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Patrons

So artists were creating all of these beautiful paintings and sculptures, and humanists and political theorists were writing texts based on ancient Greek and Roman thought. But it’s common sense that you can only be a successful artist or author if someone buys your work. Even Renaissance artists and writers had to pay their bills. And this is where the Renaissance patron fits in. A patron is a person or a group of people who commission a piece of artwork or a text. To commission something means to pay someone to create something for you.

The people who had the disposable income necessary to commission art and literature at this time were those kings, lords, and of course, the people in charge of the churches. When a patron wanted a painting or a sculpture created, they often had a particular artist in mind who they wanted to do it. For example, in my first lecture for this week, I told you that when Pope Julius II wanted to paint the Sistine Chapel, he called on Michelangelo specifically. And as you can see from the images on your screen- the painting of Pope Julius II on the right was down by Raphael, and he also had Michelangelo sculpt his tomb in Rome. So, Pope Julius was a big patron of artists.

Pope Julius, like much of the rest of the elite commissioned art for multiple reasons. At the most basic level, they wanted something pretty to look at, of course, but there something more important at play here. By commissioning art and literature, kings, lords, and even popes demonstrated their power to others. They demonstrated that they had the wealth necessary to commission art or a piece of literature. Hoping to appear the most powerful of all, the elite of Italy often competed with each other to bring in the best artists and the best intellectuals to their court.

Dr. Carol Symes Video: Key Characteristics of Renaissance Arts and Learning During the Period

I want to show you a brief video by Dr. Symes, who explains this a bit further.

Quiz Question #6

The Formation of the Italian City-States

Let’s turn now to look at the actual elite of Italy and dig further into why they wanted to show off their power. So, a couple lectures ago, we talked about the rise of cities. And I explained to you that in the 1100s and 1200s, people began giving nearby lords money in exchange for their rights as citizens of the city. Most lords accepted this exchange, but sometimes lords were not as willing to give up their claim to a nearby city, and the townspeople had to go and take it by force. And they did so by forming communes. And these communes were particularly common in north and central Italy.

In the 1200s there were over 100 of these independent communes in Italy, but over time, they began to come together to form city-states in which the largest city represented the capital of the surrounding area. Even with this idea, we see a desire on the part of people to reach back to the ancients. If you remember back towards the beginning of the semester, we talked about the city-states of Athens and Sparta in Greece. The Italian city-states borrowed this organization for themselves. This organization of city-states was different from the set up in England or France, which were unified kingdoms. And even more different, the city-states of Italy tended to have their own separate cultures and ways of doing things. The map on your screen shows the city-states of Italy in 1494. So the most powerful and wealthiest merchant families living in these Renaissance city-states often took charge and created different forms of government. The leaders of these city-states helped to bring about and expand the Renaissance because they competed to bring in the best artists and intellectuals. From their perspective, if they could turn their city-state into the cultural center of Italy, then this would demonstrate that they were the best leaders in all of Italy and all of Europe.

Quiz Question #7

The City-State of Florence

As you saw, there were quite a few city-states in Italy, but I want to focus my attention on a few specific ones to give you an idea how they differed and how they were connected to patronage and the Renaissance. Let’s start with Florence. Florence was a city-state with a theoretical Republican government. Remember, in a republican government, citizens elect representatives to make choices for them in government. But in 1434, the wealthiest merchant in Florence, Cosimo de Medici, took control of the government. He allowed elections to continue and consequently maintained an image of Florence as a Republican government. But, in reality, the only choices people had in these elections were various members of the Medici family. So in reality, if we think about the governments we discussed so far in this course, the Florence republic was really more of an oligarchy at this point. To counteract this image of tyranny, Cosimo and the other Medicis became big patrons of art and literature. By commissioning lots of artwork and literature, the Medicis shaped an image of themselves as generous and good leaders. Cosimo also commissioned art to justify his family’s power in the city. For example, in the private chapel of his palace, Cosimo had artists paint him alongside the three wise men as they traveled to see the newborn Jesus Christ. You can see this picture on the right side of your screen. In doing so, Cosimo portrayed himself as similar to the ancient kings who first recognized the holiness of Christ. The Medicis’ reliance on artwork and literature to maintain sole power in a Republican government in turn encouraged the spread of the Renaissance in Italy.

Quiz Question #8

The City-State of Urbino

Whereas Florence had a Republican government, this wasn’t the case for all Italian city-states. Some, like the city-state of Urbino, were governed by princes. They were a monarchy. The term prince meant that the ruler of the state possessed a formal title such as Marquise, Duke, or King. So, the prince of a city-state could be of royal lineage, but not necessarily. None of these princes, however, were elected officials. In the mid-1400s, the duke of the city-state of Urbino was Federico da Montifeltro. The state of Urbino wasn’t a big money maker for the duke, so he made his money by training the peasants of his state to be good soldiers, and then he hired them out to the highest bidder. In other words, the soldiers of Urbino were mercenaries. The duke’s mercenary army became very famous, and he made a lot of money off of them. He used this money to fund scholars, artists, and to build beautiful buildings for himself and his city-state. He collected Latin manuscripts, which encouraged intellectuals to come to Urbino to study them. The duke’s financing of scholarship and art meant that the state of Urbino was not only known for its military, but also its cultural significance. The Duke of Urbino wanted to have this many pretty things as the Medicis, and this competition contributed to the Renaissance in Italy.

The Papal States

The territory ruled by the Pope was situated in central Italy. And the Pope had maintained control of territory in Italy beginning centuries before when these popes began to think of themselves as the kings of the Roman Catholic Church. But when the popes moved to Avignon in France in the 1300s, they lost authority in the Papal States because they nearly bankrupted them trying to finance their new palace in France. But in the 1400s, the popes fought to retake control of the Papal States. And to demonstrate their power in the territory and throughout Italy, they, too, focused on art and literature. The popes did not want to be outdone by the merchants and lords of Italy. They wanted to show that they had the most beautiful palaces and were able to bring in the best scholars and artists. We’ve already discussed Pope Julius II and his patronage of different artists, including Michelangelo. But he certainly wasn’t the only pope. For the popes, this was about regaining their power in Europe. If they could bring in the best artists and intellectuals and possess the best works, then they were better than the regular leaders and kings. In this sense, competition was a huge contributing element to the cultural explosion of the Renaissance.

Female Political Leaders and Patrons

Now in discussing these different states, whether they had a Republican government or not, I have mentioned the names of quite a few men. But we need to note that even though the men were recognized as the official leaders of their state, the wives of these leaders often played a large role in politics and in the advancement of the Renaissance. Humanists often emphasized traditional gender roles in which men were dedicated to bettering their kingdoms and states, while women where focused on their households and remained subservient to men.

But, as we know, reality doesn’t always follow what people believe should happen. During the Renaissance, young elite women were often married off to older men who, because of their age, had managed to accumulate a lot of wealth and political clout. For example, the image of the left is a portrait of Battista Sforza, who was the second wife of Federico da Montefeltro, the Duke of Urbino, who we just discussed a few minutes ago. She married the Duke at the age of 14. The Duke was 24 years older than her. Similarly, the Bianca Maria Visconti married at the age of 16 to the Duke of Milan, who was also 24 years older than her. As a result, elite women were often widowed at a young age. Furthermore, the leaders of the Italian city-states were often gone for long periods of the year due to their work as merchants or military leaders. All of this gave elite women in Renaissance Italy more independence and opportunities to exercise power as political and cultural leaders. For example, both Battista Sfrorza and Bianca Maria acted as rulers of their city states when their husbands were away.

Similarly, Isabella d’Este was the wife of Francesco Gonzaga. He was the Prince of Mantua, another Italian state. And like the Duke of Urbino, the Prince of Mantua made money by hiring out his trained army, for which he was the commander. While he was away fighting battles, his wife Isabella governed Mantua, and she earned a reputation as an excellent negotiator and diplomat. And like other political leaders, she commissioned lots of art and scholarship. For example, the portrait of Isabella on your screen was done by Leonardo da Vinci.

Quiz Question #9

The Italian Renaissance in Other Parts of Europe

We’ve been talking primarily about Italy, which is where the Renaissance began. But over time the Renaissance spread to other European nations. European rulers who fought or studied in Italy brought back a love of Renaissance art and literature. Like Italian leaders, they began to compete to bring in the best artists and intellectuals. King Philip II of Spain, for example, was notorious for offering Italian artists lots of money to come live in his Spanish court. In addition, Italian merchants helped to spread interest in Renaissance culture as they traveled throughout Europe. And as the Renaissance spread to other kingdoms, more and more people gained an interest in the ancient Romans and Greeks, in the concept of ideal beauty, and in the ideas of Italian scholars. In turn, this interest motivated a growing demand for books. But up to this point, books were still incredibly expensive because someone writing a book had to write down each and every single word to produce that book. But when the Renaissance hit Germany, this changed.

Johannes Gutenberg and The Printing Press

In the mid-1400s, a man by the name of Johannes Gutenberg began experimenting with movable type. Gutenberg was the son of goldsmith who made coins. As you know, coins, at their most basic level, are metal disks with the same words printed over and over again. So if Gutenberg was used to printing words on coins, it’s not a huge leap to apply the concept of printing words over and over to books. Gutenberg created small metal type that could be moved around. This metal type was lead or cast-iron letter forms and punctuation marks. And he understood that by arranging this metal type into different words, you could then put ink and then transfer all those words onto a piece of paper. You could do this over and over again, producing multiple pages with the same words. Then you could move the type around and create another page of words. In doing so, you could mass produce books without having to write any words by hand. Gutenberg completed his first Bible doing this in 1455. It was the first book produced by movable type in the West. In fact, because Gutenberg was able to print so many Bibles so efficiently, 48 complete or partial copies of his Bible still survive today.

But Gutenberg’s printing press may have come to nothing if not for another development, cheap paper. A new technique of creating paper arrived from Asia in the 1400s. Prior to this, the only form of paper was made of animal skins, and as you can imagine, this was pretty expensive. But in the 1400s, mills began to turn cloth rags into pulp, which could then be turned into paper. This way of making paper meant that it was a lot less expensive, and you could make a lot more of it.

So, the combination of Gutenberg’s printing press and the development of cheaper, more plentiful paper meant that more books could be produced. They could be produced faster, and they were cheaper. The invention of the printing press and the introduction of this type of paper has an interesting relationship with the Renaissance. It was a product of the Renaissance spreading throughout Europe, but it also further encouraged the Renaissance. The artistic and intellectual experiments of the Renaissance were rapidly exported everywhere. Plans for innovative weapons were printed on the same presses that pumped out humanist writings. News of Columbus’s first voyage and the later conquests of the New World were all spread using the printing press. Printing not only increased the volume and speed of communication, but it also made it more difficult for those in power to censor dissenting opinions. Furthermore, it encouraged an increase in literacy during the Renaissance, and it also helped to standardize national languages. As more books were printed and more people read, the governments began to promote one official approach to spelling and grammar. For example, in England, the government began to promote the “king’s English”, which was a standard of spelling and grammar that authors began to use in their books. Following this, perhaps unsurprisingly, the first dictionary was printed in the early 1600s to demonstrate how words should be spelled and what they meant.

Quiz Question #10

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July 1, 2023

NURS 6630 Midterm Exam (2018): Walden University

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).

"You have to take your medication to become stable."

"Most medications will increase the number of neurotransmitters that you already have in the brain."

"Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has."

"Why do you believe that your medication is poison?"

QUESTION 2

1. Which statement about neurotransmitters and medications is true?

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

Neurotransmitters receive messages from most medications.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP's best response would be:

"In an extreme case such as yours, more than one medication is often needed."

"Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

"Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms."

"I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms."

1 points

QUESTION 4 ?

1. During gene expression, what must occur prior to a gene being expressed?

Transcription factor must bind to the regulatory region within the cell's nucleus.

RNA must be converted to mRNA.

The coding region must separate from the regulatory region. This is wrong

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 5

1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Genes impact neuron functioning directly.

Changes made to proteins lead to changes in behavior.

