NUR 546 Psychopharmacology for the Psychiatric-Mental Health Nurse Practitioner PMHNP NUR 546 Midterm MOCK Exam Review Questions and Answers | 100% Pass | Grades A+| Guaranteed Success

Administrator [COMPANY NAME] [Company address] NUR 546 Psychopharmacology for the Psychiatric-Mental Health Nurse Practitioner PMHNP NUR 546 Midterm MOCK Exam Review Questions and Answers | 100% Pass | Grades A+| Guaranteed SuccessNUR 546 Psychopharmacology Midterm Mock Exam 2 / 15 1. A 22-year-old patient recently diagnosed with bipolar disorder and states "I'm not crazy" and is refusing to take his prescribed medication. Which type of factor is contributing to this patient's nonadherence? A. Client factors B. Clinician factors C. Structural factors D. Environmental factors 2. Using Dell'Osso et al.'s sequential framework of priorities to promote medication adherence, determine which step is being defined: The PMHNP explains the mechanism of action, anticipated time to experience effects, side effects, and lifestyle instructions to a patient after prescribing Wellbutrin. A. Diagnosis B. Medication education C. Monitoring plan D. Adherence reinforcement 3. A patient recovering from a stroke has trouble with speech comprehension and works with a speech ther- apist twice a week. Which part of the patient's brain has been affected by the stroke? A. The Broca's area B.The Basal ganglia C.The Limbic system D.The Wernicke's area 4. Which of the following poses a potential ethical con- cern when prescribing psychiatric medications? A. The patient is homeless and uninsured B. The patient poses a risk to themself as they state they are experiencing very scary auditory and visual hallucinationsNUR 546 Psychopharmacology Midterm Mock Exam 3 / 15 C. Structural fac- tors B. Medication edu- cation D. The Wernicke's area B.The patient pos- es a risk to them- self as they state they are experi- encing very scary auditory and visual hallucinationsNUR 546 Psychopharmacology Midterm Mock Exam 4 / 15 C.The patient's family voices a stigma against psychi- atric medications D.The patient states they worry about the potential side effects of the medication 5. What is the name of the lobe that controls visual processing? A. Gyrus B. Frontal Lobe C. Occipital Lobe D. Parietal Lobe 6. The cerebellum, cerebrum, brain stem, and butterfly-shaped portion of the central spinal cord are com- prised of which contains neural cell bodies, axon terminals, dendrites, and all nerve synapses. A. Frontal lobe B. White mater C. Grey mater D. Corpus callosum 7. What is the function of the central sulcus? A. Separates the temporal from the occipital lobe B. Separates the frontal from the parietal lobe C. Involved in complex motor activities D. Keeps us alert to our environment 8. Which of the following is associated with motor coor- dination? A. Broca's Area B. Olfactory Nerves C. Frontal Cortex D.Thalamus C. Occipital Lobe C. Grey mater B. Separates the frontal from the parietal lobe D. Thalamus 9. C. Temporal lobeNUR 546 Psychopharmacology Midterm Mock Exam 5 / 15 Which lobe of the brain is in charge of handling mem- ory and anxiety? A. Frontal lobe B. Anxiety center C.Temporal lobe D. Central sulcus 10. Damage to the anterior portion of which lobe can cause asterogenesis? A. Frontal B.Temporal C. Parietal D. Occipital 11. What part of a neuron receives the signal? A. Axon B. Axon Terminal C. Dendrites D. Soma 12. Which of the following separates the frontal lobe from the parietal lobe? A. The grey matter B.The central sulcus C.The Hippocampus D.The Broca's area 13. What lobe of the brain is responsible for higher-level executive functions such as expressive language and voluntary movement? A. Occipital lobe B. Parietal lobe C. Frontal lobe D.Temporal lobe C. Parietal C. Dendrites B. The central sul- cus C. Frontal lobeNUR 546 Psychopharmacology Midterm Mock Exam 6 / 15 14. Which area of the brain is regulates long term memo- ry? A. Hippocampus B. Parietal lobe C.Temporal lobe D. Occipital lobe 15. Which area of the brain is associated anxiety and perception of odors? A. Amygdala B. Basal ganglia C. Prefrontal cortex D.Wernicke's area 16. The limbic system is associated with which of the following? A. Executive function B. Emotion and learning C. Intelligence and movement D. Expressive speech 17. Which channel membrane protein is specifically im- portant in the process of neurotransmitter release? A. voltage-sensitive sodium channels. B. voltage-dependent (gated) calcium channels. C. neurotransmitter receptor potassium channels. D. voltage-dependent (gated) chloride channels. 18. A 76-year-old patient who is determined to be a poor 2D6 metabolizer is being prescribed vortioxetine for his depression. What does the PMHNP need to re- member when prescribing this drug? A. The dosage of the drug will need to be increased B.The dosage needs to begin at half then increase over a 2- week periodNUR 546 Psychopharmacology Midterm Mock Exam 7 / 15 A. Hippocampus A. Amygdala B.Emotion and learning B.voltage-depen- dent (gated) calci- um channels. C.The dosage should not exceed ½ of the usual rec- ommended doseNUR 546 Psychopharmacology Midterm Mock Exam 8 / 15 C. The dosage should not exceed ½ of the usual recommended dose D. An adjunct medication will need to be prescribed until the dosage can be reduced 19. Which of the following mechanisms would you asso- ciate with an antagonist drug action? A. A drug that binds postsynaptic receptors and mim- ics the effect of the neurotransmitter. B. A drug that binds and blocks normal auto receptor function. C. A drug that increases the enzymatic synthesis of neurotransmitters. D. A drug that binds postsynaptic receptors and blocks the normal action of the neurotransmitter. 20. A court order inpatient hospitalization was ordered for a patient who is considered a danger to themselves and other. Which ethical issue is being addressed? A. Informed consent B. Off labeling prescription C. Compliance D. Restrictive methods 21. What is the expected outcome for a patient who is considered a "intermediate metabolizer"? A. No need for medication dosage readjustments B. Increased risk for drug to drug reactions C. Provider increasing drug dosages D. Subtherapuetic drug levels 22. Which of the following is true regarding epigenetic changes? A. Epigenetic changes are reversible. B. Epigenetic changes, changes the DNA and how the body reacts to the DNA sequence.NUR 546 Psychopharmacology Midterm Mock Exam 9 / 15 D.A drug that binds postsynap- tic receptors and blocks the normal action of the neu- rotransmitter. C. Compliance B. Increased risk for drug to drug re- actions A. Epigenetic changes are re- versible.NUR 546 Psychopharmacology Midterm Mock Exam 10 / C. Epigenetic changes are not linked to mental health conditions. D. When combined with genetic risks, epigenetic changes decreased the risk for a psychiatric disease. 23. Which of the following brain structures is involved in voluntary motor movements? A. Basal ganglia B. Prefrontal cortex C. Amygdala D. Limbic system 24. Obtaining consent from from a the guardian of a patient who has limited cognitive capabilities or are incompetent to make decisions represents which ethi- cal principle? A. Informed consent B. Compliance C. Off label prescribing D. Confidentiality 25. Lack of medication access and the increasing costs of medication is which type of factor contributing to medication non adherence? A. Provider B. Environmental C. Structural D. Client 26. Which of the following is an enzyme inhibitor? A. Sulfaurea B. Smoking C. Rifampin D. Sulfamide A. Basal ganglia B. Compliance C. Structural D. SulfamideNUR 546 Psychopharmacology Midterm Mock Exam 11 / 27. D. CarbamezpineNUR 546 Psychopharmacology Midterm Mock Exam 12 / Which of the following is an enzyme inducer? A. Quinidine B. Ketoconazole C. Amiodarone D. Carbamezpine 28. Which of the following definitions are correct? A. Partial agonist- drug fully activates receptors B. Antagonist- drug binds to receptor and activates a response C. Inverse agonist- drug causes an opposite effect of the agonist D. Agonist- drug binds to the receptor and does not activate a biological response 29. Ethical issues within mental health include which of the following? A. Patient unable to afford medication B. Patient unable to self-determine care C. Patient's ethnic culture D. Patients wanting to include family in treatment plan 30. A patient presents to the PMHNP with report of having anxiety, frequent occurrences of feeling frozen in place and like his heart is pounding out of his chest, as well as having difficulty sleeping. The PMHNP sus- pects the patient has an elevated level of which neu- rotransmitter? A. Serotonin B. GABA C. Norepinephrine D. Dopamine 31. Which best defines a patient who is a poor metaboliz- er? C. Inverse agonist- drug causes an opposite effect of the agonist B. Patient unable to selfdetermine care C. NorepinephrineNUR 546 Psychopharmacology Midterm Mock Exam 13 / A. This patient has a lower concentra- tion of the necNUR 546 Psychopharmacology Midterm Mock Exam 14 / A. This patient has a lower concentration of the nec- essary enzyme to metabolize a medication. B. This patient will have lower blood concentrations of the medication. C. This patient has a decreased risk of side effects and adverse reactions D.This patient should not be prescribed antidepressants. 32. Which part of the Brian activates fear? A. Striatum B. Amygdala C. Limbic system D. Basal ganglia 33. Which neurotransmitter is responsible for the regula- tion of the "fight or flight" response? A. Dopamine B. Norepinephrine C. GABA D. Histamine 34. An increase of which neurotransmitter can result in hallucinations and/or psychosis? A. Serotonin B. Acetycholine C. Dopamine D. GABA 35. Which of the following neurotransmitters is consid- ered the chief inbibitory neurotransmitter? A. Serotonin B. Histamine C. Glutamate D. GABA essary enzyme to metabolize a med- ication, B. Amygdala B.Norepinephrine C. Dopamine D.GABANUR 546 Psychopharmacology Midterm Mock Exam 15 / 36. Increased levels of acetycholine result in C. depression A. hallucinations B. alhenizmers C. depression D. parkinson's 37. SSRIs, SNRIs, and tricyclic antidepressants increase levels