MSN 611 NKU FINAL EXAM QUESTIONS WITH
CORRECT ANSWERS
A |65-year-old |man |presents |with |chronic |insomnia. |He |reports |that |his |sleep |has |improved |
after |beginning |a |new |medication, |but |he |is |experiencing |concerning |adverse |effects. |His |wife |
noticed |him |sleepwalking, |eating |during |the |night, |and |attempting |to |drive |his |car |at |night. |
The |patient |has |no |recollection |of |these |events |and |is |concerned. |Vitals |signs |are |blood |
pressure |130/80 |mmHg, |heart |rate |82 |bpm, |respiratory |rate |18 |breaths/min, |and |temperature
|98.0 |F |(36.7 |C). |Physical |examination |is |normal. |What |is |the |mechanism |of |action |of |the |
medication |responsible |for |the |patient's |adverse |effects? |- |CORRECT |ANSWER✔✔-GABA-A |
receptor |agonist
A |26-year-old |woman |is |brought |to |the |emergency |department |with |an |acute |severe |
headache. |Her |partner |reports |that |it |started |6 |hours |ago |and |that |she |vomited |several |times |
at |home. |The |patient |is |holding |her |hands |over |her |eyes |and |reports |severe |unilateral |
retroorbital |throbbing |pain. |She |has |no |significant |past |medical |history |and |takes |no |regular |
medications. |Her |vital |signs |are |within |normal |limits. |There |is |no |gross |neurological |deficit |on |
examination |of |the |cranial |nerves |and |limbs. |Given |the |most |likely |diagnosis, |what |is |the |
mechanism |of |action |of |the |best |drug |for |the |acute |treatment |of |this |patient's |condition? |- |
CORRECT |ANSWER✔✔-Cerebral |vasoconstriction
A |42-year-old |man |presents |with |a |6-month |history |of |severe, |throbbing |headaches |that |are |
generally |unilateral, |worsened |by |light |and |sound, |and |occur |biweekly |and |occasionally |
interrupt |his |workday. |He |has |no |significant |improvement |with |ibuprofen, |naproxen, |or |
acetaminophen. |Vital |signs |are |blood |pressure |139/80 |mmHg, |heart |rate |82 |bpm, |respiratory |
rate |14 |breaths/min, |and |temperature |98.0 |F |(36.7 |C). |Physical |examination |is |normal. |Which |
of |the |following |effects |is |caused |by |the |most |appropriate |treatment |option? |- |CORRECT |
ANSWER✔✔-Constriction |of |cerebral |blood |vessels.
A |20-year-old |woman |presents |with |a |severe |headache. |She |is |G2P1 |at |32 |weeks |gestation. |
Her |blood |pressure |is |201/98 |mm |Hg. |A |urine |dipstick |shows |3+ |protein. |Preparations |are |
made |for |an |emergency |cesarean |section. |She |is |started |on |a |continuous |intravenous |infusion |
,of |magnesium |sulfate |for |the |prevention |of |seizures. |What |is |a |severe, |yet |preventable, |
complication |of |continuous |intravenous |magnesium |sulfate |therapy? |- |CORRECT |ANSWER✔✔-
Respiratory |depression
A |55-year-old |man |presents |with |difficulty |passing |urine |and |suprapubic |discomfort |for |the |
past |2 |days. |His |symptoms |are |progressively |worsening. |The |patient's |past |medical |history |is |
significant |for |depression, |and |he |was |recently |started |on |a |new |medication |due |to |refractory |
symptoms. |The |physical |examination |reveals |tachycardia, |a |dry |mouth, |and |suprapubic |
fullness. |What |is |the |class |of |medication |that |is |responsible |for |this |patient's |presenting |
symptoms? |- |CORRECT |ANSWER✔✔-Tricyclic |antidepressants
A |55-year-old |man |presents |with |a |1-month |history |of |insomnia |and |fatigue. |He |states |that |he
|has |been |unable |to |complete |work |tasks |and |no |longer |enjoys |his |hobbies |or |going |out |with |
