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NURS 6630 Midterm Exam  Question and Answers

1. 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).
2. Which statement about neurotransmitters and medications is true?
3. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:
4. During gene expression, what must occur prior to a gene being expressed?
5. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?
6. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:
7. Why is the cytochrome P450 enzyme system of significance to the PMHNP?
8. 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?
9. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?
10. 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:
11. 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 Nurs 6630 Midterm exam
12. 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?
13. 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?
14. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?
15. 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?
16. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?
17. 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?
18. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?
19. 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?
20. Which statement ….by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?
21. 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?   
22. 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?
23. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, ….by severe fatigue. Nurs 6630 midterm exam Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?
24. 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?
25. A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease?
26. 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?
27. 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?
28. 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?
29. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?
30. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. Nurs 6630 midterm exam 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?
31. 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)?Not on mytest
32. 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?
33. 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 ….to be the most beneficial in producing the effects ….by Mr. Gordon?
34. A patient who was recently …..to the psychiatric nursing unit is being ….for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?
35. Ryerson is a 28-year-old patient with a mood disorder. She recently …..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?
36. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?
37. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?
38. 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?
39. 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?
40. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?
41. 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?
42. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?
43. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?I had different answer choicesthe correct answer was Both have actions at sigma receptors that contribute to both anxiolytic and antipsychotic effects nur 6630 midtm
44. 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?
45. 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?
46. 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?
47. 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 nurs 6630 midterm exam
48. The PMHNP tells the nurse she will treat the patient with the following regimen nurs 6630 midterm exam
49. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?
50. A patient is …..fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?
51. 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?
52. A 25-year-old female patient is being ….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?
53. 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?
54. A patient is ….sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?
55. A patient is ….50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?
56. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?
57. A patient who was …..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?
58. A patient who is …..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?
59. Skidmore presents for a follow-up appointment after being …..phenelzine (Nardil), and reports “I take my 45 mg pill, three times a day, just like I’m ….to.” What does the PMHNP understand about this patient?
60. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?
61. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?
62. 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?
63. A patient who was …..with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?
64. 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?
65. 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?
66. 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?
67. 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?
68. 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?
69. 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?
70. A patient was …..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:
71. 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:
72. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason nurs 6630 midterm exam
73. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?
74. A patient  is …..escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:
75. A patient …..with PTSD is …..propranolol (Inderal) and the PMHNP understands that he was ….this medication for what purpose: