NR 546 Midterm Exam questions and answers

NR 546 Midterm Exam questions and answers
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1. A patient with Bipolar I disorder is experiencing acute manic episodes. The P
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MHNP needs to choose a medication with the most rapid onset of action for agi
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tation and psychosis. Which of the following is the best first-line choice?
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A. Lamotrigine
B. Lithium
C. Valproate
D. Olanzapine
Answer: D. Olanzapine. While Lithium and Valproate are first-
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line for acute mania, second-
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generation antipsychotics (SGAs) like Olanzapine, Risperidone, and Quetiapine hav
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e a more rapid onset of action, especially when used with a benzodiazepine for agit
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ation. Lamotrigine is not effective for acute mania.
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2. What is the most critical patient education point regarding the use of L
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amotrigine?
A. The need for regular renal function tests.
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B. The risk of developing a life-threatening rash like Stevens-Johnson Syndrome.
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C. The importance of a low-sodium diet.
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D. The risk of extrapyramidal symptoms.
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Answer: B. The risk of developing a life-threatening rash like Stevens-
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Johnson Syndrome. This is a black box warning for Lamotrigine. The risk is highest d
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uring the initial titration period, and patients must be instructed to report any rash i
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mmediately.
3. Which of the following medications requires regular therapeutic drug
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monitoring? (Select all that apply) v v v v


A. Sertraline
B. Lithium
C. Valproic Acid v


D. Bupropion
Answer: B & C. Lithium and Valproic Acid. Lithium has a narrow therapeutic index (
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0.6-1.2 mEq/L), and Valproate levels are typically monitored (50-125
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, mcg/mL). SSRIs like Sertraline and antidepressants like Bupropion do not require ro
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utine serum level monitoring.
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4. A patient presents with a first episode of psychosis. The PMHNP initiates L
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urasidone (Latuda). The most important counseling point regarding adminis
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tration is: v


A. It must be taken on an empty stomach.
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B. It must be taken with at least 350 calories of food.
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C. It can be crushed and mixed with applesauce.
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D. It should be taken at least 2 hours after the evening meal.
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Answer: B. It must be taken with at least 350 calories of food. Lurasidone's absor
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ption is significantly increased (up to 2-
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3 times) when taken with a meal of at least 350 calories. Taking it on an empty stom
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ach can render it ineffective.
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5. A patient stabilized on Lithium for 6 months presents with new-
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onset tremors, nausea, vomiting, and diarrhea. The PMHNP's first action should b
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e to:
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A. Administer an antiemetic. v v


B. Order a stat Lithium level. v v v v


C. Switch the patient to Valproate. v v v v


D. Reassure the patient that these are normal side effects. v v v v v v v v


Answer: B. Order a stat Lithium level. These are classic signs of Lithium toxicity. T
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his is a medical emergency, and the first step is to confirm the diagnosis with a ser
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um level. v




6. Which antidepressant is considered the safest in terms of cardiac toxicity in o
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verdose?
A. Amitriptyline
B. Sertraline
C. Venlafaxine
D. Bupropion
Answer: B. Sertraline. As an SSRI, Sertraline has a much wider therapeutic index and
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is far safer in overdose compared to Tricyclic Antidepressants (TCAs) like Amitriptyli
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ne, which can cause fatal arrhythmias. Venlafaxine can cause hypertension, and Bu
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propion lowers the seizure threshold. v v v v




7. A patient with Generalized Anxiety Disorder (GAD) has failed two SSRIs due to s
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exual side effects. Which of the following is the best next option?
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