Neurons are able to impact protein synthesis.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points

QUESTION 6

1. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

Neurotransmitters can spread by diffusion.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

1. Why is the cytochrome P450 enzyme system of significance to the PMHNP?

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.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

The medication's chemical composition changes when it comes in contact with the acid in the stomach.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 8

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?

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

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.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

Most enzyme pathways do not have interactions between the newer medications.

1 points

QUESTION 9

1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

Most medications that act on G-protein linked receptors have antagonistic traits.

The majority of medications used in practice are full agonists and are used to stimulate the body's natural neurotransmitters.

Most medications act as partial agonists because they allow the body to use only what is needed.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points

QUESTION 10

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:

The patient smokes cigarettes.

The patient has hypertension.

The patient has chronic kidney disease, stage 2.

The patient drinks a cup of coffee a day.

1 points

QUESTION 11

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:

Alert staff to possible seizures

Write an order for a different moodstabilizer

Decrease the amount prescribed for aripiprazole (Abilify)

Explain to the patient that it will be more difficult to control his temper

1 points

QUESTION 12

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). Which is the best action for the PMHNP to take for this patient?

Review Amitriptyline (Elavil) level

Order a liver function test

Check the patient's blood pressure and pulse

Order a stat platelet count

1 points

QUESTION 13

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?

To promote the availability of serotonin

To decrease serotonin

To indirectly increase the amount of dopamine in the body

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

"I have trouble staying asleep in the middle of the night."

"My spouse told me that I seem to have trouble remembering things sometimes."

"I really want to stop smoking, but the cravings are too strong."

"I feel nervous to go outside and be in large crowds."

1 points

QUESTION 15

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?

"The drug will have an almost immediate effect."

"The drug can take a while to build up in your system."

"The drug is slow to release but lasts for a long time."

"The drug will make a subtle difference in your symptoms."

1 points

QUESTION 16

1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

Benzodiazepine

Mirtazapine (Remeron)

Ketamine

Varenicline (Chantix)

1 points

QUESTION 17

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?

Full agonists

Antagonists

Partial agonists

Inverse agonists

1 points

QUESTION 18

1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

"The patient needs to have an inverse agonist."

"The patient could benefit from an anticonvulsant."

"The patient's calcium, sodium, chloride, and potassium levels must be regulated."

"The patient should have a drug that acts on ligand-gated ion channels."

1 points

QUESTION 19

1. The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

Ligand-gated ion channels with a pentameric structure

Ligand-gated ion channels with a tetrameric structure

Voltage-sensitive ion channels

Anticonvulsants

1 points

QUESTION 20 ?

1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

"It's my fault that all of this is happening. I don't think I could ever forgive myself."

"I have to talk to the President because I'm the only one who can help him."

"I'm not sure why that lady is wearing a red jacket since it's the dogs who need food."

"I don't know that I even want to go to that meeting. It doesn't seem worth it anymore."

1 points

QUESTION 21

1. A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? I did not have this question

Obtaining raw normative metrics and using them to assess functionality

Having the patient report on cognitive function based on personal experiences

Monitoring the patient in a controlled setting

Measuring symptoms of psychosis

1 points

QUESTION 22

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?

Dopamine is terminated through multiple mechanisms.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

MAO-B presents in the mitochondria within the presynaptic neuron.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

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?

"Amphetamines may help you, as they can alleviate psychotic conditions."

"Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you."

"Amphetamines can cause hallucinations, so I would advise against this type of prescription."

"Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you."

1 points

QUESTION 24

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?

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 25

1. A patient is diagnosed with schizophrenia. What increases the patient's potential to mediate the cognitive symptoms of the disease?

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points

QUESTION 26

1. The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug?

Hypersexuality

Amenorrhea

Dystonia

Tardive dyskinesia

1 points

QUESTION 27

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. Which of the following requires the longest transition time for therapeutic benefit?

Olanzapine to clozapine

Asenapine to Risperidone

Aripripazole to ziprasidone

Aripripazole to clozapine

1 points

QUESTION 28

1. The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient?

Quetiapine

Paliperidone

Lurasidone

Clozapine

1 points

QUESTION 29

1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

Muscarinic antagonists are more likely to cause decreased prolactin levels.

D2 antagonists decrease the likelihood of EPS symptoms.

D2 antagonism is linked to antidepressant properties.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points

QUESTION 30

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?

An underlying depressive disorder

The recent change of a 2nd generation antipsychotic to a conventional one

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

All of the above

1 points

QUESTION 31

1. The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

Long-term use of antipsychotics

Genetic disposition

Age

A and C

All of the above

1 points

QUESTION 32

1. The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?

Those that are potent D2 antagonists

Those that are potent D2 antagonists with 5HT2A antagonism properties

D2 receptors that are blocked in the nigrostriatal pathway

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 33

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?

5HT2 antagonism

D2 antagonism

Alpha-2 antagonism

D2 partial agonist

1 points

QUESTION 34

1. A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

Norepinephrine

Dopamine

Serotonin

A and C

All of the above

1 points

QUESTION 35

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?

The patient has an unsustained response to antidepressants.

The patient has antidepressant-induced hypomania.

The patient has a depletion of monoamine neurotransmitters.

The patient has an adverse effect to atypical antipsychotics.

1 points

QUESTION 36

1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?

Patient with a bipolar I designation

Patient with a bipolar II designation

Patient with a bipolar III designation

None of the above

1 points

QUESTION 37

1. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

The patient may experience paranoid avoidant behavior.

The patient may experience severe depression.

The patient may experience auditory hallucinations.

The patient may experience increased mood cycling.

1 points

QUESTION 38

1. The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient's response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

The patient has a higher chance of tolerating SSRI/SNRI treatment.

The patient will have a positive response to SSRI/SNRI treatment.

The patient will develop severe mood cycling in response to treatment.

The patient may be less responsive or tolerant to the treatment.

1 points

QUESTION 39

1. Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh's serotonin levels?

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

Norepinephrine inhibits 5HT release through a2 receptors.

Norepinephrine inhibits α2 receptors on axon terminals.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

"Drugs inhibit the release of NE."

"Drugs can mimic the natural functioning of the NE neuron."

