NURS-6630 Midterm Examination

NURS-6630 Midterm Examination

Question 1

Alprazolam, phenobarbital, and alcohol all interact with GABAA receptors in an allosteric manner. What happens to the GABAA receptor when these substances bind to it?

Response Feedback: When these substances bind to the GABAA receptor, it becomes more sensitive to GABA, which is the primary inhibitory neurotransmitter within the central nervous system (CNS).

Question 2

A 27-year-old female arrives at your emergency room with a rash that started about a week ago and has now spread to cover her entire body. She has a medical history that includes type 2 diabetes, hypertension, and bipolar disorder. The patient states, “The only change has been the new medication for my bipolar disorder for a few weeks.” Among the following medications, which one is likely responsible for this severe rash?

Response Feedback: Lamotrigine can cause a severe rash that can be life-threatening.

Question 3

You have been consulted to assess a 72-year-old male who has a medical history of atrial fibrillation and COPD. He has recently been diagnosed with major depressive disorder. Considering his comorbid conditions, which antidepressant would you recommend as the first-line treatment?

Response Feedback: Given the patient’s age and comorbid conditions, a tricyclic antidepressant (TCA) would likely result in more side effects, such as an increased risk of falls due to potential orthostatic hypotension and anticholinergic-related side effects. Additionally, TCAs can result in electrocardiographic changes in susceptible individuals, and the patient has a history of cardiac abnormalities due to atrial fibrillation. Therefore, TCAs should be avoided. The best choice would be an alternative antidepressant that is safer for this patient.

Page numbers used: Page 39 for TCA side-effect profile.

Question 4

Austin is one of your clients, and he asks you why exercise makes him feel better and lifts his mood. You explain to him that his body releases _____________, which is a naturally occurring _______________.

Response Feedback: During exercise, the client’s body releases naturally occurring opioids, specifically endorphins, which are considered peptides. Other neurotransmitters mentioned are not released during exercise and do not match the correct classification.

Question 5

What is the therapeutic plasma level of carbamazepine?

Question 6

Glia cells play a supportive role in neurons. Some functions of glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. Glial cells are categorized as microglia or macroglia. Among the macroglia cells, which one plays a role in myelinating axons, which may contribute to mood disorders if altered?

NURS-6630 Midterm Examination Question 7

Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder?

Response Feedback: “Psychosis is not represented in the diagnostic features for BPD.” Psychosis typically resolves along with mood symptoms, although diagnostic criteria acknowledge that psychotic symptoms may linger beyond the end of the episode.

Question 8

When initiating lithium, how long should you wait before checking a lithium level, and what is the therapeutic goal level of lithium?

Question 9

R.J. never found relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about two months ago and is following up with you today. He reports feeling “great” and that his relationship with his girlfriend is “better than ever now.” Since he is feeling well, he wonders when he can stop taking Bupropion. How long must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy?

Response Feedback: In treatment responders, most experts favor a continuation of antidepressant therapy for a minimum of six months following the achievement of remission.

Question 10

Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression?

Response Feedback: The combination of an SSRI or an SNRI with a norepinephrine-dopamine re-uptake inhibitor (bupropion) or a serotonin-norepinephrine antagonist (mirtazapine or mianserin) is a commonly used combination.

Question 11

The serotonin system is involved in many processes in psychiatry, including mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized?

Response Feedback: Serotonin is synthesized in the raphe nuclei.

Question 12

For the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor?

Question 13

Which neurotransmitter is considered the major inhibitory neurotransmitter?

Question 14

Is it appropriate to start lamotrigine in combination with another atypical antipsychotic in the treatment of an acute manic episode in bipolar disorder?

Response Feedback: Lamotrigine has also been extensively studied in bipolar depression.

Question 15

Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin-norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder?

Response Feedback: Because SSRI/SNRIs can cause initial restlessness, insomnia, and increased anxiety, and because patients with Generalized Anxiety Disorder are commonly sensitive to somatic sensations, starting doses should be low, typically half or less of the usual starting dose.

Question 16

Which anticonvulsant below induces its own metabolism over time?

Question 17

What is the strongest established risk factor for bipolar disorder?

Response Feedback: The strongest established risk factor for bipolar disorder is a family history of bipolar disorder.

Question 18

Close-ended questions can help identify when patients are taking medications incorrectly.

Question 19

K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about two weeks ago and is now calling you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic response?

Response Feedback: It has been consistently observed and reported that remission of depression often requires four weeks of treatment or more. The use of antidepressant for at least 6-12 weeks is recommended to determine whether it is helping or not.

Question 20

Is this a TRUE or FALSE statement? The following patient case is considered an example of treatment-resistant depression.

Response Feedback: At least one trial with an antidepressant with established efficacy in major depressive disorder (MDD), with sufficient duration and doses, is considered to be adequate antidepressant treatment.

Question 21

A patient presents to your clinic with generalized anxiety disorder. Her past medical history includes type II diabetes and uncontrolled hypertension. Which of the following agents would be least appropriate to start her on?

Response Feedback: Venlafaxine has been associated with increased hypertension and should not be used as an initial treatment option.

