Nrnp 6665 Final Exam Test Questions, Nr 603 Week 7Exam Questions And Answers

NRNP 6665 FINAL EXAM TEST
QUESTIONS, NR 603 WEEK 7EXAM
QUESTIONS AND ANSWERS
Question 18: 7b


Christine is a 9-year- 7b 7b 7b


old female who presents for care after having been placed in the local foster care
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


system. She has been in and out of foster care for the last 4 years after her pare
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


nts were killed in an automobile accident. Christine has been placed in a variety of
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


homes and residential care facilities. The PMHNP recognizes that Christine is at
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


high risk for: - ANSWERS--A. Dissociative disorders
7b 7b 7b 7b 7b 7b 7b


B. Post-traumatic stress disorder
7b 7b 7b 7b


C. Impulse-control disorder
7b 7b 7b


D. Attachment disorder
7b 7b




Question 7: 7b


Caylee is a 5-year- 7b 7b 7b


old girl who is referred for evaluation by child protective services. She was recentl
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


y removed from her biological family and placed in foster care, as her home envir
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


onment was reportedly unsafe due to conditions of extreme neglect. Her foster mo
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


ther reports that Caylee is very quiet and withdrawn and always appears sad and
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


disinterested in her surroundings; however, she becomes very irritable when anyth
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


ing unexpected or unplanned occurs. The foster mother became very concerned w
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


hen it appeared that Caylee was hallucinating. The PMHNP considers that: -
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


ANSWERS--A. Caylee is at high risk for suicide and precautions should be taken
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


C. The history and reported symptoms are typical of depressive disorder in young
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


children
D. This is a common situation when prepubertal children are removed from the bio
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


logical parents regardless of how dysfunctional they are
7b 7b 7b 7b 7b 7b 7b




Question 2: 7b


Debi is a 15-year-
7b 7b 7b 7b


old girl who is currently being treated for depression. Her parents have been very
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


proactive and involved in her care, and Debi has achieved remission 2 months aft
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


er beginning treatment with a combination of pharmacotherapy and cognitive beha
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


vioral therapy. While counseling Debi's parents about important issues in manage
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


ment, the PMHNP advises that: - ANSWERS--
7b 7b 7b 7b 7b 7b


A. There is a > 50% likelihood that Debi's younger sibling will develop depressive
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


symptoms 7b


B. The mean length of major depressive episode in adolescents is 4 months
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


C. 20 to 40% of adolescents who have major depressive disorder will develop bip
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


olar I within 5 years
7b 7b 7b 7b 7b


D. Adolescent-onset depression typically need long-
7b 7b 7b 7b 7b


term pharmacologic management to prevent relapses
7b 7b 7b 7b 7b

,Agomelatine - ANSWERS--Brand: Valdoxan 7b 7b 7b


-Melatonin multimodal (Mel-MM) 7b 7b


-Agonist at melatonergic 1 and melatonergic 2 receptors
7b 7b 7b 7b 7b 7b 7b


-Antagonist at 5HT2C receptors 7b 7b 7b


-Not FDA approved: Rx for Depression, Generalized anxiety disorder
7b 7b 7b 7b 7b 7b 7b 7b


-Initial 25 mg/day at bedtime; after 2 weeks can increase to 50 mg/day at bedtime
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b




Amitriptyline (Elavil) - ANSWERS--Tricyclic antidepressant.
7b 7b 7b 7b




Aripiprazole (Abilify) - ANSWERS-- 7b 7b 7b


Treatment for depression. Atypical antipsychotic. "Dopamine stabilizer". Dopamine
7b 7b 7b 7b 7b 7b 7b 7b


receptor antagonist in high concentration and also stimulates increase of dopamin
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


e in low concentrations. Side effects: insomnia, akathisia.
7b 7b 7b 7b 7b 7b 7b




Brexpiprazole (Rexulti) - ANSWERS-- 7b 7b 7b


Treatment for depression. Atypical antipsychotic
7b 7b 7b 7b




Bupropion (Wellbutrin) - ANSWERS-- 7b 7b 7b


Antidepressant and smoking cessation aid, It can treat depression and help people
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


quit smoking. It can also prevent depression caused by seasonal affective disorde
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


r (SAD).
7b




Citalopram (Celexa) - ANSWERS--Antidepressant, SSRI: 20-40 mg qd.
7b 7b 7b 7b 7b 7b 7b




Clomipramine (Anafranil) - ANSWERS---Serotonin reuptake inhibitor (S-RI)
7b 7b 7b 7b 7b 7b


-Tricyclic antidepressant (TCA)
7b 7b


-Parent drug is a potent serotonin reuptake inhibitor
7b 7b 7b 7b 7b 7b 7b


Active metabolite is a potent norepinephrine/noradrenaline reuptake inhibitor
7b 7b 7b 7b 7b 7b 7b


