NR566 Week 8 Final Exam
Questions, Answers & Explanations
Question 33
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A middle-aged patient has a body mass index (BMI) of 32 and hypertension. They have been
following a structured lifestyle program for 6 months with minimal weight loss. Per the 2016
American Association of Clinical Endocrinology and the American College of Endocrinology
(AACE/ACE) obesity algorithm, which of the following is the most appropriate next step in
management?
Answer Choices
A. Immediately refer for bariatric surgery, because any patient with BMI >30 should receive
surgical intervention
B. Discontinue lifestyle therapy and initiate drug therapy alone, because lifestyle interventions
are ineffective at this BMI
C. Continue lifestyle therapy and consider adding drug therapy, as the patient has at
least one obesity-related complication ✓
D. Recommend only continued lifestyle therapy, since drug therapy is reserved for patients with
BMI ≥35 regardless of comorbidities
✓ Correct Answer: C — Continue lifestyle therapy and consider adding drug therapy, as
the patient has at least one obesity-related complication
Explanation: Per the AACE/ACE algorithm, pharmacotherapy may be considered for patients
with a BMI of 27-29.9 with at least one weight-related complication (such as hypertension), or a
BMI ≥30 regardless of comorbidities, always in conjunction with continued lifestyle therapy
rather than in place of it.
,Question 45
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A 45-year-old male with a history of migraines presents to the clinic complaining of frequent
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migraine attacks occurring more than 15 days per month, and reports using his abortive
medication daily for symptom relief. What complication of excessive abortive medication use
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should be considered in this patient?
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Answer Choices
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A. Serotonin syndrome
B. Opioid dependence
C. Medication overuse headache (MOH) ✓
D. Acetaminophen toxicity
✓ Correct Answer: C — Medication overuse headache (MOH)
Explanation: Medication overuse headache develops when abortive migraine medications
(triptans, NSAIDs, combination analgesics) are used too frequently (generally more than 10-15
days per month), paradoxically increasing headache frequency and severity, and requiring
withdrawal of the offending agent for resolution.
,Question 87
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A patient treated with a first-generation antipsychotic presents with severe spasms of the
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muscles of the face, neck, and back (an acute dystonic reaction). What is the most appropriate
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treatment for this condition?
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Answer Choices
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A. Centrally acting anticholinergic drugs ✓
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B. Alpha-2 blockers
C. Non-specific anticholinergic drug
D. Benzodiazepines
✓ Correct Answer: A — Centrally acting anticholinergic drugs
Explanation: Acute dystonic reactions, caused by dopamine receptor blockade from first-
generation (typical) antipsychotics, are treated with centrally acting anticholinergic agents such
as benztropine or diphenhydramine, which restore the dopamine-acetylcholine balance in the
basal ganglia.
, Question 57
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A 6-month-old infant requires treatment with a central nervous system (CNS) drug. Which
physiologic principle should the NP consider regarding drug dosing in this patient?
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Answer Choices
A. The blood-brain barrier in infants blocks most lipid-soluble drugs, requiring higher doses for
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effect
B. The infant's underdeveloped blood-brain barrier may allow higher CNS drug
penetration, increasing the risk of toxicity ✓
C. Protein-bound drugs readily cross the infant's blood-brain barrier, so lower doses are
typically required
D. Highly ionized drugs easily cross the infant's blood-brain barrier, reducing the risk of CNS
side effects
✓ Correct Answer: B — The infant's underdeveloped blood-brain barrier may allow
higher CNS drug penetration, increasing the risk of toxicity
Explanation: The blood-brain barrier is not fully developed until later in infancy, making infants
more susceptible to CNS drug penetration and toxicity. This requires careful, often weight-
based dosing and close monitoring when administering CNS-active medications to infants.
