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NRNP 6568 Week 11 Final Exam Prep |
300 Q&A | Pharmacology, Telehealth,
Legal/Ethical | Walden
1. A 45-year-old patient with major depressive disorder reports increased anxiety and
insomnia after starting a new antidepressant 2 weeks ago. What is the most
appropriate initial action?
A) Discontinue the medication immediately
B) Increase the dose for faster effect
C) Reassure the patient that these symptoms are often transient and schedule a
sooner follow-up
D) Prescribe a benzodiazepine long-term
Answer: C) Reassure the patient that these symptoms are often transient and
schedule a sooner follow-up
Rationale: Initial activation syndrome with anxiety and insomnia is common with
SSRIs/SNRIs in the first 1-2 weeks and is usually transient. Discontinuation is not
indicated unless severe. Dose increases should not occur before 4-6 weeks.
2. A 9-year-old girl with a history of frequent foster care changes is withdrawn, avoids
eye contact, and shows little emotional response. What is the most likely diagnosis?
A) ADHD
B) Oppositional defiant disorder
C) Reactive attachment disorder
D) Generalized anxiety disorder
Answer: C) Reactive attachment disorder
Rationale: RAD occurs in children with severe early neglect or frequent caregiver
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changes. Key features include social withdrawal, minimal emotional responsiveness,
and lack of comfort-seeking.
3. A telehealth patient reports unilateral eye redness, mucopurulent discharge, and
crusting on waking. No photophobia or vision changes. What is the most likely
diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Acute angle-closure glaucoma
Answer: B) Bacterial conjunctivitis
Rationale: Bacterial conjunctivitis presents with mucopurulent discharge and crusting
without photophobia. Viral conjunctivitis has watery discharge. Allergic is bilateral with
itching. Acute angle-closure glaucoma has severe pain and blurred vision.
4. A 68-year-old male has an intraocular pressure of 24 mmHg. What is the normal
range for IOP?
A) 5-10 mmHg
B) 10-21 mmHg
C) 22-30 mmHg
D) 31-40 mmHg
Answer: B) 10-21 mmHg
Rationale: Normal IOP ranges from 10-21 mmHg. Pressures above 21 mmHg are
elevated and require further evaluation for glaucoma.
5. A 72-year-old male with BPH and hypertension develops urinary retention, confusion,
and dry mouth after starting a new medication for neuropathic pain. Which
medication is most likely responsible?
A) Duloxetine
B) Amitriptyline
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C) Gabapentin
D) Pregabalin
Answer: B) Amitriptyline
Rationale: Amitriptyline is a TCA with potent anticholinergic effects causing urinary
retention, confusion, and dry mouth in elderly patients. Duloxetine, gabapentin, and
pregabalin have lower anticholinergic burden.
6. A 10-year-old male with ADHD is forgetful, loses things, blurts out answers, and
cannot wait his turn. Which non-stimulant medication is FDA-approved for ADHD
and inhibits the presynaptic norepinephrine transporter?
A) Methylphenidate
B) Dextroamphetamine
C) Atomoxetine
D) Guanfacine
Answer: C) Atomoxetine
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI)
approved for ADHD. Methylphenidate and dextroamphetamine are stimulants.
Guanfacine is an alpha-2 agonist.
7. An NP is dismissing a non-compliant patient. What action is legally required to avoid
patient abandonment?
A) Verbal notification during the final visit
B) Certified letter with return receipt providing 30 days of emergency coverage and
record transfer instructions
C) Chart note and waiting for the patient to call back
D) Immediate termination and ceasing all communication
Answer: B) Certified letter with return receipt providing 30 days of emergency
coverage and record transfer instructions
Rationale: Formal written notice via certified mail with 30 days of emergency coverage
and instructions for transferring records is required to avoid abandonment. Verbal
notification is insufficient.
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8. During a telehealth visit, a patient reports acute severe unilateral eye pain, halos
around lights, nausea, and blurred vision with a fixed mid-dilated pupil. What is the
most appropriate action?
A) Prescribe topical antibiotics and follow up in 24 hours
B) Reassure and recommend cool compresses
C) Instruct the patient to go to the nearest emergency department immediately
D) Ask the patient to perform a home visual acuity test
Answer: C) Instruct the patient to go to the nearest emergency department
immediately
Rationale: This is acute angle-closure glaucoma, an emergency requiring immediate
ED referral. Telemedicine cannot manage this condition.
9. A 7-year-old with AOM has a bulging, erythematous, immobile tympanic membrane
with purulent effusion. No drug allergies. What is the first-line antibiotic and dosage?
A) Amoxicillin 40-45 mg/kg/day divided BID
B) Amoxicillin 80-90 mg/kg/day divided BID
C) Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
D) Cefdinir 14 mg/kg/day divided BID
Answer: B) Amoxicillin 80-90 mg/kg/day divided BID
Rationale: High-dose amoxicillin (80-90 mg/kg/day) is first-line for AOM to overcome
penicillin-resistant S. pneumoniae. Lower doses are for strep pharyngitis.
10. A 16-year-old with MDD has failed two SSRIs and one SNRI. Which medication is a
melatonin receptor agonist and 5-HT2C antagonist?
A) Fluoxetine
B) Bupropion
C) Agomelatine
D) Vortioxetine
Answer: C) Agomelatine
Rationale: Agomelatine is a melatonergic agonist (MT1/MT2) and 5-HT2C antagonist.
Fluoxetine is an SSRI, bupropion is an NDRI, and vortioxetine is multimodal
serotonergic.
NRNP 6568 Week 11 Final Exam Prep |
300 Q&A | Pharmacology, Telehealth,
Legal/Ethical | Walden
1. A 45-year-old patient with major depressive disorder reports increased anxiety and
insomnia after starting a new antidepressant 2 weeks ago. What is the most
appropriate initial action?
A) Discontinue the medication immediately
B) Increase the dose for faster effect
C) Reassure the patient that these symptoms are often transient and schedule a
sooner follow-up
D) Prescribe a benzodiazepine long-term
Answer: C) Reassure the patient that these symptoms are often transient and
schedule a sooner follow-up
Rationale: Initial activation syndrome with anxiety and insomnia is common with
SSRIs/SNRIs in the first 1-2 weeks and is usually transient. Discontinuation is not
indicated unless severe. Dose increases should not occur before 4-6 weeks.
2. A 9-year-old girl with a history of frequent foster care changes is withdrawn, avoids
eye contact, and shows little emotional response. What is the most likely diagnosis?
A) ADHD
B) Oppositional defiant disorder
C) Reactive attachment disorder
D) Generalized anxiety disorder
Answer: C) Reactive attachment disorder
Rationale: RAD occurs in children with severe early neglect or frequent caregiver
, 2|Page
changes. Key features include social withdrawal, minimal emotional responsiveness,
and lack of comfort-seeking.
3. A telehealth patient reports unilateral eye redness, mucopurulent discharge, and
crusting on waking. No photophobia or vision changes. What is the most likely
diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Acute angle-closure glaucoma
Answer: B) Bacterial conjunctivitis
Rationale: Bacterial conjunctivitis presents with mucopurulent discharge and crusting
without photophobia. Viral conjunctivitis has watery discharge. Allergic is bilateral with
itching. Acute angle-closure glaucoma has severe pain and blurred vision.
4. A 68-year-old male has an intraocular pressure of 24 mmHg. What is the normal
range for IOP?
A) 5-10 mmHg
B) 10-21 mmHg
C) 22-30 mmHg
D) 31-40 mmHg
Answer: B) 10-21 mmHg
Rationale: Normal IOP ranges from 10-21 mmHg. Pressures above 21 mmHg are
elevated and require further evaluation for glaucoma.
5. A 72-year-old male with BPH and hypertension develops urinary retention, confusion,
and dry mouth after starting a new medication for neuropathic pain. Which
medication is most likely responsible?
A) Duloxetine
B) Amitriptyline
, 3|Page
C) Gabapentin
D) Pregabalin
Answer: B) Amitriptyline
Rationale: Amitriptyline is a TCA with potent anticholinergic effects causing urinary
retention, confusion, and dry mouth in elderly patients. Duloxetine, gabapentin, and
pregabalin have lower anticholinergic burden.
6. A 10-year-old male with ADHD is forgetful, loses things, blurts out answers, and
cannot wait his turn. Which non-stimulant medication is FDA-approved for ADHD
and inhibits the presynaptic norepinephrine transporter?
A) Methylphenidate
B) Dextroamphetamine
C) Atomoxetine
D) Guanfacine
Answer: C) Atomoxetine
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI)
approved for ADHD. Methylphenidate and dextroamphetamine are stimulants.
Guanfacine is an alpha-2 agonist.
7. An NP is dismissing a non-compliant patient. What action is legally required to avoid
patient abandonment?
A) Verbal notification during the final visit
B) Certified letter with return receipt providing 30 days of emergency coverage and
record transfer instructions
C) Chart note and waiting for the patient to call back
D) Immediate termination and ceasing all communication
Answer: B) Certified letter with return receipt providing 30 days of emergency
coverage and record transfer instructions
Rationale: Formal written notice via certified mail with 30 days of emergency coverage
and instructions for transferring records is required to avoid abandonment. Verbal
notification is insufficient.
, 4|Page
8. During a telehealth visit, a patient reports acute severe unilateral eye pain, halos
around lights, nausea, and blurred vision with a fixed mid-dilated pupil. What is the
most appropriate action?
A) Prescribe topical antibiotics and follow up in 24 hours
B) Reassure and recommend cool compresses
C) Instruct the patient to go to the nearest emergency department immediately
D) Ask the patient to perform a home visual acuity test
Answer: C) Instruct the patient to go to the nearest emergency department
immediately
Rationale: This is acute angle-closure glaucoma, an emergency requiring immediate
ED referral. Telemedicine cannot manage this condition.
9. A 7-year-old with AOM has a bulging, erythematous, immobile tympanic membrane
with purulent effusion. No drug allergies. What is the first-line antibiotic and dosage?
A) Amoxicillin 40-45 mg/kg/day divided BID
B) Amoxicillin 80-90 mg/kg/day divided BID
C) Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
D) Cefdinir 14 mg/kg/day divided BID
Answer: B) Amoxicillin 80-90 mg/kg/day divided BID
Rationale: High-dose amoxicillin (80-90 mg/kg/day) is first-line for AOM to overcome
penicillin-resistant S. pneumoniae. Lower doses are for strep pharyngitis.
10. A 16-year-old with MDD has failed two SSRIs and one SNRI. Which medication is a
melatonin receptor agonist and 5-HT2C antagonist?
A) Fluoxetine
B) Bupropion
C) Agomelatine
D) Vortioxetine
Answer: C) Agomelatine
Rationale: Agomelatine is a melatonergic agonist (MT1/MT2) and 5-HT2C antagonist.
Fluoxetine is an SSRI, bupropion is an NDRI, and vortioxetine is multimodal
serotonergic.
