Exam (elaborations) NURS 6630 Midterm Exam

Exam (elaborations) NURS 6630 Midterm Exam During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the PMHNP’s best response is: Selected Answer: D. “Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”  Question 2 1 out of 1 points During gene expression, what must occur prior to a gene being expressed? Selected Answers: A. Transcription factor must bind to the regulatory region within the cell’s nucleus.  Question 3 1 out of 1 points The PMNHP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This client has begun to develop a common side effect of this medication. What is this side effect? Selected Answer: D. Tardive dyskinesia  Question 4 1 out of 1 points After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect? Selected Answer: D. All of the above  Question 5 1 out of 1 points NURS 6630 Midterm Exam A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient? Selected Answer: C. The patient has severe renal impairment.  Question 6 1 out of 1 points A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do? Selected Answer: B. Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.  Question 7 1 out of 1 points Though medications have the ability to target neurotransmitter release into the synapse by the presynaptic neuron it is not always necessary. The PMHNP understands that this is because: Selected Answer: C. Neurotransmitters can spread by diffusion.  Question 8 1 out of 1 points A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease? Selected Answer: A. Achieving underactivity of the mesocorticol projections to the prefrontal cortex  Question 9 1 out of 1 points The PMHNP spends a session with a client and notices behaviors correlating with a potential manic episode. All of the following are possible manic symptoms the PMHNP could observe except: Selected Answer: D. A low self esteem  Question 10 1 out of 1 points A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug interactions? Selected Answer: D. “Decongestants should be avoided due to risk of hypertensive crisis.”  Question 11 1 out of 1 points Fluoxetine (Prozac) has been prescribed for a client with depression. Which of the following statements is true regarding the action of this medication? Selected Answer: B. Fluoxetine inhibits the serotonin transporter (SERT).  Question 12 1 out of 1 points A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the Clonazepam (klonopin) the best response is: Selected Answer: C. Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)  Question 13 1 out of 1 points Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP understand about this patient? Selected Answer: C. Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.  Question 14 1 out of 1 points A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose: Selected Answer: B. Beta blockers are linked to reconsolidation.  Question 15 1 out of 1 points What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in common? Selected Answer: A. Ligand-gated ion channels with a pentameric structure  Question 16 1 out of 1 points A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO inhibitors? Selected Answer: A. “You must avoid soy products, such as tofu.”  Question 17 1 out of 1 points When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: Selected Answer: C. “Many psychiatric illnesses involve several dys-functioning neurotransmitter systems in the brain. Often, a single medication may only effect one or two of the dys-functioning systems. The addition of another medication can work with the current medication in stabilizing multiple neurotransmitter systems and help to alleviate your symptoms.”  Question 18 1 out of 1 points A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient’s concerns? Selected Answer: D. trazadone (Oleptro)  Question 19 1 out of 1 points A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen: Selected Answer: B. SSRI/SNRI plus NDRI  Question 20 0 out of 1 points Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon? Selected Answer: A. 5HT2 antagonism  Question 21 1 out of 1 points A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? Selected Answer: D. Varenicline (Chantix)  Question 22 1 out of 1 points A 45 year old female client with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed when considering phenelzine in treating her depression? Selected Answer: B. The client will need to minimize dietary intake of foods that are high in tyramine.  Question 23 1 out of 1 points Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin? Selected Answer: D. D2 receptors are the primary binding site for dopamine agonists.  Question 24 0 out of 1 points A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this? Selected Answer: C. To indirectly increase the amount of dopamine in the body  Question 25 1 out of 1 points The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? Selected Answer: C. Patient with a bipolar III designation  Question 26 1 out of 1 points The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this patient? Selected Answer: D. Lamotrigine (Lamictal)  Question 27 1 out of 1 points Why is the cytochrome P450 enzyme system of significance to the PMHNP? Selected Answer: B. The bioavailability of the medication after it passes through the stomach and liver can be altered.  Question 28 1 out of 1 points Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription? Selected Answer: A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.  Question 29 1 out of 1 points While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? Selected Answer: B. Changes made to proteins lead to changes in behavior.  Question 30 1 out of 1 points Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh’s serotonin levels? Selected Answer: B. Norepinephrine inhibits 5HT release through a2 receptors.  Question 31 1 out of 1 points The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder? Selected Answer: D. A and C  Question 32 0 out of 1 points A client is prescribed fluoxetine but is concerned about side effects. Which statement demonstrates accurate client teaching when discussing the side effects associated with fluoxetine? Selected Answer: B. Sedation is common  Question 33 1 out of 1 points A nursing student is seeking clarification on the use of anticonvulsants to treat bipolar depression and is unclear about which anticonvulsants have the most effective outcomes in treating bipolar depression. Which of the following anticonvulsants is NOT used for treating bipolar depression? Selected Answer: B. Gabapentin (Neurontin)  Question 34 1 out of 1 points A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine? Selected Answer: C. Induction of mania is rare.  