MSN 611 NKU FINAL QUESTIONS AND 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?
- Answers :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? - Answers :Cerebral vasoconstriction
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? - Answers :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? - Answers :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? - Answers :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? - Answers
: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? - Answers :Dopamine receptor
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? - Answers :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? - Answers :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? - Answers :Tricyclic antidepressants
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? - Answers :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? - Answers :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? - Answers :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? - Answers :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? - Answers :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? - Answers :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? - Answers :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 he lost his job four months ago because of poor performance. Since then, the
patient has been living in his room and does not go outside because he thinks someone
might kill him. On examination, the patient's vitals are normal. The clinician prescribes a
medication that is known for extrapyramidal symptoms. This patient is at increased risk
of developing which of the following in the next 24 hours? - Answers :Acute dystonia
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?
- Answers :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? - Answers :Cerebral vasoconstriction
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? - Answers :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? - Answers :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? - Answers :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? - Answers
: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? - Answers :Dopamine receptor
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? - Answers :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? - Answers :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? - Answers :Tricyclic antidepressants
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? - Answers :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? - Answers :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? - Answers :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? - Answers :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? - Answers :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? - Answers :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? - Answers :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 he lost his job four months ago because of poor performance. Since then, the
patient has been living in his room and does not go outside because he thinks someone
might kill him. On examination, the patient's vitals are normal. The clinician prescribes a
medication that is known for extrapyramidal symptoms. This patient is at increased risk
of developing which of the following in the next 24 hours? - Answers :Acute dystonia