friends. |He |also |reports |a |decreased |appetite |and |bouts |of |crying. |The |patient |has |a |past |
medical |history |of |seizures, |hypothyroidism, |diabetes |mellitus, |and |asthma. |His |blood |pressure
|is |110/75 |mm |Hg, |and |his |heart |rate |is |75 |bpm. |The |clinician |prescribes |venlafaxine. |Which |of
|the |following |conditions |requires |caution |when |using |venlafaxine |in |this |patient? |- |CORRECT |
ANSWER✔✔-Seizures
A |34-year-old |woman |has |been |troubled |by |migraine |headaches |that |typically |occur |5 |to |6 |
times |monthly. |Treatment |of |the |headaches |when |they |occur |is |moderately |successful. |She |
asks |whether |there |is |anything |she |can |do |to |reduce |the |frequency |with |which |these |
headaches |occur. |She |also |has |been |troubled |by |long-standing |mood |issues, |with |episodes |
that |are |weeks |long |where |she |feels |sad. |What |therapy |might |be |recommended |that |can |both
|reduce |the |frequency |of |her |migraine |attacks |and |may |also |be |useful |in |improving |her |mood?
|- |CORRECT |ANSWER✔✔-Venlafaxine
A |patient |is |diagnosed |with |metabolic |acidosis. |His |medication |record |shows |that |he |is |
prescribed |diclofenac, |atenolol, |albuterol, |and |topiramate. |Which |of |these |medications |is |most
|likely |responsible |for |the |patient's |condition? |- |CORRECT |ANSWER✔✔-Topiramate
A |60-year-old |man |is |brought |to |the |emergency |department |after |an |episode |of |syncope. |The |
patient |was |watching |television |when |he |felt |light-headed |and |lost |consciousness. |He |regained
,|consciousness |after |a |minute |spontaneously. |The |patient's |past |medical |history |is |significant |
for |hypertension, |diabetes, |and |peripheral |neuropathy. |His |medications |include |metformin, |
hydrochlorothiazide, |and |amitriptyline. |ECG |in |the |emergency |department |shows |a |QT |interval
|of |480 |ms. |What |is |the |mechanism |of |action |of |the |drug |responsible |for |this |patient's |
symptoms |and |ECG |findings? |- |CORRECT |ANSWER✔✔-Blocking |the |reuptake |of |both |serotonin
|and |norepinephrine |neurotransmitters
A |23-year-old |man |recently |started |taking |a |new |medication |for |a |long-standing |history |of |
hallucinations, |poor |eye |contact, |flat |affect, |and |poor |work |performance. |After |six |days |of |
using |this |medication, |this |patient |presents |to |the |emergency |department |with |acute |neck |
stiffness. |On |exam, |his |head |is |rotated |to |the |left |and |flexed |in |a |fixed |position. |The |
medication |used |by |this |patient |mainly |works |by |blocking |which |of |the |following |receptor? |- |
CORRECT |ANSWER✔✔-Dopamine |receptor
A |40-year-old |man |is |brought |to |the |emergency |department |due |to |a |severe |headache |for |the
|past |hour. |His |symptoms |started |2 |hours |after |having |dinner |with |his |family. |On |further |
questioning, |his |wife |reveals |that |they |had |pizza |and |red |wine |for |dinner. |On |physical |exam, |
he |appears |anxious |and |tremulous. |Medical |history |includes |atypical |depression |being |treated |
with |phenelzine. |He |does |not |smoke |or |use |illicit |drugs. |Which |of |the |following |Is |the |most |
likely |finding? |- |CORRECT |ANSWER✔✔-Hypertension
A |25-year-old |woman |presents |with |depression |resistant |to |multiple |classes |of |
antidepressants. |A |nonselective |monoamine |oxidase |inhibitor |(MAOI) |is |prescribed. |Which |of |