"Drugs are unable to simulate the effects of NE neurons."

"Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron."

1 points

QUESTION 41

1. The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder?

Insomnia

Suicidal ideation

Problems concentrating

A and C

1 points

QUESTION 42

1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

Neuronal firing rates are not dysregulated in depression.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

Upon the acute administration of a SSRI, 5HT decreases.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

Both have a sedative-like, calming effect.

Both contribute to antipsychotic actions.

Both demonstrate favorable findings in treating depression in the elderly.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points

QUESTION 44

1. A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

The patient cannot take any antihistamines.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points

QUESTION 45

1. After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

All of the above.

1 points

QUESTION 46

1. A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?

First onset in puberty or early adulthood

Late onset of menses

Premenstrual syndrome

A and C

1 points

QUESTION 47

1. A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen:

MAOI plus SNRI

SSRI/SNRI plus NDRI

NDRI/SNRI plus mirtazapine

NDRI plus modafinil

1 points

*Q/UESTION 48

1. Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

She may experience withdrawal symptoms.

She may experience increased trauma.

Effects of abrupt cessation are unknown.

It can lead to difficulties with concentration.

1 points

QUESTION 49

1. A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

Weight gain can be problematic.

Sedation is very common.

Induction of mania is rare.

Seizures are not unusual.

1 points

QUESTION 50

1. The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

Stop the venlafaxine

Lower the dose of venlafaxine by 50%

Lower the dose of venlafaxine by 25-40%

Increase the dose of venlafaxine by 50%

1 points

QUESTION 51

1. A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses concern regarding "how she will feel and look" from taking the medicine. Which statement correctly describes the side effects as a result of taking this medication?

It can affect her menstruation.

Suicidality can be common among young adults.

Sedation may be problematic.

Weight gain is unusual.

1 points

QUESTION 52

1. Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40-50 hours a week as a contractor and "manages his stress" by smoking 3-4 cigarettes a day and having 8-10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby?

He has fibromyalgia.

He has arrhythmia.

He uses alcohol.

He is overweight.

1 points

QUESTION 53

1. A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.

1 points

QUESTION 54

1. A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

The patient has hepatic impairment.

The patient has moderate renal impairment.

The patient has severe renal impairment.

The patient has cardiac impairment.

1 points

QUESTION 55

1. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

Histamine H1 receptor blockade can cause insomnia.

Muscarinic M1 receptor blockade causes blurred vision.

Alpha 1 adrenergic receptor blockade causes weight gain.

Muscarinic M3 receptor blockade causes sedation.

1 points

QUESTION 56

1. A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO inhibitors?

"You must avoid soy products, such as tofu."

"You should not consume processed meats."

"You may consume fermented foods, like sauerkraut."

"You may continue to drink beers on tap."

1 points

QUESTION 57

1. A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug interactions?

"Decongestants are fine to continue taking with MAO inhibitors."

"Decongestants are okay to take with MAO inhibitors in moderation."

"Decongestants should be avoided due to risk of serotonin syndrome."

"Decongestants should be avoided due to risk of hypertensive crisis."

1 points

QUESTION 58

1. Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports "I take my 45 mg pill, three times a day, just like I'm supposed to." What does the PMHNP understand about this patient?

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points

QUESTION 59

1. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

Patient with PTSD

Patient with partial seizures

Patient with galactose intolerance

Patient with Lapp lactase deficiency

1 points

QUESTION 60

1. Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points

QUESTION 61

1. A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient's concerns?

mirtazapine (Remeron)

doxepin (Silenor)

alprazolam (Xanax)

trazadone (Oleptro)

1 points

QUESTION 62

1. A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

Mood stabilizers can consistently treat both mania and bipolar depression

Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to target all four therapeutic actions

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points

QUESTION 63

1. The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

Thyroid Stimulating Hormone (TSH)

Complete Blood Count (CBC)

Erythrocyte Sedimentation Rate

Platelet Count

1 points

QUESTION 64

1. A 39-year old female patient presently on lithium would like to try a new medication to treat her bipolar disorder. She has had concerns about side effects from lithium and wants to learn more about Lamotrigine (Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects of this agent, including which of the following? I don’t think I had this question

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer's disease

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points

QUESTION 65

1. A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear about most effective outcomes. Which of the following agents does the PMHNP convey as having uncertain outcomes?

Carbamazepine (Tegretol)

Gabapentin (Neurontin)

Valporoic Acid (Depakene)

All of the above

1 points

QUESTION 66

1. A 46-year old male patient mentions several alternative treatments to Carbamazepine (Tegretol) as a way to manage symptoms of his bipolar depression. Which of the following does the PMHNP indicate would not be an agent to treat bipolar depression?

Omega-3-fatty-acids

Soybean lecithin

Inositol

L-methylfolate

1 points

QUESTION 67

1. The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this patient?

Valporic Acid (Depakene)

Carbamazepine (Tegretol)

Lithium (Lithobid)

Lamotrigine (Lamictal)

1 points

QUESTION 68

1. The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

Irritability, lethargy, anger; the child should be evaluated further for ADHD.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.

1 points

QUESTION 69

1. A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the Clonazepam (klonopin) the best response is:

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points

QUESTION 70

1. During assessment a patient states "Why are you asking me about my heart, I am here for my head", the PMHNP's best response is:

"Some medications can cause heart issues so it is necessary to rule those out before you begin medication."

"This is a part of our routine admission and it is important that you give me truthful answers."

"Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus."

"Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes."

1 points

QUESTION 71

1. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

Alcohol works similar to benzodiazepines

Up to 30% of people with anxiety use alcohol to self-medicate

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points

QUESTION 72

1. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

Respiratory depression

Sedation and restlessness

Sweating and nausea (This question was marked wrong but I think the answers are different too)

Bradycardia and tachypnea

1 points

QUESTION 73

1. A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP's best response is:

"SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry."

"Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases."

"Antidepressants are prescribed prophylactically to prevent symptoms of depression."

"Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety."

1 points

QUESTION 74 ?

1. The PMHNP evaluates the patient for "fear conditioning" when he asks:

Have you ever experienced any type of trauma?

