Antipsychotic Medications and Extrapyramidal Symptoms - Prof. PURDUL, Exams of Nursing

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NURS 6630 MIDTERM EXAM –

QUESTION AND ANSWERS

(COMBINED PACKAGE) V1 TO

 MIDTERM EXAM 1-

 QUESTIONS & ANSWERS

 ALL POSSIBLE QUESTIONS &

ANSWERS 2024 UPDATE



NURS 6630 MIDTERM EXAM 1 – QUESTION AND ANSWERS

A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP). Selected Answer:

C.

“Most medications that work in the brain will result in restoring an imbalance of one or more neurotransmitters that your body already produces helping to alleviate your symptoms .” Ms. Hill is currently being treated for schizophrenia but has stopped taking her medications due to some side effects she claims she was experiencing. She presents to the clinic today with worsening symptoms. She is experiencing anhedonia, agitation, attentional impairment, and affective blunting. Which one of the symptoms mentioned is considered a positive symptom of schizophrenia? Selected Answer: B. Agitation Which statement about neurotransmitters and medications is true? Selected Answer:

D.

An imbalance of serotonin has been directly linked to depression. Following the discovery of this neurotransmitter, pharmacologists were able to develop a well- known drug- Prozac as the first medication used to restore the balance of serotonin. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: Selected Answer:

C.

“Many psychiatric illnesses involve several dys-functioning neurotransmitter systems in the brain. Often, a single medication may only effect one or two of the dys-functioning systems. The addition of another medication can work with the current medication in stabilizing multiple neurotransmitter systems and help to alleviate your symptoms.”

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Selected Answer:

A.

Most medications that act on G-protein linked receptors have antagonistic traits. 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: Selected Answer: A. The patient smokes cigarettes. A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to: Selected Answer: B. Write an order for a different mood stabilizer 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). When assessing the psychiatric medications and the reason for admission, what would be the best course of action for the PMHNP with this client? Selected Answer: A. Review Amitriptyline (Elavil) level 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? Selected Answer: D. To help decrease the amount of serotonin and dopamine The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

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Selected Answer: D. “I feel nervous to go outside and be in large crowds.” Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription? Selected Answer: A. “The drug will have an almost immediate effect.” A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? Selected Answer: D. Varenicline (Chantix) 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? Selected Answer: C. Partial agonists A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient? Selected Answer: B. “The patient could benefit from an anticonvulsant.” What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in common? Selected Answer: A. Ligand-gated ion channels with a pentameric structure

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What is accurate about the clinical description of psychosis? Selected Answer:

C.

It is a syndrome that can be associated with a number of psychiatric disorders. The PMNHP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This client has begun to develop a common side effect of this medication. What is this side effect? Selected Answer: D. Tardive dyskinesia 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 called an atypical antipsychotic. What neurotransmitters will this new medication work on? Selected Answer: A. dopamine and serotonin Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body? Selected Answer:

D.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia. Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient? Selected Answer: B. The recent change of a 2nd generation antipsychotic to a conventional one

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Mrs. Schwartzman is a 52-year-old client with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities since starting her new medication. What does the PMHNP infer from this encounter with the client? Selected Answer:

C.

The new medication is blocking D2 receptors in the mesolimbic system 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? Selected Answer: C. D2 receptors that are blocked in the nigrostriatal pathway Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon? Selected Answer: A. 5HT2 antagonism Mr. Gordon is a middle-aged client who was started on antidepressant monotherapy for depression. After beginning this medication, the PMHNP noticed that this client seemed to swing into a hypomanic episode. What can the PMHNP infer from this behavior change? Selected Answer: D. A and C Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation? Selected Answer: A. The patient has an unsustained response to antidepressants.

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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? Selected Answer: D. A and C Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication? Selected Answer:

D.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs. Fluoxetine (Prozac) has been prescribed for a client with depression. Which of the following statements is true regarding the action of this medication? Selected Answer: B. Fluoxetine inhibits the serotonin transporter (SERT). The nurse education knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities? Selected Answer:

D.

Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic effects. A 45 year old female client with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed when considering phenelzine in treating her depression? Selected Answer:

B.

The client will need to minimize dietary intake of foods that are high in tyramine.

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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? Selected Answer: D. A and C 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: Selected Answer: B. SSRI/SNRI plus NDRI A nurse overhears that a client has failed monotherapy with an SSRI and an SNRI. She also learns that the client has failed dual SSRI + SNRI therapy. The nurse approaches the PMHNP and asks what treatment options should be considered in this treatment resistant client. The PMHNP tells the nurse that she will treat the client with the following regimen. Selected Answer: B. SSRI + NDRI 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? Selected Answer: C. Induction of mania is rare. A client is prescribed fluoxetine but is concerned about side effects. Which statement demonstrates accurate client teaching when discussing the side effects associated with fluoxetine? Selected Answer: C. Sedation is unusual

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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? Selected Answer: A. “You must avoid soy products, such as tofu.” 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? Selected Answer: D. “Decongestants should be avoided due to risk of hypertensive crisis.” 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? Selected Answer:

C.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)? Selected Answer: B. Patient with partial seizures 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? Selected Answer: A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

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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? Selected Answer: D. trazadone (Oleptro) 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? Selected Answer:

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 A client who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response? Selected Answer:

C.

