Section 1 Test

Question 1

A patient presents to an outpatient clinic with anxiety associated with flying in an airplane. The patient usually avoids flying but recently started a job that requires weekly travel by airplane. The patient attempted exposure therapy for six months but is still unable to fly without anxiety.

Which maintenance medication should be used to manage this disorder?

Answer 1

Sertraline (Zoloft)

Phobias are associated with the malfunctioning of the amygdala-centered circuits. The first-line treatment is exposure therapy, followed by SSRIs.

Question 2

A patient presents to an outpatient clinic. The patient has been binging on excessive amounts of food and vomiting daily for almost a year. The patient has been treated with psychotherapy for the last six months but continues to engage in this behavior.

Which medication should be used to treat this disorder?

Answer 2

Fluoxetine (Prozac)

The first-line treatment for bulimia nervosa is psychotherapy. If unsuccessful, they should be treated with fluoxetine (the only SSRI approved for the treatment of bulimia nervosa).

Question 3

A patient presents to an ED for the 6th time in the last month with a complaint of a cough. The patient believes they have cancer, based on an internet search of their symptoms. Physical exam and diagnostic testing reveal a non productive cough with no evidence of cancer or lung disease. The patient has a 3-year history of anxiously seeking medical care, believing they have acquired a serious illness, but no serious illness is found. The patient has been treated with psychotherapy for the last year without success.

Which medication should be prescribed for this patient?

Answer 3

Citalopram (Celexa)

First-line treatment for anxiety disorders is psychotherapy. If unsuccessful, treat with an antidepressant.

Question 4

A patient presents with symptoms that meet the criteria for a major depressive episode. Episodes are moderate and have recurred each year for the past 4 years in the fall. The episodes remit in the spring.

Which medication should be used to treat this patient?

Answer 4

Bupropion (Wellbutrin)

Bupropion is a norepinephrine-dopamine reuptake inhibitor with an indication for depression with a seasonal specified.

Question 5

An NP diagnoses a Chinese American patient with bipolar disorder, most recent episode mixed. The NP wants to initiate carbamazepine (Tegretol) to treat this disorder.

Which steps should the NP take prior to prescribing the medicine?

Answer 5

Draw for CBC, liver, kidney, thyroid function, and HLA-B*1502.

The patient identifies as being of Asian descent; having HLA-B*1502 drawn is important because individuals with this allele should not be initiated on this medication.

Question 6

An NP is treating a newly diagnosed patient for ADHD, inattentive type, with the stimulant lisdexamfetamine (Vyvanse). The patient tells the NP that they are traveling out of state for three days and want the new medication to be ordered there instead. The NP has a license to practice only in their current state.

What should this NP do?

Answer 6

Order the medication in state via the electronic prescribing tool so the patient can start the medication upon return.

Question 7

An NP is working in a neuropsychiatric clinic that manages patients who have treatment-resistant depression with esketamine (Spravato) nasal spray. A patient is presenting today for a third dose.

What should the NP do prior to dosing?

Answer 7

Assess blood pressure.

Esketamine can increase the the risk of hypertension in patients with BP over 140/90.

Question 8

An international volunteer is diagnosed with PTSD after being sexually assaulted by a local in their area. They have been evacuated to the capital for evaluation. After only 2 weeks of therapy the patient is being reassigned to another family 4 hours from the capital and will not be able to follow up with the medical officer on a regular basis. Therapy will be done via phone.

What medication should be prescribed and should the patient be allowed to leave on their next assignment?

Answer 8

Initiate mirtazapine (Remeron) and follow up via telepsychiatry.

Mirtazapine, off label, has some efficacy for treatment of PTSD.

Question 9

A psychiatric NP is starting a typical (first generation) antipsychotic on a patient newly diagnosed with schizophrenia.

Which dopaminergic side effect should the NP be concerned about?

Answer 9

Nausea

Question 10

A patient is starting a new antipsychotic, olanzepine (Zyprexa). The patient is concerned about possible dopaminergic side effects and asks the NP to review them.

What should the NP describe as one of the dopaminergic side effects?

Answer 10

Irregular heartbeats

Question 11

NP is working with a patient that has auditory and visual hallucinations. The patient is paranoid and convinced the FBI has tapped their phone and has cameras in their home. The patient is not currently on any meds. The NP considers starting risperidone (Risperdol) for the symptoms.

What is the mechanism of action for this medication?

Answer 11

Blocking of dopamine 2 receptors.

Risperdol is a second-generation antipsychotic that blocks D2 receptors and serotonin 2A receptors.

Question 12

An NP is seeing an adolescent patient experiencing their first psychotic episode. The patient requests the that the patient be started on haloperidol (Haldol) because she recalls her brother and father doing well on this med. The NP wants to start the patient on aripiprazole (Abilify).

What is the difference in how these medications work?

Answer 12

Aripiprazole is a partial dopamine and serotonin agonist. Haloperidol is a dopamine 2 receptor blocker.