NURS 6630 Midterm Exam: PMHNP
#NURS 6630 Midterm Exam (2022): PMHNP, Walden University
A non-compliant 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).
- “You have to take your medication to become stable.”
- “Most medications will increase the number of neurotransmitters that you already have in the brain.”
- “Most medications used in the treatment are either increasing or decreasing neurotransmitters that your body already has.”
- “Why do you believe that your medication is poison?”
Which statement about neurotransmitters and medications is true?
- Natural neurotransmitters such as endorphins have been discovered after the development of medications.
- Some medications were developed after the discovery and known action of the neurotransmitters in the brain.
- Neurotransmitters receive messages from most medications.
- The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.
When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:
- “In an extreme case such as yours, more than one medication is often needed.”
- “Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.
- “Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms.”
- “I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms.”
During gene expression, what must occur prior to a gene being expressed?
- Transcription factor must bind to the regulatory region within the cell’s nucleus.
- RNA must be converted to mRNA.
- The coding region must separate from the regulatory region. This is wrong
- RNA polymerase must inhibit the process of changing RNA to mRNA.
While genes have the potential to modify behavior, behavior can also modify genes. How do genes impact this process?
- Genes impact neuron functioning directly.
- Changes made to proteins lead to changes in behavior.
- Neurons are able to impact protein synthesis.
- Genes impact the DNA of a cell, leading to changes in behavior.
Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:
- Neurotransmission that occurs via the axon allows for the transport of a neurotransmitter.
- Active transport is a different type of energy that allows the transport of certain neurotransmitters.
- Neurotransmitters can spread by diffusion.
- The postsynaptic neuron can release the neurotransmitter.
Why is the cytochrome P450 enzyme system of significance to the PMHNP?
- The kidneys play a role in the excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective.
- The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer
- The medication’s chemical composition changes when it comes in contact with the acid in the stomach.
- The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.
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?
- About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.
- The term polymorphic refers to the body’s ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics.
- About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.
- Most enzyme pathways do not have interactions between the newer medications.
As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?
- Most medications that act on G-protein linked receptors have antagonistic traits.
- The majority of medications used in practice are full agonists and are used to stimulate the body’s natural neurotransmitters.
- Most medications act as partial agonists because they allow the body to use only what is needed.
- Medications used in practice may act as inverse agonists if the dosage is too high.
The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition:
- The patient smokes cigarettes.
- The patient has hypertension.
- The patient has chronic kidney disease, stage 2.
- The patient drinks a cup of coffee a day.
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:
- Alert staff to possible seizures
B.an order for a different moodstabilizer
C.Decrease the amount prescribed for aripiprazole (Abilify)
- Explain to the patient that it will be more difficult to control his temper
- 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). Which is the best action for the PMHNP to take for this patient?
- Review Amitriptyline (Elavil) level
- Order a liver function test
- Check the patient’s blood pressure and pulse
- Order a stat platelet count
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?
- To promote the availability of serotonin
- To decrease serotonin
- To indirectly increase the amount of dopamine in the body
- To help decrease the amount of serotonin and dopamine
The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?
- “I have trouble staying asleep in the middle of the night.”
- “My spouse told me that I seem to have trouble remembering things sometimes.”
- “I really want to stop smoking, but the cravings are too strong.”
- “I feel nervous to go outside and be in large crowds.”
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?
- “The drug will have an almost immediate effect.”
- “The drug can take a while to build up in your system.”
- “The drug is slow to release but lasts for a long time.”
- “The drug will make a subtle difference in your symptoms.”
A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?
- Mirtazapine (Remeron)
- Varenicline (Chantix)
The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug?
- Full agonists
- Partial agonists
- Inverse agonists
A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?
- “The patient needs to have an inverse agonist.”
- “The patient could benefit from an anticonvulsant.”
- “The patient’s calcium, sodium, chloride, and potassium levels must be regulated.”
- “The patient should have a drug that acts on ligand-gated ion channels.”
The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?
- Ligand-gated ion channels with a pentameric structure
- Ligand-gated ion channels with a tetrameric structure
- Voltage-sensitive ion channels
Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?
- “It’s my fault that all of this is happening. I don’t think I could ever forgive myself.”
- “I have to talk to the President because I’m the only one who can help him.”
- “I’m not sure why that lady is wearing a red jacket since it’s the dogs who need food.”
- “I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.”
A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? I did not have this question
- Obtaining raw normative metrics and using them to assess functionality
- Having the patient report on cognitive function based on personal experiences
- Monitoring the patient in a controlled setting
- Measuring symptoms of psychosis
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?
- Dopamine is terminated through multiple mechanisms.
- The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.
- MAO-B presents in the mitochondria within the presynaptic neuron.
- D2 receptors are the primary binding site for dopamine agonists.
Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?
- “Amphetamines may help you, as they can alleviate psychotic conditions.”
- “Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you.”
- “Amphetamines can cause hallucinations, so I would advise against this type of prescription.”
- “Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.”
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?
- Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.
- Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.
- Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.
- The neuroanatomy of dopamine neuronal pathways can explain the symptoms of schizophrenia.
A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease?
- Achieving underactivity of the mesocorticol projections to the prefrontal cortex
- Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex
- Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex
- Achieving overactivity of the mesocorticol projections to the prefrontal cortex
The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug?
- Tardive dyskinesia
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. Which of the following requires the longest transition time for therapeutic benefit?
- Olanzapine to clozapine
- Asenapine to Risperidone
- Aripripazole to ziprasidone
- Aripripazole to clozapine
The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient?
Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?
- Muscarinic antagonists are more likely to cause decreased prolactin levels.
- D2 antagonists decrease the likelihood of EPS symptoms.
- D2 antagonism is linked to antidepressant properties.
- D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.
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?
- An underlying depressive disorder
- The recent change of a 2nd generation antipsychotic to a conventional one
- The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic
- All of the above
The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?
- Long-term use of antipsychotics
- Genetic disposition
- A and C
- All of the above
The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?
- Those that are potent D2 antagonists
- Those that are potent D2 antagonists with 5HT2A antagonism properties
- D2 receptors that are blocked in the nigrostriatal pathway
- Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors
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?
- 5HT2 antagonism
- D2 antagonism
- Alpha-2 antagonism
- D2 partial agonist
A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?
- A and C
- All of the above
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?
- The patient has an unsustained response to antidepressants.
- The patient has antidepressant-induced hypomania.
- The patient has a depletion of monoamine neurotransmitters.
- The patient has an adverse effect to atypical antipsychotics.
The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?
- Patient with a bipolar I designation
- Patient with a bipolar II designation
- Patient with a bipolar III designation
- None of the above
Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?
- The patient may experience paranoid avoidant behavior.
- The patient may experience severe depression.
- The patient may experience auditory hallucinations.
- The patient may experience increased mood cycling.
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?
- The patient has a higher chance of tolerating SSRI/SNRI treatment.
- The patient will have a positive response to SSRI/SNRI treatment.
- The patient will develop severe mood cycling in response to treatment.
- The patient may be less responsive or tolerant to the treatment.
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?
- Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.
- Norepinephrine inhibits 5HT release through a2 receptors.
- Norepinephrine inhibits α2 receptors on axon terminals.
- Norepinephrine potentiates 5HT release through a1 and a2 receptors.
Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?
- “Drugs inhibit the release of NE.”
- “Drugs can mimic the natural functioning of the NE neuron.”
- “Drugs are unable to simulate the effects of NE neurons.”
- “Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron.”
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?
- Suicidal ideation
- Problems concentrating
- A and C
Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?
- Neuronal firing rates are not dysregulated in depression.
- Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.
- Upon the acute administration of a SSRI, 5HT decreases.
- The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.
The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?
- Both have a sedative-like, calming effect.
- Both contribute to antipsychotic actions.
- Both demonstrate favorable findings in treating depression in the elderly.
- Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.
A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?
- Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.
- The patient cannot take any antihistamines.
- The patient cannot have two wisdom teeth extracted while on a MAnOI.
- The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.
After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?
- Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.
- Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.
- Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.
- All of the above.
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?
- First onset in puberty or early adulthood
- Late onset of menses
- Premenstrual syndrome
- A and C
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:
- MAOI plus SNRI
- SSRI/SNRI plus NDRI
- NDRI/SNRI plus mirtazapine
- NDRI plus modafinil
Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?
- She may experience withdrawal symptoms.
- She may experience increased trauma.
- Effects of abrupt cessation are unknown.
- It can lead to difficulties with concentration.
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?
- Weight gain can be problematic.
- Sedation is very common.
- Induction of mania is rare.
- Seizures are not unusual.
The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?
- Stop the venlafaxine
- Lower the dose of venlafaxine by 50%
- Lower the dose of venlafaxine by 25-40%
- Increase the dose of venlafaxine by 50%
A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses concern regarding “how she will feel and look” from taking the medicine. Which statement correctly describes the side effects as a result of taking this medication?