Mood stabilizers can treat either manic phases or depressive phases of bipolar disorder. The PMHNP is assessing a client in the emergency room. The client shares that he has been on lithium for many years. What blood test does the PMHNP order? Selected Answer: A. Thyroid Stimulating Hormone 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? Selected Answer: B. Gabapentin (Neurontin)

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out of 1 points There are a number of endocrine reactions that accompany fear. A quick boost of cortisol may enhance survival when encountering a real but short- term threat. However, chronic elevations in cortisol can lead to increased medical comorbidities. Which of the following medical conditions may be related to these persistent cortisol elevations? Selected Answer: D. All of the above The PMHNP understands that the potential of alcohol abuse in the anxious client is higher for the following reasons: Selected Answer: a. Alcohol exerts an effect on GABAA receptors. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect? Selected Answer: D. All of the above The PMHNP evaluates the patient for “fear conditioning” when he asks: Selected Answer: D. What makes your fear better? A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose: Selected Answer: B. Beta blockers are linked to reconsolidation.

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NURS 6640 MIDTERM EXAM 2 – QUESTION AND

ANSWERS

User Course NURS-6640 Psychotherapy Individ Test Week 6 Midterm exam Status Completed Attempt Score 84% Results Displayed Submitted Answers

 Question 1

0 out of 1 points A PMHNP is treating a 45-year-old female patient who is upset that her brother has not been calling since his divorce. When asked to describe her brother and what prompts him not to call as frequently, she says, “Everything is about him, not me. I think he’s jealous that I have a good marriage and he wants me to be unhappy, too. So he doesn’t call to upset me and ruin my relationships.” Based on this information, the PMHNP can conclude that the patient _________. Selected Answer:

B.

has an insistent emphasis on the feelings of others

 Question 2

1 out of 1 points When a PMHNP is seeing a patient for the first time, what is an important step to assure that the patient and provider understand the limits of their discussion? Selected Answer:

C.

Have a discussion about the confidentiality and its limits

 Question 3

1 out of 1 points You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve seen him. It’s hard to talk about this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ which therapeutic principle? Selected A.

does it feel to you?”

 Question 8

1 out of 1 points The PMHNP understands that anxiety and depression are two disorders in which their symptoms may overlap. When discussing this, you explain that the autonomic nervous system is activated and further helps distinguish anxiety symptoms by making the following points: Selected Answer:

B.

“You may experience fear, sweating, and muscle tension.”

 Question 9

1 out of 1 points The PMHNP meets with an adolescent patient who has depression and often presents with resistance when discussing his parent’s divorce. For the past couple of sessions, the patient has been quiet, sometimes refusing to speak. To further support the therapeutic relationship, the PMNHP: Selected Answer:

A.

Observes and points out the behavior

 Question 10

1 out of 1 points The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient’s intense emotional reactions? Selected Answer:

C.

Suggest a relaxation technique, such as yoga or meditation

 Question 11

0 out of 1 points A 35-year-old patient seeks treatment for depression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to teach the safe-place exercise to create a feeling of calm. In order to walk the patient through the exercise, the PMHNP first says: Selected Answer:

D.

“Picture a beautiful beach and describe to me what you see.”

 Question 12

1 out of 1 points True or false: A PMHNP may ask his patient to describe her relationship with her father, both as a child and now, in order to assess interpersonal style. Selected Answer: Fals e

 Question 13

1 out of 1 points An initial evaluation reveals that an 11-year-old patient has moved to a new school after her parents’ recent divorce, and is having trouble making friends. The patient has normal mental status and exhibits appropriate behavior. What is the most appropriate scale for the PMHNP to use to get more information? Selected Answer:

D.

Impact of Event Scale

 Question 14

1 out of 1 points A 62-year-old patient has been diagnosed with borderline personality disorder. Upon assessment, the PMHNP learns that he participates in spending sprees and occasional binge eating, accompanied by rapid changes in self-image. Which evidence-based psychotherapeutic model does the PMHNP identify as effective and beneficial? Selected Answer:

C.

Dialectical behavior therapy

 Question 15

0 out of 1 points The PMHNP is working with an adult patient who has somatic complaints caused by a history of childhood abuse. As part of the therapeutic process, what does the PMHNP do to assess and organize a trauma history? Selected Answer:

D.

Debrief with the patient

 Question 16

1 out of 1 points The PMHNP is working with a veteran who has posttraumatic stress disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in allowing the patient to focus on the here and now. What strategies can the PMHNP use to develop dual awareness in the patient? Selected Answer:

D.

All of the above

 Question 17

1 out of 1 points A PMHNP is treating a 50-year-old patient who suffers from depression. When he was growing up, he was often responsible for taking care of his three younger siblings. Since then, the patient puts other people’s needs before his own. Based on this information, the PMHNP would conclude that his interpersonal style is __________. Selected Answer:

A.

overly nurturing