NR607 Final Exam Questions Most Tested
Questions And Answers
Which of the following are the most appropriate pharmacologic management
strategies for Skylar? Select all that apply.
-continue risperidone 6 mg daily
-switch to aripiprazole 10 mg daily
-discontinue all antipsychotic medications
-prescribe valbenazine 40 mg daily - -continue risperidone 6 mg daily
-prescribe valbenazine 40 mg daily
Rationale: The most appropriate pharmacologic management strategies for
Skylar include continuing risperidone 6 mg daily and prescribing valbenazine
40 mg daily. Skylar has had good symptom control with risperidone, but is
experiencing symptoms of tardive dyskinesia (TD) as evidenced by their AIMS
score of 2; a score of 2 or greater indicates TD. The APA recommends treating
moderate to severe TD symptoms associated with antipsychotic therapy with a
vesicular monoamine transporter 2 (VMAT2) such as valbenazine
select the most appropriate ICD-10-CM codes for Skylar s diagnosis. - F20.9
and G24.09
Rationale:
,F20.9 Schizophrenia reflects Skylar's diagnosis that is being treated at today's
visit. On the ICD 10 webpage you will see this synonym for the code:
Schizophrenia in remission.
G24.09 Other drug induced dystonia corresponds to the new diagnosis- tardive
dyskinesia.
Which of the following is the appropriate E/M code for this visit?
99214
99213
99215
99205
99204
99203 - 99215
Rationale: Skylar is an established client with one chronic illness and a newly
diagnosed second chronic illness who needs prescription drug management. The
new onset TD warrants additional decision making. Therefore, Skylar's visit
qualifies as 99215: established client with high level medical decision making.
Treatment-Resistant Depression (TRD) - -subset of MDD
-characterized by a lack of improvement despite the provision of traditional and
first-line therapeutic options
-criteria are 2+ unsuccessful trials of antidepressant pharmacotherapy
-Inaccurate TRD diagnosis can lead to pseudo-resistance
• pts prescribed suboptimal med trials D/C their meds because of adverse side
effects
,Management of TRD: Nutraceuticals - -adjunctive txs that may improve
symptoms in clients with TRD
-Omega-3 fatty acids
• thought to tx depression by decreasing chronic inflammation
-L-methylfolate
• active form of folate that crosses the blood-brain barrier
• reduces inflammation, reduces loss in gray matter, & helps regulate serotonin,
dopamine, & norepinephrine
-Other agents associated with improvement in depressant symptoms:
• zinc
• magnesium
• coenzyme Q10
Management of TRD: Electroconvulsive Therapy (ECT) - -procedure that
applies electrical stimulation to the brain through transdermal electrodes
attached to the head to trigger seizure activity
• sedated under general anesthesia & given a muscle relaxant during procedure
-Use limited to clients with:
• TRD
• elevated suicide risk
• pts with catatonia, psychosis, bipolar disorder, or dementia that have not
responded to typical tx
-typically receive ECT 2-3 times per week for 3-4 weeks
-drawbacks:
• need for general anesthesia and associated monitoring
• potential cognitive adverse effects including retrograde amnesia & memory
loss
-Up to 50% of clients receiving ECT for TRD do not maintain remission
, Management of TRD: Deep Brain Stimulation (DBS) - -surgical procedure
initially used to tx pts with movement disorders
• now an emerging tx modality for pts who have depression unresponsive to
pharmacotherapy, psychotherapy, or ECT
-Electrodes surgically placed in specific regions of the brain & connected to an
implanted subcutaneous pulse generator
• Once device activated, provides continuous electrical stimulation to the
specified areas of the brain, most common the subcallosal cingulate white
matter
-AEs typically r/t the surgery:
• infection, headache, seizure, hemorrhage
-also used to manage treatment-resistant OCD
Management of TRD: (Transcranial Magnetic Stimulation (TMS) - -non-
invasive procedure that uses rapidly alternating magnetic fields to stimulate the
brain
-may also be used to tx chronic pain, schizophrenia, motor symptoms of
Parkinson's disease, multiple sclerosis, stroke
-most effective for pts experiencing acute symptoms within 1 year of the onset
of MDD
-QD tx sessions are req for several weeks
• may present a barrier to some pts
Psilocybin-Based Treatment - -Preliminary data:
• may be effective in tx of MDD
-5HT2a agonist with cognitive enhancement effects due to high # of receptors in
the cortex
-Additional research needed to evaluate long-term effectiveness & safety
Questions And Answers
Which of the following are the most appropriate pharmacologic management
strategies for Skylar? Select all that apply.
