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NURS 6630 Final Exam – Pharmacology Spring Term

1. An adult patient presents with a history of substance use disorder and attention deficit hyperactivity disorder (ADHD). Which of the following treatment options is best for this patient?
2. The PMHNP understands that varenicline (CHANTIX) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients?
3. Which patient will receive a lower dose of guanfacine?
4. The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCsto block those channels with a“use-dependent” form of inhibition. Which agent will the PMHNP most likely select?
5. Which of the following substances has the highest probability of becoming dependent after a single use?
6. A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?
7. All drugs that lead to addiction increase in the ventral striatum, which is also called the .
8. The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?
9. The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands?
10. Daniel is a 33-year-old patient with ADHD and multiple comorbidities: mood disorder, alcohol abuse, ADHD, and nicotine dependence. Which comorbidity should be treated first?
11. Individuals who su”er from an addiction often increase the dose of medication to achieve the desired effect. The need to increase the dose to reach the safe effect is due to .
12. Sharon is a 56-year-old female that presents to the clinic with pain after suffering a back injury several years ago. The patient states she feels a tingling sensation in her legs. What type of pain is Sharon likely experiencing?
13. The PMHNP is evaluating a 7-year-old pediatric patient for the treatment of ADHD. The PMHNP decidestoprescribeamedicationthatisselectiveforalpha-2Areceptorsthathasalower incidence of sedation and hypotension. Which agent did the PMHNP prescribe?
14. Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction?
15. The PMHNP prescribes pregabalin (LYRICA) for a patient with chronic pain. How does pregabalin work to reduce pain?
16. A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?
17. A patient with the hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an anti-androgen for this patient?
18. The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication e”ective for these patients?
19. The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to sta”?
20. Jerry presents to the clinic for his four-week follow-up after starting trazodone for insomnia. How does trazodone help with insomnia?
21. The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?
22. A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response?
23. The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and seeing people chasing him. The PMHNP identifies these symptoms to be associated with which of the following?
24. Sandra complains of constipation after being on quetiapine (SEROQUEL) for several weeks. Constipation is likely caused by the binding of quetiapine (SEROQUEL) to which receptor?
25. The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?
26. A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication?
27. An interneuron is a neuron that has its cell body, dendrites, and axon within the spinal cord. The neuron can be considered excitatory if it contains or inhibitory if it contains
28. Which statement best describes a pharmacological approach to treating patients for impulsive aggression?
29. Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?
30. The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select?
31. Molly is a 52-year-old female that has a diagnosis of fibromyalgia. She complains of fatigue and cognitive difficulties. Which medication is the PMHNP most likely to prescribe?
32. An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based oneself-report from the patient, his parents, and his teacher; attention deficithy per activity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?
33. The PMHNP wishes to prescribe a medication that reduces glutamate transmission in an Alzheimer’s patient. Which medication should the PMHNP prescribe?
34. The PMHNP understands that slow-dose extended-release stimulants are most appropriate for which patient with ADHD?
35. A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice?
36. The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient?
37. Which neurotransmitter is secreted by the pineal gland that acts on the suprachiasmatic nucleus to regulate circadian rhythms?
38. A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly?
39. A patient you have been evaluating was admitted to the hospital with some abnormal lab work. Hematology/oncology was consulted and diagnoses the patient was with plastic anemia and agranulocytosis. Which medication was likely the culprit?
40. The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make?
41. An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ?
42. An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option?
43. A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects?
44. The PMHNP is caring for a patient with chronic insomnia. The PMHNP wishes to prescribe a drug with an ultra-short half-life. Which drug will the PMHNP prescribe?
45. The PMHNP is consulted to evaluate a patient in a long-term care facility that is having difficulties participating in group therapy each morning after breakfast. What is the likely cause of excessive daytime sleepiness?
46. The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching?
47. An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is e”ective in treating which condition(s) in this patient?
48. The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?
49. Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?
50. The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed?
51. Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?
52. A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?
53. Neal is complaining of restless leg syndrome and insomnia. Which first-line medication should the PMHNP prescribe to treat both?
54. Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)?
55. Jacob is a 7-year-old pediatric patient who has significant oppositional symptoms associated with his ADHD diagnosis. What is the best treatment for this patient?
56. A patient calls the clinic to ask about an over-the-counter sleep aid. What is the best response?
57. A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option?
58. A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile?
59. The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe?
60. Which of the following anticonvulsants increases serotonergic neurotransmission and GABAergictransmission, while decreasing glutamatergic neurotransmission?
61. Harold complains of pain associated with his irritable bowel syndrome with constipation. The PMHNP decides to prescribe a medication that prevents pain signals from reaching the brain. Which agent does the PMHNP prescribe?
62. A patient’s daughter calls your office with concerns that her mother is having significant gastrointestinal side effects. You review the patient’s chart and realize she is having side e”ects from donepezil (ARICEPT). What is the mechanism of the gastrointestinal disturbances?
63. Which of the following is considered as a disruptive/impulse control behavior?
64. You have been consulted to evaluate a patient who presents with symptoms of dementia. The patient is experiencing memory deficit, aphasia, apraxia, and agnosia. Which treatment option is best for this patient?
65. The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?
66. Theparentsofa 10 year old girl diagnosed with ADHDaskifthe PMHNPcanprescribe something to help their daughter’s ADHD that is not a stimulant. Which of the following responses is correct?
67. A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms:
68. A nursing student asks the PMHNP the difference between impulsivity and compulsivity. Which of the following responses is correct?
69. The PMHNP is treating a patient with depression and fibromyalgia. The PMHNP chooses to prescribe a treatment that may help treat the patient’s fibromyalgia and depressive symptoms. Which medication is the PMHNP likely to choose?
70. Karen completes the Epworth sleepiness scale and scores abnormally high. She is diagnosed with narcolepsy. The PMHNP prescribes a wake-promoting agent that is a weak dopamine transporter antagonist. Which medication did the PMHNP prescribe?
71. The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics?
72. A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end-stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?
73. The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?
74. A patient presents with psychotic aggression. Which treatment option is best for a patient presenting with psychotic aggression due to impaired top-down cortical control and excessive drive from striatal hyperactivity?
75. The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: