Pharmacological Management of Neurological Disorders and Substance Use, Exams of Nursing

Download Pharmacological Management of Neurological Disorders and Substance Use and more Exams Nursing in PDF only on Docsity! Review Test Submission- Week 11 Final Exam Latest Up 2024.Guaranteed Success. User Course NURS-6630C-8/NURS-6630N-8-Approaches to Treatment2020 Spring Qtr 02/24-05/17-PT27 Test Week 11 Final Exam Started 5/6/20 5:30 AM Submitted 5/6/20 7:30 AM Due Date 5/11/20 1:59 AM Status Completed Attemp t Score 74 out of 75 points Time Elapsed 2 hours, 0 minute out of 2 hours Results Displaye d Submitted Answers Brandon is a non-compliant patient that presents to the clinic asking for help with his alcohol dependence. The PMHNP evaluates the patient and determines a long-acting injection that blocks the mu-receptors would be the best treatment option for Brandon. Which medication should the PMHNP prescribe? Selecte d Answer: c. Naltrexon e (VIVITROL ) Sandra complains of constipation after being on quetiapine (SEROQUEL) for several weeks. Constipation is likely caused by the binding of quetiapine (SEROQUEL) to which receptor? Selected b. • Question 1 1 out of 1 points • Question 2 1 out of 1 points Answer: D 1 • Question 3 1 out of 1 points incorrectly? Selecte d Answer: b. “I am unable to fall asleep at night.” Alcohol enhances inhibition at synapses and reduces excitation at synapses. Selecte d Answer: c. Dopeminergic / Glugamate A patient’s daughter calls your office with concerns that her mother is having significant gastrointestinal side effects. You review the patient’s chart and realize she is having side effects from donepezil (ARICEPT). What is the mechanism of the gastrointestinal disturbances? Selecte d Answer : b. Donepezil increases the activity of acetylcholinesterase in the peripheral acetylcholine neurons and the decline in acetylcholine causes increased side effects. Which of the following anticonvulsants increases serotonergic neurotransmission and GABAergic transmission, while decreasing glutamatergic neurotransmission? Selecte d Answer: a. Topiramat e (TOPAMA X) A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? • Question 8 1 out of 1 points • Question 9 1 out of 1 points • Question 10 1 out of 1 points • Question 11 1 out of 1 points Selecte d Answer: c. Citalopram (Celexa) or Escitalopram (Lexapro) An interneuron is a neuron that has its cell body, dendrites, and axon within the spinal cord. The neuron can be considered excitatory if it containsor inhibitory if it contains . Selecte d Answer: d. Glutamate / GABA Which patient will receive a lower dose of guanfacine? Selecte d Answer: c. Patient with kidney disease Mike wants to quit smoking. He has tried nicotine replacement and varenicline without success. He has asked for another medication to help him kick his habit. The PMHNP decides to try a medication that increases dopamine by prescribing a medications that can increase both norepinephrine and dopamine. Which medication did the PMHNP prescribe? Selecte d Answer: d. Bupropio n (ZYBAN) A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? Selected c. • Question 12 1 out of 1 points • Question 13 1 out of 1 points • Question 14 1 out of 1 points • Question 15 1 out of 1 points Answer: Duloxetin e (Cymbalt a) The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? Selecte d Answer: d. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? Selecte d Answer: a. Order hydroxyzine (Vistaril), 50 mg PRN or as needed A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? Selecte d Answer: d. It will block testosterone. The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? Selecte d Answer: • Question 17 1 out of 1 points • Question 18 1 out of 1 points • Question 19 1 out of 1 points • Question 16 1 out of 1 points Selecte d Answer: a. Antipsycho ti cs A nursing students asks the PMHNP the difference between impulsivity and compulsivity. Which of the following responses is correct? Selecte d Answer : b. Impulsivity is defined as acting without forethought and compulsivity is defined as actions that are inappropriate to the situation but persist. The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? Selecte d Answer : d. The use of antipsychotics may cause increased cardiovascular events and mortality and antipsychotics are often used as “chemical straightjackets” to over- tranquilize patients. The PMHNP understands that varenicline (CHANTIX) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? Selecte d Answer: a. Varenicline is a selective nicotinic acetylcholine receptor partial agonist Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? Selecte d Answer: b. All of these could potentially treat their son’s symptoms. • Question 25 1 out of 1 points • Question 26 1 out of 1 points • Question 27 1 out of 1 points • Question 28 1 out of 1 points • Question 29 1 out of 1 points The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? Selecte d Answer: d. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? Selecte d Answer: a. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. Heather is admitted for opioid withdrawals and detoxification. The PMHNP decides to prescribe an alpha-2 adrenergic agonist to reduce the symptoms of autonomic hyperactivity during withdrawal and aid in the detoxification process. Which medication did the PMHNP prescribe? Selecte d Answer: b. Clonidi n e An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ? Selecte d Answer: a. The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations. • Question 30 1 out of 1 points • Question 31 1 out of 1 points • Question 32 1 out of 1 points • Question 33 1 out of 1 points prescribe? Selecte d Answer: d. Low dose Duloxetine (CYMBALTA) The PMHNP is evaluating a 7 year old pediatric patient for the treatment of ADHD. The PMHNP decides to prescribe a medication that is selective for alpha- 2A receptors that has a lower incidence of sedation and hypotension. Which agent did the PMHNP prescribe? Selecte d Answer: a. Atomoxetin e (STRATTER A) The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? Selecte d Answer: b. Stratt e ra The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? Selecte d Answer: a. Pregabali n (Lyrica) A patient recovering from shingles presents with tenderness and sensitivity to • Question 38 1 out of 1 points • Question 39 1 out of 1 points • Question 40 1 out of 1 points • Question 41 1 out of 1 points the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? Selecte d Answer: c. Prescribe lidocaine 5% A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? Selecte d Answer: d. Decrease his SSRI and add buspirone (Buspar). An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? Selecte d Answer: a. Methylphenidate (Ritalin, Concerta) Which statement best describes a pharmacological approach to treating patients for impulsive aggression? Selecte d Answer: d. Opioid antagonists can be used to reduce drive. The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the • Question 42 1 out of 1 points • Question 43 1 out of 1 points • Question 44 1 out of 1 points • Question 45 1 out of 1 points Antihistamines may cause side effects such as blurred vision, constipation, memory problems, and dry mouth. This is due to the effects of antihistamines. Selecte d Answer: b. Dopaminer gic Which medication is an irreversible inhibitor of aldehyde dehydrogenase that creates a negative and aversive response following ingestion of alcohol? Selecte d Answer: b. Disulfiram (ANTABUS E) A patient on chronic opioids is currently on oxycodone ER (OxyContin). The PMHNP is consulted to treat underlying depression. Under which circumstance should the PMHNP order naloxone (NARCAN)? Selecte d Answer: c. The patient is somnolent and has 7 respirations per minute. A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? Selecte d Answer: b. It can cause cardiac arrhythmias. The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? Selecte d Answer: • Question 50 1 out of 1 points • Question 51 1 out of 1 points • Question 52 1 out of 1 points • Question 53 1 out of 1 points b. ApoE4 genotyp e and avoid antihista mines if possible and Type 2 diabetes and avoid olanzapine The novel neurotransmitter adenosine is responsible for the sleep-wake cycle by increasing throughout the day and diminishing during night. Which of the follow is an antagonist of adenosine? Selecte d Answer: c. Caffe i ne The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: Selecte d Answer: b. The child will be prescribed 2.5 mg. The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? Selecte d Answer: b. 8-year- old patient A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? Selecte d Answer: c. Clonidine (Catapres ) • Question 55 1 out of 1 points • Question 56 1 out of 1 points • Question 57 1 out of 1 points • Question 54 1 out of 1 points Methylphenidate, amphetamine, and cocaine are alike because all three . Selecte d Answer: c. inhibit the dopamine transporter. The PMHNP is treating a patient with depression and fibromyalgia. The PMHNP chooses to prescribe a treatment that may help treat the patient's fibromyalgia and depressive symptoms. Which medication is the PMHNP likely to choose? Selecte d Answer: a. Amitriptyline (ELAVIL) Antipsychotics are doses at a level that blocks % of D2 receptors. Selecte d Answer: b. 60- 80 A patient calls the clinic to ask about an over-the-counter sleep aid. What is the best response? Selecte d Answer: a. "Certain first-generation antihistamines may be used to help you sleep." The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? Selecte d Answer: d. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. • Question 63 1 out of 1 points • Question 64 1 out of 1 points • Question 65 1 out of 1 points • Question 66 1 out of 1 points • Question 67 the PMHNP include in the teaching? Selecte d Answer: b. The second dose should be taken at lunch. A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? Selecte d Answer: b. All of these are correct A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? Selecte d Answer: a. Guanfacine ER (Intuniv) Neal is complaining of restless leg syndrome and insomnia. Which first-line medication should the PMHNP prescribe to treat both? Selecte d Answer: c. Ripinirole (REQUIP) A patient with chronic insomnia asks the PMHNP if they can first try an over-the- counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? Selected a. • Question 72 1 out of 1 points • Question 73 1 out of 1 points • Question 74 1 out of 1 points • Question 75 1 out of 1 points Answer: “You can get melatonin over the counter, which will help with sleep onset.” When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Ye Answer: s Friday, May 8, 2020 2:12:38 AM EDT • Question 76 0 out of 0 points