Question 22

Which one of the anticonvulsants mentioned below has sufficient data to support its use in bipolar disorder?

Response Feedback: Carbamazepine

has data to support its use in the treatment of bipolar disorder. The other medications listed do not have data to support their use in any phase of bipolar disorder.

Question 23

Scott is a 70-year-old man taking citalopram 40 mg daily. You discuss changing citalopram to another medication or decreasing the dose. He is hesitant to change medications since citalopram works for him. You end up decreasing his dose to 20 mg/day. He asks why you are wanting to change his medication or lower his dose. Which of the following reasons is the main reason you made the decision to decrease his dose?

Response Feedback: A maximum daily dose of 20 mg/day is recommended in patients older than 60 years of age due to the increased risk of QT prolongation.

Question 24

A 32-year-old male calls you complaining of decreased libido since starting Paroxetine 20 mg two weeks ago. He stopped the medication one day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend?

Response Feedback: For more severe discontinuation-related adverse events, re-institution of the SSRI and slow taper may be necessary to alleviate these symptoms.

Question 25

A patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He reports starting lithium 600 mg at bedtime about five days ago and thinks that may be the cause. What is the appropriate next step for this patient?

Response Feedback: The patient is likely experiencing lithium toxicity, and lab tests should be verified before continuing with other treatments for the tremor.

Question 26

Which answer choice includes all the components of patient-focused interventions to enhance adherence?

I. Education
II. Motivation
III. Skills
IV. Logistics

NURS-6630 Midterm Examination Question 27

You are currently evaluating a patient with major depressive disorder. One of his major complaints is insomnia. He states that he is awake all night and cannot get any rest. You decide to prescribe an antidepressant that will help his depression and his insomnia. The best option is _______________.

Response Feedback: The best option for this patient is trazodone. Trazodone is helpful in patients with depression and insomnia, and it is taken at night to help the patient obtain sleep and rest.

Question 28

Choose the appropriate pair regarding acetylcholine receptors.

Response Feedback: There are two classes of ACh receptors: muscarinic and nicotinic. Muscarinic receptors are G-protein-coupled, while nicotinic receptors are ion channels, allowing for rapid influx of sodium (Na+) and calcium (Ca2+) into the post-synaptic neuron.

Question 29

Which of the following is an appropriate strategy for managing treatment-resistant depression?

Question 30

Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY.

Response Feedback: Under the pharmacokinetics and pharmacodynamics subtitle:

– NSAIDs or other COX-2 inhibitors may decrease renal blood flow and thereby increase lithium levels by up to 25%.
– Therefore, thiazide diuretics, which act distally, will tend to increase lithium levels by up to 50%, while those that act more proximally generally have less of an effect on lithium levels.

Question 31

M. M. is a 27-year-old female student pharmacist who presents to the ER after experiencing extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and HR of 45. What medication below is likely the cause of these symptoms?

Response Feedback: The use of beta-blockers may be associated with orthostatic hypotension, lightheadedness, bradycardia, and nausea.

NURS-6630 Midterm Examination Question 32

Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why?

Response Feedback: As noted previously, antidepressants may contribute to an increase in mood episode frequency.

PRAC-6540 Week 7: Quiz DIAGNOSTIC IMAGING AND LABS

Question 33

John presents with both autonomic symptoms and physical hyperarousal after abruptly stopping his chronic opioid therapy. He claims that he is afraid of taking his medication because of what he is seeing on the news regarding opioid-related deaths. You know that John is experiencing symptoms due to an increase in norepinephrine. You decide to treat John with a medication to dampen the symptoms of opioid withdrawal. Which medication do you prescribe John?

Response Feedback: Clonidine dampens the symptoms associated with opioid withdrawal. The stimulation of the alpha-2 adrenoreceptors activates an inhibitory neuron.

Question 34

Which of the following medications used for the treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia?

Response Feedback: Notably, pharmacovigilance studies suggest that atypical antipsychotics may increase stroke risk among older patients, particularly those with dementia, so the use of second-generation antipsychotics requires more caution in this group.

Question 35

Choose the appropriate statement regarding lamotrigine dosing.

Response Feedback: Carbamazepine-induced metabolism of lamotrigine requires an increase in the dose of lamotrigine. Valproate may inhibit the clearance of lamotrigine, necessitating a dose reduction of lamotrigine.

Question 36

Jamie has major depressive disorder, and you decide to prescribe an SSRI. Jamie wants to make sure her medication is covered by her insurance plan. You review a list of SSRIs and notice that one medication listed on the list is not FDA-approved for the treatment of depression. Which of the following medications do you decide to NOT prescribe for Jamie’s depression?

Response Feedback: Among the SSRIs listed, fluvoxamine is not approved for the treatment of depression in the United States; it is approved only for the treatment of obsessive-compulsive disorder (OCD).

Question 37

Which of the following syndromes is characterized by disorientation + confusion, agitation, fever, diarrhea, and ataxia? This syndrome can occur when an MAOI is given with an SSRI.

