Midterm Explained 2
Review Test Submission:
Midterm Exam - Week 6
User Msee Wa Estlando
Course NURS-6630N,Approaches to Treatment.2020 Winter Qtr
11/30-02/21
Test Midterm Exam - Week 6
Started 1/8/21
Submitted 1/9/21
Due Date 1/11/21
Status Completed
Attempt Score - out of 100 points
Time Elapsed 2 hours, 29 minutes out of 2 hours and 30 minutes
Results Feedback after exam below – Questions on last
Displayed pages
• Question 1
What is the strongest established risk factor for bipolar disorder? Family History
Response “The strongest established risk factor for BPD is a family
Feedback: history of BPD.”
• Question 2
Which of the following medications are known as selective serotonin re-uptake inhibitors
(SSRIs)?
i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine
• Question 3
Which disease state of a non-adherent patient is at greater risk for substance use,
violence, and victimization as well as worse overall quality of life? Schizophrenia
Response “Moreover, non-adherent patients with schizophrenia are at greater
Feedback: risk for substance use, violence, and victimization as well as worse
overall quality of life.”
• Question 4
Patient is a 72-year-old male with a past medical history significant for atrial fibrillation
and COPD with a new diagnosis of major depression disorder. Based on his comorbid
,Midterm Explained 2
conditions, what antidepressant would you recommend as first-line?
Response (Options C & D are both TCA antidepressants and, based on the patient’s
Feedback: age and comorbid conditions, a TCA would likely result in more side
effects, such as increased fall risk due to potential for orthostatic
hypotension and anticholinergic-related side effects. In addition, patient
has a history for cardiac abnormalities due to A. fib diagnosis - TCAs
result in electrocardiographic changes in susceptible individuals,
therefore, would likely avoid. Choice B is used more for ADHD purposes
than as an antidepressant)
Page numbers used: Page 39 for TCA side-effect profile
• Question 5
Which of the following is an appropriate strategy for managing treatment-resistant
depression?
Use both SSRI and SNRI
• Question 6
Which of the following medications is best to AVOID in maintenance treatment of bipolar
disorder and why?
Response “As noted previously, antidepressants may contribute to an
Feedback: increase in mood episode frequency.”
• Question 7
With second-generation antipsychotics, what is the main side effect that requires
frequent monitoring?
Response table 7-6 & page 80, table 7-7; Page 78: “However, attention over the
Feedback: past decade has focused on effect of second-generation antipsychotics
on glucose metabolism and lipids and associated metabolic syndrome.”
• Question 8
Which amino acid is involved in the synthesis of both norepinephrine and dopamine?
• Question 9
An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision,
and constipation. He has a past medical history significant for hypertension, heart failure,
and depression. Of the following medications, which one is likely contributing to these
side effects?
Response Only TCA is listed with most anticholinergic effects; Page 39 for TCA
Feedback: side effect profile: “dry mouth, blurred vision, constipation, urinary
hesitancy, tachycardia, memory difficulties, and ejaculatory difficulties”
• Question 10
Which medication has been studied and recommended in patients with a social anxiety
,Midterm Explained 2
disorder who also suffer from an alcohol use disorder?
Response “Suggested that treatment with the SSRI paroxetine decreased the
Feedback: anxiety and may have reduced the alcohol use as well”
• Question 11
M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is
needed. Which of the following would be a first-line treatment option for M. B.?
i. Duloxetine
ii. Quetiapine
iii. Diazepam
iv. Escitalopram
Response “As is true for panic and the other anxiety disorders, the SSRIs and
Feedback: SNRIS are generally considered first-line agents for the treatment of
GAD because of their favorable side effect profile….”
• Question 12
The serotonin system is involved in many processes in psychiatry, including, most
prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is
serotonin synthesized?
Response under serotonin subheading and figure 1-18
Feedback: on page 16:
Locus Coeruleus: Norepinephrine
Nucleus basalis: cholinergic neurons
Substantia Nigra: dopamine Ventral
Tegmental area: dopamine
• Question 13
Which of the following symptoms is NOT part of the diagnostic features for bipolar
disorder?
Response “Psychosis is not represented in the diagnostic features for BPD.”
Feedback: - “Psychosis typically resolves along with the mood symptoms, though
diagnostic criteria acknowledge that psychotic symptoms may linger
beyond the end of the episode.”
• Question 14
A 32-year-old males calls you complaining of decreased libido since starting Paroxetine
20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now
experiencing extreme irritability and nervousness. He wishes to stop this medication due
to side effects. What do you recommend?
