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NURS6630 Mental Health Mid term Exam Final Week 6 With Answers (75 Solved Questions)

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    Take Test: Week 6 Midterm Exam Test Information Description Instructions Timed Test This test has a time limit of 2 hours.You will be notified when time expires, and you may continue or submit. Warnings appear when half the time , 5 minutes , 1 minute , and 30 seconds remain. Multiple Attempts Not allowed. This test can only be taken once. Force Completion Once started, this test must be completed in one sitting. Do not leave the test before clicking Save and Submit . Remaining Time: 13 minutes, 04 seconds. Question Completion Status: QUESTION 1 1. A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP). A . “You have to take your medication to become stable.” B . “ Medications work by increasing the types of neurotransmitters produced by the human brain .” C . “M ost medications that work in the brain will result in restoring an imbalance of one or more neurotransmitters that your body already produces helping to alleviate your symptoms .” D . “Why do you believe that your medication is poison?” 1 points QUESTION 2 1. Ms. Hill is currently being treated for schizophrenia but has stopped taking her medications due to some side effects she claims she was experiencing. She presents to the clinic today with worsening symptoms. She is experiencing anhedonia, agitation, attentional impairment, and affective blunting. Which one of the symptoms mentioned is considered a positive symptom of schizophrenia?

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    A . Anhedonia B . Agitation C . Attentional Impairment D . Affective Blunting 1 points QUESTION 3 1. Which statement about neurotransmitters and medications is true? A . Endorphins were discovered before morphine which lead to the use of the opioids for pain control. B . Several psychiatric medications have been developed after discoveries of endogenous neurotransmitters and defining their function in the brain . C . Medications work by sending messages to neurotransmitters enabling them to work more effectively. D . An imbalance of serotonin has been directly linked to depression. Following the discovery of this neurotransmitter, pharmacologists were able to develop a well-known drug- Prozac as the first medication used to restore the balance of serotonin . 1 points QUESTION 4 1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: A . "M ore often than you would think, multiple medications should always be tried together to see what happens.” B . “ Due to this being your first hospitalization after starting medication treatment for the first time in your life, the only way to effectively manage your symptoms is by adding additional medications in hopes that it will work for you." C . “M any psychiatric illnesses involve several dys-functioning neurotransmitter systems in the brain. Often, a single medication may only effect one or two of the dys-functioning systems. The addition of another medication can work with the current medication in stabilizing multiple neurotransmitter systems and help to alleviate your symptoms.” D . “ I understand your concerns. Often times, it is necessary to switch medications after short periods of time to better manage your symptoms. We will discontinue your current regimen and start another single drug agent.” 1 points QUESTION 5 1. During gene expression, what must occur prior to a gene being expressed? A . Transcription factor must bind to the regulatory region within the cell’s nucleus.

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    B . RNA must be converted to mRNA. C . The coding region must separate from the regulatory region. D . RNA polymerase must inhibit the process of changing RNA to mRNA. 1 points QUESTION 6 1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? A . Genes impact neuron functioning directly. B . Changes made to proteins lead to changes in behavior. C . Neurons are able to impact protein synthesis. D . Genes impact the DNA of a cell, leading to changes in behavior. 1 points QUESTION 7 1. Though medications have the ability to target neurotransmitter release into the synapse by the presynaptic neuron it is not always necessary. The PMHNP understands that this is because: A . Neurotransmission occurring along the axon is normally at a level to prevent symptoms of mental illness and rarely require augmentation from medication therapy . B . Neurotransmission is minimally affected by medication therapy when compared to the baseline neurotransmitter release of a resting neuron . C . Neurotransmitters can spread by diffusion. D . The post synaptic neuron can produce and release its’ own neurotransmitter allowing it to function properly . 1 points QUESTION 8 1. Why is the cytochrome P450 enzyme system of significance to the PMHNP? A . The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective. B . The bioavailability of the medication after it passes through the stomach and liver can be altered. C . The medication’s chemical composition changes when it comes in contact with the acid in the stomach.

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    D . The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively. 1 points QUESTION 9 1. It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true? A . About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics. B . The term polymorphic refers to the body’s ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics. C . About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics. D . Most enzyme pathways do not have interactions between the newer medications. 1 points QUESTION 1 0 1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice? A . Most medications that act on G-protein linked receptors have antagonistic traits. B . The majority of medications used in practice are full agonists and are used to stimulate the body’s natural neurotransmitters. C . Most medications act as partial agonists because they allow the body to use only what is needed. D . Medications used in practice may act as inverse agonists if the dosage is too high. 1 points QUESTION 1 1 1. The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition: A . The patient smokes cigarettes. B . The patient has hypertension. C . The patient has chronic kidney disease, stage 2. D The patient drinks a cup of coffee a

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    . day. 1 points QUESTION 1 2 1. A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to: A . Alert staff to possible seizures B . Write an order for a different mood stabilizer C . Decrease the amount prescribed for aripiprazole (Abilify) D . Explain to the patient that it will be more difficult to control his temper 1 points QUESTION 1 3 1. A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). When assessing the psychiatric medications and the reason for admission, what would be the best course of action for the PMHNP with this client? A . Review Amitriptyline (Elavil) level B . Order a STAT BUN/SCr C . Asses the client for nystagmus D . Order a STAT platelet, D-dimer, and PT/INR 1 points QUESTION 1 4 1. A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this? A . To promote the availability of serotonin B . To decrease serotonin C . To indirectly increase the amount of dopamine in the body D To help decrease the amount of serotonin and