of which neurotransmitter? A. Dopamine B. Serotonin C. GABA D. Glutamate 38. Which medication class does not affect serotonin? A. Benzodiazepines B. MOAIs C. SSRIs D.Tricyclic antidepressants 39. Which of the following is the best medication class for the PMHNP to prescribe to address elevated norepi- nephrine levels? A. SSRI B. MAOI C. SNRI D. Benzodiazepines 40. Psychotropic drug metabolism may be impacted by many factors except for A. age B. profession C. caffeine intake D. smoking B. Serotonin A. Benzodiazepines A. SSRI B. profession 41.NUR 546 Psychopharmacology Midterm Mock Exam 16 / Which dopamine pathway is associated with galactor- rhea and gynecomastia? A. Mesocortical pathway B. Mesolimbic pathway C.Tuberoinfundibular pathway D. NIgrostriatal pathway 42. An overactive mesolimbic pathway will result in A.dystonia and akanthesia. B. sexual dysfunction C. negative symtoms D. hallucinations and psychosis 43. Decreased levels of dopamine in which pathway is responsible for negative symptoms of schizophrenia? A. Nigrostriatal pathway B.Tuberoinfundibular pathway C. Mesolimbic pathway D. Mesocortical pathway 44. A patient on Haldol 10mg daily is noted to have and extreme form of slowness. The PMHNP understands which dopamine pathway is associated with this? A. Tuberoinfundibular pathway B. Mesocortical pathway C. Nigrostriatal pathway D. Mesolimbic pathway 45. Which neurotransmitter in considered the chief in- hibitory neurotransmitter? A. Histamine B. Dopamine C. GABA D. GlutamateNUR 546 Psychopharmacology Midterm Mock Exam 17 / C. Tuberoin- fundibular path- way D. hallucinations and psychosis D. Mesocortical pathway C. Nigrostriatal pathway C. GABANUR 546 Psychopharmacology Midterm Mock Exam 18 / 46. Which of the following teaching provided by the PMH- NP is correct when teaching a patient about EPS? A. EPS may cause dystonia which feels like inner rest- lessness that may lead to locking or finger tapping. B. EPS may cause tardive dyskinesia which may cause abnormal facial and tongue movements. C. EPS may cause akathisia which is involuntary mus- cle contractions which may be painful. D. EPS may cause bradykinesia which is involuntary movements or shaking. 47. A patient who recently started on a first generation antipsychotic reports sexual dysfunction and nipple discharge. Which of the following actions by the PMH- NP is appropriate? A. The PMHNP orders blood test to examine the pa- tient's prolactin level. B.The PMHNP states this is a normal response to treatment and these symptoms will decrease with time. C.The PMHNP asks the patient if they are taking any OTC supplements. D.The PMHNP educated the patient on EPS and informs the patient that they will have to discontinue their medication. 48. The PHMNP recognizes which of the following med- ication as an atypical antipsychotic? A. chlorpromazine B. aripiprazole C. haloperidol D. mesoridazine 49. Which of the following mediation is a first generation antipsychotic?NUR 546 Psychopharmacology Midterm Mock Exam 19 / B. EPS may cause tardive dyskine- sia which may cause abnormal facial and tongue movements. A. The PMHNP orders blood test to examine the patient's prolactin level. B. aripiprazole C. thiothixeneNUR 546 Psychopharmacology Midterm Mock Exam 20 / A. risperidone B. olanzapine C. thiothixene D. cariprazine 50. Which second-generation antipsychotic requires rou- tine absolute neutrophil count monitoring? A. Brexpiprazole B. Clozapine C. Risperidone D. Ziprasidone 51. What is the contraindication for ziprasidone? A. Daytime sedation B. Obseity due to high risk of weight gain C. Liver disease and hepatic failure D. QT, myocardial infarction, heart failure 52. Which of the following second generation antipsy- chotics is available sublingually or as transdermal patch? A. Clazapine B. Quetiapine C. Asenapine D. Olanzapine 53. Which of the following is the most appropriate option for an obese patient ? A. Clozapine B. Quetiapine C. Asenapine D. Olanzapine 54. Which medication is a better choice for a patient who is overweight? B. Clozapine D. QT, myocardial infarction, heart failure C. Asenapine C. Asenapine A. AripiprazoleNUR 546 Psychopharmacology Midterm Mock Exam 21 / A. Aripiprazole B. Clozapine C. Olanzapine D. Lurasidone 55. Which medication should the PMHNP avoid prescrib- ing for their schizophrenic elderly patient with a his- tory of falls? A. Brexiprazole B. Aripiprazole C. Risperidone D. Quetiapine 56. Which medication should the PMHNP rule out for a male patient who experienced sexual dysfunction and the development of breasts with a previous prescrip- tion of first generation antipsychotic? A. Lurasidone B. Risperidone C. Olanzapine D. Cariprazine 57. Which medication is not used in the treatment of OCD? A. sertraline B. paroxetine C. fluvoxamine D. duloxetine 58. The PMHNP recognizes which of the following med- ication is best used to treat PTSD? A. atenolol B. lorazepam C. paroxetine D. fluoxetine D. Quetiapine B. Risperidone D. duloxetine C. paroxetineNUR 546 Psychopharmacology Midterm Mock Exam 22 / 59. Which medication is best used to treat the somatic symptoms of