Walden NURS6630 Final Exam

Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University

NURS6630 Final Exam: Walden University: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
What will the PMHNP most
likely prescribe to a patient with psychotic aggression who needs to manage the
top-down cortical control and the excessive drive from striatal hyperactivity?

A. Stimulants
B. Antidepressants
C. Antipsychotics
QUESTION 2: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
The PMHNP is selecting
a medication treatment option for a patient who is exhibiting psychotic
behaviors with poor impulse control and aggression. Of the available
treatments, which can help temper some of the adverse effects or symptoms that
are normally caused by D2 antagonism?

A. First-generation,
conventional antipsychotics

B. First-generation,
atypical antipsychotics

C. Second-generation,
conventional antipsychotics

D. Second-generation,
atypical antipsychotics

The PMHNP is discussing
dopamine D2 receptor occupancy and its association with aggressive behaviors in
patients with the student. Why does the PMHNP prescribe a standard dose of
atypical antipsychotics?

A. The doses are based on
achieving 100% D2 receptor occupancy.

B. The doses are based on
achieving a minimum of 80% D2 receptor occupancy.

C. The doses are based on
achieving 60% D2 receptor occupancy.

D. None of the above.QUESTION 4: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
Why does the PMHNP avoid
prescribing clozapine (Clozaril) as a first-line treatment to the patient with
psychosis and aggression?

A. There is too high a risk
of serious adverse side effects.

B. It can exaggerate the
psychotic symptoms.

C. Clozapine (Clozaril)
should not be used as high-dose monotherapy.

D. There is no
documentation that clozapine (Clozaril) is effective for patients who are

The PMHNP is caring for a
patient on risperidone (Risperdal). Which action made by the PMHNP exhibits
proper care for this patient?

A. Explaining to the
patient that there are no risks of EPS

B. Prescribing the patient
12 mg/dail

C. Titrating the dose by
increasing it every 5–7 days

D. Writing a prescription for a higher dose of
oral risperidone (Risperdal) to achieve high D2 receptor occupancy

QUESTION 6: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
The PMHNP wants to
prescribe Mr. Barber a mood stabilizer that will target aggressive and
impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood
stabilizer will the PMHNP select?

A. Lithium (Lithane)
B. Phenytoin (Dilantin)
C. Valproate (Depakote)
D. Topiramate (Topamax)

QUESTION 7: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
The parents of a 7-year-old
patient with ADHD are concerned about the effects of stimulants on their child.
The parents prefer to start pharmacological treatment with a non-stimulant.
Which medication will the PMHNP will most likely prescribe?

A. Strattera
B. Concerta
C. Daytrana
D. Adderall
8 The PMHNP understands
that slow-dose extended release stimulants are most appropriate for which
patient with ADHD?

A. 8-year-old patient
B. 24-year-old patient
C. 55-year-old patient
D. 82-year-old patient
A patient is prescribed
D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP
include when discussing the side effects with the patient?

A. The formulation can have
delayed actions when taken with food.

B. Sedation can be a common
side effect of the drug.

C. The medication can
affect your blood pressure.

D. This drug does not cause
any dependency.

The PMHNP is teaching
parents about their child’s new prescription for Ritalin. What will the PMHNP
include in the teaching?

A. The second dose should
be taken at lunch.

B. There are no risks for

C. There is only one daily
dose, to be taken in the morning.

D. There will be continued
effects into the evening.

QUESTION 11: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
A young patient is
prescribed Vyvanse. During the follow-up appointment, which comment made by the
patient makes the PMHNP think that the dosing is being done incorrectly?

A. “I take my pill at

B. “I am unable to fall
asleep at night.”

C. “I feel okay all day

D. “I am not taking my pill
at lunch.”

A 14-year-old patient is
prescribed Strattera and asks when the medicine should be taken. What does the
PMHNP understand regarding the drug’s dosing profile?

