NURS 6630 Mid Term Exam Solved

NURS 6630 Mid Term Exam Solved Questions 1 to 10

Question 1 2 pts

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

Group of answer choices

Ibuprofen – decrease lithium levels

Hydrochlorothiazide – decrease lithium levels

Naproxen – increase lithium levels

Chlorthalidone – increase lithium levels

Question 2 2 pts

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?

Group of answer choices

Tranylcypromine

Clonazepam

Propranolol

Fluoxetine

Question 3 2 pts

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.?

Group of answer choices

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 4 2 pts

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?

Group of answer choices

Locus Coeruleus

Raphe Nuclei

Nucleus Basalis

Substantia Nigra

Ventral Tegmental Area

Also Read:

NURS 6630 Week 3 Quiz Which Neurotransmitter is Considered the Major Excitatory Neurotransmitter?

NURS 6630 Week 2 Explain the Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents

Question 5 2 pts

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?

Group of answer choices

Duloxetine

Clonidine

Diphenhydramine

Zolpidem

Question 6 2 pts

You have been consulted to evaluate 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?

Group of answer choices

A. Fluoxetine

B. Atomoxetine

C. Nortriptyline

D. Imipramine

Question 7 2 pts

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

Group of answer choices

Psychosis

Grandiose

Distractible

Flight of ideas

Question 8 2 pts

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?

Group of answer choices

citalopram

fluoxetine

fluvoxamine

paroxetine

Question 9 2 pts

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?

Group of answer choices

Myocarditis

Sexual dysfunction

Decreased seizure threshold

Suicidal thinking and behavior

Question 10 2 pts

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

Group of answer choices

True

False

NURS 6630 Mid Term Exam Solved Questions 11 to 20

Question 112 pts

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.?

1. Duloxetine
2. Quetiapine
3. Diazepam
4. Escitalopram

Group of answer choices

I only

II only

IV only

I and III

I and IV

Question 122 pts

Which of the following disease states contributes to a greater risk for substance use, violence, and victimization as well as worse overall quality of life?

Group of answer choices

Parkinson’s Disease

Multiple Sclerosis

Schizophrenia

Major depressive disorder

Question 132 pts

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

Group of answer choices

Neuroleptic Malignant syndrome

Serotonin syndrome

ICU delirium

Toxic encephalopathy

Question 142 pts

Which neurotransmitter is considered the major inhibitory neurotransmitter?

Group of answer choices

Glutamate

Glycine

GABA

Acetylcholine

Question 152 pts

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?

Group of answer choices

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

This drug is safe to use by this patient.

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

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.

Question 162 pts

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

Group of answer choices

Histamine; peptide

Acetylcholine; peptide

Adrernocorticotropic hormones; monoamine

Endorphins; peptide

Question 172 pts

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

Group of answer choices

Citalopram

Lorazepam

Phenelzine

Atenolol

Question 182 pts

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

Group of answer choices

True

False

Question 192 pts

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 covering 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?  

Group of answer choices

Ziprasidone

Quetiapine

Risperidone

Lamotrigine

Question 202 pts

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?

Group of answer choices

Escitalopram

Duloxetine

Bupropion

Nortriptyline

NURS 6630 Mid Term Exam Solved Questions 21 to 30

Question 21 2 pts

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

Group of answer choices

Switch from one SSRI to another SSRI

Switch from one SSRI to a SNRI

Combine two antidepressants with different mechanisms of action

Augment with lithium

Any of the above would be an appropriate strategy

Question 222 pts

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 _______________.

Group of answer choices

Trazodone

Fluoxetine

Temazepam

Phenelzine

Question 232 pts

What is the strongest established risk factor for bipolar disorder?

Group of answer choices

Being diagnosed with ADHD as a child

Family history of bipolar disorder

Male > female

Being diagnosed with Major Depressive Disorder

Question 242 pts

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

1. Education
2. Motivation
3. Skills
4. Logistics

Group of answer choices

I, II, and III only

I, II, III, and IV

II and III only

I and IV only

Question 252 pts

Choose the appropriate pair regarding acetylcholine receptors.

Group of answer choices

Nicotinic – ion; muscarinic – ion

Nicotinic – G-protein; muscarinic – ion

Nicotinic – G-protein; muscarinic – G-protein

Nicotinic – ion; muscarinic – G-protein

None of the above is correct

Question 262 pts

Alprazolam, phenobarbital, and alcohol all bind allosterically to GABA_A receptors. What occurs to the GABA_A receptor when these substances bind to the receptor?

Group of answer choices

The receptor’s sensitivity to GABA decreases

The receptor becomes more sensitive to GABA

The substance prevents GABA from binding to the receptor

Nothing occurs since the substances mentioned do not bind to the GABA_A receptor

Question 272 pts

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?

