NR 667/668 FINAL Verified Multiple Choice and
Conceptual Actual Emended Exam Questions
With Reviewed 100% Correct Detailed Answers
Guaranteed Pass!!Current Update
1. A 49-year-old female is on Fentanyl patch at 25 mcg/hr. In the last week the
patient's valproate was increased from 750mg po BID to 1000mg po BID. In the
last 4 days the patient was placed on clarithromycin for strep throat and started
cepacol lozenges. This morning she was resuscitated with Naloxone and she
returned to baseline mantation. Which medication likely contributed to her
unresponsive episode?
- ANSWER All of these contributed to this episode. (The patient was on
Fentanyl and recently started a strong CYP3A4 inhibitor (Macrolide antibiotics
include clarithromycin). This led to a REDUCTION in the clearance of the opioid
resulting in sedation. Cepacol lozenges, Valproate & Clarithromycin)
2. Mr. Peters is a 45-year-old man who has been married for 12 years when his
wife tells him she cannot take it anymore and wants a divorce. He has sought
therapy to deal with his new circumstance and reports feeling bewildered and
fearful, is having difficulty sleeping and concentrating, and states, "I thought I did
everything right. I even told her I forgive her for the affair, and that I was proud of
her for going to Alcoholics Anonymous for the last 6 months." Which of the
following questions should the PMHNP ask?
- ANSWER Has she ever gotten so angry that she hit you?
3. Which pupillary changes would one expect to observe with acute stimulant
intoxication?
- ANSWER Dilated pupils (Stimulant intoxication is associated with pupillary
dilation. Narcotic drugs are associated with pupil constriction. Unequal pupil sizes
(anisocoria) are associated with both benign and life threatening emergencies.)
,4. A 61-year-old married woman who has been sober from alcohol use disorder
for 25 years relapsed 3 weeks ago. She reports drinking 1.5 L of vodka and half a
liter of scotch daily. On exam she is emotionally labile ranging from irritable to
crying, slurring her words, and exhibits a bilateral upper extremity fine tremor.
Vitals: blood pressure 150/100, heart rate 110, respiratory rate 18, SpO2 98%
room air. She reports feeling nauseous, sweating, and moderately anxious. What is
the primary concern for this patient?
- ANSWER Alcohol withdrawal
5. Individuals with a history of prenatal alcohol exposure are at increased risk for
what disorder?
- ANSWER The risk for all of these disorders is increased. (Individuals with a
history of prenatal alcohol exposure are at increased risk for ADHD, bipolar,
depressive disorders, ODD, conduct disorders, alcohol use disorder and substance
use disorders.)
6. Which of the following is a therapeutic technique to facilitate a health behavior
change in a 28-year-old male with substance use disorder who is in denial
regarding the severity of his habit?
- ANSWER Motivational interviewing
7. A 38-year-old male presents for follow up chronic back pain and spasm. Four
years earlier, he sustained a motorcycle accident. He has been taking morphine
extended release 40mg PO BID and Hydrocodone 10mg IR Qd PRN. Today he
complains that the medication is no longer effective. He notes diarrhea and
restlessness when he skips a dose. He continues to be employed and has not
missed any work days. He has been filling the prescription 1 day early each month
and visited an urgent care twice this summer requesting additional pain control.
The are no changes on exam today and no focal deficits. Which of the following do
you recommend for this patient?
- ANSWER Evaluate for Opioid use disorder, recommend a slow taper off full
opioid agonists and then start buprenorphine. (This patient has signs of OUD. This
,is little evidence supporting opioids for chronic pain syndromes. The patient
remains functional at work so no need for acute hospitalization. Benzodiazepines
and opioids should not be combined given the increase risk of death when used
together.)
8. A 16-year-old male with a history of smoking cigarettes and marijuana is being
evaluated at the request of the school and parents. The child states that the
reason he smokes is it "helps calm me down" as he is anxious all the time. Which
of the following medications would be the best choice?
- ANSWER Fluoxetine 20 mg PO daily
9. A patient who has been sober for 7 days struggles with cravings and is fearful of
relapse. He reports taking naltrexone daily. What agent should the PMHNP
prescribe to help reduce his cravings?
- ANSWER Citalopram
10. Jade is a 44 year old female who works second shift as an ICU nurse. She
decided to skip her daily 3 cups of coffee. She is complaining of headache, fatigue,
depressed mood, difficulty concentrating and muscle pain. Which of the following
is not true regarding caffeine withdrawal?
