Description

NR546 Week 8 Final Exam

Question 1

A client taking atomoxetine (Strattera) for ADHD begins to neglect personal hygiene and does not want to see friends. What medication would be appropriate?

1. amphetamine
   B. lisdexamfetamine
   C. bupropion ✅
   D. guanfacine

Question 2

The spouse of a client with Alzheimer disease asks the provider for more information about the rivastigmine transdermal patch that is being used. After the discussion with the provider, which statement by the spouse indicates a need for further explanation?

1. “We should remove the old patch before applying the new one.”
   B. “Doses are lower but steadier with the transdermal patch.”
   C. “We only need to change the patch every 2 weeks.” ✅
   D. “Reduced side effects occur with the transdermal patch.”

Question 3

The PMHNP prescribes rivastigmine for a client with dementia. The client reports moderate gastrointestinal side effects. What is the most appropriate course of action to decrease GI side effects?

1. Educate the client that GI side effects will decrease with time.
   B. Educate the client to take medication with food.
   C. Change from oral administration to a transdermal formulation. ✅
   D. Switch medication to donepezil for less GI effects.

Question 4

Which medication is contraindicated for use in clients with severe hepatic impairment?

1. memantine
   B. rivastigmine
   C. galantamine
   D. tacrine ✅

Question 5

Which antidepressant is used as an adjunct to treatment for clients with depression who report continuing sleep difficulties?

1. trazodone (Desyrel) ✅
   B. bupropion (Wellbutrin)
   C. escitalopram (Lexapro)
   D. citalopram (Celexa)

Question 6

A client was offered a choice between naltrexone and acamprosate for medication assisted therapy for alcohol use disorder. Which is the most accurate statement regarding these medications?

1. Naltrexone should be avoided in a client with kidney disease.
   B. Clients taking acamprosate tend to have better adherence.
   C. Naltrexone is available as one daily oral dosing or once monthly injection. ✅
   D. Naltrexone cannot be taken if the client is still drinking.

Question 7

A 70-year-old female with a history of atrial fibrillation and coronary artery disease is taking citalopram 20 mg po daily. The client tells the PMHNP that she would like to discuss a dose increase. What is the most appropriate response by the PMHNP?

1. A dose increase is limited for individuals who take aspirin.
   B. A dose increase is recommended because there are few medication interactions.
   C. A dose increase is limited due to risk of QTc prolongation. ✅
   D. A dose increase is recommended to decrease coronary artery disease.

Question 8

A 17-year-old is thrilled when he wins an important high school championship. This “natural high” is most likely associated with inducing dopamine release in the amygdala and:

1. mesolimbic pathway ✅
   B. hippocampus
   C. hypothalamus
   D. cerebellum

Question 9

An 80-year-old man with recent onset of dementia of the Alzheimer type has been treated for the last 6 months with galantamine 12 mg daily but is still experiencing moderate deterioration. Treatment options for this client include which of the following?

1. discontinuing galantamine therapy and starting ginkgo
   B. discontinuing the galantamine and starting bupropion
   C. continuing the galantamine and adding vitamin E ✅
   D. increasing the dose of galantamine

Question 10

Which medication is associated with risk of priapism?

1. paroxetine
   B. fluoxetine
   C. bupropion
   D. trazodone ✅

Question 11

Which client newly diagnosed with depression would be most likely to respond well to an antidepressant medication?

1. a 12-year-old male with difficulty concentrating and low energy
   B. a 17-year-old female with social withdrawal and suicidal ideations
   C. a 68-year-old male with anhedonia and cognitive dysfunction
   D. a 28-year-old female diagnosed with trouble sleeping and decreased appetite ✅

Question 12

An 87-year-old client with mild cognitive impairment is suspected of being in the early stages of Alzheimer’s disease. Although currently only used for research purposes, which biomarker evidence would support a diagnosis of Alzheimer’s disease?

1. increased CSF levels of amyloid beta and decreased CSF levels of tau protein
   B. decreased levels of brain amyloid beta on PET scans
   C. decreased CSF levels of amyloid beta and increased CSF levels of tau protein ✅
   D. increased levels of brain amyloid beta on PET scans

Question 13

Which of the following statements guides the selection of an alpha 2 agonist for the treatment of ADHD?

1. Clonidine is more selective for alpha 2b receptors and has a reduced side effect profile with guanfacine.
   B. Clonidine is more selective for alpha 2a receptors than guanfacine with a reduced side effect profile.
   C. Guanfacine is more selective for alpha 2a receptors and has a reduced side effect profile when compared with clonidine. ✅
   D. Guanfacine and clonidine are equally selective for alpha 2a receptors, but clonidine has a reduced side effect profile when compared with guanfacine.

Question 14

Which of the following statements is most accurate about the prescription of stimulant medications?

18. Stimulants are used in adults only and never used in pediatrics.
    B. Two-thirds of stimulants are prescribed to clients under the age of 18. ✅
    C. Stimulant medications are only prescribed to pediatric clients.
    D. Two-thirds of stimulants are prescribed to clients over the age of 18.

Question 15

Match the drug class to the baseline data the psychiatric and mental health nurse practitioner should obtain.

Baseline blood pressure should be obtained. (1)
ECG should be checked, especially in clients with known dysrhythmias or clients older than 40 years of age. (2)
Serum sodium should be checked in older adults and clients on diuretic therapy. (3)

Answers 1–3:
1. Stimulants (e.g., amphetamines) ✅
2. Tricyclic antidepressants (TCAs) ✅
3. SSRIs (e.g., sertraline, citalopram) ✅

Question 16

Which SSRI is considered the best tolerated with the fewest CYP-mediated drug interactions?

1. escitalopram
   B. fluoxetine
   C. sertraline ✅
   D. citalopram

Question 17

The client with a 6-year history of smoking is considering nicotine replacement therapy to help her quit smoking but has heard concerns about success rates from friends. Internet searches are confusing to the client. The PMHNP advises the client that which nicotine replacement therapy offers the highest rate of success?

1. bupropion
   B. nicotine nasal spray ✅
   C. nicotine transdermal patch
   D. varenicline

Question 18

A client recently disclosed a 10-year prescription opioid addiction to the PMHNP. The client is quite functional but continues seeking opiates to avoid withdrawal effects. Which of the following might the PMHNP tell the client about potential for recovery?

1. Opioid receptors return to normal immediately after discontinuing opioid use.
   B. Opioid receptors can readapt to normal but need a reduction in the amount of opiate exposure over time in order to do so. ✅
   C. Opioid receptors cannot readapt to normal after severe addiction but can reorganize to nearly full functionality with the aid of permanent pharmacotherapy.
   D. Opioid receptors can readapt to normal, but no pharmacological agent can prevent withdrawal.

Question 19

Dementia medications are likely to cause gastrointestinal (GI) distress. The PMHNP knows that GI side effects are most likely caused by which of the following?

1. AChE inhibition of butyryl cholinesterase (BuChE)
   B. AChE inhibition in pre and post synaptic neurons
   C. AChE inhibition in the periphery ✅
   D. AChE inhibition of nicotinic cholinesterase inhibitors

Question 20

Which selective serotonin reuptake inhibitor (SSRI) medication is FDA approved as a first line treatment for bulimia nervosa?

1. mirtazapine
   B. amitriptyline
   C. fluoxetine ✅
   D. bupropion