1|Page
NR 607 Final Exam|| QUESTIONS AND CORRECT
DETAILED ANSWERS ||VERIFIED EXAM!!(VERIFIED
ANSWERS) |ALREADY GRADED A+||LATEST EXAM!!!!
Harry is a 48-year-old who presents to the outpatient
mental health clinic for an initial evaluation of symptoms of
depression. Harry has been prescribed bupropion XL 300
mg daily by his primary care provider and has been taking
it for the past five years. Harry endorsed that at first, the
medication "worked really well," but states he has been
feeling more down lately and is concerned that the
medication is no longer working. He stated that about
eight months ago, he changed to a new position at work
that was "overwhelming." He had no time to participate in
his hobbies, which include reading, racquetball, and golf.
He states that since his promotion, "I have no time to do
anything but work, eat, and sleep, so I tend to eat and
sleep a lot more than I used to." Harry states that his wife
of 18 years has become frustrated with him because he
has no energy to participate in raising their children, but
Harry - ANSWER--switch to bupropion 150 mg twice daily
-recommend follow-up with a primary provider
-recommend initiating psychotherapy
Rationale: The most appropriate initial treatment for Harry
is to switch to bupropion 150 mg twice daily, recommend
follow-up with the primary provider, and recommend
initiating psychotherapy. Because the client has had
,2|Page
gastric bypass surgery, his ability to absorb extended-
release medications may be impaired. Since the
medication initially worked to control his symptoms, it is
reasonable to begin by switching to the same medication
in an immediate release format. Harry should follow up
with his primary provider to obtain a complete physical,
including lab work for possible deficiency of vitamin D or
B12. Because of the client's recent increase in daily
stressors, psychotherapy may also be appropriate at this
time.
Bettina is a 24-year-old who presents to the mental health
clinic after a referral from her primary care provider. She
endorses symptoms of depression that began "when I was
still in college," including excessive sleepiness, withdrawal
from social activities, the guilt associated with "leaving my
friends hanging," and anhedonia. Bettina states that she
saw a counselor through the college health service, which
helped her symptoms somewhat, but she was unable to
continue with counseling after graduation two years ago.
She made an appointment with her primary care provider
to discuss medications for depressive symptoms and was
prescribed citalopram 20 mg daily. After six weeks on the
medication, she did not experience relief of symptoms and
returned to the provider at which time her dose was
increased to 40 mg daily. She had a follow-up appointment
with the provider six months later, at which time she was
,3|Page
prescr - ANSWER-continue current medications and add
aripiprazole 2 mg daily
Rationale: The most appropriate treatment for Bettina is to
continue her current medications and add aripiprazole 2
mg daily. According to the STAR*D guidelines, the client
may choose to remain on the current medications and add
an atypical antipsychotic medication such as aripiprazole.
Alternatively, the client may choose to discontinue current
medications and start a tricyclic or tetracyclic
antidepressant. The client may also choose to begin
therapy. Inpatient admission is not indicated for this client.
Carlos is a 25-year-old who was admitted to the inpatient
psychiatric unit after a nonfatal suicide attempt. He has a
history of major depressive disorder which was initially
diagnosed when he was 22, at which time he was started
on sertraline 50 mg and then increased to sertraline 100
mg. Carlos attempted suicide approximately four months
after beginning the sertraline. At that time, he was referred
for psychotherapy and prescribed aripiprazole 5 mg in
addition to sertraline. Carlos states that while his
symptoms of depression improved after starting the
aripiprazole, they never completely disappeared. He
endorses frequent thoughts of dying but states "Most of
the time, they are just thoughts of not being here anymore-
they aren't active thoughts of killing myself." Carlos states
, 4|Page
that he attempted suicide by overdosing on his
medications after his girlfriend broke up with him.
Currently, he endorses active sui - ANSWER-prescribe
electroconvulsive therapy
Rationale: The most appropriate management strategy for
Carlos is electroconvulsive therapy. Since Carlos is
experiencing active suicidal thoughts, electroconvulsive
therapy may be the best treatment option at this time.
Carlos's symptoms have been resistant to multiple
medications; increasing dosages is not the best option,
especially since Carlos attempted to overdose on his
medications. Neither a suicide contract nor one-to-one
observations will provide symptom relief.
Dementia Comorbidities: - ANSWER-depression, anxiety,
psychosis, and disordered sleep.
Dementia Comorbidities: Depression - ANSWER--20-30%
have significant symptoms of depression
-difficult to detect, more advanced dementia may lack
insight into their depressive symptoms
-Symptoms:
• fatigue & lack of energy
• psychomotor agitation or retardation
NR 607 Final Exam|| QUESTIONS AND CORRECT
DETAILED ANSWERS ||VERIFIED EXAM!!(VERIFIED
ANSWERS) |ALREADY GRADED A+||LATEST EXAM!!!!