A. The patient should take
the medication at lunch.

B. The patient will have
one or two doses a day.

C. The patient will take a
pill every 17 hours.

D. The dosing should be
done in the morning and at night.

QUESTION 13: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
The PMHNP is meeting with
the parents of an 8-year-old patient who is receiving an initial prescription
for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices
when she prescribes the following dose:

A. The child will be
prescribed 2.5 mg.

B. The child will be
prescribed a 10-mg tablet.

C. The child’s dose will
increase by 2.5 mg every other week.

D. The child will take
10–40 mg, daily.

A patient is being
prescribed bupropion and is concerned about the side effects. What will the
PMHNP tell the patient regarding bupropion?

A. Weight gain is not

B. Sedation may be common.
C. It can cause cardiac

D. It may amplify fatigue.
QUESTION 15: Walden NURS6630 Final Exam July NURS6630 Final Exam: Walden University
Which patient will receive
a lower dose of guanfacine?

A. Patient who has
congestive heart failure

B. Patient who has
cerebrovascular disease

C. Patient who is pregnant
D. Patient with kidney

An 18-year-old female with
a history of frequent headaches and a mood disorder is prescribed topiramate
(Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is
effective in treating which condition(s) in this patient?

A. Migraines
B. Bipolar disorder and

C. Pregnancy-induced

D. Upper back pain
The PMHNP is treating a
patient for fibromyalgia and is considering prescribing milnacipran (Savella).
When prescribing this medication, which action is the PMHNP likely to choose?

A. Monitor liver function
every 6 months for a year and then yearly thereafter.

B. Monitor monthly weight.
C. Split the daily dose into two doses after
the first day.

D. Monitor for occult blood
in the stool.

The PMHNP is assessing a
patient she has been treating with the diagnosis of chronic pain. During the
assessment, the patient states that he has recently been having trouble getting
to sleep and staying asleep. Based on this information, what action is the
PMHNP most likely to take?

A. Order hydroxyzine
(Vistaril), 50 mg PRN or as needed

B. Order zolpidem (Ambien),
5mg at bedtime

C. Order melatonin, 5mg at

D. Order quetiapine
(Seroquel), 150 mg at bedtime

The PMHNP is assessing a
female patient who has been taking lamotrigine (Lamictal) for migraine
prophylaxis. After discovering that the patient has reached the maximum dose of
this medication, the PMHNP decides to change the patient’s medication to
zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day
activities, what should the PMHNP ensure that this patient understands?

A. Monthly blood levels
must be drawn.

B. ECG monitoring must be
done once every 3 months.

C. White blood cell count
must be monitored weekly.

D. This medication has
unwanted side effects such as sedation, lack of coordination, and drowsiness.

A patient recovering from
shingles presents with tenderness and sensitivity to the upper back. He states
it is bothersome to put a shirt on most days. This patient has end stage renal
disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that
he does not know how he can lie in a recliner for 3 hours feeling this
uncomfortable. What will be the PMHNP’s priority?

A. Order herpes simplex
virus (HSV) antibody testing

B. Order a blood urea
nitrogen (BUN) and creatinine STAT

C. Prescribe lidocaine 5%
D. Prescribe hydromorphone
(Dilaudid) 2mg

The PMHNP prescribed a
patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months
ago. The patient suddenly presents to the office with the complaint that the
medication is no longer working and complains of increased pain. What action
will the PMHNP most likely take?

A. Increase the dose of
lamotrigine (Lamictal) to 25 mg twice daily.

B. Ask if the patient has
been taking the medication as prescribed.

C. Order gabapentin
(Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no
longer working for this patient.

D. Order a complete blood
count (CBC) to assess for an infection.

An elderly woman with a
history of Alzheimer’s disease, coronary artery disease, and myocardial
infarction had a fall at home 3 months ago that resulted in her receiving an
open reduction internal fixation. While assessing this patient, the PMHNP is
made aware that the patient continues to experience mild to moderate pain. What
is the PMHNP most likely to do?

A. Order an X-ray because
it is possible that she dislocated her hip.
B. Order ibuprofen (Motrin) because she may need long-term treatment and
chronic pain is not uncommon.

C. Order naproxen
(Naprosyn) because she may have arthritis and chronic pain is not uncommon.

D. Order Morphine and
physical therapy.

The PMHNP is assessing a
49-year-old male with a history of depression, post-traumatic stress disorder
(PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and
hypertension. His physical assessment is unremarkable with the exception of
peripheral edema bilaterally to his lower extremities and a chief complaint of
pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient
on a low dose of doxepin (Sinequan). What is the next action that must be taken
by the PMHNP?

