NRNP 6665 FINAL EXAM TEST
QUESTIONS, NR 603 WEEK 7EXAM
QUESTIONS AND ANSWERS
Question 18: 8l
Christine is a 9-year- 8l 8l 8l
old female who presents for care after having been placed in the local foster care syst
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
em. She has been in and out of foster care for the last 4 years after her parents were
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
killed in an automobile accident. Christine has been placed in a variety of homes and
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
residential care facilities. The PMHNP recognizes that Christine is at high risk for: -
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
ANSWERS--A. Dissociative disorders
8l 8l 8l 8l
B. Post-traumatic stress disorder
8l 8l 8l 8l
C. Impulse-control disorder
8l 8l 8l
D. Attachment disorder
8l 8l
Question 7: 8l
Caylee is a 5-year- 8l 8l 8l
old girl who is referred for evaluation by child protective services. She was recently re
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
moved from her biological family and placed in foster care, as her home environment
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
was reportedly unsafe due to conditions of extreme neglect. Her foster mother report
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
s that Caylee is very quiet and withdrawn and always appears sad and disinterested i
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
n her surroundings; however, she becomes very irritable when anything unexpected
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
or unplanned occurs. The foster mother became very concerned when it appeared th
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
at Caylee was hallucinating. The PMHNP considers that: - ANSWERS--
8l 8l 8l 8l 8l 8l 8l 8l 8l
A. Caylee is at high risk for suicide and precautions should be taken
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
C. The history and reported symptoms are typical of depressive disorder in young chil
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
dren
D. This is a common situation when prepubertal children are removed from the biolog
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
ical parents regardless of how dysfunctional they are
8l 8l 8l 8l 8l 8l 8l
Question 2: 8l
Debi is a 15-year-
8l 8l 8l 8l
old girl who is currently being treated for depression. Her parents have been very pro
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
active and involved in her care, and Debi has achieved remission 2 months after begi
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
nning treatment with a combination of pharmacotherapy and cognitive behavioral ther
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
apy. While counseling Debi's parents about important issues in management, the PM
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
HNP advises that: - ANSWERS-- 8l 8l 8l 8l
A. There is a > 50% likelihood that Debi's younger sibling will develop depressive sy
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
mptoms 8l
B. The mean length of major depressive episode in adolescents is 4 months
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
I within 5 years
8l 8l 8l 8l
D. Adolescent-onset depression typically need long-
8l 8l 8l 8l 8l
term pharmacologic management to prevent relapses
8l 8l 8l 8l 8l
,Agomelatine - ANSWERS--Brand: Valdoxan 8l 8l 8l
-Melatonin multimodal (Mel-MM) 8l 8l
-Agonist at melatonergic 1 and melatonergic 2 receptors
8l 8l 8l 8l 8l 8l 8l
-Antagonist at 5HT2C receptors 8l 8l 8l
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
8l 8l 8l 8l 8l 8l 8l 8l
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50 mg/day at bedtime
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
Amitriptyline (Elavil) - ANSWERS--Tricyclic antidepressant.
8l 8l 8l 8l
Aripiprazole (Abilify) - ANSWERS-- 8l 8l 8l
Treatment for depression. Atypical antipsychotic. "Dopamine stabilizer". Dopamine re
8l 8l 8l 8l 8l 8l 8l 8l
ceptor antagonist in high concentration and also stimulates increase of dopamine in l
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
ow concentrations. Side effects: insomnia, akathisia.
8l 8l 8l 8l 8l
Brexpiprazole (Rexulti) - ANSWERS-- 8l 8l 8l
Treatment for depression. Atypical antipsychotic
8l 8l 8l 8l
Bupropion (Wellbutrin) - ANSWERS-- 8l 8l 8l
Antidepressant and smoking cessation aid, It can treat depression and help people q
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
uit smoking. It can also prevent depression caused by seasonal affective disorder (S
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
AD).
Citalopram (Celexa) - ANSWERS--Antidepressant, SSRI: 20-40 mg qd.
