NURS 6630 MIDTERM QUESTION AND ANSWER RETAKE

Purple answers were marked incorrect. Red answers were marked correct. QUESTION 1 1. A noncompliant patient states, "Why do you want me to put this poison in my body?" Identify the best response made by the psychiatr ...

Purple answers were marked incorrect. Red answers were marked correct. QUESTION 1 1. 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). A. "You have to take your medication to become stable." B. "Most medications will increase the number of neurotransmitters that you already have in the brain." C. "Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has." D. "Why do you believe that your medication is poison?" I received 0/1 for this answer?? 1 points QUESTION 2 1. Which statement about neurotransmitters and medications is true? My correct answer was several psychiatric meds were developed after discovery of endogenous neurotransmitters. (The answer wording is different. A. Natural neurotransmitters such as endorphins have been discovered after the development of medications. B. Some medications were developed after the discovery and known action of the neurotransmitters in the brain. C. Neurotransmitters receive messages from most medications. D. The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed. 1 points NURS 6630 MIDTERM QUESTION AND ANSWER RETAKE QUESTION 3 1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP's best response would be: A. "In an extreme case such as yours, more than one medication is often needed." B. "Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects. C. "Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms." D. "I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms." 1 points QUESTION 4 ? 1. During gene expression, what must occur prior to a gene being expressed? A. Transcription factor must bind to the regulatory region within the cell's nucleus. B. RNA must be converted to mRNA. C. The coding region must separate from the regulatory region. This is wrong D. RNA polymerase must inhibit the process of changing RNA to mRNA. 1 points QUESTION 5 1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? A. Genes impact neuron functioning directly. B. Changes made to proteins lead to changes in behavior. C. Neurons are able to impact protein synthesis. D. Genes impact the DNA of a cell, leading to changes in behavior. 1 points QUESTION 6 1. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because: A. Neurotransmission that occurs via the axon allows for transport of a neurotransmitter. B. Active transport is a different type of energy that allows the transport of certain neurotransmitters. C. Neurotransmitters can spread by diffusion. D. The postsynaptic neuron can release the neurotransmitter. 1 points QUESTION 7 1. Why is the cytochrome P450 enzyme system of significance to the PMHNP? A. The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective. B. The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer C. The medication's chemical composition changes when it comes in contact with the acid in the stomach. D. The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively. 1 points QUESTION 8 1. 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? A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics. B. The term polymorphic refers to the body's ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics. C. About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics. D. Most enzyme pathways do not have interactions between the newer medications. 1 points QUESTION 9 1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice? A. Most medications that act on G-protein linked receptors have antagonistic traits. B. The majority of medications used in practice are full agonists and are used to stimulate the body's natural neurotransmitters. C. Most medications act as partial agonists because they allow the body to use only what is needed. D. Medications used in practice may act as inverse agonists if the dosage is too high. 1 points QUESTION 10 1. 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: A. The patient smokes cigarettes. This is correct! B. The patient has hypertension. C. The patient has chronic kidney disease, stage 2. D. The patient drinks a cup of coffee a day. 1 points QUESTION 11 1. 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 druginduced thrombocytopenia. The PMHNP is aware that his next best action is to: A. Alert staff to possible seizures B. Write an order for a different mood stabilizer For some reason I got 0/1 points for this?? C. Decrease the amount prescribed for aripiprazole (Abilify) D. Explain to the patient that it will be more difficult to control his temper 1 points QUESTION 12 1. 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? A. Review Amitriptyline (Elavil) level Correct answer B. Order a liver function test C. Check the patient's blood pressure and pulse D. Order a stat platelet count 1 points QUESTION 13 1. 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? A. To promote the availability of serotonin B. To decrease serotonin C. To indirectly increase the amount of dopamine in the body D. To help decrease the amount of serotonin and dopamine 1 points QUESTION 14 1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial? A. "I have trouble staying asleep in the middle of the night." B. "My spouse told me that I seem to have trouble remembering things sometimes." C. "I really want to stop smoking, but the cravings are too strong." D. "I feel nervous to go outside and be in large crowds." 1 points QUESTION 15 1. 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? A. "The drug will have an almost immediate effect." B. "The drug can take a while to build up in your system." C. "The drug is slow to release but lasts for a long time." D. "The drug will make a subtle difference in your symptoms." 1 points QUESTION 16 1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? A. Benzodiazepine B. Mirtazapine (Remeron) C. Ketamine D. Varenicline (Chantix) 1 points QUESTION 17 1. 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? A. Full agonists B. Antagonists C. Partial agonists D. Inverse agonists 1 points QUESTION 18 1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient? A. "The patient needs to have an inverse agonist." B. "The patient could benefit from an anticonvulsant." C. "The patient's calcium, sodium, chloride, and potassium levels must be regulated." D. "The patient should have a drug that acts on ligand-gated ion channels." 1 points QUESTION 19 1. 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? A. Ligand-gated ion channels with a pentameric structure B. Ligand-gated ion channels with a tetrameric structure C. Voltage-sensitive ion channels D. Anticonvulsants 1 points QUESTION 20 ? 1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis? A. "It's my fault that all of this is happening. I don't think I could ever forgive myself." Not correct B. "I have to talk to the President because I'm the only one who can help him." C. "I'm not sure why that lady is wearing a red jacket since it's the dogs who need food." D. "I don't know that I even want to go to that meeting. It doesn't seem worth it anymore." 