NURS6630C Midterm Exam - Week 6 july 2021

Question 1

M. M. is 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?

 

A.            Tranylcypromine

 

B.            Clonazepam

 

C.            Propranolol

 

D.            Fluoxetine

 

Question 2

Which atypical antipsychotic(s) require a meal for better absorption?

i.              Quetiapine

ii.             Ziprasidone

iii.            Asenapine

iv.           Olanzapine

v.            Lurasidone

 

A.            I and V

 

B.            II and V

 

C.            III and V

 

D.            V only

 

Question 3

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

 

A.            Symptom remission is expected within 1 week.

 

B.            Symptoms may worsen initially with SSRI treatment.

 

C.            They are considered second-line therapy.

 

D.            Start at the usual starting dose that is consistent with depression treatment.

 

Question 4

Which disease state of a non-adherent patient is at greater risk for substance use, violence, and victimization as well as worse overall quality of life?

 

a.            Parkinson’s Disease

 

b.            Multiple Sclerosis

 

c.             Schizophrenia

 

d.            Major depressive disorder

 

Question 5

Choose the appropriate statement regarding lamotrigine dosing.

 

A.            If adding carbamazepine decrease lamotrigine dose

 

B.            If adding valproic acid decrease lamotrigine dose

 

C.            If adding carbamazepine no dose change is needed

 

D.            If adding valproic acid no dose change is needed

 

Question 6

K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.?

 

A.            Inform her that the therapy is working and there is no need to discontinue.

 

B.            Begin a slow taper of clonazepam and talk about alternative medications to help with her new diagnosis.

 

C.            Discontinue clonazepam at this visit and begin Escitalopram 5 mg daily.

 

D.            Change her scheduled dosing to as needed to help with anxiety symptoms.

 

 

Question 7

K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 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?

 

A.            2–4 weeks

 

B.            4–12 weeks

 

C.            ≥ 6 months

 

D.            ≤ 1 week

                               

 

 

Question 8

The following patient case is considered an example of treatment-resistant depression.

B. B. is a 26-year old-female at your clinic today with the diagnosis, “treatment-resistant depression.” She is currently on Bupropion 300 mg daily and has been at this dose for 6 weeks with no alleviation in depressive symptoms.

She has trialed the following medications in the past with treatment duration listed:

- Paroxetine 40 mg daily for 4 weeks

- Citalopram 20 mg daily for 2 weeks

 

A.            True

 

B.            False

 

Question 9

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

I.             Education

II.            Motivation

III.           Skills

IV.          Logistics

 

a.            I, II, and III only

 

b.            I, II, III, and IV

 

c.             II and III only

 

d.            I and IV only

 

Question 10

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

 

a.            True

 

b.            False

 

Question 11

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

 

A.            Sertraline + Bupropion

 

B.            Fluoxetine + Venlafaxine

 

C.            Desvenlafaxine + Bupropion

 

D.            Fluoxetine + Mirtazapine

 

 

Question 12

K. B. never felt relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today. He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.” Because he is feeling so well at this time, he is wondering 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?

 

A.            ≥ 12 months

 

B.            3 months

 

C.            ≥ 6 months

 

D.            4–12 weeks

 

Question 13

Choose the appropriate pair regarding acetylcholine receptors.

 

a.            Nicotinic – ion; muscarinic – ion

 

b.            Nicotinic – G-protein; muscarinic – ion

 

c.             Nicotinic – G-protein; muscarinic – G-protein

 

d.            Nicotinic – ion; muscarinic – G-protein

 

e.            None of the above is correct

 

Question 14

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

 

a.            Astrocytes

 

b.            Oligodendrocytes

 

c.             Schwann cells

 

d.            Ependymal cells

 

 

Question 15

Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway

 

a.            GABAA – ionotropic – calcium and potassium

 

b.            GABAB – ionotropic – chloride

 

c.             GABAB – metabotropic – Calcium and potassium

 

d.            GABAA – metabotropic – chloride

 

 

2 points  

 

 

uestion 16

Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations.

 

A.            True

 

B.            False

 

 

Question 17

Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line?

 

A.            Fluoxetine

 

B.            Atomoxetine

 

C.            Nortriptyline

 

D.            Imipramine

 

Question 18

A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to her whole body. She has a past medical history significant for type 2 diabetes, hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be causing this severe rash?

