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QUESTION

Oct 02, 2018

QUESTION 2 1. Which statement about neurotransmitters and medications is true?

QUESTION 2

1. Which statement about neurotransmitters and medications is true?

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

Neurotransmitters receive messages from most medications.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP's best response would be:

"In an extreme case such as yours, more than one medication is often needed."

"Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

"Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms."

"I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms."

1 points

QUESTION 4

1. During gene expression, what must occur prior to a gene being expressed?

Transcription factor must bind to the regulatory region within the cell's nucleus.

RNA must be converted to mRNA.

The coding region must separate from the regulatory region.

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 7

1. Why is the cytochrome P450 enzyme system of significance to the PMHNP?

The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective.

The bioavailability of the medication after it passes through the stomach and liver can be altered.

The medication's chemical composition changes when it comes in contact with the acid in the stomach.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 10

1. 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:

The patient smokes cigarettes.

The patient has hypertension.

The patient has chronic kidney disease, stage 2.

The patient drinks a cup of coffee a day.

1 points

QUESTION 12

1. 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?

Review Amitriptyline (Elavil) level

Order a liver function test

Check the patient's blood pressure and pulse

Order a stat platelet count

1 points

QUESTION 13

1. 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?

To promote the availability of serotonin

To decrease serotonin

To indirectly increase the amount of dopamine in the body

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

"I have trouble staying asleep in the middle of the night."

"My spouse told me that I seem to have trouble remembering things sometimes."

"I really want to stop smoking, but the cravings are too strong."

"I feel nervous to go outside and be in large crowds."

1 points

QUESTION 16

1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

Benzodiazepine

Mirtazapine (Remeron)

Ketamine

Varenicline (Chantix)

1 points

QUESTION 17

1. 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?

Full agonists

Antagonists

Partial agonists

Inverse agonists

1 points

QUESTION 20

1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

"It's my fault that all of this is happening. I don't think I could ever forgive myself."

"I have to talk to the President because I'm the only one who can help him."

"I'm not sure why that lady is wearing a red jacket since it's the dogs who need food."

"I don't know that I even want to go to that meeting. It doesn't seem worth it anymore."

1 points

QUESTION 22

1. Mr. 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?

Dopamine is terminated through multiple mechanisms.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

MAO-B presents in the mitochondria within the presynaptic neuron.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

1. Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?

"Amphetamines may help you, as they can alleviate psychotic conditions."

"Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you."

"Amphetamines can cause hallucinations, so I would advise against this type of prescription."

"Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you."

QUESTION 24

1. 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?

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 27

1. 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?

Olanzapine to clozapine

Asenapine to Risperidone

Aripripazole to ziprasidone

Aripripazole to clozapine

1 points

QUESTION 28

1. 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?

Quetiapine

Paliperidone

Lurasidone

Clozapine

1 points

QUESTION 31

1. 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)?

Long-term use of antipsychotics

Genetic disposition

Age

A and C

All of the above

1 points

QUESTION 32

1. The student inquires about antipsychotic medications. Which response by the PMHNP describes the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?

Those that are potent D2 antagonists

Those that are potent D2 antagonists with 5HT2A antagonism properties

D2 receptors that are blocked in the nigrostriatal pathway

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 39

1. Ms. 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?

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

Norepinephrine inhibits 5HT release through a2 receptors.

Norepinephrine inhibits α2 receptors on axon terminals.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

"Drugs inhibit the release of NE."

"Drugs can mimic the natural functioning of the NE neuron."

"Drugs are unable to simulate the effects of NE neurons."

"Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron."

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?

Neuronal firing rates are not dysregulated in depression.

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

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

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

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?

First onset in puberty or early adulthood

Late onset of menses

Premenstrual syndrome

A and C

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?

She may experience withdrawal symptoms.

She may experience increased trauma.

Effects of abrupt cessation are unknown.

It can lead to difficulties with concentration.

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?

Stop the venlafaxine

Lower the dose of venlafaxine by 50%

Lower the dose of venlafaxine by 25-40%

Increase the dose of venlafaxine by 50%

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?

"Decongestants are fine to continue taking with MAO inhibitors."

"Decongestants are okay to take with MAO inhibitors in moderation."

"Decongestants should be avoided due to risk of serotonin syndrome."

"Decongestants should be avoided due to risk of hypertensive crisis."

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?

mirtazapine (Remeron)

doxepin (Silenor)

alprazolam (Xanax)

trazadone (Oleptro)

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?

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

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

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

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

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:

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

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

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

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 74

1. The PMHNP evaluates the patient for "fear conditioning" when he asks:

Have you ever experienced any type of trauma?

What do you do when you feel fear?

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

What makes your fear better?

1 points