A combat veteran presents with anxiety, flashbacks, distressing dreams, irritable mood and sleep disturbances. The patient’s capacity for employment is limited and the patient avoids people and places that trigger memories of combat due to anxiety and feeling uncomfortable. Which medication should be used to treat this patient?
1. Selegiline (Emsam)
2. Quetiapine (Seroquel)
3. Sertraline (Zoloft)
4. Olanzapine (Zyprexa)
3
An NP completes an assessment for the presence of abnormal involuntary movements on a patient who has been taking various psychotropic medications for the past several years. The NP diagnoses the patient with tardive dyskinesia (TD). Which medication should be prescribed to treat the patient?
1. Duloxetine (Cymbalta)
2. Phenelzine (Nardil)
3. Propranolol (Inderal)
4. Deutetrabenazine (Austedo)
4
A patient with a history of social anxiety and no previous medication history recently started college. Upon moving into the dormitories, the patient immediately experienced heightened anxiety and reported low moods. Which medication should be used to address these symptoms?
1. Aripiprazole (Abilify)
2. Olanzapine (Zyprexa)
3. Paroxetine (Paxil)
4. Risperidone (Risperdal)
3
A 7-yr-old child is referred to the school psychologist for ongoing disturbances in the classroom. The child struggles with inattention, restlessness, impulsivity, and excessive talking. After multiple sessions with the child, the school psychologist decides to refer the child to a local NP based on a diagnosis of ADHD. Which medication should this NP prescribe?
1. Quetiapine (Seroquel)
2. Amphetamine (Adzenys ER)
3. Cariprazine (Vraylar)
4. Olanzapine (Zyprexa)
2
A school-aged child diagnosed with separation anxiety disorder and treated with psychotherapy continues to exhibit symptoms. The child has not been able to attend kindergarten. Which medication should be used to treat this disorder?
1. Amitriptyline (Elavil)
2. Aripiprazole (Abilify)
3. Citalopram (Celexa)
4. Clonidine (Catapres)
3
An NP has a patient who is taking Lamotrigine (Lamictal) for bipolar maintenance. The patient is well maintained on the medication. The patient expresses a desire to start oral contraceptives. Which psychoeducation should the NP provide to the patient in response to this request?
1. It is okay for the patient to start the oral contraceptive if the patient remains in contact with the NP.
2. Lamotrigine is contraindicated, so it needs to be cross-titrated to another mood stabilizer .
3. Some oral contraceptives may decrease Lamotrigine levels, so the dose may need to be increased.
4. Some oral contraceptives may increase Lamotrigine levels, so the dosage may need to be decreased.
3
An NP is managing a patient who has generalized anxiety disorder. Upon initial assessment, the Generalized Anxiety Disorder-7 (GAD-7) was 19. The patient was initiated on escitalopram (Lexapro) 8 weeks ago and is currently taking 10mg daily. During today’s visit, the patient’s GAD-7 score is 15. The NP evaluates the pharmacological outcome by using standardized symptom measurements. What should the NP determine as the patient’s current status and plan of treatment?
1. The patient is asymptomatic, so no change in medication is necessary.
2. The patient is symptomatic, though no change in medication is necessary.
3. The patient is asymptomatic, so increasing the dose is warranted.
4. The patient is symptomatic, so increasing the dose is warranted.
4
An NP is consulted about a patient on the medical floor who is diagnosed with schizophrenia, hypertension, and dyslipidemia and has been treated for a UTI and dehydration and has a pressure ulcer on their sacrum. The patient reports they had been staying in bed at home most of the day and night and that they had not gotten up to use the bathroom for over a month because voices were telling them they cannot walk; instead, they had been urinating in a disposable brief, only changing it once daily. The patient was treated in the ED 2 months ago for hypertensive crisis because the voices said to stop taking their anti hypertensives, and they have been hospitalized multiple times over the last year due to non adherence to antipsychotic medications, leading to medical consequences. How should this NP intervene?