What do you do when you feel fear?

Does your mother or father have a history of fear and/or worrying?

What makes your fear better?

1 points

QUESTION 75

1. A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

Beta blockers are linked to reconsolidation.

This medication will allow the patient to sleep throughout the night.

This medication is linked to the increase of serotonin in the brain.

See the link for Final Exam

https://www.homeworkmarket.com/questions/nurs6630-final-exam-2018-walden-university

July 1, 2023

NURS 6630 Midterm Exam (2018): Walden University

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).

"You have to take your medication to become stable."

"Most medications will increase the number of neurotransmitters that you already have in the brain."

"Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has."

"Why do you believe that your medication is poison?"

QUESTION 2

1. Which statement about neurotransmitters and medications is true?

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

Neurotransmitters receive messages from most medications.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP's best response would be:

"In an extreme case such as yours, more than one medication is often needed."

"Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

"I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms."

1 points

QUESTION 4 ?

1. During gene expression, what must occur prior to a gene being expressed?

Transcription factor must bind to the regulatory region within the cell's nucleus.

RNA must be converted to mRNA.

The coding region must separate from the regulatory region. This is wrong

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 5

1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Genes impact neuron functioning directly.

Changes made to proteins lead to changes in behavior.

Neurons are able to impact protein synthesis.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points

QUESTION 6

1. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

Neurotransmitters can spread by diffusion.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

1. Why is the cytochrome P450 enzyme system of significance to the PMHNP?

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.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

The medication's chemical composition changes when it comes in contact with the acid in the stomach.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 8

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?

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

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.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

Most enzyme pathways do not have interactions between the newer medications.

1 points

QUESTION 9

1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

Most medications that act on G-protein linked receptors have antagonistic traits.

The majority of medications used in practice are full agonists and are used to stimulate the body's natural neurotransmitters.

Most medications act as partial agonists because they allow the body to use only what is needed.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points

QUESTION 10

The patient smokes cigarettes.

The patient has hypertension.

The patient has chronic kidney disease, stage 2.

The patient drinks a cup of coffee a day.

1 points

QUESTION 11

Alert staff to possible seizures

Write an order for a different moodstabilizer

Decrease the amount prescribed for aripiprazole (Abilify)

Explain to the patient that it will be more difficult to control his temper

1 points

QUESTION 12

Review Amitriptyline (Elavil) level

Order a liver function test

Check the patient's blood pressure and pulse

Order a stat platelet count

1 points

QUESTION 13

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?

To promote the availability of serotonin

To decrease serotonin

To indirectly increase the amount of dopamine in the body

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

"I have trouble staying asleep in the middle of the night."

"My spouse told me that I seem to have trouble remembering things sometimes."

"I really want to stop smoking, but the cravings are too strong."

"I feel nervous to go outside and be in large crowds."

1 points

QUESTION 15

"The drug will have an almost immediate effect."

"The drug can take a while to build up in your system."

"The drug is slow to release but lasts for a long time."

"The drug will make a subtle difference in your symptoms."

1 points

QUESTION 16

1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

Benzodiazepine

Mirtazapine (Remeron)

Ketamine

Varenicline (Chantix)

1 points

QUESTION 17

Full agonists

Antagonists

Partial agonists

Inverse agonists

1 points

QUESTION 18

1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

"The patient needs to have an inverse agonist."

"The patient could benefit from an anticonvulsant."

"The patient's calcium, sodium, chloride, and potassium levels must be regulated."

"The patient should have a drug that acts on ligand-gated ion channels."

1 points

QUESTION 19

1. The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

Ligand-gated ion channels with a pentameric structure

Ligand-gated ion channels with a tetrameric structure

Voltage-sensitive ion channels

Anticonvulsants

1 points

QUESTION 20 ?

1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

"It's my fault that all of this is happening. I don't think I could ever forgive myself."

"I have to talk to the President because I'm the only one who can help him."

"I'm not sure why that lady is wearing a red jacket since it's the dogs who need food."

"I don't know that I even want to go to that meeting. It doesn't seem worth it anymore."

1 points

QUESTION 21

Obtaining raw normative metrics and using them to assess functionality

Having the patient report on cognitive function based on personal experiences

Monitoring the patient in a controlled setting

Measuring symptoms of psychosis

1 points

QUESTION 22

Dopamine is terminated through multiple mechanisms.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

MAO-B presents in the mitochondria within the presynaptic neuron.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

"Amphetamines may help you, as they can alleviate psychotic conditions."

"Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you."

"Amphetamines can cause hallucinations, so I would advise against this type of prescription."

"Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you."

1 points

QUESTION 24

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 25

1. A patient is diagnosed with schizophrenia. What increases the patient's potential to mediate the cognitive symptoms of the disease?

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points

QUESTION 26

Hypersexuality

Amenorrhea

Dystonia

Tardive dyskinesia

1 points

QUESTION 27

Olanzapine to clozapine

Asenapine to Risperidone

Aripripazole to ziprasidone

Aripripazole to clozapine

1 points

QUESTION 28

Quetiapine

Paliperidone

Lurasidone

Clozapine

1 points

QUESTION 29

1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

Muscarinic antagonists are more likely to cause decreased prolactin levels.

D2 antagonists decrease the likelihood of EPS symptoms.

D2 antagonism is linked to antidepressant properties.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points

QUESTION 30

An underlying depressive disorder

The recent change of a 2nd generation antipsychotic to a conventional one

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

All of the above

1 points

QUESTION 31

1. The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

Long-term use of antipsychotics

Genetic disposition

Age

A and C

All of the above

1 points

QUESTION 32

Those that are potent D2 antagonists

Those that are potent D2 antagonists with 5HT2A antagonism properties

D2 receptors that are blocked in the nigrostriatal pathway

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 33

5HT2 antagonism

D2 antagonism

Alpha-2 antagonism

D2 partial agonist

1 points

QUESTION 34

1. A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

Norepinephrine

Dopamine

Serotonin

A and C

All of the above

1 points

QUESTION 35

The patient has an unsustained response to antidepressants.

The patient has antidepressant-induced hypomania.