Group of answer choices

Astrocytes

Oligodendrocytes

Schwann cells

Ependymal cells

Question 282 pts

R.J. 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?

Group of answer choices

≥ 12 months

3 months

≥ 6 months

4–12 weeks

Question 292 pts

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

Group of answer choices

Gabapentin

Zonisamide

Pregabalin

Carbamazepine

Question 302 pts

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

Group of answer choices

Carbamazepine

Lithium

Bupropion

Olanzapine

NURS 6630 Mid Term Exam Solved Questions 31 to 40

Question 312 pts

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

Group of answer choices

Tyrosine

Glutamic acid

Tryptophan

Phenylalanine

Question 322 pts

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?

Group of answer choices

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

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

Switch to Bupropion 150 mg daily.

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

Question 332 pts

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

Group of answer choices

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

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

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

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

Question 342 pts

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

1. Nortriptyline
2. Citalopram
3. Duloxetine
4. Fluoxetine
5. Venlafaxine

Group of answer choices

i, iii, and v only

iii and v only

i only

ii and iv only

i, ii, iii, iv, and v

Question 352 pts

Which anticonvulsant below induces its own metabolism over time?

Group of answer choices

Lamotrigine

Gabapentin

Valproate

Carbamazepine

Question 362 pts

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

Group of answer choices

Sertraline + Bupropion

Fluoxetine + Citalopram

Desvenlafaxine + Bupropion

Fluoxetine + Mirtazapine

Question 372 pts

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

1. Lithium
2. Fluoxetine
3. Aripiprazole
4. Risperidone
5. Ziprasidone
6. Venlafaxine
7. Quetiapine
8. Valproate

Group of answer choices

II, III, and VIII only

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

II, III, and VI only

I only

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

Question 382 pts

Choose the appropriate statement regarding lamotrigine dosing.

Group of answer choices

If adding carbamazepine decrease lamotrigine dose

If adding valproic acid decrease lamotrigine dose

If adding carbamazepine no dose change is needed

If adding valproic acid no dose change is needed

Question 392 pts

Scott is a 70-year-old man that is 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.

Group of answer choices

doses above 40 mg/day increases the patient’s risk of sexual dysfunction

you want to save the patient money since higher doses are not typically covered by the patient’s insurance plan

a maximum daily dose of 20 mg is recommended in patients > 60 years of age due to the risk of QT prolongation

doses above 20 mg can cause insomnia

Question 402 pts

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

Group of answer choices

Citalopram

Paroxetine

Sertraline

Sertraline

NURS 6630 Mid Term Exam Solved Questions 41 to 50

Question 41 2 pts

Is this a TRUE or FALSE statement? 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 6 weeks

– Citalopram 20 mg daily for 2 weeks

Group of answer choices

True

False

Question 422 pts

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?

Group of answer choices

Sodium – ionotropic

Sodium – metabotropic

Magnesium – metabotropic

Magnesium – ionotropic

Question 432 pts

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

Group of answer choices

Symptom remission is expected within 1 week.

Symptoms may worsen initially with SSRI treatment.

They are considered second-line therapy.

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

Question 442 pts

What is the therapeutic plasma level of carbamazepine?

Group of answer choices

4 to 12 µg/mL

4 to 12 mg/mL

0.8–1.2 mEq/mL

0.6 to 0.8 mEq/L

Question 452 pts

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

Group of answer choices

sertraline

paroxetine

venlafaxine

citalopram

Question 462 pts

Ronnie presents to your clinic with tremor, bradykinesia, and rigidity. The symptoms are very similar to what you would see in a patient with Parkinson’s disease. The client was prescribed risperidone several weeks ago. What is the reason for Ronnie’s symptoms?

Group of answer choices

Risperidone blocks dopamine receptors in the striatum

Risperidone increases dopamine concentrations in the striatum

Risperidone blocks serotonin receptors in the striatum

Risperidone increases serotonin concentrations in the striatum

Question 472 pts

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

Group of answer choices

GABAA – ionotropic – calcium and potassium

GABAB – ionotropic – chloride

GABAB – metabotropic – Calcium and potassium

GABAA – metabotropic – chloride

Question 482 pts

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?

Group of answer choices

2–4 weeks

4–12 weeks

≥ 6 months

≤ 1 week

Question 492 pts

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?

Group of answer choices

Start propranolol for the tremor.

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

Verify labs to determine appropriate lithium level.

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

Question 502 pts

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

Group of answer choices

5 days; 0.6 to 0.8 mEq/L

4–6 weeks; 0.6 to 0.8 mEq/L

3 days; 0.8 – 1.2 mEq/L

No need to check until patient experiences symptoms of lithium toxicity

Question 510 pts

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

Group of answer choices

True

False