A. Orders liver function

B. Educate the patient on
avoiding grapefruits when taking this medication.

C. Encourage this patient
to keep fluids to 1500 ml/day until the swelling subsides.

D. Order a BUN/Creatinine

The PMHNP is evaluating a
30-year-old female patient who states that she notices pain and a drastic
change in mood before the start of her menstrual cycle. The patient states that
she has tried diet and lifestyle changes but nothing has worked. What will the
PMHNP most likely do? A. Prescribe Estrin FE 24 birth control

B. Prescribe ibuprofen
(Motrin), 800 mg every 8 hours as needed for pain

C. Prescribe desvenlafaxine
(Pristiq), 50 mg daily

D. Prescribe risperidone
(Risperdal), 2 mg TID

A patient with chronic back
pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI).
How does the PMHNP describe the action of SNRIs on the inhibition of pain to
the patient?

A. “The SNRI can increase
noradrenergic neurotransmission in the descending spinal pathway to the dorsal

B. “The SNRI can decrease
noradrenergic neurotransmission in the descending spinal pathway to the dorsal

C. “The SNRI can reduce
brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal

D. “The SNRI can increase
neurotransmission to descending neurons.”

A patient with fibromyalgia
and major depression needs to be treated for symptoms of pain. Which is the
PMHNP most likely to prescribe for this patient?

Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Clozapine (Clozaril)
Phenytoin (Dilantin)
The PMHNP prescribes
gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP
anticipate the drug to work?

A. It will bind to the
alpha-2-delta ligand subunit of voltage-sensitive calcium channels.

B. It will induce synaptic
changes, including sprouting.

C. It will act on the
presynaptic neuron to trigger sodium influx.

D. It will inhibit activity
of dorsal horn neurons to suppress body input from reaching the brain.

Mrs. Rosen is a 49-year-old
patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs.
Rosen to improve this condition?

A. Venlafaxine (Effexor)
B. Armodafinil (Nuvigil)
C. Bupropion (Wellbutrin)
D. All of the above
The PMHNP is caring for a
patient with fibromyalgia. Which second-line treatment does the PMHNP select
that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin)
B. Viloxazine (Vivalan)
C. Imipramine (Tofranil)
D. Bupropion (Wellbutrin
The PMHNP is attempting to
treat a patient’s chronic pain by having the agent bind the open channel
conformation of VSCCs to block those channels with a “use-dependent” form of
inhibition. Which agent will the PMHNP most likely select?

A. Pregabalin (Lyrica)
B. Duloxetine (Cymbalta)
C. Modafinil (Provigil)
D. Atomoxetine (Strattera)
A patient with irritable
bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the
patient an agent that will cause irrelevant nociceptive inputs from the pain to
be ignored and no longer perceived as painful. Which drug will the PMHNP

A. Pregabalin (Lyrica)
B. Gabapentin (Neurontin)
C. Duloxetine (Cymbalta)
D. B and C
The PMHNP wants to use a
symptom-based approach to treating a patient with fibromyalgia. How does the
PMHNP go about treating this patient?

A. Prescribing the patient
an agent that ignores the painful symptoms by initiating a reaction known as

B. Targeting the patient’s
symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral
prefrontal cortex

C. Matching the patient’s
symptoms with the malfunctioning brain circuits and neurotransmitters that
might mediate those symptoms D. None of the above

The PMHNP is working with
the student to care for a patient with diabetic peripheral neuropathic pain.
The student asks the PMHNP why SSRIs are not consistently useful in treating
this particular patient’s pain. What is the best response by the PMHNP?

A. “SSRIs only increase
norepinephrine levels.”

B. “SSRIs only increase
serotonin levels.”

C. “SSRIs increase
serotonin and norepinephrine levels.”

D. “SSRIs do not increase
serotonin or norepinephrine levels.”

A patient with gambling
disorder and no other psychiatric comorbidities is being treated with
pharmacological agents. Which drug is the PMHNP most likely to prescribe?

