PMHNP Psychopharm Exam 18 2024
A 61-year-old married woman who has been sober from alcohol use disorder for 25 years
relapsed 3 weeks ago. She reports drinking 1.5 L of vodka and half a liter of scotch daily. On
exam she is emotionally labile ranging from irritable to crying, slurring her words, and
exhibits a bilateral upper extremity fine tremor. Vitals: blood pressure 150/100, heart rate
110, respiratory rate 18, SpO2 98% room air. She reports feeling nauseous, sweating, and
moderately anxious. What is the primary concern for this patient?
A. Alcohol use disorder
B. Generalized anxiety disorder
C. Alcohol withdrawal
D. Delirium tremens - Answer C.
Alcohol withdrawal symptoms include emotional lability, bilateral upper extremity tremor,
hypertension, tachycardia, nausea, sweating, and anxiety. Alcohol use disorder is
characterized by a pattern of use with significant impairment with two or more Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria over the previous
12-month period. Generalized anxiety disorder is characterized by excessive worrying lasting
at least 6 months. Delirium tremens is a severe form of alcohol withdrawal marked by global
confusion, audiovisual hallucinations, fever, hypertension, and diaphoresis, which occur
within 3 to 10 days of the last alcoholic drink.
A patient who has required increasing amounts of medication to achieve the desired effect
and develops withdrawal symptoms when dosing is delayed is said to be:
A. Dependent
B. Tolerant
C. Addicted
D. In withdrawal - Answer A.
Dependence is characterized by the repeated use of a substance for physical needs leading to
increased tolerance and, when discontinued, results in physical withdrawal symptoms.
Tolerance is a condition in which repeated administration of the dosage causes a decreased
effect despite increasingly larger doses, which are required to obtain the effect observed in
the initial dosage. Addiction is psychological dependence leading to persistent and increased
use of the substance or behavior and when discontinued causes distress and urges to resume
use despite adverse consequences. Withdrawal is a substance-specific cluster of signs and
symptoms that occur when reducing or stopping the consistent use of the substance.
A patient is complaining of chronic back pain and requests a refill of his oxycodone
prescription because the pain is so bad he becomes suicidal. As a result, his primary care
provider referred him to the PMHNP. The patient states he can tell if he is late taking his next
dose by even 1 hour as he becomes very anxious, restless, irritable, and begins sweating. He
states that he is so worried about having pain attacks that much of his day is spent waiting to
take the next dose. When he runs out of his medication between visits he buys some from his
friend. Which of the following best describes the patient's condition?
A. Dependence
B. Addiction
C. Tolerance
D. Withdrawal - Answer B.
, Addiction is psychological dependence leading to persistent and increased use of the
substance or behavior and, when discontinued, causes distress and urges to resume use
despite adverse consequences. Dependence is characterized by the repeated use of a
substance for physical needs leading to increased tolerance and, when discontinued, results in
physical withdrawal symptoms. Tolerance is a condition in which repeated administration of
the dosage causes a decreased effect despite increasingly larger doses, which are required to
obtain the effect observed in the initial dosage. Withdrawal is a substance-specific cluster of
signs and symptoms that occur when reducing or stopping the consistent use of the substance.
A 30-year-old male who was started on sertraline for generalized anxiety disorder was also
started on lorazepam 1 mg for sleep during the first 2 weeks as he was adjusting to the
medication. At the 2-week follow-up visit his psychiatrist increased the sertraline, but the
dose of lorazepam does not seem to be helping with sleep and the patient is requesting a
higher dose. Which of the following best describes the patient's condition?
A. Dependence
B. Addiction
C. Tolerance
D. Withdrawal - Answer C.
Tolerance is a condition in which repeated administration of the dosage causes a decreased
effect despite increasingly larger doses which are required to obtain the effect observed in the
initial dosage. Dependence is characterized by the repeated use of a substance for physical
needs leading to increased tolerance and, when discontinued, results in physical withdrawal
symptoms. Addiction is psychological dependence leading to persistent and increased use of
the substance or behavior and, when discontinued, causes distress and urges to resume use
despite adverse consequences. Withdrawal is a substance-specific cluster of signs and
symptoms that occur when reducing or stopping the consistent use of the substance.
A patient who has been drinking a six-pack of beer each night to relax after work has been
having trouble staying asleep through the night. When she wakes up at 2 a.m. she takes
diphenhydramine 25 mg to help her fall back asleep, but this makes her sleep through the
alarm clock and late for work. She also reports having a headache through midmorning until
she gets her second cup of coffee. She thinks this is related to her alcohol use and has
unsuccessfully tried to cut down several times in the past year. Which of the following
disorders best describes this patient's condition?
A. Alcohol use disorder
B. Withdrawal syndrome
C. Caffeine use disorder
D. Insomnia - Answer A.
Alcohol use disorder is characterized by a pattern of use with significant impairment with two
or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
criteria over the previous 12-month period. Withdrawal syndrome is a cluster of symptoms
related to significantly reducing or stopping a substance or behavior. Caffeine intoxication
requires a dose more than 250 mg in addition to a cluster of central nervous system excitatory
symptoms shortly after the consumption. Insomnia is characterized by a persistent pattern of
interrupted sleep and may be a primary problem or secondary concern induced by alcohol
use.
