Psychiatric Nurse Practitioner Assessment Exam Questions & Answers
Explain the clinical signifcance of the As more contempts are tried with SSRIs to relieve depressive
Stystematic Treatment Enhancement symptoms, the client becomes more treatment resistant leading to
Program for Bipolar Disorder: STEP- poor outcomes.
BD)
Explain the clinical significance Strong behavioral therapy combined with medications lead to 30%
of the Sequenced Treatment better outcomes as compared to monotherapy or medication or
Alternative to Relieve therapy alone.
Depression STAR D
Describe the mechanism of Blocking D2 receptors in the mesolimbic and mesocortical
action of Typical
Antipsychotics
The Blocking D2 receptors in tract reducing positive symptoms of psychosis, does effect the
the mesolimbic and mesocortical negative symptoms of the disorder, can create EPS symptoms in the
tract nigro-striatal tract,
Nigrostriatal involved with muscular movement
Mesolimbic source of visual hallucinations and auditory hallucinations,
Mesocortical mesocortical area holds affective symptoms,
Second generation antipsychotics are blocking both D2 and 5HT receptors in the brain and also relieve the
pharmacology directed to negative symptoms of psychosi
down regulation blocking Alpha Orthostatic hypotension and dizziness which comes
! receptors
down regulation of blocking Weight gain, dizziness
Muscarinic and Histamine
receptors
serontin down regulation in the gut constipation
Neuroleptic malignant syndrome cause by increased medication changes or treatment naive patients
What are notable side effects of Induced by cigarette smoking which is through the 1A2 pathway
Clozapine
, Recommended dosing schedule Start at 12.5 first day,
for clozapine then in divide doses of 25-50 mg/day up to 300-400 mg per day.
Maximum dose is 900 mg per day.
Clozapine maxes
No single dose should exceed 450 mg
Need to register at the clozapine website as a
Clozapine monitoring provider Normal levels of WBCs > 3500
Normal levels of ANC > 2000
WBC with differentials, Absolute Neutrophil Count
wbc Blood draws are done weekly for the first 6 months, then every other
week for 6 months, then monthly
Increase risk of seizure
Notable side effects of Risperidone Contraindicated for
pregnancy Increased
prolactin
Combination of any three of the following
Abdominal circumference > 37 in males > 31.5 in
femaies Plus any two of the following:
Metabolic syndrome diagnostic Elevated Triglycerides > 150 mg/dl
criteria HDL less than 40 mg/dl in men, 50 mg/dl in women
Blood pressure >130/85, or receiving treatment for
hypertension Fasting blood sugar >110 mg/dl or prior
type of DM diagnosis
A weight increase of 7% should to consider a different medication.
prompt the provider
Within 2 weeks of beginning the medication or a significant medication
Neuroleptic Malignant Syndrome
criteria increase / or present with abrupt withdrawal of levodopa or exposure
to a dopamine agonist
Hot, Stiff, and Out of it: includes extreme mental status
Classic triad:
change/confusion, extreme muscle rigidity, and extremem autonomic
instability/hyperthermia:
What is the appropriate Dantrolene bromocriptine to relieve rigidity
treatment for Neuroleptic
Malignant Syndrome
How are TCA metabolized the 2D6 pathway
The importance of TCA to be aware Toxicity causes heart block, torsade de pointes arrythmia or sudden death
of:
Monoamine Oxidase Inhibitor Low tyramine diet including red wine, cheese, processed foods,
(MAOIs) concern for treatment causes a hypertensive crisis (high blood pressure)
Buproprion Can lower the seizure threshold, should avoid in children and the elderly, NDRI
Explain the clinical signifcance of the As more contempts are tried with SSRIs to relieve depressive
Stystematic Treatment Enhancement symptoms, the client becomes more treatment resistant leading to
Program for Bipolar Disorder: STEP- poor outcomes.
BD)
Explain the clinical significance Strong behavioral therapy combined with medications lead to 30%
of the Sequenced Treatment better outcomes as compared to monotherapy or medication or
Alternative to Relieve therapy alone.
Depression STAR D
Describe the mechanism of Blocking D2 receptors in the mesolimbic and mesocortical
action of Typical
Antipsychotics
The Blocking D2 receptors in tract reducing positive symptoms of psychosis, does effect the
the mesolimbic and mesocortical negative symptoms of the disorder, can create EPS symptoms in the
tract nigro-striatal tract,
Nigrostriatal involved with muscular movement
Mesolimbic source of visual hallucinations and auditory hallucinations,
Mesocortical mesocortical area holds affective symptoms,
Second generation antipsychotics are blocking both D2 and 5HT receptors in the brain and also relieve the
pharmacology directed to negative symptoms of psychosi
down regulation blocking Alpha Orthostatic hypotension and dizziness which comes
! receptors
down regulation of blocking Weight gain, dizziness
Muscarinic and Histamine
receptors
serontin down regulation in the gut constipation
Neuroleptic malignant syndrome cause by increased medication changes or treatment naive patients
What are notable side effects of Induced by cigarette smoking which is through the 1A2 pathway
Clozapine
, Recommended dosing schedule Start at 12.5 first day,
for clozapine then in divide doses of 25-50 mg/day up to 300-400 mg per day.
Maximum dose is 900 mg per day.
Clozapine maxes
No single dose should exceed 450 mg
Need to register at the clozapine website as a
Clozapine monitoring provider Normal levels of WBCs > 3500
Normal levels of ANC > 2000
WBC with differentials, Absolute Neutrophil Count
wbc Blood draws are done weekly for the first 6 months, then every other
week for 6 months, then monthly
Increase risk of seizure
Notable side effects of Risperidone Contraindicated for
pregnancy Increased
prolactin
Combination of any three of the following
Abdominal circumference > 37 in males > 31.5 in
femaies Plus any two of the following:
Metabolic syndrome diagnostic Elevated Triglycerides > 150 mg/dl
criteria HDL less than 40 mg/dl in men, 50 mg/dl in women
Blood pressure >130/85, or receiving treatment for
hypertension Fasting blood sugar >110 mg/dl or prior
type of DM diagnosis
A weight increase of 7% should to consider a different medication.
prompt the provider
Within 2 weeks of beginning the medication or a significant medication
Neuroleptic Malignant Syndrome
criteria increase / or present with abrupt withdrawal of levodopa or exposure
to a dopamine agonist
Hot, Stiff, and Out of it: includes extreme mental status
Classic triad:
change/confusion, extreme muscle rigidity, and extremem autonomic
instability/hyperthermia:
What is the appropriate Dantrolene bromocriptine to relieve rigidity
treatment for Neuroleptic
Malignant Syndrome
How are TCA metabolized the 2D6 pathway
The importance of TCA to be aware Toxicity causes heart block, torsade de pointes arrythmia or sudden death
of:
Monoamine Oxidase Inhibitor Low tyramine diet including red wine, cheese, processed foods,
(MAOIs) concern for treatment causes a hypertensive crisis (high blood pressure)
Buproprion Can lower the seizure threshold, should avoid in children and the elderly, NDRI