A. Antipsychotics
B. Lithium
D. Naltrexone
Kevin is an adolescent who
has been diagnosed with kleptomania. His parents are interested in seeking
pharmacological treatment. What does the PMHNP tell the parents regarding his
treatment options?

A. “Naltrexone may be an
appropriate option to discuss.”

B. “There are many medicine
options that treat kleptomania.”

C. “Kevin may need to be
prescribed antipsychotics to treat this illness.”

D. “Lithium has proven
effective for treating kleptomania.”

Which statement best
describes a pharmacological approach to treating patients for impulsive

A. Anticonvulsant mood
stabilizers can eradicate limbic irritability.

B. Atypical antipsychotics
can increase subcortical dopaminergic stimulation.

C. Stimulants can be used
to decrease frontal inhibition.

D. Opioid antagonists can
be used to reduce drive.

A patient with hypersexual
disorder is being assessed for possible pharmacologic treatment. Why does the
PMHNP prescribe an antiandrogen for this patient?

A. It will prevent feelings
of euphoria.

B. It will amplify impulse

C. It will block

D. It will redirect the
patient to think about other things.

Mrs. Kenner is concerned
that her teenage daughter spends too much time on the Internet. She inquires
about possible treatments for her daughter’s addiction. Which response by the
PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

A. “Compulsive Internet use
can be treated similarly to how we treat people with substance use disorders.”

B. “Internet addiction is
treated with drugs that help block the tension/arousal state your daughter

C. “When it comes to Internet
addiction, we prefer to treat patients with pharmaceuticals rather than
psychosocial methods.”

D. “There are no
evidence-based treatments for Internet addiction, but there are behavioral
therapies your daughter can try.”

Mr. Peterson is meeting
with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr.
Peterson is obese and needs to modify his food intake. “Sometimes I think I’m
addicted to food the way some people are addicted to drugs,” he says. Which
statement best describes the neurobiological parallels between food and drug

A. There is decreased
activation of the prefrontal cortex.

B. There is increased
sensation of the reactive reward system.

C. There is reduced
activation of regions that process palatability.

D. There are amplified
reward circuits that activate upon consumption.

The PMHNP is caring for a
patient who reports excessive arousal at nighttime. What could the PMHNP use
for a time-limited duration to shift the patient’s brain from a hyperactive
state to a sleep state?

A. Histamine 2 receptor

B. Benzodiazepines
C. Stimulants
D. Caffeine

The PMHNP is caring for a
patient who experiences too much overstimulation and anxiety during daytime
hours. The patient agrees to a pharmacological treatment but states, “I don’t
want to feel sedated or drowsy from the medicine.” Which decision made by the
PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate
treatment options?

A. Avoiding prescribing the
patient a drug that blocks H1 receptors

B. Prescribing the patient
a drug that acts on H2 receptors

C. Stopping the patient
from taking medicine that unblocks H1 receptors

D.None of the above
The PMHNP is performing a
quality assurance peer review of the chart of another PMHNP. Upon review, the
PMHNP reviews the chart of an older adult patient in long-term care facility
who has chronic insomnia. The chart indicates that the patient has been
receiving hypnotics on a nightly basis. What does the PMHNP find problematic
about this documentation?

A. Older adult patients are
contraindicated to take hypnotics.

B. Hypnotics have prolonged
half-lives that can cause drug accumulation in the elderly.

C. Hypnotics have short
half-lives that render themselves ineffective for older adults.

D. Hypnotics are not
effective for “symptomatically masking” chronic insomnia in the elderly.

The PMHNP is caring for a
patient with chronic insomnia who is worried about pharmacological treatment
because the patient does not want to experience dependence. Which
pharmacological treatment approach will the PMHNP likely select for this
patient for a limited duration, while searching and correcting the underlying
pathology associated with the insomnia?

A. Serotonergic hypnotics
B. Antihistamines
C. Benzodiazepine hypnotics

D. Non-benzodiazepine

The PMHNP is caring for a
patient with chronic insomnia who would benefit from taking hypnotics. The
PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3
hours). Which drug will the PMHNP prescribe?