anxiety? A. hydroxyzine B. propanolol C. citalopram D. buspirone 60. Which of the following statements is false related to buspirone? A. Buspirone is habit forming and can cause with- drawal symptoms. B. Can be prescribed short term, alone or adjunct. C. Binds to serotonin and dopamine receptors. D. Usually presided BID or TID due to short 1/2 half. 61. All of the following medications is an SNRI expect for: A. duloxetine B. venlafaxine C. desvenlafaxine D. sertaline 62. The patient reports a history of QT prolongation. Which medication is QT prolongation considered a contraindication? A. buspirone B. hydroxyzine C. gabapentin D. paroxetine 63. The patient reports a history of hypertension. Which medication should the PMHNP avoid prescribing in the treatment of anxiety for this patient? A. diazepam B. atenololNUR 546 Psychopharmacology Midterm Mock Exam 23 / B. propanolol A. Buspirone is habit forming and can cause withdrawal symptoms. D. sertaline B. hydroxyzine C. venlafaxineNUR 546 Psychopharmacology Midterm Mock Exam 24 / C. venlafaxine D. escitalopram1 / 21 1. MAOIs (monoamine oxidase inhibitors) affect which neurotransmitters? A. Serotonin, Dopamine, Norepinephrine B. Serotonin, GABA, Glutamate C. Acetylcholine, Dopamine, Norepinephrine D. Dopamine, GABA, Acetylcholine 2. Which of the following is considered first line treat- ment for depression? A. SSRI B. FGA C. SNRI D. MAOI 3. When treating a patient for major depression disorder which medication would the PMHNP consider first? A. Depakote B. Selegiline C. Escitalopram D. Isocarboxazid 4. Which of the following medication should be consid- ered for a patient diagnosed with major depressive disorder who reports "always forgetting to take my pills"? A. Mirtazapine B. Fluvoxamine C. Fluoxetine D. Carbemazepine 5. Which of the following medication has a black box warning of a life-threatening skin rash? A. Lithium B. Lamotrigine A. Serotonin, Dopamine, Norepinephrine A. SSRI C. Escitalopram C. Fluoxetine B. Lamotrigine2 / 21 C. Lurasidone D. Lorazepam 6. Which medication is considered the best tolerated SSRI? A. Venlafaxine B. Bupropion C. Setraline D. Escitalopram 7. During a 4 week follow up appointment, Rashida, who is prescribed Sertraline 25mg qAM reports slight im- provement in depression symptoms and tolerating medication well. Which of the following should the PMHNP do? A. Increase Setraline dose B. Switch to an SNRI C. Switch to a different SSRI D. Add Trazodone qHS for sleep. 8. Which medication should be avoided for the 66 year patient diagnosed with major depressive disorder and anxiety with a reported fall 3 months ago? A. Citalopram B. Setraline C. Paroxetine D. Aripiprazole 9. A patient reports upset stomach and diarrhea 3 days after taking new prescription of sertraline. Which of the following is the most appropriate response from the PMHNP? A. "Start doubling the dose of sertraline and your symptoms will begin to ease up". B. "Most side effects subside after 4-5 days.Your body is getting adjusted to the increased serotonin levels".3 / 21 D. Escitalopram A. Increase Setra- line dose C. Paroxetine B."Most side ef- fects subside af- ter 4-5 days. Your body is getting ad- justed to the in- creased serotonin levels".4 / 21 C. "Stop taking it immediately and go to the local emergency department". D. "You must take Sertraline with food, otherwise you will continue to experience GI symptoms". 10. During a 2 week follow up appointment, the patient reports no improvement in depressive symptoms with escitalopram. Which of the following statement made by the PMHNP is correct? A. "Let's discontinue escitalopram and start you on something stronger". B. "It can take up to 6 weeks before you notice im- provements of depressive symptoms". C. "I am going to prescibe Trazodone. Take it at night to help you sleep". D. "Start taking two pills at a time". 11. Duloxetine effects which two neurotransmitters? A. serotonin and norepinephrine B. serotonin and dopamine C. norepinephrine and GABA D. glutamate and acetylcholine 12. Awura, a 70 year old patient diagnosed with major depressive disorder reports a recent 40 pound weight loss within the last 3 months. Which medication should the PMHNP consider adding to her med- ication regimen? A. quetiapine B. mirtazpine C. valproic acid D. paroxetine 13. Which of the following symptoms is NOT an adverse effect associated with the acute use of opioids? A. Sedation5 / 21 B."It can take up to 6 weeks before you notice improvements of depressive symp- toms". A. serotonin and norepinephrine B.mirtazpine C. Immunosup- pression6 / 21 B. Respiratory depression C. Immunosuppression D. Itching 14. When dosing citalopram for Lynee, a 72 year old patient, the PMHNP understands to dose at 1/2 dose due to the increased risk of A. delirium B. polypharmacy C. falls D. QTc prolongation 15. Which of the following medication class is approved for first line treatment for OCD? A. Atypical antipsychotics B. Benzodiazepines C. MAOI D. SSRI 16. Which SSRI has a mild antihistamine effect? A. Paroxetine B. Fluoxetine C. Citalopram D. Sertraline 17. Which medication should the