8l 8l 8l 8l 8l 8l 8l
Clomipramine (Anafranil) - ANSWERS---Serotonin reuptake inhibitor (S-RI)8l 8l 8l 8l 8l 8l
-Tricyclic antidepressant (TCA) 8l 8l
-Parent drug is a potent serotonin reuptake inhibitor
8l 8l 8l 8l 8l 8l 8l
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
8l 8l 8l 8l 8l 8l 8l
-
Increases serotonergic neurotransmission by blocking the serotonin reuptake pump (t
8l 8l 8l 8l 8l 8l 8l 8l 8l
ransporter), - 8l
Desensitization of serotonin receptors, especially serotonin 1A receptors 8l 8l 8l 8l 8l 8l 8l
-
Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
8l 8l 8l 8l 8l 8l 8l 8l
pump (transporter), -Desensitization of beta adrenergic receptors
8l 8l 8l 8l 8l 8l
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
8l 8l 8l 8l 8l 8l 8l 8l 8l
-Lacks dopamine transporters
8l 8l
-Increases dopamine neurotransmission in this part of the brain
8l 8l 8l 8l 8l 8l 8l 8l
**FDA Approved for Pediatrics in tx Obsessive-
8l 8l 8l 8l 8l 8l
compulsive disorder (OCD) (ages 10 and older) 8l 8l 8l 8l 8l 8l
*Off-Label for Pediatric Use: Depression, Severe and treatment-
8l 8l 8l 8l 8l 8l 8l
resistant, depression, Cataplexy syndrome, Anxiety, Insomnia,
8l 8l 8l 8l 8l
Neuropathic pain/chronic pain 8l 8l
-Full therapeutic benefits may take 2-8 weeks
8l 8l 8l 8l 8l 8l
-Dosing: in Peds/Adolescents/Adults:
8l 8l
100-250mg/day
Cyamemazine (Tercian) - ANSWERS--Treatment for depression. 8l 8l 8l 8l 8l
-Known as cyamepromazine
8l 8l 8l
-Typical antipsychotic drug of the phenothiazine class.
8l 8l 8l 8l 8l 8l 8l 8l
, -Treatment for schizophrenia
8l 8l 8l
and psychosis-associated
8l 8l
anxiety
8l
-Behaves like an atypical 8l 8l 8l
antipsychotic, due to its
8l 8l 8l 8l
potent anxiolytic effects (5-HT2C) and lack of extrapyramidal side effects (5-HT2A).
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
-
Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist, serot
8l 8l 8l 8l 8l 8l 8l
onin dopamine antagonist)
8l 8l
-Commonly Prescribed for (not FDA approved): 8l 8l 8l 8l 8l
-Schizophrenia
8l
-Anxiety associated with psychosis (short-term)
8l 8l 8l 8l 8l
-
8l
Anxiety associated with nonpsychotic disorders, including mood disorders and perso
8l 8l 8l 8l 8l 8l 8l 8l 8l
nality disorders (short-term)
8l 8l
-Severe depression
8l 8l
-Bipolar disorder
8l 8l
-Other psychotic disorders
8l 8l 8l
-Acute agitation/aggression (injection)
8l 8l 8l
-Benzodiazepine withdrawal
8l 8l
Desiprimine (Norpramine) - ANSWERS--Treats depression 8l 8l 8l 8l 8l
Brand: Norpramin 8l
-TCA
-Norepinephrine noradrenaline reuptake inhibitor. 8l 8l 8l
-FDA approved for treating depression.
8l 8l 8l 8l 8l
-Off-label: Anxiety, Insomnia, 8l 8l
Neuropathic pain/chronic pain, Treatment-resistant depression. 8l 8l 8l 8l
-
More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
(serotonin transporter).
8l 8l
-May have immediate effects in treating insomnia or anxiety.
8l 8l 8l 8l 8l 8l 8l 8l
-If it is not working within 6-
8l 8l 8l 8l 8l 8l
8 weeks for depression, it may require a dosage increase or it may not work at all
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
-100-200 mg/day (for depression) 8l 8l 8l
50-150 mg/day (for chronic pain). 8l 8l 8l 8l
Desvenlafaxine (Pristiq) - ANSWERS-- 8l 8l 8l
Dual serotonin and norepinephrine reuptake inhibitor-
8l 8l 8l 8l 8l
often classified as an antidepressant.