- It can affect her menstruation.
- Suicidality can be common among young adults.
- Sedation may be problematic.
- Weight gain is unusual.
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?
- He has fibromyalgia.
- He has arrhythmia.
- He uses alcohol.
- He is overweight.
A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?
- Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.
- Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.
- Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.
- Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.
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?
- The patient has hepatic impairment.
- The patient has moderate renal impairment.
- The patient has severe renal impairment.
- The patient has cardiac impairment.
The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?
- Histamine H1 receptor blockade can cause insomnia.
- Muscarinic M1 receptor blockade causes blurred vision.
- Alpha 1 adrenergic receptor blockade causes weight gain.
- Muscarinic M3 receptor blockade causes sedation.
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?
- “You must avoid soy products, such as tofu.”
- “You should not consume processed meats.”
- “You may consume fermented foods, like sauerkraut.”
- “You may continue to drink beers on tap.”
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?
- “Decongestants are fine to continue taking with MAO inhibitors.”
- “Decongestants are okay to take with MAO inhibitors in moderation.”
- “Decongestants should be avoided due to risk of serotonin syndrome.”
- “Decongestants should be avoided due to risk of hypertensive crisis.”
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?
- Ms. Skidmore is taking the correct dose of phenelzine (Nardil).
- Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.
- Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.
- Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.
The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?
- Patient with PTSD
- Patient with partial seizures
- Patient with galactose intolerance
- Patient with Lapp lactase deficiency
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?
- The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.
- The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.
- The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.
- The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.
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?
- mirtazapine (Remeron)
- doxepin (Silenor)
- alprazolam (Xanax)
- trazadone (Oleptro)
A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?
- Mood stabilizers are only prescribed to treat manic phases of bipolar depression
- Mood stabilizers can consistently treat both mania and bipolar depression
- Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to target all four therapeutic actions
- Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression
The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?
- Thyroid Stimulating Hormone (TSH)
- Complete Blood Count (CBC)
- Erythrocyte Sedimentation Rate
- Platelet Count
A 39-year old female patient presently on lithium would like to try a new medication to treat her bipolar disorder. She has had concerns about side effects from lithium and wants to learn more about Lamotrigine (Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects of this agent, including which of the following? I don’t think I had this question
- There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer’s disease
- Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome
- It was one of the first anticonvulsants approved by the FDA to treat bipolar depression
- There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age
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?
- Carbamazepine (Tegretol)
- Gabapentin (Neurontin)
- Valporoic Acid (Depakene)
- All of the above
A 46-year old male patient mentions several alternative treatments to Carbamazepine (Tegretol) as a way to manage symptoms of his bipolar depression. Which of the following does the PMHNP indicate would not be an agent to treat bipolar depression?
- Soybean lecithin
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?
- Valporic Acid (Depakene)
- Carbamazepine (Tegretol)
- Lithium (Lithobid)
- Lamotrigine (Lamictal)
The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?
- Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.
- Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD
- Irritability, lethargy, anger; the child should be evaluated further for ADHD.
- Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.
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:
- Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain
- Clonazepam (klonopin) is not recommended for long term use due to possible sedation
- Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)
- Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other
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:
- “Some medications can cause heart issues so it is necessary to rule those out before you begin medication.”
- “This is a part of our routine admission and it is important that you give me truthful answers.”
- “Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus.”
- “Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”
The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason:
- Alcohol is legal and is a common way that most people deal with their problems.
- Alcohol works similar to benzodiazepines
- Up to 30% of people with anxiety use alcohol to self-medicate
- Alcohol increases serotonin at the synapse and the patient may temporarily feel happy
After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?
- Respiratory depression
- Sedation and restlessness
- Sweating and nausea (This question was marked wrong but I think the answers are different too)
- Bradycardia and tachypnea
A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:
- “SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry.”
- “Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases.”
- “Antidepressants are prescribed prophylactically to prevent symptoms of depression.”
D.”Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety.”
QUESTION 74 ?
The PMHNP evaluates the patient for “fear conditioning” when he asks:
- Have you ever experienced any type of trauma?
- What do you do when you feel fear?
- Does your mother or father have a history of fear and/or worrying?
- What makes your fear better?
A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:
- He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.
- Beta blockers are linked to reconsolidation.
- This medication will allow the patient to sleep throughout the night.
- This medication is linked to the increase of serotonin in the brain.