NR 546/ NR 546 MIDTERM EXAM NEWEST
ACTUAL EXAM WITH COMPLETE 300
QUESTIONS AND DETAILED ANSWERS
GRADED A | BRAND NEW!!!
Sofia presents to the PMHNP with a report of being
overwhelmed with stress and worry. Sofia reports she has
always dealt with these feelings, but it has been worse since
she has taken a more advanced role in her work with significant
responsibility. She has difficulty relaxing and is often fatigued.
The PMHNP diagnoses Sofia with generalized anxiety disorder.
sertraline 25 mg po once daily.
Rationale: Anxiety can often be treated with antidepressants.
The best choice for Sofia is the SSRI, sertraline because it is
half the recommended dose for depression. The duloxetine
dosage listed is an appropriate dose for depression. When
treating anxiety, the dosage should start at 30 mg and be
titrated up. Buspirone is not the first drug of choice and it is
typically used short-term. A benzodiazepine should not be the
first drug of choice.
,Many persons with schizophrenia are treated successfully in an
______________, though some clients may require
________________ for initial treatment and subsequent
treatment of psychotic episodes
outpatient setting, inpatient hospitalizations
Why begin with monotherapy? (antipsychotics)
The use of multiple antipsychotics can increase the risk of QT
prolongation.
-Combinations considered only after single med have
provided inadequate response.
If antipsychotics switched too quickly
can develop agitation, activation, insomnia, and experience
withdrawal
-due to the binding differences in each medication
subcategory
*Cross titration over several days to weeks is required to
prevent side effects
,Clients are more likely to experience side effects when
changing from a medication in one ___________ to a
medication in another ____________
subcategory, subcategory
(ex: pine to done)
special considerations: Pregnancy (antipsychotics)
-Risk of withdrawal symptoms in the newborn:
extrapyramidal symptoms may be present at delivery.
-atypical antipsychotics appear more harmful than typical
antipsychotics due to increased risk of gestational metabolic
complications, increased gestational age weight, and
increased birth weight.
-Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and
quetiapine, especially in the third trimester
Sofia was prescribed sertraline 25 mg po once daily. Sofia's
dosage was increased to 50 mg after week 1, increased to 100
mg after week 2, and increased to 150 mg after week 3. At
, Sofia's 4-week follow-up visit, she is tolerating the medication
well and symptoms are slightly improved. Which is the best
action by the PMHNP?
increase the sertraline dose to 200 mg
Rationale: The PMHNP should increase the sertraline dose to
the maximum dose of 200 mg because the client has slightly
improved symptoms. It may take several months for the client
to see full relief, so it is best to wait before adding additional
drugs or switching drugs.
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
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