NURS 6630 MIDTERM EXAM RECOMMENDED BY EXPERT ANSWERS. ALREADY GRADED A+

• NURS 6630 MIDTERM EXAM • Question 1 1 out of 1 points A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP). Selected Answer: D. “Why do you believe that your medication is poison?” • Question 2 0 out of 1 points Which statement about neurotransmitters and medications is true? Selected Answer: D. The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed. • Question 3 0 out of 1 points When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: Selected Answer: B. “Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects. • Question 4 0 out of 1 points During gene expression, what must occur prior to a gene being expressed? Selected Answers: A. Transcription factor must bind to the regulatory region within the cell’s nucleus. B. RNA must be converted to mRNA. • Question 5 1 out of 1 points While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? Selected Answer: B. Changes made to proteins lead to changes in behavior. • Question 6 1 out of 1 points Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because: Selected Answer: C. Neurotransmitters can spread by diffusion. • Question 7 0 out of 1 points Why is the cytochrome P450 enzyme system of significance to the PMHNP? Selected Answer: C. The medication’s chemical composition changes when it comes in contact with the acid in the stomach. • Question 8 1 out of 1 points It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true? Selected Answer: A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics. • Question 9 1 out of 1 points As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice? Selected Answer: A. Most medications that act on G-protein linked receptors have antagonistic traits. • Question 10 0 out of 1 points The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition: Selected Answer: D. The patient drinks a cup of coffee a day. • Question 11 1 out of 1 points A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to: Selected Answer: B. Write an order for a different mood stabilizer • Question 12 0 out of 1 points A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). Which is the best action for the PMHNP to take for this patient? Selected Answer: B. Order a liver function test • Question 13 0 out of 1 points A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this? Selected Answer: C. To indirectly increase the amount of dopamine in the body • Question 14 0 out of 1 points The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial? Selected Answer: A. “I have trouble staying asleep in the middle of the night.” • Question 15 1 out of 1 points Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription? Selected Answer: A. “The drug will have an almost immediate effect.” • Question 16 0 out of 1 points A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? Selected Answer: C. Ketamine • Question 17 0 out of 1 points The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug? Selected Answer: B. Antagonists • Question 18 1 out of 1 points A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient? Selected Answer: B. “The patient could benefit from an anticonvulsant.” • Question 19 1 out of 1 points The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient? Selected Answer: A. Ligand-gated ion channels with a pentameric structure • Question 20 0 out of 1 points Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis? Selected Answer: D. “I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.” • Question 21 1 out of 1 points A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? Selected Answer: A. Obtaining raw normative metrics and using them to assess functionality • Question 22 0 out of 1 points Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin? Selected Answer: C. MAO-B presents in the mitochondria within the presynaptic neuron. • Question 23 0 out of 1 points Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate? Selected Answer: D. “Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.” • Question 24 0 out of 1 points The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient? Selected Answer: A. Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms. • Question 25 1 out of 1 points A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease? Selected Answer: D. Achieving overactivity of the mesocorticol projections to the prefrontal cortex • Question 26 1 out of 1 points The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug? Selected Answer: C. Dystonia • Question 27 0 out of 1 points The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent. Which of the following requires the longest transition time for therapeutic benefit? Selected Answer: C. Aripripazole to ziprasidone • Question 28 0 out of 1 points The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient? Selected Answer: D. Clozapine • Question 29 1 out of 1 points Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body? Selected Answer: D. D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia. • Question 30 1 out of 1 points Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient? Selected Answer: D. All of the above • Question 31 0 out of 1 points The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)? Selected Answer: D. A and C • Question 32 0 out of 1 points The student inquires about antipsychotic medications. Which response by the PMHNP describes the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics? Selected Answer: D. Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors • Question 33 1 out of 1 points Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon? Selected Answer: B. D2 antagonism • Question 34 1 out of 1 points A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals? Selected Answer: E. All of the above • Question 35 1 out of 1 points Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation? Selected Answer: A. The patient has an unsustained response to antidepressants.