Response under selective serotonin re-uptake inhibitors discontinuation syndrome
Feedback: subtitle: “The risk of such adverse events occurring seems to be inversely
related to the half-life of the SSRI, with fluoxetine reported as having a
significantly lower risk than paroxetine in two studies. For more severe
discontinuation-related adverse events, re-institution of the SSRI and
slow taper may be necessary to alleviate these symptoms.”
• Question 15
, Midterm Explained 2
It is appropriate to start lamotrigine in combination with another atypical antipsychotic in
treatment of an acute manic episode in bipolar disorder.
Response “Lamotrigine has also been extensively studied in bipolar
Feedback: depression as well….”
• Question 16
Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar
disorder?
i. Depakote
ii. Lamotrigine
iii. Topiramate
iv. Carbamazepine
v. Gabapentin
Response All the others listed except for lamotrigine are not used in
Feedback: treatment of bipolar disorder.
• Question 17
A 23-year-old female was just diagnosed with major depressive disorder and is being
started on escitalopram 10 mg daily. The patient should be counseled about which Black
Box warning?
Response “In 2004, the FDA asked manufacturers of almost all the new
Feedback: antidepressant drugs to include in their labeling a warning statement
that recommends close observation of adult and pediatric patients
treated with these drugs for worsening depression or the emergence of
suicidality."
• Question 18
Which statement is TRUE regarding the use of selective serotonin reuptake
inhibitors (SSRI)/serotonin-norepinephrine reuptake inhibitors (SNRI) in patients with
Generalized Anxiety Disorder?
Response “Because the SSRI/SNRIs have the potential to cause initial restlessness,
Feedback: insomnia, and increased anxiety, and because the patients are
commonly sensitive to somatic sensations, the starting doses should be
low, typically half (or less) of the usual starting dose….”
• Question 19
Which of the following statements below is NOT considered an appropriate treatment
strategy for treatment-resistant depression?
Response “Combination of an SSRI OR an SNRI with a norepinephrine-dopamine
Feedback: re-uptake inhibitor (bupropion) or a serotonin-norepinephrine
antagonist (mirtazapine or mianserin) is a commonly used combination”
• Question 20
Which atypical antipsychotic(s) require a meal for better absorption?
i. Quetiapine
ii. Ziprasidone
Review Test Submission:
Midterm Exam - Week 6
User Msee Wa Estlando
Course NURS-6630N,Approaches to Treatment.2020 Winter Qtr
11/30-02/21
Test Midterm Exam - Week 6
Started 1/8/21
Submitted 1/9/21
Due Date 1/11/21
Status Completed
Attempt Score - out of 100 points
Time Elapsed 2 hours, 29 minutes out of 2 hours and 30 minutes
Results Feedback after exam below – Questions on last
Displayed pages
• Question 1
What is the strongest established risk factor for bipolar disorder? Family History
Response “The strongest established risk factor for BPD is a family
Feedback: history of BPD.”
• Question 2
Which of the following medications are known as selective serotonin re-uptake inhibitors
(SSRIs)?
i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine
• Question 3
Which disease state of a non-adherent patient is at greater risk for substance use,
violence, and victimization as well as worse overall quality of life? Schizophrenia
Response “Moreover, non-adherent patients with schizophrenia are at greater
Feedback: risk for substance use, violence, and victimization as well as worse
overall quality of life.”
• Question 4
Patient is a 72-year-old male with a past medical history significant for atrial fibrillation
and COPD with a new diagnosis of major depression disorder. Based on his comorbid
,Midterm Explained 2
conditions, what antidepressant would you recommend as first-line?
Response (Options C & D are both TCA antidepressants and, based on the patient’s
Feedback: age and comorbid conditions, a TCA would likely result in more side
effects, such as increased fall risk due to potential for orthostatic
hypotension and anticholinergic-related side effects. In addition, patient
has a history for cardiac abnormalities due to A. fib diagnosis - TCAs
result in electrocardiographic changes in susceptible individuals,
therefore, would likely avoid. Choice B is used more for ADHD purposes
than as an antidepressant)
Page numbers used: Page 39 for TCA side-effect profile
• Question 5
Which of the following is an appropriate strategy for managing treatment-resistant
depression?
Use both SSRI and SNRI
• Question 6
Which of the following medications is best to AVOID in maintenance treatment of bipolar
disorder and why?
Response “As noted previously, antidepressants may contribute to an
Feedback: increase in mood episode frequency.”
• Question 7
With second-generation antipsychotics, what is the main side effect that requires
frequent monitoring?