1 points QUESTION 21 1. 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? I did not have this question A. Obtaining raw normative metrics and using them to assess functionality B. Having the patient report on cognitive function based on personal experiences C. Monitoring the patient in a controlled setting D. Measuring symptoms of psychosis 1 points QUESTION 22 1. 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? A. Dopamine is terminated through multiple mechanisms. B. The D2 autoreceptor regulates release of dopamine from the presynaptic neuron. C. MAO-B presents in the mitochondria within the presynaptic neuron. D. D2 receptors are the primary binding site for dopamine agonists. Correct answer 1 points QUESTION 23 1. 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? A. "Amphetamines may help you, as they can alleviate psychotic conditions." B. "Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you." C. "Amphetamines can cause hallucinations, so I would advise against this type of prescription."Correct D. "Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you." 1 points QUESTION 24 1. 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? A. Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms. B. Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia. C. Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia. D. The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia. 1 points QUESTION 25 1. A patient is diagnosed with schizophrenia. What increases the patient's potential to mediate the cognitive symptoms of the disease? A. Achieving underactivity of the mesocorticol projections to the prefrontal cortex B. Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex C. Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex D. Achieving overactivity of the mesocorticol projections to the prefrontal cortex 1 points QUESTION 26 1. 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? A. Hypersexuality B. Amenorrhea C. Dystonia D. Tardive dyskinesia correct answer A. 1 points QUESTION 27 1. 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? Not on my test Olanzapine to clozapine B. Asenapine to Risperidone C. Aripripazole to ziprasidone D. Aripripazole to clozapine 1 points QUESTION 28 1. 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? Not on my test A. Quetiapine B. Paliperidone C. Lurasidone D. Clozapine 1 points QUESTION 29 1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body? A. Muscarinic antagonists are more likely to cause decreased prolactin levels. B. D2 antagonists decrease the likelihood of EPS symptoms. C. D2 antagonism is linked to antidepressant properties. D. D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia. 1 points QUESTION 30 1. 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? A. An underlying depressive disorder B. The recent change of a 2nd generation antipsychotic to a conventional one This is correct C. The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic D. All of the above 1 points QUESTION 31 1. 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)? Not on my test A. Long-term use of antipsychotics B. Genetic disposition C. Age D. A and C 2333326 E. All of the above 1 points QUESTION 32 1. The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics? A. Those that are potent D2 antagonists B. Those that are potent D2 antagonists with 5HT2A antagonism properties C. D2 receptors that are blocked in the nigrostriatal pathway D. Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors 1 points QUESTION 33 1. 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? A. 5HT2 antagonism B. D2 antagonism This was wrong 0/1 C. Alpha-2 antagonism D. D2 partial agonist 1 points QUESTION 34 1. 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? A. Norepinephrine B. Dopamine C. Serotonin D. A and C E. All of the above 1 points QUESTION 35 1. 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? A. The patient has an unsustained response to antidepressants. B. The patient has antidepressant-induced hypomania. C. The patient has a depletion of monoamine neurotransmitters. D. The patient has an adverse effect to atypical antipsychotics. 1 points QUESTION 36 1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? A. Patient with a bipolar I designation I don’t know why but this was marked 0/1 for me B. Patient with a bipolar II designation C. Patient with a bipolar III designation D. None of the above 1 points QUESTION 37 1. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy? Not on my test A. The patient may experience paranoid avoidant behavior. B. The patient may experience severe depression. C. The patient may experience auditory hallucinations. D. The patient may experience increased mood cycling. 1 points QUESTION 38 1. The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient's response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment? A. The patient has a higher chance of tolerating SSRI/SNRI treatment. B. The patient will have a positive response to SSRI/SNRI treatment. C. The patient will develop severe mood cycling in response to treatment. D. The patient may be less responsive or tolerant to the treatment. 1 points QUESTION 39 1. Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh's serotonin levels? A. Norepinephrine potentiates 5HT release through a2 postsynaptic receptors. B. Norepinephrine inhibits 5HT release through a2 receptors. C. Norepinephrine inhibits α2 receptors on axon terminals. D. Norepinephrine potentiates 5HT release through a1 and a2 receptors. 1 points QUESTION 40 1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment? A. "Drugs inhibit the release of NE." B. "Drugs can mimic the natural functioning of the NE neuron." C. "Drugs are unable to simulate the effects of NE neurons." D. "Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron." 1 points QUESTION 41 1. The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder? A. Insomnia B. Suicidal ideation C. Problems concentrating D. A and C 1 points QUESTION 42 1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication? A. Neuronal firing rates are not dysregulated in depression. B. Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses. C. Upon the acute administration of a SSRI, 5HT decreases. D. The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs. Correct 1 points QUESTION 43 1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities? I had different answer choices the correct answer was Both have actions at sigma receptors that contribute to both anxiolytic and antipsychotic effects A. Both have a sedative-like, calming effect. B. Both contribute to antipsychotic actions. C. Both demonstrate favorable findings in treating depression in the elderly. D. Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.