Harry is a 48-year-old who presents to the outpatient
mental health clinic for an initial evaluation of symptoms of
depression. Harry has been prescribed bupropion XL 300
mg daily by his primary care provider and has been taking
it for the past five years. Harry endorsed that at first, the
medication "worked really well," but states he has been
feeling more down lately and is concerned that the
medication is no longer working. He stated that about
eight months ago, he changed to a new position at work
that was "overwhelming." He had no time to participate in
his hobbies, which include reading, racquetball, and golf.
He states that since his promotion, "I have no time to do
anything but work, eat, and sleep, so I tend to eat and
sleep a lot more than I used to." Harry states that his wife
of 18 years has become frustrated with him because he
has no energy to participate in raising their children, but
Harry - ANSWER--switch to bupropion 150 mg twice daily
-recommend follow-up with a primary provider
-recommend initiating psychotherapy
Rationale: The most appropriate initial treatment for Harry
is to switch to bupropion 150 mg twice daily, recommend
follow-up with the primary provider, and recommend
initiating psychotherapy. Because the client has had
,2|Page
gastric bypass surgery, his ability to absorb extended-
release medications may be impaired. Since the
medication initially worked to control his symptoms, it is
reasonable to begin by switching to the same medication
in an immediate release format. Harry should follow up
with his primary provider to obtain a complete physical,
including lab work for possible deficiency of vitamin D or
B12. Because of the client's recent increase in daily
stressors, psychotherapy may also be appropriate at this
time.
Bettina is a 24-year-old who presents to the mental health
clinic after a referral from her primary care provider. She
endorses symptoms of depression that began "when I was
still in college," including excessive sleepiness, withdrawal
from social activities, the guilt associated with "leaving my
friends hanging," and anhedonia. Bettina states that she
saw a counselor through the college health service, which
helped her symptoms somewhat, but she was unable to
continue with counseling after graduation two years ago.
She made an appointment with her primary care provider
to discuss medications for depressive symptoms and was
prescribed citalopram 20 mg daily. After six weeks on the
medication, she did not experience relief of symptoms and
returned to the provider at which time her dose was
increased to 40 mg daily. She had a follow-up appointment
with the provider six months later, at which time she was
,3|Page
prescr - ANSWER-continue current medications and add
aripiprazole 2 mg daily
Rationale: The most appropriate treatment for Bettina is to
continue her current medications and add aripiprazole 2
mg daily. According to the STAR*D guidelines, the client
may choose to remain on the current medications and add
an atypical antipsychotic medication such as aripiprazole.
Alternatively, the client may choose to discontinue current
medications and start a tricyclic or tetracyclic
antidepressant. The client may also choose to begin
therapy. Inpatient admission is not indicated for this client.
Carlos is a 25-year-old who was admitted to the inpatient
psychiatric unit after a nonfatal suicide attempt. He has a
history of major depressive disorder which was initially
diagnosed when he was 22, at which time he was started
on sertraline 50 mg and then increased to sertraline 100
mg. Carlos attempted suicide approximately four months
after beginning the sertraline. At that time, he was referred
for psychotherapy and prescribed aripiprazole 5 mg in
addition to sertraline. Carlos states that while his
symptoms of depression improved after starting the
aripiprazole, they never completely disappeared. He
endorses frequent thoughts of dying but states "Most of
the time, they are just thoughts of not being here anymore-
they aren't active thoughts of killing myself." Carlos states
, 4|Page
that he attempted suicide by overdosing on his
medications after his girlfriend broke up with him.
Currently, he endorses active sui - ANSWER-prescribe
electroconvulsive therapy
Rationale: The most appropriate management strategy for
Carlos is electroconvulsive therapy. Since Carlos is
experiencing active suicidal thoughts, electroconvulsive
therapy may be the best treatment option at this time.
Carlos's symptoms have been resistant to multiple
medications; increasing dosages is not the best option,
especially since Carlos attempted to overdose on his
medications. Neither a suicide contract nor one-to-one
observations will provide symptom relief.
Dementia Comorbidities: - ANSWER-depression, anxiety,
psychosis, and disordered sleep.
Dementia Comorbidities: Depression - ANSWER--20-30%
have significant symptoms of depression
-difficult to detect, more advanced dementia may lack
insight into their depressive symptoms
-Symptoms:
• fatigue & lack of energy
• psychomotor agitation or retardation
