A+ NR546 EXAM QUESTIONS AND ANSWERS LATEST UPDATE
which benzodiazepine is safe in lactation
lifespan and lifestyle factors that are foundational to safe prescribing: Breast
feeding
Contraindicated when breastfeeding:
-gabapentine
-benzodiazepines
-histamine receptor agents
-alpha 2 ligands
lifespan and lifestyle factors that are foundational to safe prescribing: Older adult
decline in renal and liver function may contribute to the prolonged elimination of
medications leading to increased sedative effects and fall risk
-Consider decreasing the dosage of sedative-hypnotics
-taper whenever possible
2019 American Geriatric Society (AGS) Beers Criteria include the following
recommendations:
-avoid barbiturates (increased dependence, tolerance, risk of overdose)
-avoid benzodiazepines (increased sensitivity, decreased metabolism)
-avoid gabapentin and pregabalin (falls due to sedation)
-avoid hydroxyzine (clients with dementia, cognitive impairment, delirium, lower urinary
symptoms, or benign prostatic hyperplasia [BPH])
lifespan and lifestyle factors that are foundational to safe prescribing: Children
-Anxiety disorders often begin in childhood and are often comorbid with depression or
bipolar disorder.
-For children and adolescents, psychotherapy is the first choice of treatment. SSRIs
may be used for severe symptoms or when psychotherapy is not effective.
*There is an increased risk of suicide in clients less than 30 years using SSRIs.
-Gabapentin is not approved for anxiety in children, it may only be used for seizures.
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.
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
which benzodiazepine is safe in lactation
lifespan and lifestyle factors that are foundational to safe prescribing: Breast
feeding
Contraindicated when breastfeeding:
-gabapentine
-benzodiazepines
-histamine receptor agents
-alpha 2 ligands
lifespan and lifestyle factors that are foundational to safe prescribing: Older adult
decline in renal and liver function may contribute to the prolonged elimination of
medications leading to increased sedative effects and fall risk
-Consider decreasing the dosage of sedative-hypnotics
-taper whenever possible
2019 American Geriatric Society (AGS) Beers Criteria include the following
recommendations:
-avoid barbiturates (increased dependence, tolerance, risk of overdose)
-avoid benzodiazepines (increased sensitivity, decreased metabolism)
-avoid gabapentin and pregabalin (falls due to sedation)
-avoid hydroxyzine (clients with dementia, cognitive impairment, delirium, lower urinary
symptoms, or benign prostatic hyperplasia [BPH])
lifespan and lifestyle factors that are foundational to safe prescribing: Children
-Anxiety disorders often begin in childhood and are often comorbid with depression or
bipolar disorder.
-For children and adolescents, psychotherapy is the first choice of treatment. SSRIs
may be used for severe symptoms or when psychotherapy is not effective.
*There is an increased risk of suicide in clients less than 30 years using SSRIs.
-Gabapentin is not approved for anxiety in children, it may only be used for seizures.
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.
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