A. Flurazepam (Dalmane)
B. Estazolam (ProSom)
C. Triazolam (Halcion)
D. Zolpidem CR (Ambien)
The PMHNP is attempting to
treat a patient’s chronic insomnia and wishes to start with an initial
prescription that has a half-life of approximately 1–2 hours. What is the most
appropriate prescription for the PMHNP to make?

A. Triazolam (Halcion)
B. Quazepam (Doral)
C. Temazepam (Restoril)
D. Flurazepam (Dalmane)
A patient with chronic
insomnia asks the PMHNP if they can first try an over-the-counter (OTC)
medication before one that needs to be prescribed to help the patient sleep.
Which is the best response by the PMHNP?

A. “There are no
over-the-counter medications that will help you sleep.”

B. “You can choose from one
of the five benzo hypnotics that are approved in the United States.”

C. “You will need to ask
the pharmacist for a non-benzodiazepine medicine.”

D. “You can get melatonin
over the counter, which will help with sleep onset.”

A patient with chronic
insomnia and depression is taking trazodone (Oleptro) but complains of feeling
drowsy during the day. What can the PMHNP do to reduce the drug’s daytime
sedating effects?

A. Prescribe the patient an
antihistamine to reverse the sedating effects B. Increasing the patient’s dose
and administer it first thing in the morning C. Give the medicine at night and
lower the dose D. None of the above

The PMHNP is teaching a
patient with a sleep disorder about taking diphenhydramine (Benadryl). The
patient is concerned about the side effects of the drug. What can the PMHNP
teach the patient about this treatment approach?

A. “It can cause diarrhea.”

B. “It can cause blurred

C. “It can cause increased

D. “It can cause heightened
cognitive effects.”

Parents of a 12-year-old
boy want to consider attention deficit hyperactivity disorder (ADHD) medication
for their son. Which medication would the PMHNP start?

Methylphenidate Amphetamine
salts Atomoxetine All of the above could potentially treat their son’s

An adult patient presents with a history of
alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given
these comorbidities, the PMHNP determines which of the following medications
may be the best treatment option?

A. Methylphenidate
(Ritalin, Concerta)

B. Amphetamine
C. Atomoxetine (Strattera)
D. Fluoxetine (Prozac)
An 8-year-old patient
presents with severe hyperactivity, described as “ants in his pants.” Based on
self-report from the patient, his parents, and his teacher; attention deficit
hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most
likely to prescribe?

A. Methylphenidate
(Ritalin, Concerta)

B. Clonidine (Catapres)
C. Bupropion (Wellbutrin)
D. Desipramine (Norpramin)
A 9-year-old female patient
presents with symptoms of both attention deficit hyperactivity disorder (ADHD)
and oppositional defiant disorder. In evaluating her symptoms, the PMHNP
determines that which of the following medications may be beneficial in augmenting
stimulant medication?

A. Bupropion (Wellbutrin)
B. Methylphenidate
(Ritalin, Concerta)

C. Guanfacine ER (Intuniv)
D. Atomoxetine (Strattera)

A PMHNP supervisor is
discussing with a nursing student how stimulants and noradrenergic agents
assist with ADHD symptoms. What is the appropriate response?

A. They both increase
signal strength output dopamine (DA) and norepinephrine (NE).

B. Dopamine (DA) and
norepinephrine (NE) are increased in the prefrontal cortex.

C. Noradrenergic agents correct
reductions in dopamine (DA) in the reward pathway leading to increased ability
to maintain attention to repetitive or boring tasks and resist distractions.

D. All of the above.
A 43-year-old male patient
is seeking clarification about treating attention deficit hyperactivity
disorder (ADHD) in adults and how it differs from treating children, since his
son is on medication to treat ADHD. The PMHNP conveys a major difference is which
of the following?

A. Stimulant prescription
is more common in adults.

B. Comorbid conditions are
more common in children, impacting the use of stimulants in children.

C. Atomoxetine (Strattera)
use is not advised in children.

D. Comorbidities are more
common in adults, impacting the prescription of additional agents.

A 26-year-old female
patient with nicotine dependence and a history of anxiety presents with
symptoms of attention deficit hyperactivity disorder (ADHD). Based on the
assessment, what does the PMHNP consider?

