Which statement about nicotine gum is TRUE?
A. The pt chews each piece continuously until the nicotine is depleted.
B. The gum is most effective when used to supplement the nicotine patch.
C. Pts with depressive symptoms should avoid this product.
D. Users will likely require several pieces each day.
D. Users will likely require several pieces each day.
-provides an alternative source of nicotine.
-Each piece provides nicotine for approximately 30 minutes.
-To avoid overdose, do not use in combination with other sources of nicotine such as the patch.
-Ok to use nicotine gum with depressive medications such as Buproprion (Wellbutrin) and Varenicline (Chantix).
An older adult male with alcohol use disorder is scheduled for a physical exam and laboratory testing. The pt’s laboratory blood test results may show:
A. Increased serum creatinine levels and eGFR.
B. Decreased number of platelets and increased MCV.
C. Increased serum potassium and increased triglycerides.
D. Decreased AST and ALT levels.
B. Decreased number of platelets and increased MCV.
-Chronic alcohol use affects the MCV because the reduction of folate levels from dietary deficiency and absorption issues.
-Interferes with the production and function of WBCs.
-Interferes with platelet production, resulting in thrombocytopenia.
-ETOH pts are at higher risk for bleeding.
-ETOH can increase AST and ALT due to liver inflammation.
-ETOH affects lipid metabolism in the liver, resulting in hypertriglyceridemia.
Which of the following is part of the female athlete triad?
A. Lanugo
B. Premature osteoporosis
C. Self-absorbed behavior
D. Insulin resistance.
B. Premature osteoporosis
-Triad = amenorrhea, premature osteopenia/osteoporosis, and disordered eating.
-Lanugo and self-absorbed behavior is seen in anorexia nervosa, not part of the triad.
-Insulin resistance is seen is metabolic syndrome.
Which of the following individuals is at the highest risk for suicide?
A. White female teenager who fails an exam in high school.
B. Black middle-aged female who is newly diagnosed with type-2 diabetes.
C. Older adult White male whose spouse of 40 years recently died.
D. Asian adult whose parent has a chronic illness.
C. Older adult White male whose spouse of 40 years recently died.
Which of the following medications is MOST LIKELY to cause erectile dysfunction?
A. Levothyroxine
B. Paroxetine
C. Penicillin
D. Digoxin
B. Paroxetine
-Paroxetine can also affect female orgasm.
An older adult female pt with peripheral neuropathy due to diabetes is recently diagnosed with major depression. The pt refuses psychotherapy and wants medication. She denies suicidal and homicidal ideation. Which of the following pharmacological agents is the BEST choice for this pt?
A. Quetiapine (Seroquel)
B. Duloxetine (Cymbalta)
C. Escitalopram (Lexapro)
D. Olanzapine (Zyprexa)
B. Duloxetine (Cymbalta)
-Duloxetine is a SNRI used for depression, chronic anxiety, and management of diabetic peripheral neuropathy.
-Quetiapine (Seroquel) and Olanzapine (Zyprexa) are atypical antipsychotics.
-Escitalopram (Lexapro) is a SSRI used for depression and generalized anxiety disorder, but is not indicated for peripheral neuropathy.
A pt with depression is taking Citalopram (Celexa) daily. They inform the nurse practitioner that they recently started taking St. John’s wort as a supplement to improve their depression. What recommendation is the MOST appropriate?
A. “Call if you think you are experiencing any reactions to the combination”.
B. “You should stop taking the St. John’s wort”.
C. “You may need to adjust your Citalopram dosage”.
D. “You should consider taking a different herbal supplement”.
B. “You should stop taking the St. John’s wort”.
-Concurrent use of St. John’s wort with SSRIs can result in drug interactions, reducing the effectiveness of the medication.
-Avoid the supplement.
A male pt’s history indicates that they are prescribed Phenelzine (Nardil) for depression and anxiety. What information revealed during the pt interview would be the MOST URGENT for the nurse practitioner to address with the pt?
A. Drinks 1-2 beers each week.
B. Smokes 3-4 cigarettes daily.
C. Has occasional difficulty sleeping.
D. Reports poor appetite recently.
A. Drinks 1-2 beers each week.
-Phenelzine (Nardil) is a MAOI, which should not be mixed with alcohol because it contains tyramine.
-This combination can result in severely elevated blood pressure and increased risk of stroke.
A pt reports concern about the amount of alcohol they consume. Which screening tool should the nurse practitioner considering administering?
A. AUDIT
B. PCL-5
C. PHQ-2
D. GAD-7
A. AUDIT
-Alcohol Use Disorder Identification Test (AUDIT) is a highly accurate tool used to screen for potential alcohol use disorder.
-PCL-5 = PTSD
-PHQ-2 = Depression
-GAD-7 = Anxiety
The nurse practitioner is conducting the Mini-Mental State Exam (MMSE) on a pt. Which result indicates impairment?
A. Inability to copy an image of intersecting pentagons.
B. Inability to recall today’s date.
C. At least two positive findings
D. A score of 20.
D. A score of 20.
-MMSE is used to determine confusion and dementia.
-Max points of 30, scores >19 indicate impairment.
The nurse practitioner has finished conducting the CAGE questionnaire with a pt. The pt responded “YES” when asked if they felt the need to cut down on their drinking and if they felt guilty about their drinking. The pt responded “NO” to the other 2 questions. What is the appropriate next question?
A. Prescribe Disulfiram
B. Ask the pt to complete the T-ACE questionnaire to obtain more information.
C. Discuss the possibility of alcohol misuse with the pt.
D. Document the results as normal findings.
C. Discuss the possibility of alcohol misuse with the pt.
-A 4-question exam, 2 affirmative responses indicates misuse of ETOH.
-Disulfiram (Antabuse)- is useful in the treatment of alcohol use disorder (AUD), but not warranted solely based on a positive CAGE tool.
A pt who has been prescribed Lamotrigine (Lamictal) for bipolar disorder calls the clinic to report a rash. Which syndrome does the nurs practitioner suspect?
A. Malignant neuroleptic
B. Acute serotonin
C. Stevens-Johnson
D. Korsakoff’s
C. Stevens-Johnson
-Lamictal is an anticonvulsant medication sometimes used to treat bipolar disorder.
-Malignant neuroleptic syndrome = associated with the use of antipsychotic medications, includes fever, muscle rigidity, mental status changes, and dysautonomia.
Acute serotonin syndrome = associated with medications that block serotonin (SSRIs, SRNIs, MAOIs, TCAs, Triptans, and Tryptophan), causing seizure-like movements.
Korsakoff’s syndrome = a neurologic complication of chronic alcohol use disorder with symptoms such as mental confusion, ataxia, stupor, coma, and hypotension.
Which of the following would BEST support a diagnosis of “factitious disorder imposed on self”?
A. Reporting symptoms that cannot be definitively attributed to a health disorder.
B. Denying symptoms that are consistent with a diagnosed disorder.
C. Falsifying symptoms to obtain medical treatment.
D. Intentionally harming another to obtain medical treatment.
C. Falsifying symptoms to obtain medical treatment.
-AKA Munchausen Syndrome.
A pt diagnosed with insomnia has expressed a preference for alternative treatment instead of medication. What option should the nurse practitioner suggest?
A. Kava Kava
B. Melatonin
C. Diphenhydramine (Benadryl)
D. St. John’s wort
B. Melatonin
-Useful in the treatment of insomnia and other sleep disorders.
-Avoid Kava Kava = associated with liver injury.
-St. John’s wort is not effective for insomnia.
While examining an 80-year-old pt who lives with an adult caregiver, the nurse practitioner observes burn marks on the pt’s back. The pt appears quiet and fearful in the caregiver’s presence. What initial action should the nurse practitioner take?
A. Report suspected elder abuse to the appropriate state agency.
B. Ask the caregiver to explain the injuries.
C. Have the caregiver wait in a different room.
D. Tell the pt, “You have some burn-like marks on your back”.
C. Have the caregiver wait in a different room.
Which of the following is a principle of motivational interviewing?
