PMHNP Psychopharm Exam 14 2024
Which statement is true regarding bipolar disorder and pregnancy?
1. A
Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations
2. B
Divalproex sodium (Depakote) is a safe alternative to lithium carbonate
3. C
Lithium (Lithane, Lithobid) is safe during the first and third trimesters
4. D
Carbamazepine (Tegretol, Carbatrol, Equetro) is a safe alternative to lithium carbonate -
Correct answer: Clonazepam (Klonopin) does not carry an increased risk of major fetal
malformations
Commonly used mood-stabilizing medications for bipolar disorder carry an increased risk of
major fetal malformations. However, clonazepam, lorazepam, and alprazolam are effective in
the management of acute manic episodes as an adjuvant to maintenance therapy in lieu of
antipsychotics. As an adjuvant to lithium or lamotrigine, clonazepam may result in increased
time between cycles and fewer depressive episodes.
During the first trimester, the use of lithium (Lithane, Lithobid) increases the risk of fetal
cardiac malformations to 7.7%. Lithium can be used in the second and third trimesters, but it
must be stopped peripartum due to the rapid fluid shifts during birth. Both carbamazepine
(Tegretol, Carbatrol, Equetro) and divalproex sodium (Depakote) increase the risk of neural
tube defects.
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 379, 951, 988.
In common psychiatric disorders, neurotransmitters are implicated in the complex
pathophysiology of certain disease processes. A decrease in dopamine will cause an
exacerbation of which disorder?
1. A
Anxiety disorders
2. B
Anhedonia
3. C
Obsessive-compulsive disorders
4. D
Psychosis - Hide Explanation
Correct answer: Anhedonia
Patients suffering from anhedonia present with a decrease in dopamine activity.
Patients suffering from psychosis and schizophrenia present with an increase in dopamine
activity.
Patients suffering from anxiety disorders present with a decrease in gamma-aminobutyric
acid, or GABA.
Patients suffering from obsessive-compulsive disorders present with a decrease in serotonin
activity.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition.
Pg 70.
,What is the difference between pharmacokinetics and pharmacodynamics?
1. A
Pharmacokinetics is the study of what the body does to drugs, and pharmacodynamics is the
study of what drugs do to the body
2. B
Pharmacokinetics is the study of drug receptors and enzymes, and pharmacodynamics is the
study of the mechanism of action of drugs
3. C
Pharmacokinetics is the study of absorption, distribution, metabolism, and excretion; and
pharmacodynamics is the study of what the body does to drugs
4. D
Pharmacokinetics is the study of what drugs do and how they do it, and pharmacodynamics is
the study of target sites for drug actions - Pharmacokinetics is the study of what the body
does to drugs, and pharmacodynamics is the study of what drugs do to the body
A 40-year-old man diagnosed with schizophrenia presents to your office with bradykinesia,
drooling, and a festinating gait. Which antipsychotic medication is least likely to cause these
side effects?
1. A
Haloperidol (Haldol)
2. B
Olanzapine (Zyprexa)
3. C
Thioridazine (Mellaril)
4. D
Chlorpromazine (Thorazine) - Correct answer: Olanzapine (Zyprexa)
These symptoms suggest antipsychotic-induced parkinsonism, which usually begins after
several weeks of treatment. Drug-induced parkinsonism is more common in typical or high-
potency antipsychotics like haloperidol, thioridazine, and chlorpromazine and is much less
common in atypical or low-potency antipsychotics like olanzapine.
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 972.
Psychotropic antipsychotics such as Seroquel and Risperdal can cause blurry vision and
cataracts.
1.
True
2.
False - Hide Explanation
Correct answer: True
Psychotropic antipsychotics such as Seroquel and Risperdal can cause blurry vision and
cataracts. Patients are advised to have routine eye exams every six months while being
treated with antipsychotics.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 84.
,A 31-year-old male diagnosed with depression undergoes an fMRI. His test reveals increased
activity in the ventromedial prefrontal cortex. Which class of medication aids in pyramidal
cell functioning in the prefrontal cortex by preventing the excessive release of glutamate?
1. A
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
2. B
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
3. C
Serotonin antagonist/reuptake inhibitors
4. D
Selective serotonin reuptake inhibitors (SSRIs) - Hide Explanation
Correct answer: Serotonin antagonist/reuptake inhibitors
Serotonin antagonist/reuptake inhibitors block 5HT2A receptors. This action inhibits
glutamate release in the prefrontal cortex of the brain.
