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NURS-6630D-3/NURS-6630N-3/NURS-6630F-3-Approaches to Treatment Summer Qtr

Week 11 Final Exam

1. A patient diagnosed with obsessive-compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following?
2. The PMHNP prescribes pregabalin (LYRICA) for a patient with chronic pain. How does pregabalin work to reduce pain?
3. 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:  
4. Mike wants to quit smoking. He has tried nicotine replacement and varenicline without success. He has asked for another medication to help him kick his habit. The PMHNP decides to try a medication that increases dopamine by prescribing medications that can increase both norepinephrine and dopamine. Which medication did the PMHNP prescribe?
5. 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?
6. 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?
7. Heather is admitted for opioid withdrawals and detoxification. The PMHNP decides to prescribe an alpha-2 adrenergic agonist to reduce the symptoms of autonomic hyperactivity during withdrawal and aid in the detoxification process. Which medication did the PMHNP prescribe?
8. A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion?
9. 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. 
10. 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?
11. A young patient is prescribed Vyvanse. During the follow-up appointment, which comments made by the patient make the PMHNP think that the dosing is being done incorrectly?
12. A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient?  
13. 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?
14. The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)?
15. 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? 
16. Jordan is diagnosed with obsessive-compulsive disorder. He has been trialed on several different SSRIs and is currently on high-dose sertraline. He reports an inability to carry out responsibilities because of an obsession with handwashing. Which is the best treatment option for Jordan?
17. A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP?
18. A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrants prescribing a medication. Select the answer that is matched with an appropriate treatment. 
19. Which patient will receive a lower dose of guanfacine?
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 caring for a patient who openly admitted to drinking a quart of vodka daily. Prior to prescribing this patient disulfiram (Antabuse), it is important for the PMHNP to:
22. A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient?
23. Insomnia is caused by excessive nighttime arousal. The PMHNP is likely to prescribe which of the following to treat insomnia?
24. 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?
25. Which of the following is considered as a disruptive/impulse control behavior?
26. An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?
27. 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?
28. The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?
29. A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?
30. The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?
31. The novel neurotransmitter adenosine is responsible for the sleep-wake cycle by increasing throughout the day and diminishing during night.  Which of the follow is an antagonist of adenosine?
32. 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?
33. The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 
34. Which neurotransmitter is secreted by the pineal gland that acts on the suprachiasmatic nucleus to regulate circadian rhythms?
35. 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?
36. You decide to start a patient on lurasidone (LATUDA). Which of these counseling points is correct?
37. The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors?
38. 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?
39. The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in the 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?
40. 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 ____________.
41. 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 effective in treating which condition(s) in this patient?
42. 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.
43. 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?
44. The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?
45. 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?
46. A nursing student asks the PMHNP about the difference between the use of stimulants in the treatment of ADHD and the abuse of stimulants in substance-use disorders. Which is the correct response?
47. 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?
48. 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? 
49. A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?
50. The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia?
51. Which medication below inhibits serotonin and norepinephrine reuptake and is an antagonist of histamine 1, muscarinic 1, and alpha-1 adrenergic receptors at high doses, but only retains activity for histamine 1 receptors at very low doses?
52. The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and sees people chasing him. The PMHNP identifies these symptoms to be associated with which of the following?
53. The parents of a 10 year old girl diagnosed with ADHD ask if the PMHNP can prescribe something to help their daughter’s ADHD that is not a stimulant. Which of the following responses is correct?
54. 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?
55. Which of the following anticonvulsants increases serotonergic neurotransmission and GABAergic transmission, while decreasing glutamatergic neurotransmission?
56. 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?
57. Neal is complaining of restless leg syndrome and insomnia. Which first-line medication should the PMHNP prescribe to treat both?
58. 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?
59. 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? 
60. 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?
61. The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe?
62. The PMHNP wishes to prescribe a medication that reduces glutamate transmission in an Alzheimer’s patient. Which medication should the PMHNP prescribe?
63. Individuals who suffer 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 __________________.
64. Antipsychotics are doses at a level that blocks ________% of D2 receptors.
65. 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?
66. All drugs that lead to addiction increase __________________in the ventral striatum, which is also called the _______________.
67. Which of the following substances has the highest probability of becoming dependent after a single use?
68. A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?
69. 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?
70. 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?  
71. A patient on chronic opioids is currently on oxycodone ER (OxyContin). The PMHNP is consulted to treat underlying depression. Under which circumstance should the PMHNP order naloxone (NARCAN)?
72. 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 staff?
73. 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?
74. A 72-year-old male patient is diagnosed with frontotemporal dementia and presents with aggression and agitation. The PMHNP is consulted and decided to prescribe which of the following?
75. Brandon is a non-compliant patient that presents to the clinic asking for help with his alcohol dependence. The PMHNP evaluates the patient and determines a long-acting injection that blocks the mu-receptors would be the best treatment option for Brandon. Which medication should the PMHNP prescribe?