- ANSWER Withdrawal headaches may last 3 months (Caffeine withdrawal
does include Flu-like symptoms as listed in criterion B of the DSM-5, along with
headache, fatigue, depressed or irritable mood and difficulty concentrating.
Withdrawal headaches beyond 3-4 weeks of caffeine abstinence would raise
concern that the headaches have other etiology.)
11. Abrupt cessation of daily diazepam 40 mg use after 2 years may present with
what?
- ANSWER Seizure (Abrupt cessation of a benzodiazepine after chronic use
may result in a withdrawal seizure, delirium or other withdrawal reaction which
may be life threatening.)
, 12. Which of the following symptoms would likely emerge after abrupt cessation
of daily cannabis use for 2 years?
- ANSWER Depressed mood and decreased appetite (Cannabis withdrawal is
common with abrupt cessation. The symptoms typically emerge within 1 week
after a period of heavy and prolonged use. The symptoms may include; irritability,
anger, aggression, nervousness, anxiety, sleep difficulty, decreased appetite,
weight loss, restlessness, depressed mood and physical symptoms such as fever,
chills, sweating, abdominal pain and headache.)
13. Which of the following medications is preferred for a 21-year-old male with a
history of polysubstance use disorder and difficulty with medication adherence?
- ANSWER Naltrexone 380 mg IM monthly
14. A patient who has been stable on his long-acting injectable medication tells
the PMHNP that he would like to quit smoking. What is the best response?
- ANSWER "Let us make an appointment as your medication dose may need
to be lowered."
15. A 30-year-old male who was started on sertraline for generalized anxiety
disorder was also started on lorazepam 1 mg for sleep during the first 2 weeks as
he was adjusting to the medication. At the 2-week follow-up visit his psychiatrist
increased the sertraline, but the dose of lorazepam does not seem to be helping
with sleep and the patient is requesting a higher dose. Which of the following best
describes the patient's condition?
- ANSWER Tolerance
What would a COWS score of 16 indicate?
- ANSWER Moderate Withdrawal (The COWS or Clinical Opiate Withdrawal
Scale can range from 0 - 36+. A Score of 5 - 12 would be considered mild. A score
of 13 - 24 would be considered moderate. A score of 25 - 36 would be considered
moderately severe and a score of more than 36 would indicate severe
withdrawal.)
Conceptual Actual Emended Exam Questions
With Reviewed 100% Correct Detailed Answers
Guaranteed Pass!!Current Update
1. A 49-year-old female is on Fentanyl patch at 25 mcg/hr. In the last week the
patient's valproate was increased from 750mg po BID to 1000mg po BID. In the
last 4 days the patient was placed on clarithromycin for strep throat and started
cepacol lozenges. This morning she was resuscitated with Naloxone and she
returned to baseline mantation. Which medication likely contributed to her
unresponsive episode?
- ANSWER All of these contributed to this episode. (The patient was on
Fentanyl and recently started a strong CYP3A4 inhibitor (Macrolide antibiotics
include clarithromycin). This led to a REDUCTION in the clearance of the opioid
resulting in sedation. Cepacol lozenges, Valproate & Clarithromycin)
2. Mr. Peters is a 45-year-old man who has been married for 12 years when his
wife tells him she cannot take it anymore and wants a divorce. He has sought
therapy to deal with his new circumstance and reports feeling bewildered and
fearful, is having difficulty sleeping and concentrating, and states, "I thought I did
everything right. I even told her I forgive her for the affair, and that I was proud of
her for going to Alcoholics Anonymous for the last 6 months." Which of the
following questions should the PMHNP ask?
- ANSWER Has she ever gotten so angry that she hit you?
3. Which pupillary changes would one expect to observe with acute stimulant
intoxication?
- ANSWER Dilated pupils (Stimulant intoxication is associated with pupillary
dilation. Narcotic drugs are associated with pupil constriction. Unequal pupil sizes
(anisocoria) are associated with both benign and life threatening emergencies.)
,4. A 61-year-old married woman who has been sober from alcohol use disorder
for 25 years relapsed 3 weeks ago. She reports drinking 1.5 L of vodka and half a
liter of scotch daily. On exam she is emotionally labile ranging from irritable to
crying, slurring her words, and exhibits a bilateral upper extremity fine tremor.
Vitals: blood pressure 150/100, heart rate 110, respiratory rate 18, SpO2 98%
room air. She reports feeling nauseous, sweating, and moderately anxious. What is
the primary concern for this patient?