the |following |should |be |included |in |patient |counseling |regarding |the |prevention |of |one |of |the |
most |serious |adverse |effects |of |this |drug? |- |CORRECT |ANSWER✔✔-Avoid |tyramine-containing |
foods
A |48-year-old |man |with |a |20-pack-year |smoking |history |presents |with |3 |weeks |of |insomnia, |
anhedonia, |and |decreased |concentration |after |losing |his |father |to |lung |cancer. |He |worries |that
|he |will |die |of |cancer |and |be |unable |to |provide |for |his |family. |He |often |feels |down |and |spends |
most |of |his |day |in |bed. |He |has |lost |5 |lbs |(2.2 |kg) |over |the |past |2 |weeks |due |to |poor |appetite. |
He |denies |suicidal |ideation |and |would |like |to |quit |smoking. |What |is |the |best |pharmacotherapy
|for |this |patient? |- |CORRECT |ANSWER✔✔-Bupropion
, A |65-year-old |woman |presents |to |the |clinic |with |signs |and |symptoms |of |depression. |She |states
|she |has |been |feeling |hopeless |and |depressed |for |the |past |six |months |since |her |mother's |
death |and |the |loss |of |her |job. |She |has |a |past |medical |history |of |chronic |sinusitis, |for |which |
she |has |been |taking |antihistamines |for |the |past |two |months. |Her |current |vital |signs |are |as |
follows; |blood |pressure |126/80 |mmHg, |heart |rate |70/min, |respiratory |rate |18/min, |and |
temperature |98.6 |F. |What |is |the |next |best |step |for |this |patient? |- |CORRECT |ANSWER✔✔-Start |
on |sertraline
A |17-year-old |female |presents |for |a |follow-up |on |major |depressive |disorder |therapy |with |
venlafaxine. |The |mother |and |patient |state |that |the |patient's |symptoms |have |improved. |She |
has |been |performing |better |at |school, |enjoying |activities |with |her |friends, |and |going |to |the |
gym |every |day. |However, |the |patient |has |trouble |falling |asleep. |The |mother |states |that |she |
gives |her |daughter |a |cough |medication, |dextromethorphan, |to |make |her |drowsy |and |help |her |
fall |asleep. |The |mother |and |patient |ask |if |they |should |be |concerned |about |the |use |of |
dextromethorphan. |What |is |the |best |response |to |their |question? |- |CORRECT |ANSWER✔✔-
There |is |an |increased |risk |of |serotonin |syndrome |if |dextromethorphan |is |used |with |
venlafaxine.
A |25-year-old |woman |presents |with |severe |acute |asthma |exacerbation. |She |inadequately |
responds |to |a |combination |of |nebulized |albuterol, |inhaled |ipratropium, |prednisone, |and |
oxygen. |The |clinical |team |decides |to |administer |intravenous |magnesium. |While |placing |the |
order, |the |clinician |receives |an |alert |for |potential |overdose |with |this |medication. |Which |of |the |
following |symptoms |is |most |likely |to |occur |if |there |is |an |overdose? |- |CORRECT |ANSWER✔✔-
Muscle |weakness
A |40-year-old |male |with |a |history |of |bipolar |1 |disorder |is |admitted |to |a |psychiatric |inpatient |
facility |after |an |episode |of |aggression |and |is |currently |prescribed |aripiprazole. |While |on |the |
inpatient |psychiatric |unit, |he |continues |to |be |agitated |with |the |inpatient |staff |and |other |
patients |on |the |unit. |The |psychiatrist |prescribes |him |lithium |to |augment |treatment |for |
agitation. |Lithium, |by |acting |on |which |of |the |neurotransmitters, |will |be |helpful |for |the |
patient's |agitation? |- |CORRECT |ANSWER✔✔-Serotonin
A |45-year-old |man |is |brought |to |the |hospital |by |his |sister |with |a |history |of |seeing |a |man |
following |him |for |the |last |nine |months. |He |says |that |only |he |can |see |this |man. |She |also |says |