PMHNP prescribe for a patient diagnosed with major depressive disorder but takes multiple medications for other chronic condi- tions? A. Sertraline B. Escitalopram C. Buspirone D. Clonazepam 18. The patient reports suffering from insomnia and anx- iety. Which SSRI should be prescribed? D. QTc prolonga- tion D. SSRI C. Citalopram B. Escitalopram A. Paroxetine7 / 21 A. Paroxetine B. Duloxetine C. Fluoxetine D.Venlafaxine 19. Tricyclic antidepressants (TCA) act as antagonists on which of the following neurotransmitters? A. Acetylcholine and Dopamine B. Histamine and Acetylcholine C. Dopamine and Histamine D. Serotonin and Norepinephrine 20. Which foods should the PMHNP educate their patient to avoid while they are taking Selegiline? A. Nuts, milk and wheat B. Aged wine, cheeses, and meats C. Green leafy vegetables and tomatoes D. Grapefruit and grapefruit juice 21. Which neurotransmitter is associated with reward and addiction? A. Norepinephrine B. GABA C. Dopamine D. Histamine 22. Emily, a 22 year old female, reports she is 4 weeks pregnant and wants to get clean from heroin. Which medication is most appropriate for Emily? A. Buprenorphine/ Naloxone B. Naltrexone C. Buprenorphine D. Methadone 23.23. B. Histamine and Acetylcholine B.Aged wine, cheeses, and meats C. Dopamine D.Methadone8 / 21 Which of the following is the most appropriate response made by the PMHNP to a breastfeeding patient inquiring about a prescription for buprenorphine? A. "You can breastfeed 6 hours after you take the buprenorphine". B. "You can only breastfeed before you take buprenor- phine" C. "2 hours after taking buprenorphine, pump your breastmilk and discard it. You can resume breastfeed- ing afterwards". D. "You will need to transition to bottle feeding while taking buprenorphine". 24. Keaton presents to the ED and reports daily drinking of 18 beers for nearly 20 years. Keaton reports a his- tory of withdrawal seizures when he stops drinking. Which medication should the PMHNP order? A. disulfiram B. topiramate C. lorazepam D. naltrexone D. "You will need to transition to bot- tle feeding while taking buprenorphine". C. lorazepam 25. A patient reports wanting to abstain from alcohol use. B. naltrexone They report a history of abusing opioids in the past, but they have not used any in the last several months. They are concerned that they are at risk of abusing opioids again. Which of the following is the best phar- maceutical option for this patient? A. diazepam B. naltrexone C. chlordiazepoxide D. acamprosate 26. A Ellie-Ann, 31 year-old patient with a history of abus- ing opioids and binge drinking, reports they are not committed to9 / 21 abstain from using at this time. Which B. naloxone10 / medication is appropriate for Ellie-Ann? A. disulfiram B. naloxone C. naltrexone d. lorazepam 27. The PMHNP is treating a 27 year old patient diagnosed with ADHD who is actively trying to get pregnant. Which medication is most appropriate? A. Methylphenidate B. Lisdexamfetamine C. Atomoxetine D. Selegiline 28. Which of the following statements best explains the monoamine hypothesis of depression? A. Depression is caused by a deficiency of monoamine neurotransmission. B. Depression is a result of chemical a chemical im- balance of monoamine neurotransmission. C. Depression is caused by an excess of monoamine neurotransmission. D. Depression is a result from maladaptive or irrational cognitions taking the form of distorted thoughts core beliefs and judgments 29. Which combination therapy is considered first line for bipolar I, current manic episode, with depressive features? A. Bupropion + Aripiprazole . B. Lithium + Lamotrigine C. Valproic Acid + Duloxetine D. Atomoxetine + Risperidal 30. Why should antidepressants be used in combination therapy with mood stabilizers when treating bipolar11 / C. Atomoxetine A. Depression is caused by a deficiency of monoamine neu- rotransmission. B. Lithium + Lam- otrigine C. To decrease in- cidence of death12 / disorder? A. To target depression symptoms quickly and reduce rapid cycling of bipolar depression B.To reduce the gastrointestinal side effects caused by antidepressants. C.To decrease incidence of death by suicide in chil- dren and young adults. D.To increase patient medication adherence. 31. Which of the following medication should be avoided when the patient has anxiety because it can exacer- bate anxiety? A. Escitalopram B. Sertraline C. Fluvoxamine D. Duloxetine 32. Which SSRI is most likely to cause discontinuation syndrome if abruptly stopped? A. Fluoxetine B. Selegiline C. Mirtazapine D. Paroxetine 33. Which medication should not be prescribed to the patient with a seizure history? A. Venlafaxine B.Trazodone C. Bupropion D. Amitriptyline 34. "Serotonin antagonist and reuptake inhibitor" describes the neurotransmitter actions for which med- ication? A. Citalopram by suicide in chil- dren and young adults. D. Duloxetine D. Paroxetine C. Bupropion C. Trazodone13 / B. Desvenlafaxine C.Trazodone D. Mirtazapine 35. Which medication inhibits the reuptake of both norep- inephrine and dopamine? A. Methylphenidate B. Bupropion C. Lithium D.Venlafaxine 36. Which of the following statements made by the PMHMP is correct for patient medication education related to Trazodone? A. "If you had a seizure before, we should try a differ- ent medication". B. "If you experience a prolonged painful erection, get emergency help as soon as possible." C. "This medication can cause breast tissue enlarge- ment in men". D. "The best time to take this medication is first thing in the morning to avoid insomnia at night". 