The patient has a depletion of monoamine neurotransmitters.

The patient has an adverse effect to atypical antipsychotics.

1 points

QUESTION 36

1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?

Patient with a bipolar I designation

Patient with a bipolar II designation

Patient with a bipolar III designation

None of the above

1 points

QUESTION 37

1. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

The patient may experience paranoid avoidant behavior.

The patient may experience severe depression.

The patient may experience auditory hallucinations.

The patient may experience increased mood cycling.

1 points

QUESTION 38

1. The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient's response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

The patient has a higher chance of tolerating SSRI/SNRI treatment.

The patient will have a positive response to SSRI/SNRI treatment.

The patient will develop severe mood cycling in response to treatment.

The patient may be less responsive or tolerant to the treatment.

1 points

QUESTION 39

1. Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh's serotonin levels?

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

Norepinephrine inhibits 5HT release through a2 receptors.

Norepinephrine inhibits α2 receptors on axon terminals.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

"Drugs inhibit the release of NE."

"Drugs can mimic the natural functioning of the NE neuron."

"Drugs are unable to simulate the effects of NE neurons."

"Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron."

1 points

QUESTION 41

Insomnia

Suicidal ideation

Problems concentrating

A and C

1 points

QUESTION 42

1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

Neuronal firing rates are not dysregulated in depression.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

Upon the acute administration of a SSRI, 5HT decreases.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

Both have a sedative-like, calming effect.

Both contribute to antipsychotic actions.

Both demonstrate favorable findings in treating depression in the elderly.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points

QUESTION 44

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

The patient cannot take any antihistamines.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points

QUESTION 45

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

All of the above.

1 points

QUESTION 46

First onset in puberty or early adulthood

Late onset of menses

Premenstrual syndrome

A and C

1 points

QUESTION 47

MAOI plus SNRI

SSRI/SNRI plus NDRI

NDRI/SNRI plus mirtazapine

NDRI plus modafinil

1 points

*Q/UESTION 48

1. Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

She may experience withdrawal symptoms.

She may experience increased trauma.

Effects of abrupt cessation are unknown.

It can lead to difficulties with concentration.

1 points

QUESTION 49

1. A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

Weight gain can be problematic.

Sedation is very common.

Induction of mania is rare.

Seizures are not unusual.

1 points

QUESTION 50

1. The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

Stop the venlafaxine

Lower the dose of venlafaxine by 50%

Lower the dose of venlafaxine by 25-40%

Increase the dose of venlafaxine by 50%

1 points

QUESTION 51

It can affect her menstruation.

Suicidality can be common among young adults.

Sedation may be problematic.

Weight gain is unusual.

1 points

QUESTION 52

He has fibromyalgia.

He has arrhythmia.

He uses alcohol.

He is overweight.

1 points

QUESTION 53

1. A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.

1 points

QUESTION 54

1. A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

The patient has hepatic impairment.

The patient has moderate renal impairment.

The patient has severe renal impairment.

The patient has cardiac impairment.

1 points

QUESTION 55

1. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

Histamine H1 receptor blockade can cause insomnia.

Muscarinic M1 receptor blockade causes blurred vision.

Alpha 1 adrenergic receptor blockade causes weight gain.

Muscarinic M3 receptor blockade causes sedation.

1 points

QUESTION 56

"You must avoid soy products, such as tofu."

"You should not consume processed meats."

"You may consume fermented foods, like sauerkraut."

"You may continue to drink beers on tap."

1 points

QUESTION 57

"Decongestants are fine to continue taking with MAO inhibitors."

"Decongestants are okay to take with MAO inhibitors in moderation."

"Decongestants should be avoided due to risk of serotonin syndrome."

"Decongestants should be avoided due to risk of hypertensive crisis."

1 points

QUESTION 58

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points

QUESTION 59

1. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

Patient with PTSD

Patient with partial seizures

Patient with galactose intolerance

Patient with Lapp lactase deficiency

1 points

QUESTION 60

1. Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points

QUESTION 61

1. A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient's concerns?

mirtazapine (Remeron)

doxepin (Silenor)

alprazolam (Xanax)

trazadone (Oleptro)

1 points

QUESTION 62

1. A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

Mood stabilizers can consistently treat both mania and bipolar depression

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points

QUESTION 63

1. The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

Thyroid Stimulating Hormone (TSH)

Complete Blood Count (CBC)

Erythrocyte Sedimentation Rate

Platelet Count

1 points

QUESTION 64

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer's disease

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points

QUESTION 65

Carbamazepine (Tegretol)

Gabapentin (Neurontin)

Valporoic Acid (Depakene)

All of the above

1 points

QUESTION 66

Omega-3-fatty-acids

Soybean lecithin

Inositol

L-methylfolate

1 points

QUESTION 67

Valporic Acid (Depakene)

Carbamazepine (Tegretol)

Lithium (Lithobid)

Lamotrigine (Lamictal)

1 points

QUESTION 68

1. The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

Irritability, lethargy, anger; the child should be evaluated further for ADHD.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.

1 points

QUESTION 69

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points

QUESTION 70

1. During assessment a patient states "Why are you asking me about my heart, I am here for my head", the PMHNP's best response is:

"Some medications can cause heart issues so it is necessary to rule those out before you begin medication."

"This is a part of our routine admission and it is important that you give me truthful answers."

"Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus."

"Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes."

1 points

QUESTION 71

1. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

Alcohol works similar to benzodiazepines

Up to 30% of people with anxiety use alcohol to self-medicate

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points

QUESTION 72

1. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

Respiratory depression

Sedation and restlessness

Sweating and nausea (This question was marked wrong but I think the answers are different too)

Bradycardia and tachypnea

1 points

QUESTION 73

1. A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP's best response is:

"SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry."

"Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases."

"Antidepressants are prescribed prophylactically to prevent symptoms of depression."

"Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety."

1 points

QUESTION 74 ?

1. The PMHNP evaluates the patient for "fear conditioning" when he asks:

Have you ever experienced any type of trauma?

What do you do when you feel fear?

Does your mother or father have a history of fear and/or worrying?

What makes your fear better?