Questions, Answers & Explanations
Question 33
i a
uv
St
x-
fe
ht
rig
:B
m
ro
yF
nl
yO
Bu
A middle-aged patient has a body mass index (BMI) of 32 and hypertension. They have been
following a structured lifestyle program for 6 months with minimal weight loss. Per the 2016
American Association of Clinical Endocrinology and the American College of Endocrinology
(AACE/ACE) obesity algorithm, which of the following is the most appropriate next step in
management?
Answer Choices
A. Immediately refer for bariatric surgery, because any patient with BMI >30 should receive
surgical intervention
B. Discontinue lifestyle therapy and initiate drug therapy alone, because lifestyle interventions
are ineffective at this BMI
C. Continue lifestyle therapy and consider adding drug therapy, as the patient has at
least one obesity-related complication ✓
D. Recommend only continued lifestyle therapy, since drug therapy is reserved for patients with
BMI ≥35 regardless of comorbidities
✓ Correct Answer: C — Continue lifestyle therapy and consider adding drug therapy, as
the patient has at least one obesity-related complication
Explanation: Per the AACE/ACE algorithm, pharmacotherapy may be considered for patients
with a BMI of 27-29.9 with at least one weight-related complication (such as hypertension), or a
BMI ≥30 regardless of comorbidities, always in conjunction with continued lifestyle therapy
rather than in place of it.
,Question 45
i a
uv
St
x-
fe
ht
rig
:B
m
ro
A 45-year-old male with a history of migraines presents to the clinic complaining of frequent
yF
migraine attacks occurring more than 15 days per month, and reports using his abortive
medication daily for symptom relief. What complication of excessive abortive medication use
nl
should be considered in this patient?
yO
Answer Choices
Bu
A. Serotonin syndrome
B. Opioid dependence
C. Medication overuse headache (MOH) ✓
D. Acetaminophen toxicity
✓ Correct Answer: C — Medication overuse headache (MOH)
Explanation: Medication overuse headache develops when abortive migraine medications
(triptans, NSAIDs, combination analgesics) are used too frequently (generally more than 10-15
days per month), paradoxically increasing headache frequency and severity, and requiring
withdrawal of the offending agent for resolution.
,Question 87
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uv
St
x-
fe
ht
rig
:B
m
A patient treated with a first-generation antipsychotic presents with severe spasms of the
ro
muscles of the face, neck, and back (an acute dystonic reaction). What is the most appropriate
yF
treatment for this condition?
nl
Answer Choices
yO
A. Centrally acting anticholinergic drugs ✓
Bu
B. Alpha-2 blockers
C. Non-specific anticholinergic drug
D. Benzodiazepines
✓ Correct Answer: A — Centrally acting anticholinergic drugs
Explanation: Acute dystonic reactions, caused by dopamine receptor blockade from first-
generation (typical) antipsychotics, are treated with centrally acting anticholinergic agents such
as benztropine or diphenhydramine, which restore the dopamine-acetylcholine balance in the
basal ganglia.
, Question 57
ia
uv
St
x-
fe
ht
rig
:B
m
ro
yF
A 6-month-old infant requires treatment with a central nervous system (CNS) drug. Which
physiologic principle should the NP consider regarding drug dosing in this patient?
nl
yO
Answer Choices
A. The blood-brain barrier in infants blocks most lipid-soluble drugs, requiring higher doses for
Bu
effect
B. The infant's underdeveloped blood-brain barrier may allow higher CNS drug
penetration, increasing the risk of toxicity ✓
C. Protein-bound drugs readily cross the infant's blood-brain barrier, so lower doses are
typically required
D. Highly ionized drugs easily cross the infant's blood-brain barrier, reducing the risk of CNS
side effects
✓ Correct Answer: B — The infant's underdeveloped blood-brain barrier may allow
higher CNS drug penetration, increasing the risk of toxicity
Explanation: The blood-brain barrier is not fully developed until later in infancy, making infants
more susceptible to CNS drug penetration and toxicity. This requires careful, often weight-
based dosing and close monitoring when administering CNS-active medications to infants.