37. A patient has been admitted to the emergency department with a suspected overdose. Their EKG is noted to have a widened QRS complex. Which antidepressant does the PMHNP suspect the patient has overdosed on? A. Paroxetine B. Amitriptyline C. Phenelzine D. Isocarboxazid 38. Tricyclic antidepressants (TCA) act as reuptake inhibitors on which of the following neurotransmitters? A. Norepineph rine and Serotonin14 / B. Bupropion B. "If you experi- ence a prolonged painful erection, get emergency help as soon as possible." B. Amitriptyline A. Norepinephrine and Serotonin15 / B. GABA and Acetylcholine C. Dopamine and Histamine D. Histamine and Acetylcholine 39. Which medication is safest for 28 year old patient, diagnosed with major depressive disorder, who is ac- tively trying to conceive? A. Sertraline B.Topiramate C. Lithium D. Paroxetine 40. Which best describes serotonin syndrome? A. Occurs when serotonergic medications deplete lev- els of norepinephrine in the body. B. Occurs when serotonergic medications build an abnormally high levels of serotonin in the body. C. Occurs when serotonergic medications are abrupt- ly discontinued. D. Occurs when serotonergic medications interact with foods containing high levels of tyramine. 41. Which of the following medications is a serotonin norepinephrine receptor agonist? A. Bupropion B. Mirtazapine C.Trazodone D. Nortripyline 42. Which medication should the PMHNP consider prescribing for the patient diagnosed with bipolar disor- der reporting suicidal ideations? A. Valproic acid B. Lithium C. Escitalopra m D. Ziprazadone16 / A. Sertraline B. Occurs when serotonergic med- ications build an abnormally high levels of serotonin in the body. B. Mirtazapine B. Lithium17 / 43. For the past week, Amiee who is prescribed lithium re- ports using NSAIDs to treat tension headache. Which of the following should the PMHNP anticipate? A. decreased levels of lithium B. QTC prolongation C. elevated levels of lithium D. mild diffuse rash throughout body 44. The PMHNP increased their patient's lithium dose from 300mg daily to 600mg daily. When should the patient's lithium level be monitored next? A. 3 months for 1 year after dosage change B. Next follow up appointment in 6 months C. Within the next 14 days D. 5 days after dosage change 45. Rebecca presents for treatment of moderate depression. Her medical history includes the use of four medications for comorbid physical diagnoses. Which medication is least likely to interact with other pre- scriptions? A.Fluoxetine B. Duloxetine C. Paroxetine D. Escitalopram 46. Lithium levels can be decreased by which of the fol- lowing? A. Aripiprazole B. Grapefruit C. ACE inhibitors D. Coffee 47. Patient presents to the ED with the following symptoms: tachycardia, hypertension, and mydriasis. Floor18 / C. elevated levels of lithium D.5 days after dosage change D. Escitalopram D. Coffee C. Methampheta- mine19 / staff reports the patient is constantly making sexual advances towards them. Which substance is this pa- tient most likely intoxicated from? A. Marijuana B. Benzodiazepines C. Methamphetamine D. Cocaine 48. PMHNP was called to assess a patient in the emergency room who reports bruxism. Which recreational stimulant is this patient most likely withdrawing from? A. Marijuana B. MDMA C. Methamphetamines D. Methylphenidate 49. Which antidepressant is paired most appropriately with its mechanism of action? A. Mirtazapine - serotonin norepinephrine receptor agonist B.Topiramate- serotonin norepinephrine reuptake in- hibitor C. Bupropion- serotonin antagonist and reuptake in- hibitor D.Trazodone- serotonin reuptake inhibitor 50. Which of the following best describes the signs and symptoms of intoxication from opiates? A. Sedation, amnesia, and ataxia B. Euphoria, miosis, and decreased gag reflex C. Delirium, hallucinations, and tremor D. Agitation, mydriasis, and tachycardia 51. PMHNP was called to assess a patient in the emergency room who required 5 nurses to restraint them due to increased agitation. Upon assessment the20 / B. MDMA A. Mirtazapine - serotonin norepi- nephrine receptor agonist B. Euphoria, mio- sis, and decreased gag reflex C. PCP21 / PMHNP noted the patient had nystagmus. Which sub- stance is this patient most likely intoxicated from? A. LSD B. Herion C. PCP D. Cocaine 52. Which antidepressant is pharmacologically similar to a combination of an SSRI and buspirone? A. Vilazodone B.Trazodone C. Venlafaxine D.Valproic Acid 53. Which of the following statements best defines impul- sivity? A. Repetitive behavior that has no adaptive function- ing. B.The inability to terminate ongoing actions. C. Behavior that