- ANSWER Alcohol withdrawal
5. Individuals with a history of prenatal alcohol exposure are at increased risk for
what disorder?
- ANSWER The risk for all of these disorders is increased. (Individuals with a
history of prenatal alcohol exposure are at increased risk for ADHD, bipolar,
depressive disorders, ODD, conduct disorders, alcohol use disorder and substance
use disorders.)
6. Which of the following is a therapeutic technique to facilitate a health behavior
change in a 28-year-old male with substance use disorder who is in denial
regarding the severity of his habit?
- ANSWER Motivational interviewing
7. A 38-year-old male presents for follow up chronic back pain and spasm. Four
years earlier, he sustained a motorcycle accident. He has been taking morphine
extended release 40mg PO BID and Hydrocodone 10mg IR Qd PRN. Today he
complains that the medication is no longer effective. He notes diarrhea and
restlessness when he skips a dose. He continues to be employed and has not
missed any work days. He has been filling the prescription 1 day early each month
and visited an urgent care twice this summer requesting additional pain control.
The are no changes on exam today and no focal deficits. Which of the following do
you recommend for this patient?
- ANSWER Evaluate for Opioid use disorder, recommend a slow taper off full
opioid agonists and then start buprenorphine. (This patient has signs of OUD. This
,is little evidence supporting opioids for chronic pain syndromes. The patient
remains functional at work so no need for acute hospitalization. Benzodiazepines
and opioids should not be combined given the increase risk of death when used
together.)
8. A 16-year-old male with a history of smoking cigarettes and marijuana is being
evaluated at the request of the school and parents. The child states that the
reason he smokes is it "helps calm me down" as he is anxious all the time. Which
of the following medications would be the best choice?
- ANSWER Fluoxetine 20 mg PO daily
9. A patient who has been sober for 7 days struggles with cravings and is fearful of
relapse. He reports taking naltrexone daily. What agent should the PMHNP
prescribe to help reduce his cravings?
- ANSWER Citalopram
10. Jade is a 44 year old female who works second shift as an ICU nurse. She
decided to skip her daily 3 cups of coffee. She is complaining of headache, fatigue,
depressed mood, difficulty concentrating and muscle pain. Which of the following
is not true regarding caffeine withdrawal?
- ANSWER Withdrawal headaches may last 3 months (Caffeine withdrawal
does include Flu-like symptoms as listed in criterion B of the DSM-5, along with
headache, fatigue, depressed or irritable mood and difficulty concentrating.
Withdrawal headaches beyond 3-4 weeks of caffeine abstinence would raise
concern that the headaches have other etiology.)
11. Abrupt cessation of daily diazepam 40 mg use after 2 years may present with
what?
- ANSWER Seizure (Abrupt cessation of a benzodiazepine after chronic use
may result in a withdrawal seizure, delirium or other withdrawal reaction which
may be life threatening.)
, 12. Which of the following symptoms would likely emerge after abrupt cessation
of daily cannabis use for 2 years?
- ANSWER Depressed mood and decreased appetite (Cannabis withdrawal is
common with abrupt cessation. The symptoms typically emerge within 1 week
after a period of heavy and prolonged use. The symptoms may include; irritability,
anger, aggression, nervousness, anxiety, sleep difficulty, decreased appetite,
weight loss, restlessness, depressed mood and physical symptoms such as fever,
chills, sweating, abdominal pain and headache.)
13. Which of the following medications is preferred for a 21-year-old male with a
history of polysubstance use disorder and difficulty with medication adherence?
- ANSWER Naltrexone 380 mg IM monthly
14. A patient who has been stable on his long-acting injectable medication tells
the PMHNP that he would like to quit smoking. What is the best response?
- ANSWER "Let us make an appointment as your medication dose may need
to be lowered."
15. A 30-year-old male who was started on sertraline for generalized anxiety
disorder was also started on lorazepam 1 mg for sleep during the first 2 weeks as
he was adjusting to the medication. At the 2-week follow-up visit his psychiatrist
increased the sertraline, but the dose of lorazepam does not seem to be helping
with sleep and the patient is requesting a higher dose. Which of the following best
describes the patient's condition?
- ANSWER Tolerance
What would a COWS score of 16 indicate?
- ANSWER Moderate Withdrawal (The COWS or Clinical Opiate Withdrawal
Scale can range from 0 - 36+. A Score of 5 - 12 would be considered mild. A score
of 13 - 24 would be considered moderate. A score of 25 - 36 would be considered
moderately severe and a score of more than 36 would indicate severe
withdrawal.)