 

A.            Ziprasidone

 

B.            Quetiapine

 

C.            Risperidone

 

D.            Lamotrigine

 

 

Question 19

With second-generation antipsychotics, what is the main side effect that requires frequent monitoring?

 

A.            Metabolic Syndrome

 

B.            Extra-pyramidal symptoms

 

C.            Parkinsonism

 

D.            Dystonia

 

 

Question 20

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

i.              Nortriptyline

ii.             Citalopram

iii.            Duloxetine

iv.           Fluoxetine

v.            Venlafaxine

 

A.            i, iii, and v only

 

B.            iii and v only

 

C.            i only

 

D.            ii and iv only

 

E.            i, ii, iii, iv, and v

 

 

Question 21

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

 

A.            Switch from one SSRI to another SSRI

 

B.            Switch from one SSRI to a SNRI

 

C.            Combine two antidepressants with different mechanisms of action

 

D.            Augment with lithium

 

E.            Any of the above would be an appropriate strategy

 

Question 22

M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the following would be a first-line treatment option for M. B.?

I.             Duloxetine

II.            Quetiapine

III.           Diazepam

IV.          Escitalopram

 

A.            I only

 

B.            II only

 

C.            IV only

 

D.            I and III

 

E.            I and IV

 

 

Question 23

Which anticonvulsant below induces its own metabolism over time?

 

A.            Lamotrigine

 

B.            Gabapentin

 

C.            Valproate

 

D.            Carbamazepine

 

 

Question 24

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

 

A.            Citalopram

 

B.            Lorazepam

 

C.            Phenelzine

 

D.            Atenolol

 

 

 

Question 25

Of the following antipsychotic medications listed below, which one has a Black Box Warning for seizure, agranulocytosis, and seizures?

 

A.            Quetiapine

 

B.            Clozapine

 

C.            Olanzapine

 

D.            Lurasidone

 

 

Question 26

In order 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?

 

a.            Sodium – ionotropic

 

b.            Sodium – metabotropic

 

c.             Magnesium – metabotropic

 

d.            Magnesium – ionotropic

 

Question 27

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

 

A.            Psychosis

 

B.            Grandiose

 

C.            Distractible

 

D.            Flight of ideas

 

 

Question 28

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 5 days ago and thinks that may be the cause. What is the appropriate next step for this patient?

 

A.            Start propranolol for the tremor.

 

B.            Tell patient to cut dose in half to stop the tremor.

 

C.            Verify labs to determine appropriate lithium level.

 

D.            Tell patient to discontinue the medication all together due to lithium toxicity.

 

uestion 29

A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning?

 

A.            Myocarditis

 

B.            Sexual dysfunction

 

C.            Decreased seizure threshold

 

D.            Suicidal thinking and behavior

 

Question 30

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

 

A.            Valproate, because it is only used in the treatment of acute manic episodes.

 

B.            Lithium, because it is only used in the treatment of acute manic episodes.

 

C.            Venlafaxine, because it can possibly increase frequency of mood episodes.

 

D.            Lamotrigine, because it is only used in initial treatment of bipolar depression, but not maintenance.

 

Question 31

It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of an acute manic episode in bipolar disorder.

 

A.            True

 

B.            False

 

 

Question 32

Which neurotransmitter is considered the major inhibitory neurotransmitter?

 

a.            Glutamate

 

b.            Glycine

 

c.             GABA

 

d.            Acetylcholine

 

Question 33

A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend?

 

A.            Taper Paroxetine over 2–4 weeks and then he can switch to another antidepressant, such as fluoxetine.

 

B.            Continue for 2 more weeks so the therapy can be considered adequate before discontinuing.

 

C.            Switch to Bupropion 150 mg daily.

 

D.            Do not restart the medication because this is considered treatment failure and another antidepressant should be started right away.

 

Question 34

Which drug below has an interaction with cigarette smoking and should be adjusted based on patient’s tobacco use/non-use?

 

A.            Risperidone

 

B.            Haloperidol

 

C.            Aripiprazole

 

D.            Clozapine

 

Question 35

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

 

A.            Carbamazepine

 

B.            Lithium

 

C.            Bupropion

 

D.            Olanzapine

 

Question 36

Which amino acid is involved in the synthesis of both norepinephrine and dopamine?

