1
NR 546 NR546 MIDTERM EXAM 2025 ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALL ANSWERED {291 Q & A}
ALREADY GRADED A+
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 2025 ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALL ANSWERED {291 Q & A}
ALREADY GRADED A+
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.
