and increased to 150 mg after week 3. At Sofia's 4-week follow-up visit, she is tolerating the medication well and symptoms are slightly improved. Which is the best action by the PMHNP? increase the sertraline dose to 200 mg Rationale: The PMHNP should increase the sertraline dose to the maximum dose of 200 mg because the client has slightly improved symptoms. It may take several months for the client to see full relief, so it is best to wait before adding additional drugs or switching drugs. At Sofia's 12-week follow-up visit, the client is taking the maximum dose of sertraline and is experiencing improvement in symptoms, but not full relief from symptoms. Which is the best action by the PMHNP? augment with buspirone Rationale: The client has improvement in symptoms, but not full relief, so the best action is to augment the current therapy. Buspirone offers anxiety relief but does not have the effects of a CNS depressant or cause dependence like benzodiazepines. Buspirone does take approximately 4 weeks to reach full therapeutic effects. If the client did not experience an improvement in symptoms, switching to another SSRI would be the best action. If antipsychotics switched too quickly can develop agitation, activation, insomnia, and experience withdrawal -due to the binding differences in each medication subcategory *Cross titration over several days to weeks is required to prevent side effects Jill, a 23-year-old graduate student, presents with reports of panic attacks and worry "my whole life." She reports that she can bring on panic attacks herself when she worries. This happens almost every day and some days it is so bad she cannot go to work or school. She was offered a few Xanax by a friend, and she wants a prescription because "they really help." The PMHNP diagnoses Jill with Generalized Anxiety Disorder (GAD). Which is the best medication for the PMHNP to prescribe? escitalopram Rationale: Escitalopram is the only listed SSRI that is the appropriate drug class for GAD. Bupropion is an SNRI. Medications that contain norepinephrine can increase anxiety. Jill has chronic anxiety, not acute anxiety. Benzodiazepines should be prescribed only for short-term use, less than 4 weeks as an adjunct until the SSRI achieves efficacy. Buspirone seems like a good choice because this medication targets 5HT1A; however, this medication is used as an adjunct therapy, not monotherapy