Walden NUrs6630 final exam August 2018

QUESTION 1

What will the PMHNP most likely prescribe to a patient with
psychotic aggression who needs to manage the top-down cortical control and the
excessive drive from striatal hyperactivity?

A.

Stimulants

B.

Antidepressants

C.

Antipsychotics

D.

SSRIs

1 points

QUESTION 2

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?

A.

First-generation, conventional antipsychotics

B.

First-generation, atypical antipsychotics

C.

Second-generation, conventional antipsychotics

D.

Second-generation, atypical antipsychotics

1 points

QUESTION 3

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?

A.

The doses are based on achieving 100% D2 receptor occupancy.

B.

The doses are based on achieving a minimum of 80% D2
receptor occupancy.

C.

The doses are based on achieving 60% D2 receptor occupancy.

D.

None of the above.

1 points

QUESTION 4

Why does the PMHNP avoid prescribing clozapine (Clozaril) as
a first-line treatment to the patient with psychosis and aggression?

A.

There is too high a risk of serious adverse side effects.

B.

It can exaggerate the psychotic symptoms.

C.

Clozapine (Clozaril) should not be used as high-dose
monotherapy.

D.

There is no documentation that clozapine (Clozaril) is
effective for patients who are violent.

1 points

QUESTION 5

The PMHNP is caring for a patient on risperidone
(Risperdal). Which action made by the PMHNP exhibits proper care for this
patient? </p?

A.

Explaining to the patient that there are no risks of EPS

B.

Prescribing the patient 12 mg/dail

C.

Titrating the dose by increasing it every 5–7 days

D.

Writing a prescription for a higher dose of oral risperidone
(Risperdal) to achieve high D2 receptor occupancy

1 points

QUESTION 6

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?

A.

Lithium (Lithane)

B.

Phenytoin (Dilantin)

C.

Valproate (Depakote)

D.

Topiramate (Topamax)

1 points

QUESTION 7

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?

A.

Strattera

B.

Concerta

C.

Daytrana

D.

Adderall

1 points

QUESTION 8

The PMHNP understands that slow-dose extended release
stimulants are most appropriate for which patient with ADHD?

A.

8-year-old patient

B.

24-year-old patient

C.

55-year-old patient

D.

82-year-old patient

1 points

QUESTION 9

A patient is prescribed D-methylphenidate, 10-mg
extended-release capsules. What should the PMHNP include when discussing the
side effects with the patient?

A.

The formulation can have delayed actions when taken with
food.

B.

Sedation can be a common side effect of the drug.

C.

The medication can affect your blood pressure.

D.

This drug does not cause any dependency.

1 points

QUESTION 10

The PMHNP is teaching parents about their child’s new
prescription for Ritalin. What will the PMHNP include in the teaching?

A.

The second dose should be taken at lunch.

B.

There are no risks for insomnia.

C.

There is only one daily dose, to be taken in the morning.

D.

There will be continued effects into the evening.

1 points

QUESTION 11

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?

A.

“I take my pill at breakfast.”

B.

“I am unable to fall asleep at night.”

C.

“I feel okay all day long.”

D.

“I am not taking my pill at lunch.”

1 points

QUESTION 12

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?

A.

The patient should take the medication at lunch.

B.

The patient will have one or two doses a day.

C.

The patient will take a pill every 17 hours.

D.

The dosing should be done in the morning and at night.

1 points

QUESTION 13

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:

A.

The child will be prescribed 2.5 mg.

B.

The child will be prescribed a 10-mg tablet.

C.

The child’s dose will increase by 2.5 mg every other week.

D.

The child will take 10–40 mg, daily.

1 points

QUESTION 14

A patient is being prescribed bupropion and is concerned
about the side effects. What will the PMHNP tell the patient regarding
bupropion?

A.

Weight gain is not unusual.

B.

Sedation may be common.

C.

It can cause cardiac arrhythmias.

D.

It may amplify fatigue.

1 points

QUESTION 15

Which patient will receive a lower dose of guanfacine?

A.