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    . dopamine 1 points QUESTION 1 5 1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial? A . “I have trouble staying asleep in the middle of the night.” B . “My spouse told me that I seem to have trouble remembering things sometimes.” C . “I really want to stop smoking, but the cravings are too strong.” D . “I feel nervous to go outside and be in large crowds.” 1 points QUESTION 1 6 1. Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription? A . “The drug will have an almost immediate effect.” B . “The drug can take a while to build up in your system.” C . “The drug is slow to release but lasts for a long time.” D . “The drug will make a subtle difference in your symptoms.” 1 points QUESTION 1 7 1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient? A . Benzodiazepine B . Mirtazapine (Remeron) C . Ketamine D . Varenicline (Chantix)

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    1 points QUESTION 1 8 1. The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug? A . Full agonists B . Antagonists C . Partial agonists D . Inverse agonists 1 points QUESTION 1 9 1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient? A . “The patient needs to have an inverse agonist.” B . “The patient could benefit from an anticonvulsant.” C . “The patient’s calcium, sodium, chloride, and potassium levels must be regulated.” D . “The patient should have a drug that acts on ligand-gated ion channels.” 1 points QUESTION 2 0 1. What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in common? A . Ligand-gated ion channels with a pentameric structure B . Ligand-gated ion channels with a tetrameric structure C . Voltage-sensitive ion channels D . Are G-coupled protein receptors 1 points QUESTION 2 1

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    1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis? A . “It’s my fault that all of this is happening. I don’t think I could ever forgive myself.” B . “I have to talk to the President because I’m the only one who can help him.” C . “I’m not sure why that lady is wearing a red jacket since it’s the dogs who need food.” D . “I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.” 1 points QUESTION 2 2 1. Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin? A . Dopamine is terminated through multiple mechanisms. B . The D2 autoreceptor regulates release of dopamine from the presynaptic neuron. C . MAO-B presents in the mitochondria within the presynaptic neuron. D . D2 receptors are the primary binding site for dopamine agonists. 1 points QUESTION 2 3 1. Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate? A . “Amphetamines may help you, as they can alleviate psychotic conditions.” B . “Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you.” C . “Amphetamines can cause hallucinations, so I would advise against this type of prescription.” D . “Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.” 1 points QUESTION 2 4

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    1. The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient? A . Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms. B . Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia. C . Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia. D . The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia. 1 points QUESTION 2 5 1. A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease? A . Achieving underactivity of the mesocorticol projections to the prefrontal cortex B . Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex C . Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex D . Achieving overactivity of the mesocorticol projections to the prefrontal cortex 1 points QUESTION 2 6 1. What is accurate about the clinical description of psychosis? A . It is simply a separate way to clinically describe the diagnosis of schizophrenia in a client. B . Psychosis is listed in the DSM as a distinct disorder with unique screening criteria. C . It is a syndrome that can be associated with a number of psychiatric disorders. D . Psychosis is always demonstrated by a paranoia in the client. 1 points QUESTION 2 7 1. The PMNHP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This client has begun to develop a common side effect of this medication. What is this side effect?

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    A . Increased hallucinations and positive symptoms B . Hypersexuality C . Reduction in negative symptoms D . Tardive dyskinesia 1 points QUESTION 2 8 1. The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent called an atypical antipsychotic . What neurotransmitters will this new medication work on? A . dopamine and serotonin B . dopamine and norepinephrine C . dopamine and GABA D . GABA and glutamate 1 points QUESTION 2 9 1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body? A . Muscarinic antagonists are more likely to cause decreased prolactin levels. B . D2 antagonists decrease the likelihood of EPS symptoms. C . D2 antagonism is linked to antidepressant properties. D . D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia. 1 points QUESTION 3 0 1. Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient? A . An underlying depressive disorder

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    B . The recent change of a 2nd generation antipsychotic to a conventional one C . The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic D . All of the above 1 points QUESTION 3 1 1. Mrs. Schwartzman is a 52-year-old client with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities since starting her new medication. What does the PMHNP infer from this encounter with the client? A . The client has been misdiagnosed with schizophrenia B . The client is not compliant with this new medication C . The new medication is blocking D2 receptors in the mesolimbic system D . The dose of this new antipsychotic medication is too low 1 points QUESTION 3 2 1. The student inquires about antipsychotic medications. Which response by the PMHNP describes the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics? A . Those that are potent D2 antagonists B . Those that are potent D2 antagonists with 5HT2A antagonism properties C . D2 receptors that are blocked in the nigrostriatal pathway D . Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors 1 points QUESTION 3 3 1. Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon? A . 5HT2 antagonism

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    B . D2 antagonism C . Alpha-2 antagonism D . D2 partial agonist 1 points QUESTION 3 4 1. Mr. Gordon is a middle-aged client who was started on antidepressant monotherapy for depression. After beginning this medication, the PMHNP noticed that this client seemed to swing into a hypomanic episode. What can the PMHNP infer from this behavior change? A . This client may have Bipolar III disorder B . The antidepressant monotherapy should be continued C . A second antidepressant agent should be added as dual therapy D . A and C 1 points QUESTION 3 5 1. Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation? A . The patient has an unsustained response to antidepressants. B . The patient has antidepressant-induced hypomania. C . The patient has a depletion of monoamine neurotransmitters. D . The patient has an adverse effect to atypical antipsychotics. 1 points QUESTION 3 6 1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? A . Patient with a bipolar I designation

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