 

a.            Tyrosine

 

b.            Glutamic acid

 

c.             Tryptophan

 

d.            Phenylalanine

 

Question 37

Of the following medications, which ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy)?

I.             Lithium

II.            Fluoxetine

III.           Aripiprazole

IV.          Risperidone

V.            Ziprasidone

VI.          Venlafaxine

VII.         Quetiapine

VIII.        Valproate

 

A.            II, III, and VIII only

 

B.            I, III, IV, V, VII, and VIII only

 

C.            II, III, and VI only

 

D.            I only

 

E.            All that are listed are appropriate in treating the acute episode.

 

Question 38

Which of the following receptors below would likely result in extra-pyramidal symptoms, tardive dyskinesia, and hyperprolactinemia?

 

A.            5-HT2 agonism

 

B.            D2 agonism

 

C.            D2 antagonism

 

D.            5-HT2 antagonism

 

 

Question 39

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

 

A.            5 days; 0.6 to 0.8 mEq/L

 

B.            4–6 weeks; 0.6 to 0.8 mEq/L

 

C.            3 days; 0.8 – 1.2 mEq/L

 

D.            No need to check until patient experiences symptoms of lithium toxicity

 

Question 40

How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic?

 

A.            Stop offending agent

 

B.            Initiate Dantrolene

 

C.            Both A & B

 

D.            None of the above

 

 

Question 41

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

 

A.            Citalopram

 

B.            Paroxetine

 

C.            Sertraline

 

D.            Sertraline

 

Question 42

Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder?

i.              Depakote

ii.             Lamotrigine

iii.            Topiramate

iv.           Carbamazepine

v.            Gabapentin

 

A.            i and ii

 

B.            ii and iv

 

C.            i and iv

 

D.            iii and v

 

 

uestion 43

An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of the following medications, which one is likely contributing to these side effects?

 

A.            Escitalopram

 

B.            Duloxetine

 

C.            Bupropion

 

D.            Nortriptyline

 

 

Question 44

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

 

A.            Ibuprofen – decrease lithium levels

 

B.            Hydrochlorothiazide – decrease lithium levels

 

C.            Naproxen – increase lithium levels

 

D.            Chlorthalidone – increase lithium levels

 

Question 45

What is the therapeutic plasma level of carbamazepine?

 

A.            4 to 12 µg/mL

 

B.            4 to 12 mg/mL

 

C.            0.8–1.2 mEq/mL

 

D.            0.6 to 0.8 mEq/L

 

uestion 46

Which drug below differs from other atypical antipsychotics in causing persistent hyperprolactinemia?

 

A.            Clozapine

 

B.            Risperidone

 

C.            Aripiprazole

 

D.            Olanzapine

 

uestion 47

What is the strongest established risk factor for bipolar disorder?

 

A.            Female > Male

 

B.            Family history of bipolar disorder

 

C.            Male > female

 

D.            Being diagnosed with Major Depressive Disorder

 

uestion 48

Which of the following are NOT primary target(s) symptom for antipsychotic agents in schizophrenia?

i.              Depression, anxiety, demoralization, suicidality, excitability, and agitation

ii.             Delusions, hallucinations, disorganized thoughts

iii.            Affective flattening, alogia, avolition, anhedonia, social withdrawal

iv.           Attention, memory, and executive functions

 

A.            II and III only

 

B.            I and IV only

 

C.            I, II and IV only

 

D.            IV only

 

 

uestion 49

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

 

a.            Locus Coeruleus

 

 

 

                b.            Raphe Nuclei

 

c.             Nucleus Basalis

 

d.            Substantia Nigra

 

e.            Ventral Tegmental Area

 

Question 50

A 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar disorder and was previously prescribed valproic acid by another doctor. What is your concern with this medication in this specific patient?

 

A.            The drug causes weight gain, therefore, I would likely not want patient on it for her disease state.

 

B.            This drug is safe to use by this patient.

 

C.            This drug is used more for seizures than bipolar disorder, therefore, I would want to look at other options first.

 

D.            This drug is a teratogen, therefore, I would need to counsel on avoidance of this medication while trying for a baby, and to follow-up with the doctor who prescribed it.

 

uestion 51

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

  Yes