NURS 6630 Midterm Exam
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Question 1
Alprazolam, phenobarbital, and alcohol all bind allosterically to GABAA receptors. What occurs to the GABAA receptor when these substances bind to the receptor?
A. The receptor’s sensitivity to GABA decreases
B. The receptor becomes more sensitive to GABA
C. The substance prevents GABA from binding to the receptor
D. Nothing occurs since the substances mentioned do not bind to the GABAA receptor
Question 2
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?
A. Ziprasidone
B. Quetiapine
C. Risperidone
D. Lamotrigine
Question 3
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?
A. Fluoxetine
B. Atomoxetine
C. Nortriptyline
D. Imipramine
Question 4
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 _______________.
A. Histamine; peptide
B. Acetylcholine; peptide
C. Adrernocorticotropic hormones; monoamine
D. Endorphins; peptide
Question 5
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
Question 6
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 7
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 8
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 9
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?
A. ≥ 12 months
B. 3 months
C. ≥ 6 months
D. 4–12 weeks
Question 10
Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression?
A. Sertraline + Bupropion
B. Fluoxetine + Citalopram
C. Desvenlafaxine + Bupropion
D. Fluoxetine + Mirtazapine
Question 11
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 12
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 13
Which neurotransmitter is considered the major inhibitory neurotransmitter?
a. Glutamate
b. Glycine
c. GABA
d. Acetylcholine
Question 14
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
A
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?
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 16
Which anticonvulsant below induces its own metabolism over time?
A. Lamotrigine
B. Gabapentin
C. Valproate
D. Carbamazepine
Question 17
What is the strongest established risk factor for bipolar disorder?
A. Being diagnosed with ADHD as a child
B. Family history of bipolar disorder
C. Male > female
D. Being diagnosed with Major Depressive Disorder
Question 18
Close-ended questions will help identify when patients are taking medications incorrectly.
a. True
b. False
Question 19
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 20
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
A. True
B. False
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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?
A. sertraline
B. paroxetine
C. venlafaxine
D. citalopram
Question 22
Which one of the anticonvulsants mentioned below has sufficient data to support its use in bipolar disorder?
A. Gabapentin
B. Zonisamide
C. Pregabalin
D. Carbamazepine
Question 23
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.
A. doses above 40 mg/day increases the patient’s risk of sexual dysfunction
B. you want to save the patient money since higher doses are not typically covered by the patient’s insurance plan
C. a maximum daily dose of 20 mg is recommended in patients > 60 years of age due to the risk of QT prolongation
D. doses above 20 mg can cause insomnia
Question 24
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 25
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.
Question 26
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 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 _______________.
A. Trazodone
B. Fluoxetine
C. Temazepam
D. Phenelzine
Question 28
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 29
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 30
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 31
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 32
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 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?
A. Duloxetine
B. Clonidine
C. Diphenhydramine
D. Zolpidem
Question 34
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 35
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 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?
A. citalopram
B. fluoxetine
C. fluvoxamine
D. paroxetine
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
A. Neuroleptic Malignant syndrome
B. Serotonin syndrome
C. ICU delirium
D. Toxic encephalopathy
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
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 39
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 40
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?
A. Risperidone blocks dopamine receptors in the striatum
B. Risperidone increases dopamine concentrations in the striatum
C. Risperidone blocks serotonin receptors in the striatum
D. Risperidone increases serotonin concentrations in the striatum
Question 41
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.
Question 42
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 43
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
Question 44
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 45
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?
a. Parkinson’s Disease
b. Multiple Sclerosis
c. Schizophrenia
d. Major depressive disorder
Question 46
Which amino acid is involved in the synthesis of both norepinephrine and dopamine?
a. Tyrosine
b. Glutamic acid
c. Tryptophan
d. Phenylalanine
Question 47
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 48
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 49
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 50
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
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