1
NR 546/ NR546 MIDTERM EXAM ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALL ANSWERED {291 Q & A}
ALREADY GRADED A+ | GUARANTEED PASS | NR 546
At Sofia's 12-week follow-up visit, the client is taking the maximum dose of
sertraline and is experiencing improvement in symptoms, but not full relief from
symptoms. Which is the best action by the PMHNP?
Augment with buspirone
Rationale:
The client has improvement in symptoms, but not full relief, so the best action is
to augment the current therapy. Buspirone offers anxiety relief but does not
have the effects of a CNS depressant or cause dependence like benzodiazepines.
Buspirone does take approximately 4 weeks to reach full therapeutic effects. If
the client did not experience an improvement in symptoms, switching to
another SSRI would be the best action.
Carla is a 35-year-old woman that is currently taking olanzapine for her diagnosed
schizophrenia. She has gained 30 pounds in the last 6 months and her waist
circumference is 37 inches. She requests a change in medications. Which of the
following medications is less associated with weight gain?
Aripiprazole
,2
-associated with the lowest risk weight gain.
Mary Ann is a 55-year-old woman who scheduled an appointment with the
PMHNP a month before a planned vacation to Hawaii. Mary Ann states, "I have
been on a plane once before, and I had a major panic attack. It was terrible." She
is concerned about having another panic attack on the long transpacific flight. She
is in good health and is not taking any medications. Which is the best choice for
the PMHNP to prescribe?
Alprazolam #4 tabs PRN
Rationale:
Alprazolam #4 tabs PRN is the best choice for anxiety in a specific high-anxiety
situation such as flying. Benzodiazepines can be prescribed for PRN use. Limiting
the number of pills is appropriate to help prevent misuse and diversion of the
medication. In this case, medication was provided for departure and return.
Using daily medication is not necessary since Mary Ann does not have chronic
anxiety. Providing an SSRI PRN is not appropriate as it may take up to 6 weeks
for efficacy.
Alex is a returning client who reports leaking fluid from his nipples. Which of the
following is most likely responsible for these undesirable side effects?
Risperidone
-highest risk for galactorrhea, due to hyperprolactinemia.
,3
Jill, a 23-year-old graduate student, presents with reports of panic attacks and
worry "my whole life." She reports that she can bring on panic attacks herself
when she worries. This happens almost every day and some days it is so bad she
cannot go to work or school. She was offered a few Xanax by a friend, and she
wants a prescription because "they really help." The PMHNP diagnoses Jill with
Generalized Anxiety Disorder (GAD). Which is the best medication for the PMHNP
to prescribe?
Escitalopram
Rationale:
Escitalopram is the only listed SSRI that is the appropriate drug class for GAD.
Bupropion is an SNRI. Medications that contain norepinephrine can increase
anxiety. Jill has chronic anxiety, not acute anxiety. Benzodiazepines should be
prescribed only for short-term use, less than 4 weeks as an adjunct until the SSRI
achieves efficacy. Buspirone seems like a good choice because this medication
targets 5HT1A; however, this medication is used as an adjunct therapy, not
monotherapy.
Andrea is a 65-year-old woman who presents for care because "her nerves are a
mess." Her husband was diagnosed this week with Stage IV pancreatic cancer and
has less than a month to live. Andrea can not eat or sleep. She cries constantly
and "her heart is broken." Andrea is on no medications. Which is the best choice
for the PMHNP to prescribe?
, 4
Citalopram daily and alprazolam #15 tabs PRN
Rationale:
Citalopram and alprazolam are the best choices. Starting an SSRI with a PRN
benzodiazepine is appropriate to help cope while waiting for the full effects of
citalopram. Venlafaxine, an SNRI, contains norepinephrine which can increase
anxiety. Trazadone may help with sleep, but the dosing required for depression
and anxiety would result in increased sedation, which can increase fall risk in
older adults. Mirtazapine is appropriate for the loss of appetite, but the
complaint is less than 1 week. Mirtazapine is associated with weight gain and is
not a first-line treatment for anxiety.
What should the PMHNP consider when prescribing chemical restraints?
-allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical
restraint
-state regulations regarding chemical restrains must be reviewed
Are the PMHNP and other staff liable if the client has an allergic reaction or
adverse side effects to the drugs used for chemical restraint?
No.