Neither SSRIs, SNRIs, nor NDRIs block 5HT2A receptors.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review
Manual, Fourth Edition. Pg 154-155.
Systemic effects of hyponatremia include which of the following?
1. A
Thirst
2. B
Restlessness
3. C
Fever
4. D
Confusion - Hide Explanation
Correct answer: Confusion
Systemic effects of hypernatremia include restlessness, thirst, and fever.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 91.
All of the following are examples of nursing-sensitive adverse events except:
1. A
Medication errors
2. B
Failure to rescue
3. C
Low nurse-to-patient ratio
4. D
Nosocomial infections - Hide Explanation
Correct answer: Low nurse-to-patient ratio
Low nurse-to-patient ratio is not an example of a nursing-sensitive adverse event (NSAE).
Examples of NSAEs include:
o Failure to rescue
o Nosocomial infections
o Pressure ulcers
o Falls
, o Medication errors
o Transfusion errors
Reference:
Zaccagnini, M. E., & White, K. W. (2017). The doctor of nursing practice essentials: A new
model for advanced practice nursing. Burlington: Jones & Bartlett Learning. Pg 169-172.
At what age would you expect a child to hold his head erect for a few seconds, follow
moving objects to midline, and smile preferentially at his mother?
1. A
4 weeks
2. B
12 months
3. C
28 weeks
4. D
16 weeks - Hide Explanation
Correct answer: 4 weeks
At four weeks, landmarks of normal behavioral development include
o Hands fisted
o Head sags but can hold head erect for a few seconds
o Follows moving objects to midline
o Responds to speech
o Smiles preferentially at mother
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 1087.
Pharmacokinetics is the term that describes what a drug does to the body when ingested and
paired with the individual's enzyme activity.
1. A
True
2. B
False - Hide Explanation
Correct answer: False
Pharmacodynamics is the term that describes what a drug does to the body when ingested and
paired with the individual's pharmacodynamic gene profile.
Pharmacokinetics refers to what the body does to a drug when it's ingested.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 75.
Single nucleotide polymorphisms (SNPs) detect single based changes in DNA sequence.
1.
True
2.
False - .Hide Explanation
Correct answer: True
Single nucleotide polymorphisms detect single based changes during the DNA sequencing
process.
Reference:
Which statement is true regarding bipolar disorder and pregnancy?
1. A
Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations
2. B
Divalproex sodium (Depakote) is a safe alternative to lithium carbonate
3. C
Lithium (Lithane, Lithobid) is safe during the first and third trimesters
4. D
Carbamazepine (Tegretol, Carbatrol, Equetro) is a safe alternative to lithium carbonate -
Correct answer: Clonazepam (Klonopin) does not carry an increased risk of major fetal
malformations
Commonly used mood-stabilizing medications for bipolar disorder carry an increased risk of
major fetal malformations. However, clonazepam, lorazepam, and alprazolam are effective in
the management of acute manic episodes as an adjuvant to maintenance therapy in lieu of
antipsychotics. As an adjuvant to lithium or lamotrigine, clonazepam may result in increased
time between cycles and fewer depressive episodes.
During the first trimester, the use of lithium (Lithane, Lithobid) increases the risk of fetal
cardiac malformations to 7.7%. Lithium can be used in the second and third trimesters, but it
must be stopped peripartum due to the rapid fluid shifts during birth. Both carbamazepine
(Tegretol, Carbatrol, Equetro) and divalproex sodium (Depakote) increase the risk of neural
tube defects.
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 379, 951, 988.
In common psychiatric disorders, neurotransmitters are implicated in the complex
pathophysiology of certain disease processes. A decrease in dopamine will cause an
exacerbation of which disorder?
1. A
Anxiety disorders
2. B
Anhedonia
3. C
Obsessive-compulsive disorders
4. D
Psychosis - Hide Explanation
Correct answer: Anhedonia
Patients suffering from anhedonia present with a decrease in dopamine activity.
Patients suffering from psychosis and schizophrenia present with an increase in dopamine
activity.
Patients suffering from anxiety disorders present with a decrease in gamma-aminobutyric
acid, or GABA.
Patients suffering from obsessive-compulsive disorders present with a decrease in serotonin
activity.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition.
Pg 70.
,What is the difference between pharmacokinetics and pharmacodynamics?