1. Inform the patient that a psychiatric advance directive will be implemented.
2. Inform the patient that a medical power of attorney will be appointed .
3. Assess the patient’s ability to independently ambulate to a bathroom.
4. Assess the patient’s capacity for adequate medical decision-making.
4
A high school graduate took a year off before attending college to work with a therapist on meeting goals to reduce symptoms of ADHD. The patient made significant progress in meeting therapy goals, but continues to struggle with taking notes during lectures in science classes required for the patient’s chemistry major. The patient was initially diagnosed with ADHD at 6 and was treated with amphetamine (Adzenys ER) but is now prescribed the maximum dose of methylphenidate (Cotempla XR-ODT) and takes Clonidine (Catapres) twice a day. The treatment team, including the patient, believes that the maximum benefit has been obtained from therapy and medications. The patient will continue using skills learned and has engaged in ADHD coaching near campus. Despite the comprehensive treatment plan, the patient’s struggle with note taking is affecting their academic performance. Which action should an NP take to help this patient improve their academic performance?
1. Advise the school about the diagnosis and treatment plan and complete the forms requesting accommodations .
2. Recommend that the student consider changing majors to one with an easier curriculum and continue medications as prescribed.
3. Advise the school about the diagnosis and treatment plan and obtain legal counsel to ensure accommodations.
4. Recommend that the student consider changing majors to one with an easier curriculum and adjust the dosages of both medications.
1
A patient presents to an ED with symptoms of a URI. The patient’s medical history includes hypertension, well controlled on lisinopril (Prinivil), and schizoaffective disorder, stable on clozapine (Clozaril). The ED assessment includes a chest x-ray, sputum culture, and CBC with differential. The CBC indicated a low white blood count and low neutrophil count. An emergency physician contacts an NP on call as a psychiatric consultant-liaison. The NP calculates the absolute neutrophil count (ANC) as 1,110 uL. How should the NP manage this case?
1. Discontinue clozapine (Clozaril), standard order for ANC monitoring 3 times weekly, and coordinate care with a hematologist.
2. Continue clozapine (Clozaril), standing order for ANC monitoring daily for one month, and coordinate care with a hematologist .
3. Discontinue clozapine (Clozaril), standing order for ANC monitoring daily for one month, and coordinate care with an outpatient psychiatric prescriber.
4. Continue clozapine (Clozaril), standing order for ANC monitoring 3 times weekly until ANC is greater than 1500 uL, and coordinate care with an outpatient psychiatric prescriber.
4
A 20-yr-old patient arrives at a psychiatric crisis center with a friend. The patient is exhibiting symptoms of mood lability, hallucinations, and paranoia. The NP decides to prescribe a 2nd generation antipsychotic medication to target the acute psychotic symptoms and arranges for inpatient admission. Which baseline lab should this NP order and continue to monitor throughout the treatment?
1. Urine drug screen
2. Ferritin level
3. Fasting lipids
4. Urinalysis
3
A 32-yr-old patient presents for a follow-up medication management appointment at an outpatient clinic. When asked about side effects, the patient endorses recent sexual dysfunction along with enlargement of breast tissue. A review of the medical record reveals that a 2nd generation antipsychotic medication was started about 6 months ago. Lab results confirm elevated prolactin level. Which brain function is affected by a dopamine blockade to cause these side effects?
1. Tuberoinfundibular pathway
2. Raphe nuclei
3. Nigrostriatal pathway
4. Cerebral cortex
1
A patient is stable with minimal side effects on Olanzapine (Zyprexa) for symptoms of schizophrenia. After consulting with the patient, an NP asks the preceptor about the dopamine theory. What should the preceptor provide as the premise of this theory?
1. Hyperactivity of dopamine at D2 receptors is found in the mesolimbic pathway.
2. Hypoactive dopamine transmission stimulates the 5HT2A receptor hyperfunction in the cortex.
3. The N-methyl-D-aspartate receptor (NMDAR) hypofunction affects dopamine transmission.
4. Neurotransmitters serotonin, norepinephrine, or dopamine are depleted in the CNS.
1
An NP is discharging a patient on an antipsychotic medication from an inpatient setting. Which education should this NP include in the discharge teaching plan?
1. Minimize physical activity
2. Rinse mouth thoroughly
3. Drink lots of water to avoid constipation
4. Avoid excessive exposure to sunlight
4
A patient is meeting with an NP and has some questions about a new medication, aripiprazole (Abilify). The patient understands that aripiprazole is a 2nd generation antipsychotic. The patient wants to know what this drug blocks in the brain. Which response should this NP provide?