A. Providing the pt with reasons to change their behavior.
B. Emphasizing the need to rely on a support network.
C. Confronting the pt for the ambivalence.
D. Rolling with the pt’s resistance.
D. Rolling with the pt’s resistance.
-Motivational interviewing is a counseling technique used to help a pt find their internal motivation to make changes to improve their health.
-The 5 principles of motivational interviewing are: expressing empathy, understanding the pt’s motivation, avoiding confrontation, rolling with the resistance, and supporting self-efficacy.
A 20-year-old female pt with co-occurring bulimia nervosa presents to the clinic for treatment of major depressive disorder. Which medication is CONTRAINDICATED for this pt?
A. Paroxetine (Paxil)
B. Fluoxetine (Prozac)
C. Bupropion (Wellbutrin)
D. Duloxetine (Cymbalta)
C. Bupropion (Wellbutrin)
-An atypical antidepressant that is contraindicated in pts with bulimia/anorexia nervosa because it lowers the seizure threshold.
-Consider the use of Paroxetine (Paxil), Fluoxetine (Prozac), or Duloxetine (Cymbalta) for treatment.
Sexual side effects resulting from use of a SSRI can be treated with the adjunctive medication:
A. Buspirone (Buspar)
B. Bupropion (Wellbutrin)
C. Paroxetine (Paxil)
D. Sertraline (Zoloft)
B. Bupropion (Wellbutrin)
-An atypical antidepressant can be prescribed off-label for the treatment of SSRI-induced sexual dysfunction.
-Buspirone (BuSpar) = anxiety treatment
-Paroxetine (Paxil) and Sertraline (Zoloft) = SSRIs can contribute to sexual dysfunction.
A pt who has been successfully treating depressive symptoms with a prescribed SSRI expresses interest in taking omega-3 fatty acids as complementary therapy. How should the NP advise the pt?
A. Point out that complementary and alternative therapies are ineffective for mood disorders.
B. Inform the pt that it may trigger a dangerous interaction with the prescribed medication.
C. Suggest tryptophan as a safer alternative.
D. Help the pt identify an appropriate dosage.
D. Help the pt identify an appropriate dosage.
-Omega-3 fatty acids are not associated with any major drug interactions.
-May be used as a complementary therapy for mood disorders by reducing neuroinflammation, modulating serotonin and dopamine, and protecting nerve cells.
-High intake can increase bleeding risk, so an appropriate dose should be identified.
-Discontinue ahead of any scheduled surgery.
-Tryptophan can interact with a number of psychotropic medications including SSRIs.
A pt accompanied by a family member presents with mental confusion, ataxia, and hypotension. The family member indicates the pt has a history of alcohol use disorder. Which of the following is MOST LIKELY to be included in the treatment plan?
A. Vitamin B1 (thiamine)
B. Bupropion (Wellbutrin)
C. Paroxetine (Paxil)
D. Triazolam (Halcion)
A. Vitamin B1 (thiamine)
-The pt’s signs and history are consistent with Korsakoff’s syndrome = caused by chronic deficiency of vitamin B1 (thiamine) resulting from chronic alcohol use disorder.
-Treatment involves immediate administration of high-dose parenteral vitamins.
-Bupropion (Wellbutrin) = depression and smoking cessation treatment.
- Paroxetine (Paxil) = depression and mood disorder treatment.
-Triazolam (Halcion) = anxiety and sleep disorder treatment.
What are the contraindications of SSRI use?
-Avoid SSRI use within 14 days of a taking a MAOI to decrease risk of serotonin syndrome.
-SSRIs can induce mania if used in pts with bipolar disorder.
What are three other uses for tricyclic antidepressants other than treating depression?
-Postherpetic neuralgia (Chronic pain)
-Urinary incontinence (Anticholinergic effects)
-Migraine headache prophylaxis
Which type of psychotic medications should not be given to treat depression in a pt who has suicidal ideation?
-Tricyclic Antidepressants, high risk for overdose.
What are the 2 conditions associated with a TCA overdose?
-Fatal cardiac effects (ventricular arrhythmias)
- Neurologic effects (seizures)
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