CORRECT ANSWERS
A |65-year-old |man |presents |with |chronic |insomnia. |He |reports |that |his |sleep |has |improved |
after |beginning |a |new |medication, |but |he |is |experiencing |concerning |adverse |effects. |His |wife |
noticed |him |sleepwalking, |eating |during |the |night, |and |attempting |to |drive |his |car |at |night. |
The |patient |has |no |recollection |of |these |events |and |is |concerned. |Vitals |signs |are |blood |
pressure |130/80 |mmHg, |heart |rate |82 |bpm, |respiratory |rate |18 |breaths/min, |and |temperature
|98.0 |F |(36.7 |C). |Physical |examination |is |normal. |What |is |the |mechanism |of |action |of |the |
medication |responsible |for |the |patient's |adverse |effects? |- |CORRECT |ANSWER✔✔-GABA-A |
receptor |agonist
A |26-year-old |woman |is |brought |to |the |emergency |department |with |an |acute |severe |
headache. |Her |partner |reports |that |it |started |6 |hours |ago |and |that |she |vomited |several |times |
at |home. |The |patient |is |holding |her |hands |over |her |eyes |and |reports |severe |unilateral |
retroorbital |throbbing |pain. |She |has |no |significant |past |medical |history |and |takes |no |regular |
medications. |Her |vital |signs |are |within |normal |limits. |There |is |no |gross |neurological |deficit |on |
examination |of |the |cranial |nerves |and |limbs. |Given |the |most |likely |diagnosis, |what |is |the |
mechanism |of |action |of |the |best |drug |for |the |acute |treatment |of |this |patient's |condition? |- |
CORRECT |ANSWER✔✔-Cerebral |vasoconstriction
A |42-year-old |man |presents |with |a |6-month |history |of |severe, |throbbing |headaches |that |are |
generally |unilateral, |worsened |by |light |and |sound, |and |occur |biweekly |and |occasionally |
interrupt |his |workday. |He |has |no |significant |improvement |with |ibuprofen, |naproxen, |or |
acetaminophen. |Vital |signs |are |blood |pressure |139/80 |mmHg, |heart |rate |82 |bpm, |respiratory |
rate |14 |breaths/min, |and |temperature |98.0 |F |(36.7 |C). |Physical |examination |is |normal. |Which |
of |the |following |effects |is |caused |by |the |most |appropriate |treatment |option? |- |CORRECT |
ANSWER✔✔-Constriction |of |cerebral |blood |vessels.
A |20-year-old |woman |presents |with |a |severe |headache. |She |is |G2P1 |at |32 |weeks |gestation. |
Her |blood |pressure |is |201/98 |mm |Hg. |A |urine |dipstick |shows |3+ |protein. |Preparations |are |
made |for |an |emergency |cesarean |section. |She |is |started |on |a |continuous |intravenous |infusion |
,of |magnesium |sulfate |for |the |prevention |of |seizures. |What |is |a |severe, |yet |preventable, |
complication |of |continuous |intravenous |magnesium |sulfate |therapy? |- |CORRECT |ANSWER✔✔-
Respiratory |depression
A |55-year-old |man |presents |with |difficulty |passing |urine |and |suprapubic |discomfort |for |the |
past |2 |days. |His |symptoms |are |progressively |worsening. |The |patient's |past |medical |history |is |
significant |for |depression, |and |he |was |recently |started |on |a |new |medication |due |to |refractory |
symptoms. |The |physical |examination |reveals |tachycardia, |a |dry |mouth, |and |suprapubic |
fullness. |What |is |the |class |of |medication |that |is |responsible |for |this |patient's |presenting |
symptoms? |- |CORRECT |ANSWER✔✔-Tricyclic |antidepressants
A |55-year-old |man |presents |with |a |1-month |history |of |insomnia |and |fatigue. |He |states |that |he
|has |been |unable |to |complete |work |tasks |and |no |longer |enjoys |his |hobbies |or |going |out |with |