1 points

QUESTION 75

1. A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

Beta blockers are linked to reconsolidation.

This medication will allow the patient to sleep throughout the night.

This medication is linked to the increase of serotonin in the brain.

See the link for Final Exam

https://www.homeworkmarket.com/questions/nurs6630-final-exam-2018-walden-university

July 1, 2023

NURS 6630 Midterm Exam (2018): Walden University

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).

"You have to take your medication to become stable."

"Most medications will increase the number of neurotransmitters that you already have in the brain."

"Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has."

"Why do you believe that your medication is poison?"

QUESTION 2

1. Which statement about neurotransmitters and medications is true?

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

Neurotransmitters receive messages from most medications.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP's best response would be:

"In an extreme case such as yours, more than one medication is often needed."

"Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

"I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms."

1 points

QUESTION 4 ?

1. During gene expression, what must occur prior to a gene being expressed?

Transcription factor must bind to the regulatory region within the cell's nucleus.

RNA must be converted to mRNA.

The coding region must separate from the regulatory region. This is wrong

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 5

1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Genes impact neuron functioning directly.

Changes made to proteins lead to changes in behavior.

Neurons are able to impact protein synthesis.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points

QUESTION 6

1. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

Neurotransmitters can spread by diffusion.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

1. Why is the cytochrome P450 enzyme system of significance to the PMHNP?

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.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

The medication's chemical composition changes when it comes in contact with the acid in the stomach.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 8

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?

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

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.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

Most enzyme pathways do not have interactions between the newer medications.

1 points

QUESTION 9

1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

Most medications that act on G-protein linked receptors have antagonistic traits.

The majority of medications used in practice are full agonists and are used to stimulate the body's natural neurotransmitters.

Most medications act as partial agonists because they allow the body to use only what is needed.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points

QUESTION 10

The patient smokes cigarettes.

The patient has hypertension.

The patient has chronic kidney disease, stage 2.

The patient drinks a cup of coffee a day.

1 points

QUESTION 11

Alert staff to possible seizures

Write an order for a different moodstabilizer

Decrease the amount prescribed for aripiprazole (Abilify)

Explain to the patient that it will be more difficult to control his temper

1 points

QUESTION 12

Review Amitriptyline (Elavil) level

Order a liver function test

Check the patient's blood pressure and pulse

Order a stat platelet count

1 points

QUESTION 13

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?

To promote the availability of serotonin

To decrease serotonin

To indirectly increase the amount of dopamine in the body

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

"I have trouble staying asleep in the middle of the night."

"My spouse told me that I seem to have trouble remembering things sometimes."

"I really want to stop smoking, but the cravings are too strong."

"I feel nervous to go outside and be in large crowds."

1 points

QUESTION 15

"The drug will have an almost immediate effect."

"The drug can take a while to build up in your system."

"The drug is slow to release but lasts for a long time."

"The drug will make a subtle difference in your symptoms."

1 points

QUESTION 16

1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

Benzodiazepine

Mirtazapine (Remeron)

Ketamine

Varenicline (Chantix)

1 points

QUESTION 17

Full agonists

Antagonists

Partial agonists

Inverse agonists

1 points

QUESTION 18

1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

"The patient needs to have an inverse agonist."

"The patient could benefit from an anticonvulsant."

"The patient's calcium, sodium, chloride, and potassium levels must be regulated."

"The patient should have a drug that acts on ligand-gated ion channels."

1 points

QUESTION 19

1. The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

Ligand-gated ion channels with a pentameric structure

Ligand-gated ion channels with a tetrameric structure

Voltage-sensitive ion channels

Anticonvulsants

1 points

QUESTION 20 ?

1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

"It's my fault that all of this is happening. I don't think I could ever forgive myself."

"I have to talk to the President because I'm the only one who can help him."

"I'm not sure why that lady is wearing a red jacket since it's the dogs who need food."

"I don't know that I even want to go to that meeting. It doesn't seem worth it anymore."

1 points

QUESTION 21

Obtaining raw normative metrics and using them to assess functionality

Having the patient report on cognitive function based on personal experiences

Monitoring the patient in a controlled setting

Measuring symptoms of psychosis

1 points

QUESTION 22

Dopamine is terminated through multiple mechanisms.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

MAO-B presents in the mitochondria within the presynaptic neuron.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

"Amphetamines may help you, as they can alleviate psychotic conditions."

"Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you."

"Amphetamines can cause hallucinations, so I would advise against this type of prescription."

"Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you."

1 points

QUESTION 24

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 25

1. A patient is diagnosed with schizophrenia. What increases the patient's potential to mediate the cognitive symptoms of the disease?

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points

QUESTION 26

Hypersexuality

Amenorrhea

Dystonia

Tardive dyskinesia

1 points

QUESTION 27

Olanzapine to clozapine

Asenapine to Risperidone

Aripripazole to ziprasidone

Aripripazole to clozapine

1 points

QUESTION 28

Quetiapine

Paliperidone

Lurasidone

Clozapine

1 points

QUESTION 29

1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

Muscarinic antagonists are more likely to cause decreased prolactin levels.

D2 antagonists decrease the likelihood of EPS symptoms.

D2 antagonism is linked to antidepressant properties.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points

QUESTION 30

An underlying depressive disorder

The recent change of a 2nd generation antipsychotic to a conventional one

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

All of the above

1 points

QUESTION 31

1. The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

Long-term use of antipsychotics

Genetic disposition

Age

A and C

All of the above

1 points

QUESTION 32

Those that are potent D2 antagonists

Those that are potent D2 antagonists with 5HT2A antagonism properties

D2 receptors that are blocked in the nigrostriatal pathway

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 33

5HT2 antagonism

D2 antagonism

Alpha-2 antagonism

D2 partial agonist

1 points

QUESTION 34

1. A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

Norepinephrine

Dopamine

Serotonin

A and C

All of the above

1 points

QUESTION 35

The patient has an unsustained response to antidepressants.

The patient has antidepressant-induced hypomania.

The patient has a depletion of monoamine neurotransmitters.

The patient has an adverse effect to atypical antipsychotics.

1 points

QUESTION 36

1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?