Response Feedback: The serotonin syndrome is characterized by alterations in cognition (e.g., disorientation and confusion), behavior (e.g., agitation and restlessness), autonomic nervous system function (e.g., fever, shivering, diaphoresis, and diarrhea), and neuromuscular activity (e.g., ataxia, hyperreflexia, and myoclonus). This syndrome can occur when an MAOI is given with an SSRI or other serotonergic drugs.

Question 38

Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)?

i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine

Question 39

Of the following medications used in the treatment of social anxiety disorder, which one would you AVOID in a patient who has uncontrolled hypertension?

Response Feedback: Phenelzine is known to have hypertensive reactions as a primary side effect, so it should be avoided in patients with uncontrolled hypertension.

Question 40

Which medication

has been studied and recommended in patients with social anxiety disorder who also suffer from an alcohol use disorder?

Response Feedback: Studies have suggested that treatment with the SSRI paroxetine decreased anxiety and may have reduced alcohol use as well.

Question 41

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

Paraphrased Text:

NURS-6630 Midterm Exam

Question 23

A 70-year-old male patient taking citalopram 40 mg daily is concerned about a potential change in medication or dose reduction. He ultimately agrees to a dose reduction to 20 mg/day but questions the reasoning behind this decision. The primary reason for decreasing his dose is to mitigate the risk of QT prolongation, which is more pronounced in patients over 60 years old.

Question 24

A 32-year-old male who recently started taking Paroxetine 20 mg experiences decreased libido and severe irritability upon discontinuing the medication due to side effects. To address this issue, it is recommended to reinstitute the SSRI and initiate a slow taper to alleviate withdrawal symptoms.

Question 25

A 59-year-old male with bipolar disorder, hypertension, and COPD calls with complaints of extreme fatigue and hand tremors after initiating lithium 600 mg at bedtime five days ago. Before considering other treatments for the tremor, it is essential to verify lithium toxicity through lab tests.

Question 26

Patient-focused interventions to enhance adherence involve four key components:

I. Education
II. Motivation
III. Skills
IV. Logistics

Question 27

A patient with major depressive disorder presents with severe insomnia. Trazodone is recommended as the most suitable antidepressant option due to its potential to address both depression and insomnia, with the medication taken at night to promote sleep and rest.

Question 28

The appropriate pair regarding acetylcholine receptors is as follows:

There are two classes of ACh receptors: muscarinic and nicotinic. While muscarinic receptors are G-protein-coupled, nicotinic receptors function as ion channels, allowing for rapid influx of sodium (Na+) and calcium (Ca2+) into the post-synaptic neuron.

Question 29

An appropriate strategy for managing treatment-resistant depression is the combination of an SSRI or an SNRI with a norepinephrine-dopamine re-uptake inhibitor (bupropion) or a serotonin-norepinephrine antagonist (mirtazapine or mianserin), which is commonly used in clinical practice.

Question 30

Correct statements regarding lithium levels include:

– NSAIDs or other COX-2 inhibitors may decrease renal blood flow and increase lithium levels by up to 25%.
– Thiazide diuretics, which act distally, tend to increase lithium levels by up to 50%, while those acting more proximally generally have less effect on lithium levels.

Question 31

A patient experiencing extreme lightheadedness during a seminar presentation has a BP of 107/65 and an HR of 45, likely due to the use of beta-blockers, which can be associated with orthostatic hypotension, lightheadedness, bradycardia, and nausea.

Question 32

In the maintenance treatment of bipolar disorder, it is advisable to avoid antidepressants as they may contribute to an increase in mood episode frequency.

Question 33

To alleviate symptoms of opioid withdrawal, Clonidine is prescribed. Clonidine dampens the symptoms associated with opioid withdrawal by stimulating alpha-2 adrenoreceptors, activating inhibitory neurons.

Question 34

Atypical antipsychotics may increase stroke risk among older patients, especially those with dementia. Therefore, caution is advised when using second-generation antipsychotics in this patient population.

Question 35

The appropriate statement regarding lamotrigine dosing is as follows:

Carbamazepine-induced metabolism of lamotrigine requires an increase in the dose of lamotrigine, while valproate may inhibit lamotrigine clearance, necessitating a dose reduction of lamotrigine.

Question 36

Among SSRIs, fluvoxamine is not approved for the treatment of depression in the United States; it is approved solely for the treatment of obsessive-compulsive disorder (OCD).

Question 37

Serotonin syndrome, characterized by disorientation, confusion, agitation, fever, diarrhea, and ataxia, can occur when an MAOI is administered with an SSRI or other serotonergic drugs.

Question 38

Selective serotonin re-uptake inhibitors (SSRIs) include:

ii. Citalopram
iv. Fluoxetine

Question 39

In patients with uncontrolled hypertension, phenelzine should be avoided as it is known to cause hypertensive reactions as a primary side effect.

Question 40

Paroxetine has been studied and recommended in patients with social anxiety disorder who also have an alcohol use disorder, as it may decrease anxiety and reduce alcohol use.

Question 41

When completing this exam, adherence to Walden University’s Code of Conduct, including the expectations for academic integrity, was ensured.