is performed as a means of avioding percevied negative consequences. D.The inability to stop initiating actions with disregard for the negative consequences of these actions 54. Which neural circuit is associated with reward and addiction? A. Mesolimbic pathway B.Tuberoinfundibular pathway C. Nigrosstriatal pathway D. Mesocortical pathway 55. A client walked into the emergency department and tells the PMHNP that she has run out of money for herion and feels like they are about to start detoxing. Which symptoms are most associated with herion withdrawal?22 / A. Vilazodone D. The inability to stop initiating ac- tions with disregard for the nega- tive consequences of these actions A. Mesolimbic pathway C. Mydrasis, pilo- erection, and diar- rhea23 / A. Miosis, depression, and increased appetite. B. Mydrasis, euphoria, and agitation C. Mydrasis, piloerection, and diarrhea D. Miosis, CNS depression, and decreased gag reflex 56. Which neurotransmitter is associated with reward and addiction? A. Norepinephrine B. Serotonin C. Glutamine D. Dopamine 57. A patient is suspected of overdosing from morphine. Which medication should immediately be adminis- tered? A. Naloxone B. Naltrexone C. Methadone D. Meperidine 58. Zara, a 34 year old female, is currently a participant in a methadone MAT program. Zara reports she is 8 weeks pregnant and asks if she should stop methadone "cold turkey". Which of the following is the best response to Zara made by the PMHNP? A. "You must stop taking Methadone immediately to reduce risk of harm to the fetus". B. "You can continue to use Methadone, we will just need to adjust the dose". C. "Lets switch you to naloxone which will reduce the risk of neonatal abstinence syndrome". D. "Currently, your best option is buprenor- phine/naloxone". 59. A patient newly prescribed buprenorphine could be dosed how much by day 2?24 / D. Dopamine A. Naloxone B. "You can con- tinue to use Methadone, we will just need to ad- just the dose". A. 14mg25 / A. 14mg B. 8mg C. 25mg D. 50mg 60. Robert, 45 year old patient, has a history of alcohol abuse and reports he is unsure if he can abstain from alcohol at this time. Which medication is most appropriate for Robert? A. Buprenorphine/naloxone B. Acamprosate C. Naltrexone D. Disulfiram 61. A patient prescribed disulfiram attended a Christmas party, drank a beer, and is now currently in the emergency department. Which of the following symptoms is expected? A. Sedation, euphoria, and amnesia B. Nystagmus, agitation, and diarrhea C. Hallucinations, delirium, and tremors D. Palpitations, nausea, and vomiting 62. Which of the following anticonvulsants can be used to reduce the cravings for alcohol? A. Valproic Acid B. Lorazepam C. Carbamazepine D.Topiramate 63. When can a patient start taking acamprosate for alco- hol abuse? A. Absence is not necessary to initiate medication B. As soon as abstinence is achieved C. Naltrexone D. Palpitations , nausea, and vom- iting D. Topiramate B.As soon as abstinence is achieved26 / C. 12 weeks after abstinence is achieved D. 14 days after abstinence is maintained 64. Which opioid can cause respiratory depression if used with benzodiazepines and can be used during acute coronary syndrome or refractory ischemic chest pain? A. Hydromorphone B. Clonazepam C. Fentanyl D. Morphine 65. Which opioid is an opioid agonist but is more potent than morphine? A. Methadone B. Herion C. Lorazepam D. Hydromorphone 66. Which medication is a pure opioid antagonist that is used in the treatment of acute opioid overdose? A. Naloxone B. Naltrexone C. Buprenorphine/naloxone D. Buprenorphine 67. The PMHNP is rounding on patients on a postsurgical floor in the hospital. Upon entering a patient's room, the PMHNP notices the patient is not responding to voice, has pinpoint pupils, and a respiration rate of 6 breaths per minute. The PMHNP suspects opioid overdose. Which action is correct at this time? A. The PHMNP reviews the patient's care to determine which opioid was administered. B.The PHMNP instructs the bedside nurse to administer naloxone 2 mg IV Q3 minutes until the patient is27 / D. Morphine D. Hydromor- phone A. Naloxone B.The PHMNP in- structs the bed- side nurse to administer naloxone 2 mg IV Q3 min- utes until the pa- tient is responsive.28 / responsive. C.The PMHNP orders chlordiazepoxide 50mg to be administered via CIWA-Ar protocols. D.The PMHNP instructs the bedside nurse to contact the emergency medicine doctor to assist with an emergent intubation 68. Which of the following is not true related to the patho- physiology of attention-deficit/hyperactivity disorder (ADHD) across the lifespan? A. ADHD symptoms change with age. B. ADHD is not only a childhood diagnosis. C. Hyperactivity increases with age. D. Adults with ADHD may experience occupational stress or anxiety. 