Patient with a bipolar I designation

Patient with a bipolar II designation

Patient with a bipolar III designation

None of the above

1 points

QUESTION 37

1. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

The patient may experience paranoid avoidant behavior.

The patient may experience severe depression.

The patient may experience auditory hallucinations.

The patient may experience increased mood cycling.

1 points

QUESTION 38

1. The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient's response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

The patient has a higher chance of tolerating SSRI/SNRI treatment.

The patient will have a positive response to SSRI/SNRI treatment.

The patient will develop severe mood cycling in response to treatment.

The patient may be less responsive or tolerant to the treatment.

1 points

QUESTION 39

1. Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh's serotonin levels?

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

Norepinephrine inhibits 5HT release through a2 receptors.

Norepinephrine inhibits α2 receptors on axon terminals.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

"Drugs inhibit the release of NE."

"Drugs can mimic the natural functioning of the NE neuron."

"Drugs are unable to simulate the effects of NE neurons."

"Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron."

1 points

QUESTION 41

Insomnia

Suicidal ideation

Problems concentrating

A and C

1 points

QUESTION 42

1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

Neuronal firing rates are not dysregulated in depression.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

Upon the acute administration of a SSRI, 5HT decreases.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

Both have a sedative-like, calming effect.

Both contribute to antipsychotic actions.

Both demonstrate favorable findings in treating depression in the elderly.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points

QUESTION 44

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

The patient cannot take any antihistamines.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points

QUESTION 45

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

All of the above.

1 points

QUESTION 46

First onset in puberty or early adulthood

Late onset of menses

Premenstrual syndrome

A and C

1 points

QUESTION 47

MAOI plus SNRI

SSRI/SNRI plus NDRI

NDRI/SNRI plus mirtazapine

NDRI plus modafinil

1 points

*Q/UESTION 48

1. Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

She may experience withdrawal symptoms.

She may experience increased trauma.

Effects of abrupt cessation are unknown.

It can lead to difficulties with concentration.

1 points

QUESTION 49

1. A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

Weight gain can be problematic.

Sedation is very common.

Induction of mania is rare.

Seizures are not unusual.

1 points

QUESTION 50

1. The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

Stop the venlafaxine

Lower the dose of venlafaxine by 50%

Lower the dose of venlafaxine by 25-40%

Increase the dose of venlafaxine by 50%

1 points

QUESTION 51

It can affect her menstruation.

Suicidality can be common among young adults.

Sedation may be problematic.

Weight gain is unusual.

1 points

QUESTION 52

He has fibromyalgia.

He has arrhythmia.

He uses alcohol.

He is overweight.

1 points

QUESTION 53

1. A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.

1 points

QUESTION 54

1. A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

The patient has hepatic impairment.

The patient has moderate renal impairment.

The patient has severe renal impairment.

The patient has cardiac impairment.

1 points

QUESTION 55

1. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

Histamine H1 receptor blockade can cause insomnia.

Muscarinic M1 receptor blockade causes blurred vision.

Alpha 1 adrenergic receptor blockade causes weight gain.

Muscarinic M3 receptor blockade causes sedation.

1 points

QUESTION 56

"You must avoid soy products, such as tofu."

"You should not consume processed meats."

"You may consume fermented foods, like sauerkraut."

"You may continue to drink beers on tap."

1 points

QUESTION 57

"Decongestants are fine to continue taking with MAO inhibitors."

"Decongestants are okay to take with MAO inhibitors in moderation."

"Decongestants should be avoided due to risk of serotonin syndrome."

"Decongestants should be avoided due to risk of hypertensive crisis."

1 points

QUESTION 58

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points

QUESTION 59

1. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

Patient with PTSD

Patient with partial seizures

Patient with galactose intolerance

Patient with Lapp lactase deficiency

1 points

QUESTION 60

1. Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points

QUESTION 61

1. A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient's concerns?

mirtazapine (Remeron)

doxepin (Silenor)

alprazolam (Xanax)

trazadone (Oleptro)

1 points

QUESTION 62

1. A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

Mood stabilizers can consistently treat both mania and bipolar depression

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points

QUESTION 63

1. The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

Thyroid Stimulating Hormone (TSH)

Complete Blood Count (CBC)

Erythrocyte Sedimentation Rate

Platelet Count

1 points

QUESTION 64

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer's disease

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points

QUESTION 65

Carbamazepine (Tegretol)

Gabapentin (Neurontin)

Valporoic Acid (Depakene)

All of the above

1 points

QUESTION 66

Omega-3-fatty-acids

Soybean lecithin

Inositol

L-methylfolate

1 points

QUESTION 67

Valporic Acid (Depakene)

Carbamazepine (Tegretol)

Lithium (Lithobid)

Lamotrigine (Lamictal)

1 points

QUESTION 68

1. The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

Irritability, lethargy, anger; the child should be evaluated further for ADHD.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.

1 points

QUESTION 69

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points

QUESTION 70

1. During assessment a patient states "Why are you asking me about my heart, I am here for my head", the PMHNP's best response is:

"Some medications can cause heart issues so it is necessary to rule those out before you begin medication."

"This is a part of our routine admission and it is important that you give me truthful answers."

"Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus."

"Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes."

1 points

QUESTION 71

1. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

Alcohol works similar to benzodiazepines

Up to 30% of people with anxiety use alcohol to self-medicate

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points

QUESTION 72

1. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

Respiratory depression

Sedation and restlessness

Sweating and nausea (This question was marked wrong but I think the answers are different too)

Bradycardia and tachypnea

1 points

QUESTION 73

1. A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP's best response is:

"SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry."

"Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases."

"Antidepressants are prescribed prophylactically to prevent symptoms of depression."

"Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety."

1 points

QUESTION 74 ?

1. The PMHNP evaluates the patient for "fear conditioning" when he asks:

Have you ever experienced any type of trauma?

What do you do when you feel fear?

Does your mother or father have a history of fear and/or worrying?

What makes your fear better?

1 points

QUESTION 75

1. A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

Beta blockers are linked to reconsolidation.

This medication will allow the patient to sleep throughout the night.

This medication is linked to the increase of serotonin in the brain.

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