Question 35 1 out of 1 points A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear about most effective outcomes. Which of the following agents does the PMHNP convey as having uncertain outcomes? Selected Answer: B. Gabapentin (Neurontin)  Question 36 1 out of 1 points The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)? Selected Answer: B. Muscarinic M1 receptor blockade causes blurred vision.  Question 37 1 out of 1 points What is accurate about the clinical description of psychosis? Selected Answer: C. It is a syndrome that can be associated with a number of psychiatric disorders.  Question 38 1 out of 1 points The PMHNP is assessing a client in the emergency room. The client shares that he has been on lithium for many years. What blood test does the PMHNP order? Selected A. Answer: Thyroid Stimulating Hormone  Question 39 1 out of 1 points The student inquires about antipsychotic medications. Which response by the PMHNP describes the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics? Selected Answer: B. Those that are potent D2 antagonists with 5HT2A antagonism properties  Question 40 1 out of 1 points The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this client? Selected Answer: C. Lithium (Lithobid)  Question 41 1 out of 1 points As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice? Selected Answer: A. Most medications that act on G-protein linked receptors have antagonistic traits.  Question 42 1 out of 1 points A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression? Selected Answer: D. A and C  Question 43 1 out of 1 points It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true? Selected Answer: A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.  Question 44 1 out of 1 points The PMHNP understands that the potential of alcohol abuse in the anxious client is higher for the following reasons: Selected Answer: a. Alcohol exerts an effect on GABAA receptors.  Question 45 1 out of 1 points The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient? Selected Answer: B. Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.  Question 46 1 out of 1 points Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription? Selected Answer: A. “The drug will have an almost immediate effect.”  Question 47 1 out of 1 points Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body? Selected Answer: D. D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.  Question 48 1 out of 1 points The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient’s response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment? Selected Answer: D. The patient may be less responsive or tolerant to the treatment.  Question 49 1 out of 1 points A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). When assessing the psychiatric medications and the reason for admission, what would be the best course of action for the PMHNP with this client? Selected Answer: A. Review Amitriptyline (Elavil) level  Question 50 1 out of 1 points Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient? Selected Answer: B. The recent change of a 2nd generation antipsychotic to a conventional one  Question 51 1 out of 1 points Mrs. Schwartzman is a 52-year-old client with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities since starting her new medication. What does the PMHNP infer from this encounter with the client? Selected Answer: C. The new medication is blocking D2 receptors in the mesolimbic system  Question 52 1 out of 1 points The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent called an atypical antipsychotic. What neurotransmitters will this new medication work on? Selected Answer: A. dopamine and serotonin  Question 53 1 out of 1 points A nurse overhears that a client has failed monotherapy with an SSRI and an SNRI. She also learns that the client has failed dual SSRI + SNRI therapy. The nurse approaches the PMHNP and asks what treatment options should be considered in this treatment resistant client. The PMHNP tells the nurse that she will treat the client with the following regimen. Selected Answer: B. SSRI + NDRI  Question 54 1 out of 1 points Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation? Selected Answer: A. The patient has an unsustained response to antidepressants.  Question 55 1 out of 1 points Which statement about neurotransmitters and medications is true? Selected Answer: B. Several psychiatric medications have been developed after discoveries of endogenous neurotransmitters and defining their function in the brain.  Question 56 1 out of 1 points Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40–50 hours a week as a contractor and “manages his stress” by smoking 3–4 cigarettes a day and having 8–10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby? Selected Answer: C. He uses alcohol.  Question 57 1 out of 1 points The nurse education knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities? Selected Answer: D. Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic effects.  Question 58 1 out of 1 points The PMHNP evaluates the patient for “fear conditioning” when he asks: Selected Answer: A. Have you ever experienced any type of trauma?  Question 59 0 out of 0 points When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Ye s  Question 60 1 out of 1 points A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to: Selected Answer: C. Decrease the amount prescribed for aripiprazole (Abilify)  Question 61 1 out of 1 points A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP). Selected Answer: C. “Most medications that work in the brain will result in restoring an imbalance of one or more neurotransmitters that your body already produces helping to alleviate your symptoms .”  Question 62 1 out of 1 points Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication? Selected Answer: D. The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.  Question 63 1 out of 1 points The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)? Selected Answer: B. Patient with partial