A. ADHD is often not the
focus of treatment in adults with comorbid conditions.

B. ADHD should always be
treated first when comorbid conditions exist.

C. Nicotine has no reported
impact on ADHD symptoms.

D. Symptoms are often easy
to treat with stimulants, given the lack of comorbidity with other conditions.

Which of the following is a
true statement regarding the use of stimulants to treat attention deficit
hyperactivity disorder (ADHD)?

A. In adults with both ADHD
and anxiety, treating the anxiety with selective serotonin reuptake inhibitors
(SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or
benzodiazepines and the ADHD with stimulants is most effective in treating both

B. Signal strength output
is increased by dialing up the release of dopamine (DA) and norepinephrine

C. In conditions where
excessive DA activation is present, such as psychosis or mania, comorbid ADHD
should never be treated with stimulants.

D. High dose and pulsatile
delivery of stimulants that are short acting are preferred to treat ADHD.

The PMHNP is providing a
workshop for pediatric nurses, and a question is posed about noradrenergic
agents to treat ADHD. Which of the following noradrenergic agents have
norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?

A. Desipramine (Norpramin)
B. Methylphenidate
(Ritalin, Concerta)

C. Atomoxetine (Strattera)
D. Both “A” & “C” E.
“C” only

A 71-year-old male patient
comes to an appointment with his 65-year-old wife. They are both having
concerns related to her memory and ability to recognize faces. The PMNHP is
considering prescribing memantine (Namenda) based on the following symptoms:

A. Amnesia, aphasia, apnea
B. Aphasia, apraxia,

C. Amnesia, apraxia,

D. Aphasia, agnosia,

The PMHNP evaluates a
patient presenting with symptoms of dementia. Before the PMHNP considers
treatment options, the patient must be assessed for other possible causes of
dementia. Which of the following answers addresses both possible other causes
of dementia and a rational treatment option for Dementia?

A. Possible other causes:
hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment
option: memantine

B. Possible other causes:
hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment
option: donepezil

C. Possible other causes:
hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment
option: risperidone

D. Possible other causes:
hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment
option: donepezil

A group of nursing students
seeks further clarification from the PMHNP on how cholinesterase inhibitors are
beneficial for Alzheimer’s disease patients. What is the appropriate response?

A. Acetylcholine (ACh)
destruction is inhibited by blocking the enzyme acetylcholinesterase.

B. Effectiveness of these agents occurs in all
stages of Alzheimer’s disease.

C. By increasing
acetylcholine, the decline in some patients may be less rapid.

D. Both “A” & “C.”
The PMHNP is assessing a
patient who presents with elevated levels of brain amyloid as noted by positron
emission tomography (PET). What other factors will the PMHNP consider before
prescribing medication for this patient, and what medication would the PMHNP want
to avoid given these other factors?

A. ApoE4 genotype and avoid
antihistamines if possible

B. Type 2 diabetes and
avoid olanzapine

C. Anxiety and avoid

D. Both “A” & “B”
A 72-year-old male patient
is in the early stages of Alzheimer’s disease. The PMHNP determines that
improving memory is a key consideration in selecting a medication. Which of the
following would be an appropriate choice?

A. Rivastigmine (Exelon)
B. Donepezil (Aricept)
C. Galantamine (Razadyne)
D. All of the above
A 63-year-old patient
presents with the following symptoms. The PMHNP determines which set of
symptoms warrant prescribing a medication? Select the answer that is matched
with an appropriate treatment.

A. Reduced ability to
remember names is most problematic, and an appropriate treatment option is

B. Impairment in the
ability to learn and retain new information is most problematic, and an
appropriate treatment option would be donepezil.

C. Reduced ability to find
the correct word is most problematic, and an appropriate treatment option would
be memantine.

D. Reduced ability to
remember where objects are most problematic, and an appropriate treatment
option would be donepezil.

A 75-year-old male patient
diagnosed with Alzheimer’s disease presents with agitation and aggressive
behavior. The PMHNP determines which of the following to be the best treatment

A. Immunotherapy
Donepezil (Aricept)

Haloperidol (Haldol)

D. Citalopram (Celexa) or
Escitalopram (Lexapro)

The PMHNP has been asked to
provide an in-service training to include attention to the use of
antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff?