1. A
Pharmacokinetics is the study of what the body does to drugs, and pharmacodynamics is the
study of what drugs do to the body
2. B
Pharmacokinetics is the study of drug receptors and enzymes, and pharmacodynamics is the
study of the mechanism of action of drugs
3. C
Pharmacokinetics is the study of absorption, distribution, metabolism, and excretion; and
pharmacodynamics is the study of what the body does to drugs
4. D
Pharmacokinetics is the study of what drugs do and how they do it, and pharmacodynamics is
the study of target sites for drug actions - Pharmacokinetics is the study of what the body
does to drugs, and pharmacodynamics is the study of what drugs do to the body
A 40-year-old man diagnosed with schizophrenia presents to your office with bradykinesia,
drooling, and a festinating gait. Which antipsychotic medication is least likely to cause these
side effects?
1. A
Haloperidol (Haldol)
2. B
Olanzapine (Zyprexa)
3. C
Thioridazine (Mellaril)
4. D
Chlorpromazine (Thorazine) - Correct answer: Olanzapine (Zyprexa)
These symptoms suggest antipsychotic-induced parkinsonism, which usually begins after
several weeks of treatment. Drug-induced parkinsonism is more common in typical or high-
potency antipsychotics like haloperidol, thioridazine, and chlorpromazine and is much less
common in atypical or low-potency antipsychotics like olanzapine.
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 972.
Psychotropic antipsychotics such as Seroquel and Risperdal can cause blurry vision and
cataracts.
1.
True
2.
False - Hide Explanation
Correct answer: True
Psychotropic antipsychotics such as Seroquel and Risperdal can cause blurry vision and
cataracts. Patients are advised to have routine eye exams every six months while being
treated with antipsychotics.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 84.
,A 31-year-old male diagnosed with depression undergoes an fMRI. His test reveals increased
activity in the ventromedial prefrontal cortex. Which class of medication aids in pyramidal
cell functioning in the prefrontal cortex by preventing the excessive release of glutamate?
1. A
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
2. B
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
3. C
Serotonin antagonist/reuptake inhibitors
4. D
Selective serotonin reuptake inhibitors (SSRIs) - Hide Explanation
Correct answer: Serotonin antagonist/reuptake inhibitors
Serotonin antagonist/reuptake inhibitors block 5HT2A receptors. This action inhibits
glutamate release in the prefrontal cortex of the brain.
Neither SSRIs, SNRIs, nor NDRIs block 5HT2A receptors.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review
Manual, Fourth Edition. Pg 154-155.
Systemic effects of hyponatremia include which of the following?
1. A
Thirst
2. B
Restlessness
3. C
Fever
4. D
Confusion - Hide Explanation
Correct answer: Confusion
Systemic effects of hypernatremia include restlessness, thirst, and fever.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 91.
All of the following are examples of nursing-sensitive adverse events except:
1. A
Medication errors
2. B
Failure to rescue
3. C
Low nurse-to-patient ratio
4. D
Nosocomial infections - Hide Explanation
Correct answer: Low nurse-to-patient ratio
Low nurse-to-patient ratio is not an example of a nursing-sensitive adverse event (NSAE).
Examples of NSAEs include:
o Failure to rescue
o Nosocomial infections
o Pressure ulcers
o Falls
, o Medication errors
o Transfusion errors
Reference:
Zaccagnini, M. E., & White, K. W. (2017). The doctor of nursing practice essentials: A new
model for advanced practice nursing. Burlington: Jones & Bartlett Learning. Pg 169-172.
At what age would you expect a child to hold his head erect for a few seconds, follow
moving objects to midline, and smile preferentially at his mother?
1. A
4 weeks
2. B
12 months
3. C
28 weeks
4. D
16 weeks - Hide Explanation
Correct answer: 4 weeks
At four weeks, landmarks of normal behavioral development include
o Hands fisted
o Head sags but can hold head erect for a few seconds
o Follows moving objects to midline
o Responds to speech
o Smiles preferentially at mother
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 1087.
Pharmacokinetics is the term that describes what a drug does to the body when ingested and
paired with the individual's enzyme activity.
1. A
True
2. B
False - Hide Explanation
Correct answer: False
Pharmacodynamics is the term that describes what a drug does to the body when ingested and
paired with the individual's pharmacodynamic gene profile.
Pharmacokinetics refers to what the body does to a drug when it's ingested.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 75.
Single nucleotide polymorphisms (SNPs) detect single based changes in DNA sequence.
1.
True
2.
False - .Hide Explanation
Correct answer: True
Single nucleotide polymorphisms detect single based changes during the DNA sequencing
process.
Reference:
