What direct-acting dopamine receptor agonist is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS) to help lower the dopamine
... [Show More] receptor blockade?
A. Dantrolene (Dantrium)
B. Benztropine (Cogentin)
C. Bromocriptine (Parlodel)
D. Trihexyphenidyl (Artane)
C. Bromocriptine (Parlodel)
A 74 y/o female present for an evaluation. The psychiatric nurse practitioner has the patient complete the mini mental status examination and clock drawing. The patient is unable to correctly draw the face of the clock. Which area of the brain is likely to have compromised functioning?
A. Corpus callosum
B. Wernicke's Area
C. Left Hemisphere
D. Right Hemisphere
D. Right Hemisphere
Which of the following statements reflects current understanding of neurodevelopment and best explains risk-taking behaviors of adolescent males?
A. Stimulant and substance use impairs judgment and cognitive appraisal
B. Pruning of serotonin circuits in the adolescent brain is associated with increased impulsivity
C. Maturation of the prefrontal cortex continues into mid-20s and early 30s
D. Hormonal flooding, especially testosterone and oxytocin, increase dopamine levels in the brain
C. Maturation of the prefrontal cortex continues into mid-20s and early 30s
What cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine?
A. 2C19
B. 1A2
C. 2C9
D. 2D6
B. 1A2
As a psychiatric mental health nurse practitioner, you are aware of antipsychotic medication side effects. Which of the following side effects of antipsychotic medications has an insidious, delayed-onset typically 1 to 2 years after initiation of the medication?
A. Sedation
B. Weight gain
C. Tardive dyskinesia
D. Dry mouth
C. Tardive dyskinesia
Which mood stabilizer is most associated with a potentially life-threatening rash?
A. Divalproex (depakote)
B. Carbamazepine (tegretol)
C. Lithium (eskalith)
D. Lamotrigine (lamictal)
D. Lamotrigine (lamictal)
The psychiatric-Mental Health Nurse Practitioner would expect to see which of the following during a physical exam for a patient with bulimia nervosa?
A. Alopecia areata
B. Tachycardia
C. Erosion of dental enamel
D. Obesity
C. Erosion of dental enamel
Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiety disorders?
A. Decreasing norepinephrine in the locus ceruleus diminishes symptoms of anxiety
B. Increasing serotonergic activity in the amygdala diminishes symptoms of anxiety
C. Increased levels of CRF in the amygdala, hippocampus and locus ceruleus increases symptoms of anxiety
D. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety
D. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety
Mr. Smith is a 56 y/o white male who has been successfully treated on Selegiline for over 4 years. Mr. Smith is going in for an elective surgical procedure. Which medication is strictly contraindicated with Selegiline?
A. Codeine
B. NSAIDs
C. Meperidine
D. Morphine
C. Meperidine
Which of the following medications has a unique mechanism of action in that it is both a dopamine and norepinephrine reuptake inhibitor?
A. Imipramine (Tofranil)
B. Duloxetine (Cymbalta)
C. Bupropion (Wellbutrin)
D. Venlafaxine (Effexor)
C. Bupropion (Wellbutrin)
When assessing an elderly patient who complains of tinnitus, the PMHNP would associate which of the following findings with an acoustic neuroma?
A. Perforation of tympanic membrane
B. Suppuration of the labyrinth
C. Unilateral ringing in ear
D. Inflammation of middle ear
C. Unilateral ringing in ear
Which of the following statements regarding disulfiram (Antabuse) is correct?
A. Disulfiram should not be taken for at least 6 hours after drinking alcohol
B. A disulfiram-alcohol reaction can occur up to 1 week after discontinuing disulfiram
C. Disulfiram can lower liver function tests so monitoring is necessary
D. Avoid anything containing alcohol (I.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing
D. Avoid anything containing alcohol (I.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing
Which of the following findings would raise concern in an annual sports exam for a 15 y/o girl?
A. BP 86/56
B. Ht 67 inches, wt 102 lb
C. Pulse 60, respirations 26
D. Scar tissue from a hymenal tear at 11 o'clock (reported biking injury)
B. Ht 67 inches, wt 102 lb
Your patient comes into the office for her middle of the year appointment. She is diagnosed with Bipolar 1 disorder. She has been maintained well for the past 3 years on Oxcarbazepine (Trileptal) 900 mg PO Q HS. Her labs are normal except for a blood sugar of 114 and her HA1c is 5.6. She has normal energy level and states that her mood is stable but complains of excessive urination and thirst. You suspect:
A. Side effects of Oxcarbazepine
B. Possible hyponatremia
C. Possible polydipsia
D. Possible diabetes 2
A. Side effects of Oxcarbazepine
Patty is a 62 y/o white female with Bipolar 1 disorder and has been stable for 2 years on valproate and risperidone. She was recently diagnosed with shingles, and her primary care nurse practitioner started her on corticosteroids. As the psychiatric mental health nurse practitioner treating Patty, you are concerned that the addition of the corticosteroids may cause
A. Neuroleptic Malignant Syndrome
B. A hypertensive crisis
C. Stevens-Johnson syndrome
D. A manic episode
D. A manic episode
A 37 y/o patient with schizophrenia is started on a high dose of chlorpromazine (Thorazine). The next day, he complains of lightheadedness after standing up. Vital sign changes reflect a significant decrease in BP and an increase in heart rate. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing
A. Decreased sweating
B. Dry mouth
C. Respiratory depression
D. Orthostatic hypotension
D. Orthostatic hypotension
Which of the following patients with generalized anxiety disorder is most likely to be a CYP 2C19 poor metabolizer and have an exaggerated response to diazepam (Valium) 5 mg TID with increased sedation, central nervous system, and cognitive side effects?
A. 50 y/o Caucasian male
B. 40y/o Asian male
C. 20 y/o African American female
D. 30 y/o African American male
B. 40y/o Asian male
You are on call for your service. You arrive at the Emergency Department to find a 22 y/o male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 ft 7 in tall; his wt is 140 lbs; and his labs are all in the normal range. He states that he has been taking Aripiprazole (Abilify) for the last 2 months for his Bipolar 1 disorder. He had the dose raised to 15 mg PO Q am 4 days ago to manage a manic episode. He states that one to three times a day for the past 2 days his eyes will roll upwards for 10 to 15 minutes and he will have trouble seeing until they roll back down. When you examine his eyes, he is able to fully open his eyes but he is not able to focus his eyes on you. His eyes are rolled upwards about 2/3rds of the way towards his upper eyelid. After examination you decide to:
A. Discontinue the Abilify and begin the patient on a gradually increasing regimen of Lamotrigine 25 mg 1 PO QHS for 1 week. Have him return to his provider for further management of his bipolar disorder
B. Discontinue the Abilify and give Benztropine Mesylate (Cognetin) 1 mg IM. Have him take Cogentin 1mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day
C. Continue the Abilify and give Cogentin 1mg IM. Have him take Cogentin 1 mg PO BID. Have him return to his provider for further management of his bipolar disorder the next day.
D. Begin a cross titration downward of the Abilify and upwards of Haloperidol (Haldol) Have him return to his provider for further management of his bipolar disorder
B. Discontinue the Abilify and give Benztropine Mesylate (Cognetin) 1 mg IM. Have him take Cogentin 1mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day
Sandy, a 32 y/o separated female presents for an initial intake. Sandy states she recently left an abusive relationship, is living alone, and is experiencing fear, panic, and extreme anxiety. Which brain structure is activated in patients with severe anxiety, as expressed by Sandy?
A. amygdala
B. Hippocampus
C. thalamus
D. Cingulate gyrus
A. amygdala
You have a 17 y/o female patient who suffers with bipolar disorder. The patient has history of impulsive acting out and promiscuity. You make a decision to add Folic acid 0.8 mg to her medication regimen of Lamotrigine (Lamictal) 200 mg po QHS and Quetiapine XR (Seroquel XR) 50mg PO QHS. Why is this important?
A. The folic acid is important to help her with her hypotension induced by the Quetiapine XR (Seroquel XR) 50 mg PO QHS
B. The folic acid is important for the continuing development of the patient's neuroendocrine system
C. The folic acid is important to help her with the sleepiness induced by her bipolar medications
D. The folic acid supports neural tube development during the first month that a woman is pregnant
D. The folic acid supports neural tube development during the first month that a woman is pregnant
A 17 y/o female presents to your clinic reporting anhedonia, decreased energy, and hopelessness for the past 2 years. She denies drinking alcohol, smoking or using illegal substances. Her physical examination results are within normal limits and she denies suicidal ideations. As the treating psychiatric mental health nurse practitioner, you decide to prescribe her bupropion (Wellbutrin). Of the following, which is a contraindication for bupropion?
A. bulimia
B. fatigue
C. dysthymia
D. smoking
A. bulimia
Which of the following statements reflects the current understanding of dopamine (DA) pathways and clinical symptoms of schizophrenia?
A. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system
B. Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system
C. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area
D. Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area
A. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system
Which serotonin receptor antagonism makes an antipsychotic "atypical"?
A. 5HT1A
B. 5HT2A
C. 5HT3A
D. 5HT4A
B. 5HT2A
A 24 y/o mother of a 2 y/o child presents to the clinic. Which of the following facial characteristics would lead the PMHNP to believe the child has fetal alcohol syndrome?
A. High nasal bridge, plump midface, and large eyelid opening
B. Large head, thick upper lip, and overdeveloped jaw
C. Small head, thin upper lip, and smooth philtrum
D. Long nose, large eyelid opening, and developed philtrum
C. Small head, thin upper lip, and smooth philtrum
The risk of bleeding on selective reuptake inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), or aspirin, is an example of which of the following principles?
A. Distribution
B. Pharmacodynamic
C. Absorption
D. Pharmacokinetic
B. Pharmacodynamic
A 43 y/o male is treated for Bipolar I on lithium. Which of the following hematologic changes is associated with lithium?
A. anemia
B. leukocytosis
C. leukopenia
D. Agranulocytosis
B. leukocytosis
When studying pharmacodynamics involving receptors, you know that an inverse agonist produces the following effect:
A. Activates a biological response, and opens the ion channels
B. Does not fully activate the receptor and causes only limited actions
C. Blocks the agonist from opening the channel, and does not activate a biological response
D. Causes the opposite effect of agonist, and causes the receptor to close the ion channel
D. Causes the opposite effect of agonist, and causes the receptor to close the ion channel
What is a rate but serious side effect of trazodone (Desyrel)?
A. tremor
B. confusion
C. priapism
D. rash
C. priapism
Norepinephrine is a neurotransmitter that is implicated in alertness and anxiety. What area of the brain has a large majority of norepinephrine neurons?
A. amygdala
B. Locus coeruleus
C. hippocampus
D. Nucleus accumbens
B. Locus coeruleus
While treating a 12 y/o boy for ADHD, the PMHNP observes which of the following physical features that raise concerns for genetic evaluation for Fragile X syndrome?
A. Small head, short palpebral fissure, inner epicanthal folds
B. Long head and ears, short stature, hyperextensible joints
C. Obesity, small stature, small hands and feet, hypotonia
D. Café au lait spots on face and arms, neurofibromas
B. Long head and ears, short stature, hyperextensible joints
A client is suffering from schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the tuberoinfundibular pathway?
A. Are you experiencing drooling?
B. Are you experiencing dizziness?
C. Are you experiencing breast discharge?
D. Are you experiencing tremors?
C. Are you experiencing breast discharge?
Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia?
A. Decreased total brain volume
B. Decreased size of cerebral ventricles
C. Decreased electrical activity in the frontal lobes
D. Decreased glutamate & GABA release
B. Decreased size of cerebral ventricles [Show Less]