friends. |He |also |reports |a |decreased |appetite |and |bouts |of |crying. |The |patient |has |a |past |
medical |history |of |seizures, |hypothyroidism, |diabetes |mellitus, |and |asthma. |His |blood |pressure
|is |110/75 |mm |Hg, |and |his |heart |rate |is |75 |bpm. |The |clinician |prescribes |venlafaxine. |Which |of
|the |following |conditions |requires |caution |when |using |venlafaxine |in |this |patient? |- |CORRECT |
ANSWER✔✔-Seizures
A |34-year-old |woman |has |been |troubled |by |migraine |headaches |that |typically |occur |5 |to |6 |
times |monthly. |Treatment |of |the |headaches |when |they |occur |is |moderately |successful. |She |
asks |whether |there |is |anything |she |can |do |to |reduce |the |frequency |with |which |these |
headaches |occur. |She |also |has |been |troubled |by |long-standing |mood |issues, |with |episodes |
that |are |weeks |long |where |she |feels |sad. |What |therapy |might |be |recommended |that |can |both
|reduce |the |frequency |of |her |migraine |attacks |and |may |also |be |useful |in |improving |her |mood?
|- |CORRECT |ANSWER✔✔-Venlafaxine
A |patient |is |diagnosed |with |metabolic |acidosis. |His |medication |record |shows |that |he |is |
prescribed |diclofenac, |atenolol, |albuterol, |and |topiramate. |Which |of |these |medications |is |most
|likely |responsible |for |the |patient's |condition? |- |CORRECT |ANSWER✔✔-Topiramate
A |60-year-old |man |is |brought |to |the |emergency |department |after |an |episode |of |syncope. |The |
patient |was |watching |television |when |he |felt |light-headed |and |lost |consciousness. |He |regained
,|consciousness |after |a |minute |spontaneously. |The |patient's |past |medical |history |is |significant |
for |hypertension, |diabetes, |and |peripheral |neuropathy. |His |medications |include |metformin, |
hydrochlorothiazide, |and |amitriptyline. |ECG |in |the |emergency |department |shows |a |QT |interval
|of |480 |ms. |What |is |the |mechanism |of |action |of |the |drug |responsible |for |this |patient's |
symptoms |and |ECG |findings? |- |CORRECT |ANSWER✔✔-Blocking |the |reuptake |of |both |serotonin
|and |norepinephrine |neurotransmitters
A |23-year-old |man |recently |started |taking |a |new |medication |for |a |long-standing |history |of |
hallucinations, |poor |eye |contact, |flat |affect, |and |poor |work |performance. |After |six |days |of |
using |this |medication, |this |patient |presents |to |the |emergency |department |with |acute |neck |
stiffness. |On |exam, |his |head |is |rotated |to |the |left |and |flexed |in |a |fixed |position. |The |
medication |used |by |this |patient |mainly |works |by |blocking |which |of |the |following |receptor? |- |
CORRECT |ANSWER✔✔-Dopamine |receptor
A |40-year-old |man |is |brought |to |the |emergency |department |due |to |a |severe |headache |for |the
|past |hour. |His |symptoms |started |2 |hours |after |having |dinner |with |his |family. |On |further |
questioning, |his |wife |reveals |that |they |had |pizza |and |red |wine |for |dinner. |On |physical |exam, |
he |appears |anxious |and |tremulous. |Medical |history |includes |atypical |depression |being |treated |
with |phenelzine. |He |does |not |smoke |or |use |illicit |drugs. |Which |of |the |following |Is |the |most |
likely |finding? |- |CORRECT |ANSWER✔✔-Hypertension
A |25-year-old |woman |presents |with |depression |resistant |to |multiple |classes |of |
antidepressants. |A |nonselective |monoamine |oxidase |inhibitor |(MAOI) |is |prescribed. |Which |of |
the |following |should |be |included |in |patient |counseling |regarding |the |prevention |of |one |of |the |