A 61-year-old married woman who has been sober from alcohol use disorder for 25 years
relapsed 3 weeks ago. She reports drinking 1.5 L of vodka and half a liter of scotch daily. On
exam she is emotionally labile ranging from irritable to crying, slurring her words, and
exhibits a bilateral upper extremity fine tremor. Vitals: blood pressure 150/100, heart rate
110, respiratory rate 18, SpO2 98% room air. She reports feeling nauseous, sweating, and
moderately anxious. What is the primary concern for this patient?
A. Alcohol use disorder
B. Generalized anxiety disorder
C. Alcohol withdrawal
D. Delirium tremens - Answer C.
Alcohol withdrawal symptoms include emotional lability, bilateral upper extremity tremor,
hypertension, tachycardia, nausea, sweating, and anxiety. Alcohol use disorder is
characterized by a pattern of use with significant impairment with two or more Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria over the previous
12-month period. Generalized anxiety disorder is characterized by excessive worrying lasting
at least 6 months. Delirium tremens is a severe form of alcohol withdrawal marked by global
confusion, audiovisual hallucinations, fever, hypertension, and diaphoresis, which occur
within 3 to 10 days of the last alcoholic drink.
A patient who has required increasing amounts of medication to achieve the desired effect
and develops withdrawal symptoms when dosing is delayed is said to be:
A. Dependent
B. Tolerant
C. Addicted
D. In withdrawal - Answer A.
Dependence is characterized by the repeated use of a substance for physical needs leading to
increased tolerance and, when discontinued, results in physical withdrawal symptoms.
Tolerance is a condition in which repeated administration of the dosage causes a decreased
effect despite increasingly larger doses, which are required to obtain the effect observed in
the initial dosage. Addiction is psychological dependence leading to persistent and increased
use of the substance or behavior and when discontinued causes distress and urges to resume
use despite adverse consequences. Withdrawal is a substance-specific cluster of signs and
symptoms that occur when reducing or stopping the consistent use of the substance.
A patient is complaining of chronic back pain and requests a refill of his oxycodone
prescription because the pain is so bad he becomes suicidal. As a result, his primary care
provider referred him to the PMHNP. The patient states he can tell if he is late taking his next
dose by even 1 hour as he becomes very anxious, restless, irritable, and begins sweating. He
states that he is so worried about having pain attacks that much of his day is spent waiting to
take the next dose. When he runs out of his medication between visits he buys some from his
friend. Which of the following best describes the patient's condition?
A. Dependence
B. Addiction
C. Tolerance
D. Withdrawal - Answer B.
, Addiction is psychological dependence leading to persistent and increased use of the
substance or behavior and, when discontinued, causes distress and urges to resume use
despite adverse consequences. Dependence is characterized by the repeated use of a
substance for physical needs leading to increased tolerance and, when discontinued, results in
physical withdrawal symptoms. Tolerance is a condition in which repeated administration of
the dosage causes a decreased effect despite increasingly larger doses, which are required to
obtain the effect observed in the initial dosage. Withdrawal is a substance-specific cluster of
signs and symptoms that occur when reducing or stopping the consistent use of the substance.
A 30-year-old male who was started on sertraline for generalized anxiety disorder was also
started on lorazepam 1 mg for sleep during the first 2 weeks as he was adjusting to the
medication. At the 2-week follow-up visit his psychiatrist increased the sertraline, but the
dose of lorazepam does not seem to be helping with sleep and the patient is requesting a
higher dose. Which of the following best describes the patient's condition?
A. Dependence
B. Addiction
C. Tolerance
D. Withdrawal - Answer C.
Tolerance is a condition in which repeated administration of the dosage causes a decreased
effect despite increasingly larger doses which are required to obtain the effect observed in the
initial dosage. Dependence is characterized by the repeated use of a substance for physical
needs leading to increased tolerance and, when discontinued, results in physical withdrawal
symptoms. Addiction is psychological dependence leading to persistent and increased use of
the substance or behavior and, when discontinued, causes distress and urges to resume use
despite adverse consequences. Withdrawal is a substance-specific cluster of signs and
symptoms that occur when reducing or stopping the consistent use of the substance.
A patient who has been drinking a six-pack of beer each night to relax after work has been
having trouble staying asleep through the night. When she wakes up at 2 a.m. she takes
diphenhydramine 25 mg to help her fall back asleep, but this makes her sleep through the
alarm clock and late for work. She also reports having a headache through midmorning until
she gets her second cup of coffee. She thinks this is related to her alcohol use and has
unsuccessfully tried to cut down several times in the past year. Which of the following
disorders best describes this patient's condition?
A. Alcohol use disorder
B. Withdrawal syndrome
C. Caffeine use disorder
D. Insomnia - Answer A.
Alcohol use disorder is characterized by a pattern of use with significant impairment with two
or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
criteria over the previous 12-month period. Withdrawal syndrome is a cluster of symptoms
related to significantly reducing or stopping a substance or behavior. Caffeine intoxication
requires a dose more than 250 mg in addition to a cluster of central nervous system excitatory
symptoms shortly after the consumption. Insomnia is characterized by a persistent pattern of
interrupted sleep and may be a primary problem or secondary concern induced by alcohol
use.