1. Postsynaptic brain dopamine D2 receptors
2. Reabsorption (reuptake) of serotonin into the neurons
3. Reuptake of the neurotransmitters serotonin and norepinephrine
4. Post synaptic brain dopamine D2 receptors and serotonin receptors
4
A 19-yr-old patient is brought to the ED by their parents after their parents found the patient unresponsive and breathing shallowly. The parents report finding a bottle of pills next to the patient. Further investigation reveals the patient took a benzodiazepine. Which medication should be administered to this patient?
1. Clonazepam (Klonopin)
2. Naltrexone (ReVia)
3. Flumazenil (Romazicon)
4. Naloxone (Narcan)
3
An NP is managing a patient who has ADHD, maintained with a stimulant medication. The patient comes to a session with a distinct odor of alcohol, slurred speech, and ataxia. The patient wants a refill on the stimulant. How should the NP manage this patient?
1. Hold the prescription and follow up with a PCP.
2. Refill the prescription and transfer the patient to a residential addiction program.
3. Refill the prescription, with a follow-up appointment in 1 month.
4. Hold the prescription and transfer the patient to an emergency department.
4
A patient arrives at an ED unconscious with a respiratory rate of 4 breaths/minute and miotic pupils. Which treatment should be used for this patient?
1. Charcoal (Actidose)
2. Albuterol (Ventolin)
3. Lorazepam (Ativan)
4. Naloxone (Narcan)
4
A patient presents with perioral dermatitis, unsteady gait, and tremor and has a strong odor of glue. The patient endorses huffing glue. Which physiological process explains these symptoms?
1. Peripheral vasoconstriction
2. CNS depression
3. Peripheral dilation
4. CNS stimulation
2
A 16-yr-old patient is brought in by a family member after the patient ingested an unknown substance and the family member witnessed a seizure. Further assessment indicates hyperthermia, hyperreflexia, and signs of dehydration. The patient is admitted overnight for monitoring and to make sure all medical conditions are stabilized. Which substance causes these symptoms?
1. N, N-dimethyltdyptamine (DMT)
2. Delta-9 tetrahydrocannabinal (THC)
3. 3,4- methylenedioxymeth-amphetamine (MDMA)
4. Gamma hydroxybutyrate (GHB)
3
An acutely manic patient is admitted to an inpatient health unit. An NP diagnoses the patient with treatment-resistant bipolar disorder. What medication should be used off-label for this patient?
1. Selegiline (Emsam)
2. Clozapine (Clozaril)
3. Lithium (Eskalith)
4. Duloxetine (Cymbalta)
2
An NP is addressing a 25-yr-old patient who has a history of TBI. Collateral information obtained by the patient’s parents includes periods of agitation and aggression. The parents are concerned that one of the patient’s medications may be causing the agitation. Which medication may cause paradoxical agitation given this patient’s history?
1. Benzodiazepines
2. Beta blockers
3. Antipsychotics
4. Sedatives
1
An NP is evaluating a patient for shift work sleep disorder. The patient works from 11pm to 7am five days per week and expresses having trouble staying asleep, feeling excessively fatigued, and often feeling restless. The patient denies previous history of these symptoms prior to starting the night shift. Which medication is FDA approved for this condition?
1. TemAZEpam (Restoril)
2. Trazodone (Desyrel)
3. Mirtazepine (Remeron)
4. Modafinil (Provigil)
4
A patient with chronic nerve pain reports that they are experiencing restlessness, difficulty sleeping, ruminating thoughts, and constant worrying. Which drugs should be prescribed to this patient to treat these symptoms?
1. Fluoxetine (Prozac)
2. Prazosin (Minipress)
3. Venlafaxine (Effexor)
4. Gabapentin (Neurontin)
4
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Neurotransmitters46
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Pharmacokinetics18
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Antidepressants41
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Legal, Ethical, Professional12
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Section 1 Test12
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Antipsychotics40
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Mood Stabilizers23
-
Anxiolytics25
-
Hypnotics8
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Analgesics24
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Stimulants15
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Antidementia13
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Recreational Stimulants40
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Substance Abuse5
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Recreational Depressants41
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Hallucinogens22
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Cannabis And Others32
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Drug-Drug Interactions29
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Unit 2 Questions and Test42
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Managing Anxiety And Sleep Disorders17
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Managing Bipolar Disorders28
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Psychotherapies29
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Review From Book82
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Managing Major Depression17
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Managing Mental Health during Childbearing Years12
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Managing Psychosis14
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Managing ADHD21
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Managing Geriatric Aggression32
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Preventing Treatment Resistance15
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Section 3 Test24
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Pre-Test50