Patient who has congestive heart failure

B.

Patient who has cerebrovascular disease

C.

Patient who is pregnant

D.

Patient with kidney disease

1 points

QUESTION 16

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?

A.

Migraines

B.

Bipolar disorder and depression

C.

Pregnancy-induced depression

D.

Upper back pain

1 points

QUESTION 17

The PMHNP is treating a patient for fibromyalgia and is
considering prescribing milnacipran (Savella). When prescribing this
medication, which action is the PMHNP likely to choose?

A.

Monitor liver function every 6 months for a year and then
yearly thereafter.

B.

Monitor monthly weight.

C.

Split the daily dose into two doses after the first day.

D.

Monitor for occult blood in the stool.

1 points

QUESTION 18

The PMHNP is assessing a patient she has been treating with
the diagnosis of chronic pain. During the assessment, the patient states that
he has recently been having trouble getting to sleep and staying asleep. Based
on this information, what action is the PMHNP most likely to take?

A.

Order hydroxyzine (Vistaril), 50 mg PRN or as needed

B.

Order zolpidem (Ambien), 5mg at bedtime

C.

Order melatonin, 5mg at bedtime

D.

Order quetiapine (Seroquel), 150 mg at bedtime

1 points

QUESTION 19

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?

A.

Monthly blood levels must be drawn.

B.

ECG monitoring must be done once every 3 months.

C.

White blood cell count must be monitored weekly.

D.

This medication has unwanted side effects such as sedation,
lack of coordination, and drowsiness.

1 points

QUESTION 20

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?

A.

Order herpes simplex virus (HSV) antibody testing

B.

Order a blood urea nitrogen (BUN) and creatinine STAT

C.

Prescribe lidocaine 5%

D.

Prescribe hydromorphone (Dilaudid) 2mg

1 points

QUESTION 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg
by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to
the office with the complaint that the medication is no longer working and
complains of increased pain. What action will the PMHNP most likely take?

A.

Increase the dose of lamotrigine (Lamictal) to 25 mg twice
daily.

B.

Ask if the patient has been taking the medication as
prescribed.

C.

Order gabapentin (Neurontin), 100 mg three times a day,
because lamotrigine (Lamictal) is no longer working for this patient.

D.

Order a complete blood count (CBC) to assess for an
infection.

1 points

QUESTION 22

An elderly woman with a history of Alzheimer’s disease,
coronary artery disease, and myocardial infarction had a fall at home 3 months
ago that resulted in her receiving an open reduction internal fixation. While assessing
this patient, the PMHNP is made aware that the patient continues to experience
mild to moderate pain. What is the PMHNP most likely to do?

A.

Order an X-ray because it is possible that she dislocated
her hip.

B.

Order ibuprofen (Motrin) because she may need long-term
treatment and chronic pain is not uncommon.

C.

Order naproxen (Naprosyn) because she may have arthritis and
chronic pain is not uncommon.

D.

Order Morphine and physical therapy.

1 points

QUESTION 23

The PMHNP is assessing a 49-year-old male with a history of
depression, post-traumatic stress disorder (PTSD), alcoholism with
malnutrition, diabetes mellitus type 2, and hypertension. His physical
assessment is unremarkable with the exception of peripheral edema bilaterally
to his lower extremities and a chief complaint of pain with numbness and
tingling to each leg 5/10. The PMHNP starts this patient on a low dose of
doxepin (Sinequan). What is the next action that must be taken by the PMHNP?

A.

Orders liver function tests.

B.

Educate the patient on avoiding grapefruits when taking this
medication.

C.

Encourage this patient to keep fluids to 1500 ml/day until
the swelling subsides.

D.

Order a BUN/Creatinine test.

1 points

QUESTION 24

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?

A.

Prescribe Estrin FE 24 birth control

B.

Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed
for pain

C.

Prescribe desvenlafaxine (Pristiq), 50 mg daily

D.

Prescribe risperidone (Risperdal), 2 mg TID

1 points

QUESTION 25

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?

A.

