Psychopharmacologic Approaches to Treatment of Psychopathology

Psychopharmacologic Approaches to Treatment of Psychopathology


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 Question 1
1 out of 1 points
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?
“I can prescribe atomoxetine for your daughter. This medication help ADHD
symptoms and is not considered a stimulant.”

 Question 2
1 out of 1 points
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?
Selected Answer: d.
“You can get melatonin over the counter, which will help with sleep onset.”

 Question 3
1 out of 1 points
Methylphenidate, amphetamine, and cocaine are alike because all three
Selected Answer: c.
act as depressants.


NURS6630 Final Exam: Walden University

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

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.

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
A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion
(Wellbutrin) D. Desipramine (Norpramin)

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)

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.

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.

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

A 26-year-old female patient with nicotine dependence and a history of anxiety presents
with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the
assessment, what does the PMHNP consider?
A. ADHD is often not the focus of treatment in adults with comorbid conditions. B.
ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no
reported impact on ADHD symptoms. D. Symptoms are often easy to treat with
stimulants, given the lack of comorbidity with other conditions.

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

A 43-year-old male patient is seeking clarification about treating attention deficit
hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his
son is on medication to treat ADHD. The PMHNP conveys a major difference is which of
the following?
A. Stimulant prescription is more common in adults. B. Comorbid conditions are more
common in children, impacting the use of stimulants in children. C. Atomoxetine
(Strattera) use is not advised in children. D. Comorbidities are more common in adults,
impacting the prescription of additional agents.

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.

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

A 63-year-old patient presents with the following symptoms. The PMHNP determines
which set of symptoms warrant prescribing a medication? Select the answer that is
matched with an appropriate treatment.
A. Reduced ability to remember names is most problematic, and an appropriate treatment
option is memantine. B. Impairment in the ability to learn and retain new information is
most problematic, and an appropriate treatment option would be donepezil. C. Reduced
ability to find the correct word is most problematic, and an appropriate treatment option
would be memantine. D. Reduced ability to remember where objects are most
problematic, and an appropriate treatment option would be donepezil.

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:
A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D.
Aphasia, agnosia, arthralgia

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?
A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the

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?
A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or
Escitalopram (Lexapro)

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable
bowel syndrome. Which cholinergic drug may be the best choice for treatment given the
patient’s gastrointestinal problems?
A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above

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

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet.
She inquiries about possible treatments for her daughter’s addiction. Which response by
the PMHNP demonstrates understanding of pharmacologic approaches for compulsive
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.”

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.

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)

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.”

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
A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs

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.

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

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.


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

Which of the following is a true statement regarding the use of stimulants to treat attention
deficit hyperactivity disorder (ADHD)?
A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake
inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines
and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength
output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In
conditions where excessive DA activation is present, such as psychosis or mania, comorbid
ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants
that are short acting are preferred to treat ADHD.

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?
A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera)
D. Both “A” & “C” E. “C” only

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

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 norepinephrine (NE). B.
Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C.
Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to
increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All
of the above.

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.

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

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.”

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.

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

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

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.

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

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.

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.”

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)
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

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.

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

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

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.

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

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.”

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

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.

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

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

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

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.

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. Nonbenzodiazepine

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

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

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.”

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

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.”

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)

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.

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the
PMHNP considers treatment options, the patient must be assessed for other possible causes
of dementia. Which of the following answers addresses both possible other causes of
dementia and a rational treatment option for Dementia?
A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible
treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency,
hyperparathyroidism Possible treatment option: donepezil C. Possible other causes:
hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone
D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus
Possible treatment option: donepezil

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?
A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B.
Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing
acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.”

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?
A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine
C. Anxiety and avoid methylphenidate D. Both “A” & “B”

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?
A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good
option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C.
Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both
“A” & “C.”

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients
with smoking cessation. Why is this medication effective for these patients?
A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive
through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the
way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling
more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to
increase the availability of dopamine.

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the
following conditions?
A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal

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?
A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine

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
A. Evaluate the patient’s willingness to abstain from alcohol B. Counsel the patient on dietary
restrictions C. Obtain liver function tests D. Assess for addiction to opioids

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?
A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI.
C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his
symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA.

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?
A. Kidney disease stage II B. Obesity C. Cardiovascular disease D. Diabetes type II

The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER
(Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine
A. Phentermine (Adipex-P) dose can be increased safely when taken with an anticonvulsant. B.
Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts
by inhibiting appetite. C. Topiramate (Topamax) potentiates appetite suppression achieved by
phentermine (Adipex-P). D. Topiramate (Topamax) helps prevent the unwanted side effects of
phentermine (Adipex-P).

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?
A. Barbiturate intoxication B. Marijuana intoxication C. “Bath salt” intoxication D. Cocaine

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?
A. The patient’s speech is slurred, and he is in and out of sleep. B. The patient’s appetite has decreased
from eating 100% of his meal to 50% of his meal. C. The patient complains of not having a bowel
movement for 4 days. D. The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure,
and 8 respirations.

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