8l 8l 8l 8l
-FDA approved to tx MDD. 8l 8l 8l 8l
-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/
8l 8l 8l 8l 8l 8l 8l 8l 8l
o, PTSD, PMDD
8l 8l
-
Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack dop
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
amine transporters) med can increase dopamine neurotransmission in this part of the
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
brain
8l
-
QUESTIONS, NR 603 WEEK 7EXAM
QUESTIONS AND ANSWERS
Question 18: 8l
Christine is a 9-year- 8l 8l 8l
old female who presents for care after having been placed in the local foster care syst
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
em. She has been in and out of foster care for the last 4 years after her parents were
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
killed in an automobile accident. Christine has been placed in a variety of homes and
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
residential care facilities. The PMHNP recognizes that Christine is at high risk for: -
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
ANSWERS--A. Dissociative disorders
8l 8l 8l 8l
B. Post-traumatic stress disorder
8l 8l 8l 8l
C. Impulse-control disorder
8l 8l 8l
D. Attachment disorder
8l 8l
Question 7: 8l
Caylee is a 5-year- 8l 8l 8l
old girl who is referred for evaluation by child protective services. She was recently re
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
moved from her biological family and placed in foster care, as her home environment
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
was reportedly unsafe due to conditions of extreme neglect. Her foster mother report
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
s that Caylee is very quiet and withdrawn and always appears sad and disinterested i
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
n her surroundings; however, she becomes very irritable when anything unexpected
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
or unplanned occurs. The foster mother became very concerned when it appeared th
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
at Caylee was hallucinating. The PMHNP considers that: - ANSWERS--
8l 8l 8l 8l 8l 8l 8l 8l 8l
A. Caylee is at high risk for suicide and precautions should be taken
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
C. The history and reported symptoms are typical of depressive disorder in young chil
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
dren
D. This is a common situation when prepubertal children are removed from the biolog
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
ical parents regardless of how dysfunctional they are
8l 8l 8l 8l 8l 8l 8l
Question 2: 8l
Debi is a 15-year-
8l 8l 8l 8l
old girl who is currently being treated for depression. Her parents have been very pro
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
active and involved in her care, and Debi has achieved remission 2 months after begi
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
nning treatment with a combination of pharmacotherapy and cognitive behavioral ther
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
apy. While counseling Debi's parents about important issues in management, the PM
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
HNP advises that: - ANSWERS-- 8l 8l 8l 8l
A. There is a > 50% likelihood that Debi's younger sibling will develop depressive sy
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
mptoms 8l
B. The mean length of major depressive episode in adolescents is 4 months
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
I within 5 years
8l 8l 8l 8l
D. Adolescent-onset depression typically need long-
8l 8l 8l 8l 8l
term pharmacologic management to prevent relapses
8l 8l 8l 8l 8l
,Agomelatine - ANSWERS--Brand: Valdoxan 8l 8l 8l
-Melatonin multimodal (Mel-MM) 8l 8l
-Agonist at melatonergic 1 and melatonergic 2 receptors
8l 8l 8l 8l 8l 8l 8l
-Antagonist at 5HT2C receptors 8l 8l 8l
-Not FDA approved: Rx for Depression, Generalized anxiety disorder
8l 8l 8l 8l 8l 8l 8l 8l
-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50 mg/day at bedtime
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
Amitriptyline (Elavil) - ANSWERS--Tricyclic antidepressant.
8l 8l 8l 8l
Aripiprazole (Abilify) - ANSWERS-- 8l 8l 8l
Treatment for depression. Atypical antipsychotic. "Dopamine stabilizer". Dopamine re
8l 8l 8l 8l 8l 8l 8l 8l
ceptor antagonist in high concentration and also stimulates increase of dopamine in l
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
ow concentrations. Side effects: insomnia, akathisia.
8l 8l 8l 8l 8l
Brexpiprazole (Rexulti) - ANSWERS-- 8l 8l 8l
Treatment for depression. Atypical antipsychotic
8l 8l 8l 8l
Bupropion (Wellbutrin) - ANSWERS-- 8l 8l 8l
Antidepressant and smoking cessation aid, It can treat depression and help people q
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
uit smoking. It can also prevent depression caused by seasonal affective disorder (S
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
AD).
Citalopram (Celexa) - ANSWERS--Antidepressant, SSRI: 20-40 mg qd.
