NURS 6630 Week 9 Quiz Question 1

NURS 6630 Week 9 Quiz Question 1

Stephanie, a 36-year-old female with a history of anxiety, presents at the clinic. Her social history is unremarkable. She has been effectively managed on paroxetine for four years, but she feels it is no longer effective. You’ve decided to change her medication to vortioxetine 5mg, titrating up to a maximum dose of 20mg per day based on tolerability. The patient expresses, “I can’t even last 1 more day without feeling like my insides are going to explode with anxiety.” What is the most appropriate course of action?

a. Suggest that the patient try yoga or other natural remedies until vortioxetine takes effect.
b. Prescribe a short-term course of a low-dose benzodiazepine, such as alprazolam.
c. Prescribe an SNRI, such as venlafaxine, in addition to vortioxetine.
d. Recommend in-patient mental health care for the foreseeable future.

Question 2

Stephanie, a 36-year-old female with a history of anxiety, presents at the clinic. Her social history is unremarkable. She has been effectively managed on paroxetine for four years, but she feels it is no longer effective. You’ve decided to change her medication to vortioxetine 5mg, titrating up to a maximum dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” What is the best response?

3 or 4 days
1 or 2 weeks
3 or 4 weeks
10 weeks

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NURS 6630 Week 9 Quiz Question 3

Richard, a 54-year-old male with schizophrenia, has exhausted various medication options. You’ve decided to start him on Clozapine. Which of the statements below is true regarding Clozapine?

Regular blood monitoring must be performed to monitor for neutropenia.
Clozapine can only be filled by a pharmacy that participates in the REMS program.
Bradycardia is a common side effect of Clozapine.
A & B
All of the above

Question 4

Which of the following statements are true?

First-generation (typical) antipsychotics are associated with a higher incidence of EPS.
Second-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects.
There is evidence that atypical antipsychotics are significantly more effective than typical antipsychotics in the treatment of cognitive symptoms associated with schizophrenia.
A & B
A, B, and C

Question 5

The patient in the previous question states, “I can’t even last 1 more day without feeling like my insides are going to explode with anxiety.” What is the most appropriate course of action?

Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect.
Prescribe a short-term course of low-dose benzodiazepine, such as alprazolam.
Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine.
Recommend in-patient mental health care for the foreseeable future.

Question 6

Thomas, a 28-year-old male, presents at the clinic with signs and symptoms consistent with MDD. He is concerned about starting antidepressant therapy due to a friend’s experience of erectile dysfunction on an antidepressant. Which of the following would be the most appropriate antidepressant to start Thomas on?

Vilazodone
Sertraline
Paroxetine
Citalopram

Question 7

Stephanie, a 36-year-old female with a history of anxiety, presents at the clinic. Her social history is unremarkable. She has been effectively managed on paroxetine for four years, but she feels it is no longer effective. You’ve decided to change her medication to vortioxetine 5mg, titrating up to a maximum dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” What is the best response?

3 or 4 days
1 or 2 weeks
3 or 4 weeks
10 weeks

NURS 6630 Week 9 Quiz Question 8

Jane, a 17-year-old patient, presents at the office with signs consistent with schizophrenia. She expresses concern about gaining weight, as she has her prom dress picked out and a date for prom. Which of the following is the least appropriate choice to prescribe Jane?

Aripiprazole
Olanzapine
Haloperidol
Brexpiprazole

NURS 5644 Advanced Health Assessment/ Differential Diagnosis

Question 9

John, a 41-year-old patient, presents at the clinic with diarrhea, fatigue, and recent tremors. He was diagnosed with bipolar disorder 19 years ago and is currently managed on Lithium 300mg BID. His lithium level comes back at 2.3mmol/l. What is the most appropriate course of action?