“The SNRI can increase noradrenergic neurotransmission in
the descending spinal pathway to the dorsal horn.”

B.

“The SNRI can decrease noradrenergic neurotransmission in
the descending spinal pathway to the dorsal horn.”

C.

“The SNRI can reduce brain atrophy by slowing the gray
matter loss in the dorsolateral prefrontal cortex.”

D.

“The SNRI can increase neurotransmission to descending
neurons.”

1 points

QUESTION 26

A patient with fibromyalgia and major depression needs to be
treated for symptoms of pain. Which is the PMHNP most likely to prescribe for
this patient?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Clozapine (Clozaril)

Phenytoin (Dilantin)

1 points

QUESTION 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s
chronic pain. How does the PMHNP anticipate the drug to work?

A.

It will bind to the alpha-2-delta ligand subunit of
voltage-sensitive calcium channels.

B.

It will induce synaptic changes, including sprouting.

C.

It will act on the presynaptic neuron to trigger sodium
influx.

D.

It will inhibit activity of dorsal horn neurons to suppress
body input from reaching the brain.

1 points

QUESTION 28

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?

A.

Venlafaxine (Effexor)

B.

Armodafinil (Nuvigil)

C.

Bupropion (Wellbutrin)

D.

All of the above

1 points

QUESTION 29

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?

A.

Methylphenidate (Ritalin)

B.

Viloxazine (Vivalan)

C.

Imipramine (Tofranil)

D.

Bupropion (Wellbutrin

1 points

QUESTION 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?

A.

Pregabalin (Lyrica)

B.

Duloxetine (Cymbalta)

C.

Modafinil (Provigil)

D.

Atomoxetine (Strattera)

1 points

QUESTION 31

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?

A.

Pregabalin (Lyrica)

B.

Gabapentin (Neurontin)

C.

Duloxetine (Cymbalta)

D.

B and C

1 points

QUESTION 32

The PMHNP wants to use a symptom-based approach to treating
a patient with fibromyalgia. How does the PMHNP go about treating this patient?

A.

Prescribing the patient an agent that ignores the painful
symptoms by initiating a reaction known as “fibro-fog”

B.

Targeting the patient’s symptoms with anticonvulsants that
inhibit gray matter loss in the dorsolateral prefrontal cortex

C.

Matching the patient’s symptoms with the malfunctioning
brain circuits and neurotransmitters that might mediate those symptoms

D.

None of the above

1 points

QUESTION 33

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?

A.

“SSRIs only increase norepinephrine levels.”

B.

“SSRIs only increase serotonin levels.”

C.

“SSRIs increase serotonin and norepinephrine levels.”

D.

“SSRIs do not increase serotonin or norepinephrine levels.”

1 points

QUESTION 34

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?

A.

Antipsychotics

B.

Lithium

C.

SSRI

D.

Naltrexone

1 points

QUESTION 35

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?

A.

“Naltrexone may be an appropriate option to discuss.”

B.

“There are many medicine options that treat kleptomania.”

C.

“Kevin may need to be prescribed antipsychotics to treat
this illness.”

D.

“Lithium has proven effective for treating kleptomania.”

1 points

QUESTION 36

Which statement best describes a pharmacological approach to
treating patients for impulsive aggression?

A.

Anticonvulsant mood stabilizers can eradicate limbic
irritability.

B.

Atypical antipsychotics can increase subcortical
dopaminergic stimulation.

C.

Stimulants can be used to decrease frontal inhibition.

D.

Opioid antagonists can be used to reduce drive.

1 points

QUESTION 37

A patient with hypersexual disorder is being assessed for
possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen
for this patient?

A.

It will prevent feelings of euphoria.

B.

It will amplify impulse control.

C.

It will block testosterone.

D.

It will redirect the patient to think about other things.

1 points

QUESTION 38

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?

A.

“Compulsive Internet use can be treated similarly to how we
treat people with substance use disorders.”

B.

“Internet addiction is treated with drugs that help block
the tension/arousal state your daughter experiences.”

C.

“When it comes to Internet addiction, we prefer to treat
patients with pharmaceuticals rather than psychosocial methods.”