-continue risperidone 6 mg daily
-switch to aripiprazole 10 mg daily
-discontinue all antipsychotic medications
-prescribe valbenazine 40 mg daily - -continue risperidone 6 mg daily
-prescribe valbenazine 40 mg daily
Rationale: The most appropriate pharmacologic management strategies for
Skylar include continuing risperidone 6 mg daily and prescribing valbenazine
40 mg daily. Skylar has had good symptom control with risperidone, but is
experiencing symptoms of tardive dyskinesia (TD) as evidenced by their AIMS
score of 2; a score of 2 or greater indicates TD. The APA recommends treating
moderate to severe TD symptoms associated with antipsychotic therapy with a
vesicular monoamine transporter 2 (VMAT2) such as valbenazine
select the most appropriate ICD-10-CM codes for Skylar s diagnosis. - F20.9
and G24.09
Rationale:
,F20.9 Schizophrenia reflects Skylar's diagnosis that is being treated at today's
visit. On the ICD 10 webpage you will see this synonym for the code:
Schizophrenia in remission.
G24.09 Other drug induced dystonia corresponds to the new diagnosis- tardive
dyskinesia.
Which of the following is the appropriate E/M code for this visit?
99214
99213
99215
99205
99204
99203 - 99215
Rationale: Skylar is an established client with one chronic illness and a newly
diagnosed second chronic illness who needs prescription drug management. The
new onset TD warrants additional decision making. Therefore, Skylar's visit
qualifies as 99215: established client with high level medical decision making.
Treatment-Resistant Depression (TRD) - -subset of MDD
-characterized by a lack of improvement despite the provision of traditional and
first-line therapeutic options
-criteria are 2+ unsuccessful trials of antidepressant pharmacotherapy
-Inaccurate TRD diagnosis can lead to pseudo-resistance
• pts prescribed suboptimal med trials D/C their meds because of adverse side
effects
,Management of TRD: Nutraceuticals - -adjunctive txs that may improve
symptoms in clients with TRD
-Omega-3 fatty acids
• thought to tx depression by decreasing chronic inflammation
-L-methylfolate
• active form of folate that crosses the blood-brain barrier
• reduces inflammation, reduces loss in gray matter, & helps regulate serotonin,
dopamine, & norepinephrine
-Other agents associated with improvement in depressant symptoms:
• zinc
• magnesium
• coenzyme Q10
Management of TRD: Electroconvulsive Therapy (ECT) - -procedure that
applies electrical stimulation to the brain through transdermal electrodes
attached to the head to trigger seizure activity
• sedated under general anesthesia & given a muscle relaxant during procedure
-Use limited to clients with:
• TRD
• elevated suicide risk
• pts with catatonia, psychosis, bipolar disorder, or dementia that have not
responded to typical tx
-typically receive ECT 2-3 times per week for 3-4 weeks
-drawbacks:
• need for general anesthesia and associated monitoring
• potential cognitive adverse effects including retrograde amnesia & memory
loss
-Up to 50% of clients receiving ECT for TRD do not maintain remission
, Management of TRD: Deep Brain Stimulation (DBS) - -surgical procedure
initially used to tx pts with movement disorders
• now an emerging tx modality for pts who have depression unresponsive to
pharmacotherapy, psychotherapy, or ECT
-Electrodes surgically placed in specific regions of the brain & connected to an
implanted subcutaneous pulse generator
• Once device activated, provides continuous electrical stimulation to the
specified areas of the brain, most common the subcallosal cingulate white
matter
-AEs typically r/t the surgery:
• infection, headache, seizure, hemorrhage
-also used to manage treatment-resistant OCD
Management of TRD: (Transcranial Magnetic Stimulation (TMS) - -non-
invasive procedure that uses rapidly alternating magnetic fields to stimulate the
brain
-may also be used to tx chronic pain, schizophrenia, motor symptoms of
Parkinson's disease, multiple sclerosis, stroke
-most effective for pts experiencing acute symptoms within 1 year of the onset
of MDD
-QD tx sessions are req for several weeks
• may present a barrier to some pts
Psilocybin-Based Treatment - -Preliminary data:
• may be effective in tx of MDD
-5HT2a agonist with cognitive enhancement effects due to high # of receptors in
the cortex
-Additional research needed to evaluate long-term effectiveness & safety