Investigate other differential diagnoses for his symptoms.
Tell John to skip his next four Lithium doses and resume therapy.
Tell John he needs to go to the hospital and call an ambulance to bring him.
Prescribe loperamide to treat the diarrhea and ropinirole to treat the tremors

Question 10

Jordyn, a 27-year-old patient, presents at the clinic with GAD. She is 30 weeks pregnant and has been well controlled on sertraline 50mg daily. Jordyn says that “about once or twice a week, my husband really gets on my nerves, and I can’t take it.” She opposes increasing the sertraline dose due to the risk of further weight gain. You’ve decided to prescribe a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepine to prescribe to this patient?

Diazepam
Alprazolam
Clonazepam
Lorazepam

Question 11

Rebecca, a 32-year-old female, was recently prescribed escitalopram for MDD. She presents at the clinic today complaining of diaphoresis, tachycardia, and confusion. Based on the symptoms presented, what is the differential diagnosis for this patient?

Panic disorder
Gastroenteritis
Abnormal gait
Serotonin syndrome

Question 12

Mark, a 46-year-old male with treatment-resistant depression, has tried various medications, including SSRIs, SNRI, and TCAs. You’ve decided to initiate therapy with phenelzine. What must the PMHNP take into consideration when initiating therapy with phenelzine?

There is a minimum 7-day washout period when switching from another antidepressant to phenelzine.
Patient must be counseled on dietary restrictions.
MAOIs may be given as an adjunctive therapy with SSRIs.
A & B
All of the above

Question 13

Melvin, an 89-year-old male, presents with symptoms consistent with MDD. Which of the following would be the LEAST appropriate medication to prescribe to this elderly patient?

Nortriptyline
Amitriptyline
Desipramine
Trazodone

Question 14

Earle, an 86-year

-old patient with Community Acquired Pneumonia, often seems agitated during his hospital stay. He suffers from cognitive decline and currently takes no mental health medications. Treatment for CAP includes ceftriaxone and azithromycin. What is the LEAST appropriate medication to treat Earle’s anxiety?

Sertraline
Duloxetine
Citalopram
Venlafaxine

NURS 6630 Week 9 Quiz Question 15

Martin, a 92-year-old male with signs/symptoms consistent with MDD, suffers from glaucoma and recently underwent cataract surgery. Which of the following is the LEAST appropriate course of therapy when treating MDD?

Sertraline
Amitriptyline
Duloxetine
Vilazodone

Question 16

Sam, a 48-year-old male, presents at the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy?

Duloxetine
Sertraline
Mirtazapine
Buproprion

Question 17

Steve, a 35-year-old male, presents at the primary care office complaining of anxiety secondary to quitting smoking cold turkey 2 weeks ago. He has a 14-year history of smoking two packs per day. The patient has an unremarkable social history other than a recent divorce from his wife, Brittany. Which of the following would be the LEAST effective medication to treat Steve’s anxiety?

Buproprion
Sertraline
Varenicline
Alprazolam

Question 18

Amber, a 26-year-old female, presents at the clinic 6 weeks postpartum. She states that she has been “feeling down” since the birth of her son. She is currently breastfeeding her infant. You diagnose the patient with Postpartum depression. Which of the following is the LEAST appropriate option in treating her PPD?

Paroxetine
Escitalopram
Citalopram
Sertraline

Question 19

Cindy, a 55-year-old patient, presents with symptoms consistent with Generalized anxiety disorder. The patient has an unremarkable social history other than consuming two or three glasses of wine per night. Which of the following would be an appropriate therapy to start this patient on?

Xanax 0.25mg BID PRN Anxiety
Escitalopram 10mg daily
Buspirone 10mg BID
Aripiprazole 10mg daily

Question 20

Mirza, a 75-year-old patient with a long history of schizophrenia, has shown significant cognitive decline consistent with dementia. She has been well controlled on a regimen of risperidone 1mg BID. What is the most appropriate course of action for this patient?

Increase the risperidone to 1mg QAM, 2mg QPM
Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna.
Discontinue risperidone and initiate therapy with clozapine.
Augment the patient’s risperidone with brexpiprazole.