-
Increases serotonergic neurotransmission by blocking the serotonin reuptake pum
7b 7b 7b 7b 7b 7b 7b 7b


p (transporter), -
7b 7b


Desensitization of serotonin receptors, especially serotonin 1A receptors
7b 7b 7b 7b 7b 7b 7b


-
Increases noradrenergic neurotransmission by blocking the norepinephrine reuptak
7b 7b 7b 7b 7b 7b 7b


e pump (transporter), -Desensitization of beta adrenergic receptors
7b 7b 7b 7b 7b 7b 7b


-Dopamine is inactivated by norepinephrine reuptake in the frontal cortex
7b 7b 7b 7b 7b 7b 7b 7b 7b


-Lacks dopamine transporters
7b 7b


-Increases dopamine neurotransmission in this part of the brain
7b 7b 7b 7b 7b 7b 7b 7b


**FDA Approved for Pediatrics in tx Obsessive-
7b 7b 7b 7b 7b 7b


compulsive disorder (OCD) (ages 10 and older)
7b 7b 7b 7b 7b 7b


*Off-Label for Pediatric Use: Depression, Severe and treatment-
7b 7b 7b 7b 7b 7b 7b


resistant, depression, Cataplexy syndrome, Anxiety, Insomnia,
7b 7b 7b 7b 7b


Neuropathic pain/chronic pain 7b 7b


-Full therapeutic benefits may take 2-8 weeks
7b 7b 7b 7b 7b 7b


-Dosing: in Peds/Adolescents/Adults:
7b 7b


100-250mg/day

Cyamemazine (Tercian) - ANSWERS--Treatment for depression.
7b 7b 7b 7b 7b


-Known as cyamepromazine
7b 7b 7b


-Typical antipsychotic drug of the phenothiazine class.
7b 7b 7b 7b 7b 7b 7b 7b

, 7b-Treatment for schizophrenia 7b 7b


7band psychosis-associated
7b


7banxiety
-Behaves like an atypical 7b 7b 7b


7bantipsychotic, due to its 7b 7b 7b


7bpotent anxiolytic effects (5-HT2C) and lack of extrapyramidal side effects (5-
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


HT2A).
-
Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist, ser
7b 7b 7b 7b 7b 7b 7b


otonin dopamine antagonist)
7b 7b


-Commonly Prescribed for (not FDA approved): 7b 7b 7b 7b 7b


7b-Schizophrenia
7b-Anxiety associated with psychosis (short-term)
7b 7b 7b 7b


7b-
Anxiety associated with nonpsychotic disorders, including mood disorders and pers
7b 7b 7b 7b 7b 7b 7b 7b 7b


onality disorders (short-term)
7b 7b


7b-Severe depression 7b


7b-Bipolar disorder 7b


7b-Other psychotic disorders
7b 7b


7b-Acute agitation/aggression (injection)
7b 7b


7b-Benzodiazepine withdrawal 7b




Desiprimine (Norpramine) - ANSWERS--Treats depression
7b 7b 7b 7b 7b


Brand: Norpramin 7b


-TCA
-Norepinephrine noradrenaline reuptake inhibitor. 7b 7b 7b


-FDA approved for treating depression.
7b 7b 7b 7b 7b


-Off-label: Anxiety, Insomnia, 7b 7b


Neuropathic pain/chronic pain, Treatment-resistant depression.
7b 7b 7b 7b


-
More potent inhibitor of norepinephrine reuptake pump than serotonin reuptake pu
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


mp (serotonin transporter).
7b 7b


-May have immediate effects in treating insomnia or anxiety.
7b 7b 7b 7b 7b 7b 7b 7b


-If it is not working within 6-
7b 7b 7b 7b 7b 7b


8 weeks for depression, it may require a dosage increase or it may not work at all
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


-100-200 mg/day (for depression) 7b 7b 7b


50-150 mg/day (for chronic pain).
7b 7b 7b 7b




Desvenlafaxine (Pristiq) - ANSWERS-- 7b 7b 7b


Dual serotonin and norepinephrine reuptake inhibitor-
7b 7b 7b 7b 7b


often classified as an antidepressant.
7b 7b 7b 7b


-FDA approved to tx MDD.
7b 7b 7b 7b


-Off-label: Vasomotor sx's, fibromyalgia, GAD, Social Anx d/o, panic d/
7b 7b 7b 7b 7b 7b 7b 7b 7b


o, PTSD, PMDD
7b 7b


-
Dopamine is inactivated by norepinephrine reuptake in frontal cortex (which lack d
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


opamine transporters) med can increase dopamine neurotransmission in this part
7b 7b 7b 7b 7b 7b 7b 7b 7b 7b


of the brain
7b 7b


-