A. The use of
antipsychotics may cause increased cardiovascular events and mortality.

B. A good option in
treating agitation and psychosis in Alzheimer’s patients is haloperidol

C. Antipsychotics are often
used as “chemical straightjackets” to over-tranquilize patients.

D. Both “A” & “C.”
An 80-year-old female
patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel
syndrome. Which cholinergic drug may be the best choice for treatment given the
patient’s gastrointestinal problems?

A. Donepezil (Aricept)
B. Rivastigmine (Exelon)
C. Memantine (Namenda)
D. All of the above
The PMHNP understands that
bupropion (Wellbutrin) is an effective way to assist patients with smoking
cessation. Why is this medication effective for these patients?

A. Bupropion (Wellbutrin)
releases the dopamine that the patient would normally receive through smoking.

B. Bupropion (Wellbutrin)
assists patients with their cravings by changing the way that tobacco tastes.

C. Bupropion (Wellbutrin)
blocks dopamine reuptake, enabling more availability of dopamine.

D. Bupropion (Wellbutrin)
works on the mesolimbic neurons to increase the availability of dopamine.

Naltrexone (Revia), an
opioid antagonist, is a medication that is used for which of the following

A. Alcoholism
B. Chronic pain
C. Abuse of inhalants
D. Mild to moderate heroin

A patient addicted to
heroin is receiving treatment for detoxification. He begins to experience
tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe
for this patient?

A. Phenobarbital (Luminal)
B. Methadone (Dolophine)
C. Naloxone (Narcan)
D. Clonidine (Catapres)
A patient diagnosed with
obsessive compulsive disorder has been taking a high-dose SSRI and is
participating in therapy twice a week. He reports an inability to carry out
responsibilities due to consistent interferences of his obsessions and
compulsions. The PMHNP knows that the next step would be which of the

A. Decrease his SSRI and
add buspirone (Buspar).

B. Decrease his SSRI and
add an MAOI.

C. Decrease his SSRI
steadily until it can be discontinued then try an antipsychotic to manage his

D. Keep his SSRI dosage the
same and add a low-dose TCA.

The PMHNP is assessing a
patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax)
(Qsymia). Which of the following conditions/diseases will require further
evaluation before this medication can be prescribed?

A. Kidney disease stage II
B. Obesity
C. Cardiovascular disease
D. Diabetes type II
The PMHNP prescribes an
obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is
topiramate (Topamax) often prescribed with phentermine (Adipex-P)?

A. Phentermine (Adipex-P)
dose can be increased safely when taken with an anticonvulsant.

B. Phentermine (Adipex-P)
works by suppressing appetite while topiramate (Topamax) acts by inhibiting

C. Topiramate (Topamax)
potentiates appetite suppression achieved by phentermine (Adipex-P).

D. Topiramate (Topamax)
helps prevent the unwanted side effects of phentermine (Adipex-P).

The PMHNP is assessing a
patient who has expressed suicidal intent and is now stating that he is hearing
voices and sees people chasing him. The PMHNP identifies these symptoms to be
associated with which of the following?

A. Barbiturate intoxication

B. Marijuana intoxication
C. “Bath salt” intoxication

D. Cocaine intoxication
The PMHNP is caring for a
patient who openly admitted to drinking a quart of vodka daily. Prior to
prescribing this patient disulfiram (Antabuse), it is important for the PMHNP

A. Evaluate the patient’s
willingness to abstain from alcohol

B. Counsel the patient on
dietary restrictions

C. Obtain liver function

D. Assess for addiction to

QUESTION 75 An opioid-naive
patient is taking MS Contin (morphine sulfate) to treat his pain that is
secondary to cancer. Under what circumstances would the PMHNP order naloxone
(Narcan) IM/SQ?

A. The patient’s speech is
slurred, and he is in and out of sleep.

B. The patient’s appetite
has decreased from eating 100% of his meal to 50% of his meal.

C. The patient complains of
not having a bowel movement for 4 days.

D. The patient’s vital
signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations.

When completing this exam,
did you comply with Walden University’s Code of Conduct including the
expectations for academic integrity?


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