69. The PMHNP is considering treatment options for an 18-year-old man with ADHD who has a history of alcohol and marijuana abuse. Which of the following accurately explains the effects of different stimulant formulations on neuronal firing? A. Extended-release stimulants result in phasic stimulation of NE and DA signals, but this does not lead to euphoria and abuse. B.Tonic firing is the result of rapid receptor occupan- cy and fast onset of action, as seen with extended-re- lease formulations C. Extended-release stimulants lead a sustained in- crease in NE and DA which enhances tonic firing. D. Immediate-release stimulants lead to tonic firing, which can lead to euphoria and abuse. 70. Roy is a 44 year old patient presents with comorbid alcohol abuse, generalized anxiety, bipolar disorder, and ADHD. Which disorder should be treated first? A. Generalized anxiety disorder29 / C. Hyperactivity in- creases with age. C. Extended-re- lease stimulants lead a sustained increase in NE and DA which en- hances tonic firing. B. Alcohol abuse30 / B. Alcohol abuse C. ADHD D. Bipolar disorder 71. Which of the following ADHD medications would be most appropriate for a school aged child? A. Dexmethylphenidate B. Clonidine C. Guanfacine D. Atomoxetine 72. Eric, a 25 year old law student, reports ADHD symptoms and wants to start medications. Upon review of Eric's medical history, the PMHNP learns that Eric has battled with opioid addiction his past. Which medica- tion should the PMHNP consider prescribing first? A. Atomoxetine B. Concerta C. Amphetamine D. Lisdexamfetamine 73. "Increases norepinephrine and especially dopamine actions by blocking their reuptake" best described the mechanism of action of which of the following medications except? A. Jornay PM B. Amphetamine C. Mehtylenidate D. Guanfacine 74. Which of the formulations of methylphenidate is best for a child who can not swallow pills? A. Ritalin B. Daytrana C. Dexmethylphenidate D. Concerta31 / A. Dexmethylphenidate A. Atomoxetine D. Guanfacine A. Ritalin32 / 75. What is the difference between methylphenidate and dexmethylphenidate? A. Methylphenidate is more appropriate for children. B. Dexmethylphenidate is not available in IR or XR. C. Methylphenidate is 10x more potent than dexmethylphenidate D. Dexmethylphenidate is associated with more ad- verse effects in comparison to methylphenidate. 76. The parent of a child diagnosed with ADHD demon- strates correct understanding dextroamphetamine when they state which of the following? A. "I give him a pill every time he has an outburst. We are up to 6 pills a day!" B. "We need 2 refills for the winter break". C. "He been taking it right before bed". D. "Can we plan on giving him a "drug holiday" over the summer break.". 77. The PMHNP understand that which of the following ADHD medications is the most abused and desired? A. atomoxetine B. dexmethylophenidate C. dextroamphetamine D. lisdexamfetamine 78. Which of the following medications has central actions on postsynaptic alpha 2A receptors in the pre- frontal cortex in the treatment of ADHD? A. clonidine B. atomextine C. lisdexamfetamine D. bupropion33 / D. Dexmethylphenidate is associated with more adverse effects in comparison to methylphenidate. D. "Can we plan on giving him a "drug holiday" over the summer break.". C. dextroamphetamine A. clonidine 79.79.34 / Sarah, 39 year old, has a diagnosis of ADHD and is tak- A. "Start taking ing clonidine daily reports sleep disturbances. Which statement made by the PMHNP is most correct? A. "Start taking clonidine at bedtime. That should help". B. "Lets increase the daytime dosage". C. "Stop taking the medication immediately". D. "Take clonidine with a small snack". 80. During a followup visit with Coraan 11-year-old who is currently prescribed 5mg methylphenidate IR in the morning, her mother reports slight improvement in Cora's behavior but the medication seems to wear off within a few hours. Which of the following changes would you make to Cora's initial prescription? A. Increase dose to 5 mg methylphenidate IR twice daily. B. Change dose to methylphenidate 10 mg ER once daily. C. Switch to a different stimulant medication D. Evaluate client for non-stimulant medication 81. Patient reports difficulty staying asleep and requests for prescription medication. Which of the following should the PMHNP consider? A. Ramelteon B. Melatonin C. Suvorexant D.Valerian root 82. Which of the following medications is a dual orexin receptor antagonist (DORA)? A. Zolpidem B. Ramelteon clonidine at bed- time. That should help". A. Increase dose to 5 mg methylphenida te IR twice daily. C. Suvorexant D. Lemborexant35 / C. Trazodone D. Lemborexant 83. During an annual visit, Carol reports her PCP prescribed her diltiazem for her hypertension and chest pain. Which of the following actions done by the PMH- NP demonstrated correct understanding of Carol's concurrent prescription of suvorexant? A. The PMHNP discontinues the suvorexant prescrip- tion due to severe interactions with diltiazem. B.The PMHNP instructs Carol to take suvorexant first thing in the morning prior to taking diltiazem. C.The PMHNP decreased the dose of suvorexant. D.The PMHNP increases the dose of suvorexant. 84. Which of the following medications bind to benzodi- azepine sites on GABA receptors? A. Eszopiclone B. Ramelteon C. Lrmborexant D.Trazodone C. The PMHNP de- creased the dose of suvorexant. A. Eszopiclone