Response table 7-6 & page 80, table 7-7; Page 78: “However, attention over the
Feedback: past decade has focused on effect of second-generation antipsychotics
on glucose metabolism and lipids and associated metabolic syndrome.”
• Question 8
Which amino acid is involved in the synthesis of both norepinephrine and dopamine?
• Question 9
An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision,
and constipation. He has a past medical history significant for hypertension, heart failure,
and depression. Of the following medications, which one is likely contributing to these
side effects?
Response Only TCA is listed with most anticholinergic effects; Page 39 for TCA
Feedback: side effect profile: “dry mouth, blurred vision, constipation, urinary
hesitancy, tachycardia, memory difficulties, and ejaculatory difficulties”
• Question 10
Which medication has been studied and recommended in patients with a social anxiety
,Midterm Explained 2
disorder who also suffer from an alcohol use disorder?
Response “Suggested that treatment with the SSRI paroxetine decreased the
Feedback: anxiety and may have reduced the alcohol use as well”
• Question 11
M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is
needed. Which of the following would be a first-line treatment option for M. B.?
i. Duloxetine
ii. Quetiapine
iii. Diazepam
iv. Escitalopram
Response “As is true for panic and the other anxiety disorders, the SSRIs and
Feedback: SNRIS are generally considered first-line agents for the treatment of
GAD because of their favorable side effect profile….”
• Question 12
The serotonin system is involved in many processes in psychiatry, including, most
prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is
serotonin synthesized?
Response under serotonin subheading and figure 1-18
Feedback: on page 16:
Locus Coeruleus: Norepinephrine
Nucleus basalis: cholinergic neurons
Substantia Nigra: dopamine Ventral
Tegmental area: dopamine
• Question 13
Which of the following symptoms is NOT part of the diagnostic features for bipolar
disorder?
Response “Psychosis is not represented in the diagnostic features for BPD.”
Feedback: - “Psychosis typically resolves along with the mood symptoms, though
diagnostic criteria acknowledge that psychotic symptoms may linger
beyond the end of the episode.”
• Question 14
A 32-year-old males calls you complaining of decreased libido since starting Paroxetine
20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now
experiencing extreme irritability and nervousness. He wishes to stop this medication due
to side effects. What do you recommend?
Response under selective serotonin re-uptake inhibitors discontinuation syndrome
Feedback: subtitle: “The risk of such adverse events occurring seems to be inversely
related to the half-life of the SSRI, with fluoxetine reported as having a
significantly lower risk than paroxetine in two studies. For more severe
discontinuation-related adverse events, re-institution of the SSRI and
slow taper may be necessary to alleviate these symptoms.”
• Question 15
, Midterm Explained 2
It is appropriate to start lamotrigine in combination with another atypical antipsychotic in
treatment of an acute manic episode in bipolar disorder.
Response “Lamotrigine has also been extensively studied in bipolar
Feedback: depression as well….”
• Question 16
Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar
disorder?
i. Depakote
ii. Lamotrigine
iii. Topiramate
iv. Carbamazepine
v. Gabapentin
Response All the others listed except for lamotrigine are not used in
Feedback: treatment of bipolar disorder.
• Question 17
A 23-year-old female was just diagnosed with major depressive disorder and is being
started on escitalopram 10 mg daily. The patient should be counseled about which Black
Box warning?
Response “In 2004, the FDA asked manufacturers of almost all the new
Feedback: antidepressant drugs to include in their labeling a warning statement
that recommends close observation of adult and pediatric patients
treated with these drugs for worsening depression or the emergence of
suicidality."
• Question 18
Which statement is TRUE regarding the use of selective serotonin reuptake
inhibitors (SSRI)/serotonin-norepinephrine reuptake inhibitors (SNRI) in patients with
Generalized Anxiety Disorder?
Response “Because the SSRI/SNRIs have the potential to cause initial restlessness,
Feedback: insomnia, and increased anxiety, and because the patients are
commonly sensitive to somatic sensations, the starting doses should be
low, typically half (or less) of the usual starting dose….”
• Question 19
Which of the following statements below is NOT considered an appropriate treatment
strategy for treatment-resistant depression?
Response “Combination of an SSRI OR an SNRI with a norepinephrine-dopamine
Feedback: re-uptake inhibitor (bupropion) or a serotonin-norepinephrine
antagonist (mirtazapine or mianserin) is a commonly used combination”
• Question 20
Which atypical antipsychotic(s) require a meal for better absorption?
i. Quetiapine
ii. Ziprasidone