8l 8l 8l 8l 8l 8l 8l
Clomipramine (Anafranil) - ANSWERS---Serotonin reuptake inhibitor (S-RI)8l 8l 8l 8l 8l 8l
-Tricyclic antidepressant (TCA) 8l 8l
-Parent drug is a potent serotonin reuptake inhibitor
8l 8l 8l 8l 8l 8l 8l
Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
8l 8l 8l 8l 8l 8l 8l
-
Increases serotonergic neurotransmission by blocking the serotonin reuptake pump (t
8l 8l 8l 8l 8l 8l 8l 8l 8l
ransporter), - 8l
Desensitization of serotonin receptors, especially serotonin 1A receptors 8l 8l 8l 8l 8l 8l 8l
-
Increases noradrenergic neurotransmission by blocking the norepinephrine reuptake
8l 8l 8l 8l 8l 8l 8l 8l
pump (transporter), -Desensitization of beta adrenergic receptors
8l 8l 8l 8l 8l 8l
-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
8l 8l 8l 8l 8l 8l 8l 8l 8l
-Lacks dopamine transporters
8l 8l
-Increases dopamine neurotransmission in this part of the brain
8l 8l 8l 8l 8l 8l 8l 8l
**FDA Approved for Pediatrics in tx Obsessive-
8l 8l 8l 8l 8l 8l
compulsive disorder (OCD) (ages 10 and older) 8l 8l 8l 8l 8l 8l
*Off-Label for Pediatric Use: Depression, Severe and treatment-
8l 8l 8l 8l 8l 8l 8l
resistant, depression, Cataplexy syndrome, Anxiety, Insomnia,
8l 8l 8l 8l 8l
Neuropathic pain/chronic pain 8l 8l
-Full therapeutic benefits may take 2-8 weeks
8l 8l 8l 8l 8l 8l
-Dosing: in Peds/Adolescents/Adults:
8l 8l
100-250mg/day
Cyamemazine (Tercian) - ANSWERS--Treatment for depression. 8l 8l 8l 8l 8l
-Known as cyamepromazine
8l 8l 8l
-Typical antipsychotic drug of the phenothiazine class.
8l 8l 8l 8l 8l 8l 8l 8l
, -Treatment for schizophrenia
8l 8l 8l
and psychosis-associated
8l 8l
anxiety
8l
-Behaves like an atypical 8l 8l 8l
antipsychotic, due to its
8l 8l 8l 8l
potent anxiolytic effects (5-HT2C) and lack of extrapyramidal side effects (5-HT2A).
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
-
Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist, serot
8l 8l 8l 8l 8l 8l 8l
onin dopamine antagonist)
8l 8l
-Commonly Prescribed for (not FDA approved): 8l 8l 8l 8l 8l
-Schizophrenia
8l
-Anxiety associated with psychosis (short-term)
8l 8l 8l 8l 8l
-
8l
Anxiety associated with nonpsychotic disorders, including mood disorders and perso
8l 8l 8l 8l 8l 8l 8l 8l 8l
nality disorders (short-term)
8l 8l
-Severe depression
8l 8l
-Bipolar disorder
8l 8l
-Other psychotic disorders
8l 8l 8l
-Acute agitation/aggression (injection)
8l 8l 8l
-Benzodiazepine withdrawal
8l 8l
Desiprimine (Norpramine) - ANSWERS--Treats depression 8l 8l 8l 8l 8l
Brand: Norpramin 8l
-TCA
-Norepinephrine noradrenaline reuptake inhibitor. 8l 8l 8l
-FDA approved for treating depression.
8l 8l 8l 8l 8l
-Off-label: Anxiety, Insomnia, 8l 8l
Neuropathic pain/chronic pain, Treatment-resistant depression. 8l 8l 8l 8l
-
More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pump
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
(serotonin transporter).
8l 8l
-May have immediate effects in treating insomnia or anxiety.
8l 8l 8l 8l 8l 8l 8l 8l
-If it is not working within 6-
8l 8l 8l 8l 8l 8l
8 weeks for depression, it may require a dosage increase or it may not work at all
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
-100-200 mg/day (for depression) 8l 8l 8l
50-150 mg/day (for chronic pain). 8l 8l 8l 8l
Desvenlafaxine (Pristiq) - ANSWERS-- 8l 8l 8l
Dual serotonin and norepinephrine reuptake inhibitor-
8l 8l 8l 8l 8l
often classified as an antidepressant.
8l 8l 8l 8l
-FDA approved to tx MDD. 8l 8l 8l 8l
-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/
8l 8l 8l 8l 8l 8l 8l 8l 8l
o, PTSD, PMDD
8l 8l
-
Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack dop
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
amine transporters) med can increase dopamine neurotransmission in this part of the
8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l
brain
8l
-