D.

“There are no evidence-based treatments for Internet
addiction, but there are behavioral therapies your daughter can try.”

1 points

QUESTION 39

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?

A.

There is decreased activation of the prefrontal cortex.

B.

There is increased sensation of the reactive reward system.

C.

There is reduced activation of regions that process
palatability.

D.

There are amplified reward circuits that activate upon
consumption.

1 points

QUESTION 40

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?

A.

Histamine 2 receptor antagonist

B.

Benzodiazepines

C.

Stimulants

D.

Caffeine

1 points

QUESTION 41

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?

A.

Avoiding prescribing the patient a drug that blocks H1
receptors

B.

Prescribing the patient a drug that acts on H2 receptors

C.

Stopping the patient from taking medicine that unblocks H1
receptors

D.

None of the above

1 points

QUESTION 42

The PMHNP is performing a quality assurance peer review of
the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an
older adult patient in long-term care facility who has chronic insomnia. The
chart indicates that the patient has been receiving hypnotics on a nightly
basis. What does the PMHNP find problematic about this documentation?

A.

Older adult patients are contraindicated to take hypnotics.

B.

Hypnotics have prolonged half-lives that can cause drug
accumulation in the elderly.

C.

Hypnotics have short half-lives that render themselves
ineffective for older adults.

D.

Hypnotics are not effective for “symptomatically masking”
chronic insomnia in the elderly.

1 points

QUESTION 43

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?

A.

Serotonergic hypnotics

B.

Antihistamines

C.

Benzodiazepine hypnotics

D.

Non-benzodiazepine hypnotics

1 points

QUESTION 44

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?

A.

Flurazepam (Dalmane)

B.

Estazolam (ProSom)

C.

Triazolam (Halcion)

D.

Zolpidem CR (Ambien)

1 points

QUESTION 45

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?

A.

Triazolam (Halcion)

B.

Quazepam (Doral)

C.

Temazepam (Restoril)

D.

Flurazepam (Dalmane)

1 points

QUESTION 46

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?

A.

“There are no over-the-counter medications that will help
you sleep.”

B.

“You can choose from one of the five benzo hypnotics that
are approved in the United States.”

C.

“You will need to ask the pharmacist for a
non-benzodiazepine medicine.”

D.

“You can get melatonin over the counter, which will help
with sleep onset.”

1 points

QUESTION 47

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?

A.

Prescribe the patient an antihistamine to reverse the sedating
effects

B.

Increasing the patient’s dose and administer it first thing
in the morning

C.

Give the medicine at night and lower the dose

D.

None of the above

1 points

QUESTION 48

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?

A.

“It can cause diarrhea.”

B.

“It can cause blurred vision.”

C.

“It can cause increased salivation.”

D.

“It can cause heightened cognitive effects.”

1 points

QUESTION 49

Parents of a 12-year-old boy want to consider attention
deficit hyperactivity disorder (ADHD) medication for their son. Which
medication would the PMHNP start?

Methylphenidate

Amphetamine salts

Atomoxetine

All of the above could potentially treat their son’s
symptoms.

1 points

QUESTION 50

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?

A.

Methylphenidate (Ritalin, Concerta)

B.

Amphetamine

C.

Atomoxetine (Strattera)

D.

Fluoxetine (Prozac)

1 points

QUESTION 51

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?

A.

Methylphenidate (Ritalin, Concerta)

B.

Clonidine (Catapres)

C.

Bupropion (Wellbutrin)

D.

Desipramine (Norpramin)

1 points

QUESTION 52

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?

A.

Bupropion (Wellbutrin)

B.

Methylphenidate (Ritalin, Concerta)

C.

Guanfacine ER (Intuniv)

D.

Atomoxetine (Strattera)

1 points

QUESTION 53

A PMHNP supervisor is discussing with a nursing student how
stimulants and noradrenergic agents assist with ADHD symptoms. What is the
appropriate response?

A.

They both increase signal strength output dopamine (DA) and
norepinephrin

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