NR 546/ NR546 MIDTERM EXAM ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALL ANSWERED {291 Q & A}
ALREADY GRADED A+ | GUARANTEED PASS | NR 546
At Sofia's 12-week follow-up visit, the client is taking the maximum dose of
sertraline and is experiencing improvement in symptoms, but not full relief from
symptoms. Which is the best action by the PMHNP?
Augment with buspirone
Rationale:
The client has improvement in symptoms, but not full relief, so the best action is
to augment the current therapy. Buspirone offers anxiety relief but does not
have the effects of a CNS depressant or cause dependence like benzodiazepines.
Buspirone does take approximately 4 weeks to reach full therapeutic effects. If
the client did not experience an improvement in symptoms, switching to
another SSRI would be the best action.
Carla is a 35-year-old woman that is currently taking olanzapine for her diagnosed
schizophrenia. She has gained 30 pounds in the last 6 months and her waist
circumference is 37 inches. She requests a change in medications. Which of the
following medications is less associated with weight gain?
Aripiprazole
,2
-associated with the lowest risk weight gain.
Mary Ann is a 55-year-old woman who scheduled an appointment with the
PMHNP a month before a planned vacation to Hawaii. Mary Ann states, "I have
been on a plane once before, and I had a major panic attack. It was terrible." She
is concerned about having another panic attack on the long transpacific flight. She
is in good health and is not taking any medications. Which is the best choice for
the PMHNP to prescribe?
Alprazolam #4 tabs PRN
Rationale:
Alprazolam #4 tabs PRN is the best choice for anxiety in a specific high-anxiety
situation such as flying. Benzodiazepines can be prescribed for PRN use. Limiting
the number of pills is appropriate to help prevent misuse and diversion of the
medication. In this case, medication was provided for departure and return.
Using daily medication is not necessary since Mary Ann does not have chronic
anxiety. Providing an SSRI PRN is not appropriate as it may take up to 6 weeks
for efficacy.
Alex is a returning client who reports leaking fluid from his nipples. Which of the
following is most likely responsible for these undesirable side effects?
Risperidone
-highest risk for galactorrhea, due to hyperprolactinemia.
,3
Jill, a 23-year-old graduate student, presents with reports of panic attacks and
worry "my whole life." She reports that she can bring on panic attacks herself
when she worries. This happens almost every day and some days it is so bad she
cannot go to work or school. She was offered a few Xanax by a friend, and she
wants a prescription because "they really help." The PMHNP diagnoses Jill with
Generalized Anxiety Disorder (GAD). Which is the best medication for the PMHNP
to prescribe?
Escitalopram
Rationale:
Escitalopram is the only listed SSRI that is the appropriate drug class for GAD.
Bupropion is an SNRI. Medications that contain norepinephrine can increase
anxiety. Jill has chronic anxiety, not acute anxiety. Benzodiazepines should be
prescribed only for short-term use, less than 4 weeks as an adjunct until the SSRI
achieves efficacy. Buspirone seems like a good choice because this medication
targets 5HT1A; however, this medication is used as an adjunct therapy, not
monotherapy.
Andrea is a 65-year-old woman who presents for care because "her nerves are a
mess." Her husband was diagnosed this week with Stage IV pancreatic cancer and
has less than a month to live. Andrea can not eat or sleep. She cries constantly
and "her heart is broken." Andrea is on no medications. Which is the best choice
for the PMHNP to prescribe?
, 4
Citalopram daily and alprazolam #15 tabs PRN
Rationale:
Citalopram and alprazolam are the best choices. Starting an SSRI with a PRN
benzodiazepine is appropriate to help cope while waiting for the full effects of
citalopram. Venlafaxine, an SNRI, contains norepinephrine which can increase
anxiety. Trazadone may help with sleep, but the dosing required for depression
and anxiety would result in increased sedation, which can increase fall risk in
older adults. Mirtazapine is appropriate for the loss of appetite, but the
complaint is less than 1 week. Mirtazapine is associated with weight gain and is
not a first-line treatment for anxiety.
What should the PMHNP consider when prescribing chemical restraints?
-allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical
restraint
-state regulations regarding chemical restrains must be reviewed
Are the PMHNP and other staff liable if the client has an allergic reaction or
adverse side effects to the drugs used for chemical restraint?
No.