most |serious |adverse |effects |of |this |drug? |- |CORRECT |ANSWER✔✔-Avoid |tyramine-containing |
foods
A |48-year-old |man |with |a |20-pack-year |smoking |history |presents |with |3 |weeks |of |insomnia, |
anhedonia, |and |decreased |concentration |after |losing |his |father |to |lung |cancer. |He |worries |that
|he |will |die |of |cancer |and |be |unable |to |provide |for |his |family. |He |often |feels |down |and |spends |
most |of |his |day |in |bed. |He |has |lost |5 |lbs |(2.2 |kg) |over |the |past |2 |weeks |due |to |poor |appetite. |
He |denies |suicidal |ideation |and |would |like |to |quit |smoking. |What |is |the |best |pharmacotherapy
|for |this |patient? |- |CORRECT |ANSWER✔✔-Bupropion
, A |65-year-old |woman |presents |to |the |clinic |with |signs |and |symptoms |of |depression. |She |states
|she |has |been |feeling |hopeless |and |depressed |for |the |past |six |months |since |her |mother's |
death |and |the |loss |of |her |job. |She |has |a |past |medical |history |of |chronic |sinusitis, |for |which |
she |has |been |taking |antihistamines |for |the |past |two |months. |Her |current |vital |signs |are |as |
follows; |blood |pressure |126/80 |mmHg, |heart |rate |70/min, |respiratory |rate |18/min, |and |
temperature |98.6 |F. |What |is |the |next |best |step |for |this |patient? |- |CORRECT |ANSWER✔✔-Start |
on |sertraline
A |17-year-old |female |presents |for |a |follow-up |on |major |depressive |disorder |therapy |with |
venlafaxine. |The |mother |and |patient |state |that |the |patient's |symptoms |have |improved. |She |
has |been |performing |better |at |school, |enjoying |activities |with |her |friends, |and |going |to |the |
gym |every |day. |However, |the |patient |has |trouble |falling |asleep. |The |mother |states |that |she |
gives |her |daughter |a |cough |medication, |dextromethorphan, |to |make |her |drowsy |and |help |her |
fall |asleep. |The |mother |and |patient |ask |if |they |should |be |concerned |about |the |use |of |
dextromethorphan. |What |is |the |best |response |to |their |question? |- |CORRECT |ANSWER✔✔-
There |is |an |increased |risk |of |serotonin |syndrome |if |dextromethorphan |is |used |with |
venlafaxine.
A |25-year-old |woman |presents |with |severe |acute |asthma |exacerbation. |She |inadequately |
responds |to |a |combination |of |nebulized |albuterol, |inhaled |ipratropium, |prednisone, |and |
oxygen. |The |clinical |team |decides |to |administer |intravenous |magnesium. |While |placing |the |
order, |the |clinician |receives |an |alert |for |potential |overdose |with |this |medication. |Which |of |the |
following |symptoms |is |most |likely |to |occur |if |there |is |an |overdose? |- |CORRECT |ANSWER✔✔-
Muscle |weakness
A |40-year-old |male |with |a |history |of |bipolar |1 |disorder |is |admitted |to |a |psychiatric |inpatient |
facility |after |an |episode |of |aggression |and |is |currently |prescribed |aripiprazole. |While |on |the |
inpatient |psychiatric |unit, |he |continues |to |be |agitated |with |the |inpatient |staff |and |other |
patients |on |the |unit. |The |psychiatrist |prescribes |him |lithium |to |augment |treatment |for |
agitation. |Lithium, |by |acting |on |which |of |the |neurotransmitters, |will |be |helpful |for |the |
patient's |agitation? |- |CORRECT |ANSWER✔✔-Serotonin
A |45-year-old |man |is |brought |to |the |hospital |by |his |sister |with |a |history |of |seeing |a |man |
following |him |for |the |last |nine |months. |He |says |that |only |he |can |see |this |man. |She |also |says |
