NURS 663ON-9 WEEK 6 MIDTERM EXAM, WALDEN

Question 1 1 out of 1 points 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? Selected Answer: D. D2 receptors are the primary binding site for dopamine agonists.  Question 2 1 out of 1 points 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  Question 3 1 out of 1 points NURS 663ON-9 WEEK 6 MIDTERM EXAM, WALDEN The PMHNP evaluates the patient for “fear conditioning” when he asks: Selected Answer: A. Have you ever experienced any type of trauma?  Question 4 1 out of 1 points While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? Selected Answer: B. Changes made to proteins lead to changes in behavior.  Question 5 1 out of 1 points 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? Selected Answer: B. Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.  Question 6 1 out of 1 points A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease? Selected Answer: A. Achieving underactivity of the mesocorticol projections to the prefrontal cortex  Question 7 1 out of 1 points The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants 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  Question 8 1 out of 1 points Though medications have the ability to target neurotransmitter release into the synapse by the presynaptic neuron it is not always necessary. The PMHNP understands that this is because: Selected Answer: C. Neurotransmitters can spread by diffusion.  Question 9 1 out of 1 points 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.  Question 10 1 out of 1 points 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.”  Question 11 0 out of 1 points 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: B. D2 antagonism  Question 12 1 out of 1 points 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  Question 13 1 out of 1 points 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  Question 14 0 out of 1 points 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: A. To promote the availability of serotonin  Question 15 1 out of 1 points Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis? Selected Answer: B. “I have to talk to the President because I’m the only one who can help him.”  Question 16 1 out of 1 points 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 .”  Question 17 1 out of 1 points 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.  Question 18 1 out of 1 points The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)? Selected Answer: B. Muscarinic M1 receptor blockade causes blurred vision.  Question 19 1 out of 1 points 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: B. Those that are potent D2 antagonists with 5HT2A antagonism properties  Question 20 1 out of 1 points 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)  Question 21 1 out of 1 points 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.  Question 22 1 out of 1 points During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the PMHNP’s best response is: Selected Answer: D. “Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”  Question 23 1 out of 1 points A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? Selected Answer: D. Varenicline (Chantix)  Question 24 1 out of 1 points 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.  Question 25 1 out of 1 points 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: Selected Answer: C. Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)  Question 26 1 out of 1 points Ms. Boeckh is a 42-year-old client who is taking an antidepressant therapy. The PMHNP understands that this medication can have substantial food interactions that can cause Ms. Boeckh to develop a hypertensive crisis. Which antidepressant class is Ms. Boeckh’s medication in? Selected Answer: B. MAO inhibitors  Question 27 1 out of 1 points 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.  Question 28 0 out of 1 points The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this client? Selected Answer: D. Lamotrigine (Lamictal)  Question 29 1 out of 1 points 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  Question 30 1 out of 1 points 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  Question 31 1 out of 1 points 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  Question 32 1 out of 1 points During gene expression, what must occur prior to a gene being expressed? Selected Answers: A. Transcription factor must bind to the regulatory region within the cell’s nucleus.  Question 33 1 out of 1 points 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  Question 34 1 out of 1 points 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).  Question 35 1 out of 1 points A client is prescribed fluoxetine but is concerned about side effects. Which statement demonstrates accurate client teaching when discussing the side effects associated