02 Oct Writer Choice

38551QUESTION 41
1. 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?

A.
Insomnia

B.
Suicidal ideation

C.
Problems concentrating

D.
A and C
1 points
QUESTION 42
1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

A.
Neuronal firing rates are not dysregulated in depression.

B.
Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

C.
Upon the acute administration of a SSRI, 5HT decreases.

D.
The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.
1 points
QUESTION 43
1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

A.
Both have a sedative-like, calming effect.

B.
Both contribute to antipsychotic actions.

C.
Both demonstrate favorable findings in treating depression in the elderly.

D.
Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.
1 points
QUESTION 44
1. 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?

A.
Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

B.
The patient cannot take any antihistamines.

C.
The patient cannot have two wisdom teeth extracted while on a MAnOI.

D.
The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.
1 points
QUESTION 45
1. 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?

A.
Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

B.
Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

C.
Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

D.
All of the above.
1 points
QUESTION 46
1. 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?

A.
First onset in puberty or early adulthood

B.
Late onset of menses

C.
Premenstrual syndrome

D.
A and C
1 points
QUESTION 47
1. 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:

A.
MAOI plus SNRI

B.
SSRI/SNRI plus NDRI

C.
NDRI/SNRI plus mirtazapine

D.
NDRI plus modafinil
1 points
QUESTION 48
1. 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?

A.
She may experience withdrawal symptoms.

B.
She may experience increased trauma.

C.
Effects of abrupt cessation are unknown.

D.
It can lead to difficulties with concentration.
1 points
QUESTION 49
1. 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?

A.
Weight gain can be problematic.

B.
Sedation is very common.

C.
Induction of mania is rare.

D.
Seizures are not unusual.
1 points
QUESTION 50
1. 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?

A.
Stop the venlafaxine

B.
Lower the dose of venlafaxine by 50%

C.
Lower the dose of venlafaxine by 25-40%

D.
Increase the dose of venlafaxine by 50%
1 points
QUESTION 51
1. 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?

A.
It can affect her menstruation.

B.
Suicidality can be common among young adults.

C.
Sedation may be problematic.

D.
Weight gain is unusual.
1 points
QUESTION 52
1. 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?

A.
He has fibromyalgia.

B.
He has arrhythmia.

C.
He uses alcohol.

D.
He is overweight.
1 points
QUESTION 53
1. A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

A.
Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

B.
Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

C.
Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

D.
Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.
1 points
QUESTION 54
1. 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?

A.
The patient has hepatic impairment.

B.
The patient has moderate renal impairment.

C.
The patient has severe renal impairment.

D.
The patient has cardiac impairment.
1 points
QUESTION 55
1. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

A.
Histamine H1 receptor blockade can cause insomnia.

B.
Muscarinic M1 receptor blockade causes blurred vision.

C.
Alpha 1 adrenergic receptor blockade causes weight gain.

D.
Muscarinic M3 receptor blockade causes sedation.
1 points
QUESTION 56
1. 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?

A.
“You must avoid soy products, such as tofu.”

B.
“You should not consume processed meats.”

C.
“You may consume fermented foods, like sauerkraut.”

D.
“You may continue to drink beers on tap.”
1 points
QUESTION 57
1. 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?

A.
“Decongestants are fine to continue taking with MAO inhibitors.”

B.
“Decongestants are okay to take with MAO inhibitors in moderation.”

C.
“Decongestants should be avoided due to risk of serotonin syndrome.”

D.
“Decongestants should be avoided due to risk of hypertensive crisis.”
1 points
QUESTION 58
1. 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?

A.
Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

B.
Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

C.
Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

D.
Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.
1 points
QUESTION 59
1. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

A.
Patient with PTSD

B.
Patient with partial seizures

C.
Patient with galactose intolerance

D.
Patient with Lapp lactase deficiency
1 points
QUESTION 60
1. 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?

A.
The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

B.
The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

C.
The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

D.
The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.
1 points
QUESTION 61
1. 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?

A.
mirtazapine (Remeron)

B.
doxepin (Silenor)

C.
alprazolam (Xanax)

D.
trazadone (Oleptro)
1 points
QUESTION 62
1. 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?

A.
Mood stabilizers are only prescribed to treat manic phases of bipolar depression

B.
Mood stabilizers can consistently treat both mania and bipolar depression

C.
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

D.
Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression
1 points
QUESTION 63
1. 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?

A.
Thyroid Stimulating Hormone (TSH)

B.
Complete Blood Count (CBC)

C.
Erythrocyte Sedimentation Rate

D.
Platelet Count
1 points
QUESTION 64
1. 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?

A.
There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer’s disease

B.
Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

C.
It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

D.
There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age
1 points
QUESTION 65
1. 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?

A.
Carbamazepine (Tegretol)

B.
Gabapentin (Neurontin)

C.
Valporoic Acid (Depakene)

D.
All of the above
1 points
QUESTION 66
1. 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?

A.
Omega-3-fatty-acids

B.
Soybean lecithin

C.
Inositol

D.
L-methylfolate
1 points
QUESTION 67
1. 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?

A.
Valporic Acid (Depakene)

B.
Carbamazepine (Tegretol)

C.
Lithium (Lithobid)

D.
Lamotrigine (Lamictal)
1 points
QUESTION 68
1. 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?

A.
Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

B.
Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

C.
Irritability, lethargy, anger; the child should be evaluated further for ADHD.

D.
Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.
1 points
QUESTION 69
1. 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:

A.
Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

B.
Clonazepam (klonopin) is not recommended for long term use due to possible sedation

C.
Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

D.
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
1 points
QUESTION 70
1. 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:

A.
“Some medications can cause heart issues so it is necessary to rule those out before you begin medication.”

B.
“This is a part of our routine admission and it is important that you give me truthful answers.”

C.
“Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus.”

D.
“Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”
1 points
QUESTION 71
1. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason:

A.
Alcohol is legal and is a common way that most people deal with their problems.

B.
Alcohol works similar to benzodiazepines

C.
Up to 30% of people with anxiety use alcohol to self-medicate

D.
Alcohol increases serotonin at the synapse and the patient may temporarily feel happy
1 points
QUESTION 72
1. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

a.
Respiratory depression

b.
Sedation and restlessness

c.
Sweating and nausea

d.
Bradycardia and tachypnea
1 points
QUESTION 73
1. A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:

A.
“SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry.”

B.
“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.”

C.
“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.”
1 points
QUESTION 74
1. The PMHNP evaluates the patient for “fear conditioning” when he asks:

A.
Have you ever experienced any type of trauma?

B.
What do you do when you feel fear?

C.
Does your mother or father have a history of fear and/or worrying?

D.
What makes your fear better?
1 points
QUESTION 75
1. A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

A.
He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

B.
Beta blockers are linked to reconsolidation.

C.
This medication will allow the patient to sleep throughout the night.

D.
This medication is linked to the increase of serotonin in the brain.
1 points
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