NURS 6630 Week 6 Midterm Exam (Spring 2022)

1. Question: Is this a TRUE or FALSE statement? The following patient case is considered an example of treatment-resistant depression. 2. Question: Ronnie presents to your clinic with tremor, bradykinesia, and rigidity. The symptoms are very similar to what you would see in a patient with Parkinson’s disease. The client was prescribed risperidone several weeks ago. What is the reason for Ronnie’s symptoms? 3. Question: Scott is a 70-year-old man that is taking citalopram 40 mg daily. You discuss changing citalopram to another medication or decreasing the dose. He is hesitant to change medications since citalopram works for him. You end up decreasing his dose to 20 mg/day. He asks why you are wanting to change his medication or lower his dose. Which of the following reasons is the main reason you made the decision to decrease his dose. 4. Question: M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the following would be a first-line treatment option for M. B.? 5. Question: Which one of the anticonvulsants mentioned below has sufficient data to support its use in bipolar disorder? 6. Question: A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning? 7. Question: Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway 8. Question: A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend? 9. Question: Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder? 10. Question: An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of the following medications, which one is likely contributing to these side effects? 11. Question: You are currently evaluating a patient with major depressive disorder. One of his major complaints is insomnia. He states that he is awake all night and cannot get any rest. You decide to prescribe an antidepressant that will help his depression and his insomnia. The best option is . 12. Question: What is the strongest established risk factor for bipolar disorder? 13. Question: Which answer choice includes all the components of patient-focused interventions to enhance adherence? 14. Question: Of the following medications, which ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy)? 15. Question: K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.? 16. Question: In order for the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor? 17. Question: Which of the following syndromes is characterized by disorientation + confusion, agitation, fever, diarrhea, and ataxia? This syndrome can occur when an MAOI is given with an SSRI 18. Question: The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized? 19. Question: A patient presents to your clinic with generalized anxiety disorder. Her past medical history is significant for type II diabetes and uncontrolled hypertension. Which of the following agents would be least appropriate to start her on? 20. Question: Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression? 21. Question: You have been consulted to evaluate a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line? 22. Question: Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why? 23. Question: Which of the following disease states contributes to a greater risk for substance use, violence, and victimization as well as worse overall quality of life? 24. Question: Patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He reports starting lithium 600 mg at bedtime about 5 days ago and thinks that may be the cause. What is the appropriate next step for this patient? 25. Question: Which of the following medications used for treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia? 26. Question: Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin-norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder? 27. Question: John presents with both autonomic symptoms and physical hyperarousal after abruptly stopping his chronic opioid therapy. He claims that he is afraid of taking his medication because of what he is seeing on the news regarding opioid-related deaths. You know that John is experiencing symptoms due to an increase in norepinephrine. You decide to treat John with a medication to dampen the symptoms of opioid withdrawal. Which medication do you prescribe John? 28. Question: Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY. 29. Question: R.J. never felt relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today. He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.” Because he is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long must the patient be symptom- free before he may begin a trial to taper off the antidepressant therapy? 30. Question: A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to covering her whole body. She has a past medical history significant for type 2 diabetes, hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be causing this severe rash? 31. Question: Close-ended questions will help identify when patients are taking medications incorrectly. 32. Question: It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of an acute manic episode in bipolar disorder. 33. Question: M. M. is 27-year-old female student pharmacist who presents to the ER after experiencing extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and HR of 45. What medication below is likely the cause of these symptoms? 34. Question: K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic response? 35. Question: Which amino acid is involved in the synthesis of both norepinephrine and dopamine? 36. Question: Jamie has major depressive disorder and you decide to prescribe an SSRI. Jamie wants to make sure her medication is covered by her insurance plan. You review a list of SSRIs and notice that one medication listed on the list is not FDA-approved for the treatment of depression. Which of the following medications do you decide to NOT prescribe for Jamie’s depression? 37. Question: Alprazolam, phenobarbital, and alcohol all bind allosterically to GABAA receptors. What occurs to the GABAA receptor when these substances bind to the receptor? 38. Question: When initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium? 39. Question: Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? 40. Question: Austin is one of your clients and he asks you why exercise makes him feel better and lifts his mood. You tell him that his body is releasing which you know is a naturally occurring . 41. Question: A 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar disorder and was previously prescribed valproic acid by another doctor. What is your concern with this medication in this specific patient? 42. Question: Choose the appropriate statement regarding lamotrigine dosing. 43. Question: Which neurotransmitter is considered the major inhibitory neurotransmitter? 44. Question: Which medication has been studied and recommended in patients with a social anxiety disorder who also suffer from an alcohol use disorder? 45. Question: What is the therapeutic plasma level of carbamazepine? 46. Question: Glia cells play a supportive role in the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia or macroglia. Of the macroglia cells, which one plays a role in myelinating axons, which may contribute to mood disorders if altered? 47. Question: Which of the following is an appropriate strategy for managing treatment-resistant depression? 48. Question: Of the following medications used in the treatment of social anxiety disorder, which one would you AVOID in a patient who has uncontrolled hypertension? 49. Question: Choose the appropriate pair regarding acetylcholine receptors. 50. Question: Which anticonvulsant below induces its own metabolism over time? 51. Question: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?