MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University
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Free MSN 672 Psychopathopharmacology Final Exam at Nothern Kentucky University Questions
This is a Norepinephrine-dopamine reuptake inhibitor (NDRI) that can be used to treat ADHD. Select the medication that applies to this description.
- Bupropion
- Ritalin
- Adderall
- Fluoxetine
Explanation
Bupropion is a Norepinephrine-dopamine reuptake inhibitor (NDRI). It works by inhibiting the reuptake of both norepinephrine and dopamine, which can be helpful in treating conditions like ADHD, depression, and smoking cessation. While not typically the first-line treatment for ADHD, bupropion is used in certain cases, especially when a stimulant medication is not suitable due to side effects or other concerns.
Correct Answer: A. Bupropion
Bupropion inhibits the reuptake of norepinephrine and dopamine neurotransmitters without any significant direct effects on serotonin neurotransmission. Knowing this information, which side-effect is least likely to occur while taking Bupropion?
- Insomnia
- Weight loss
- Sexual dysfunction
- None of the above
Explanation
Bupropion works by inhibiting the reuptake of norepinephrine and dopamine, and it has minimal effect on serotonin. The most important side effects of bupropion are related to its dopamine and norepinephrine activity.
Correct Answer: C. Sexual dysfunction
In the general population, which factor is the most common cause of Attention-Deficit Hyperactivity Disorder?
- Acquired childhood diseases/infections
- Hereditary factors
- Fragile X syndrome
- Atrophy of the parietal, temporal, and occipital lobes
Explanation
Hereditary factors are the most common cause of Attention-Deficit Hyperactivity Disorder (ADHD) in the general population. Research has consistently shown that genetic predisposition plays a significant role in the development of ADHD. Children with a family history of ADHD are at a higher risk of developing the disorder themselves.
Correct Answer: B. Hereditary factors
Characteristics of Clozapine are the following (Select all that apply):
- Prescribed for patients who have not responded to standard therapy
- May affect cranial nerves that control the swallowing reflex
- May suppress bone marrow resulting in agranulocytosis
- Is an agonist at M4 receptors and antagonist at alpha 2 adrenergic receptors causing hypersalivation
Explanation
A. Prescribed for patients who have not responded to standard therapy
Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia, meaning it is prescribed to patients who have not responded adequately to standard antipsychotic medications. It is effective in these cases due to its unique pharmacological profile.
C. May suppress bone marrow resulting in agranulocytosis
One of the major risks of clozapine is agranulocytosis, a serious condition where bone marrow is suppressed, leading to a severe decrease in white blood cells (particularly neutrophils). This increases the risk of infections and requires regular monitoring of the white blood cell count during treatment.
D. Is an agonist at M4 receptors and antagonist at alpha 2 adrenergic receptors causing hypersalivation
Clozapine has activity at M4 receptors, contributing to its anticholinergic effects, including hypersalivation. It also acts as an antagonist at alpha-2 adrenergic receptors, which is associated with excessive salivation as a side effect. These effects make clozapine unique compared to other antipsychotics.
Correct Answer: A. Prescribed for patients who have not responded to standard therapy
C. May suppress bone marrow resulting in agranulocytosis
D. Is an agonist at M4 receptors and antagonist at alpha 2 adrenergic receptors causing hypersalivation
A patient with a history of opioid use disorder is requesting a prescription for buprenorphine, instead of the combination formulation with buprenorphine and naloxone. You analyze the patient's request, because as a PMHNP, you are aware that the combination formulation of buprenorphine and naloxone... (Select the best answer):
- Is more effective for withdrawal symptoms
- Is significantly cheaper
- Produces a "high"
- Prevents intravenous abuse
Explanation
The combination formulation of buprenorphine and naloxone is designed to reduce the potential for misuse, particularly intravenous abuse. Naloxone is an opioid antagonist that has minimal effect when taken orally but will induce withdrawal symptoms if the medication is injected. This discourages individuals from attempting to misuse the medication intravenously.
Correct Answer: D. Prevents intravenous abuse
The nurse practitioner is providing education for a 15-year-old male patient and his guardian. The patient has been diagnosed with Disruptive Mood Dysregulation Disorder (DMDD) and prescribed valproate. The nurse practitioner informs the patient and guardian to immediately report which symptom if it occurs? (Select all that apply)
- Vomiting
- Severe abdominal pain
- Dark urine
- Joint discomfort
Explanation
Valproate, a medication commonly used to treat bipolar disorder and epilepsy, carries a risk of serious adverse effects, particularly hepatotoxicity and pancreatitis. The symptoms that should be reported immediately include:
A. Vomiting
Vomiting can be a sign of liver dysfunction or pancreatitis, both of which are serious potential side effects of valproate. If a patient taking valproate develops vomiting, it should be assessed promptly.
B. Severe abdominal pain
Severe abdominal pain is a warning sign of pancreatitis, a potentially life-threatening condition associated with valproate use. This symptom must be reported immediately.
C. Dark urine
Dark urine may indicate hepatic dysfunction or liver toxicity, which are significant concerns when using valproate. This requires immediate attention and possible adjustment of the medication.
Correct Answer: A. Vomiting
B. Severe abdominal pain
C. Dark urine
Hypnotics with moderate half-lives (15-30 hours) may not wear off until after the individual wakes up. What are the potential residual effects? (Select all that apply).
- Loss of sleep maintenance
- Memory problems
- Rapid onset of action
- "Hangover" effects
Explanation
B. Memory problems
Hypnotics with moderate half-lives can cause residual sedative effects that impair cognitive functions, including memory. These effects can linger into the day after waking, leading to difficulty remembering events or conversations, especially when the medication hasn't completely cleared the system.
D. "Hangover" effects
"Hangover" effects, such as grogginess, drowsiness, or feeling mentally foggy, can occur because the hypnotic is still active in the system when the individual wakes up. This extended sedation can lead to feelings of sluggishness and decreased alertness, commonly reported when using hypnotics with a longer half-life.
Correct Answer: B. Memory problems
D. "Hangover" effects
The PMHNP understands that insufficient dACC can cause symptoms such as carelessness, losing items, and being easily distracted, which is often associated with selective attention. The PMHNP also knows assessing selective attention can be executed with using what test? Please select an answer below.
- Stroop Task Test
- Attention Deficit and Hyperactive Task Orientation Test
- Mini Mental State Exam
- None of the above
Explanation
The Stroop Task Test is a well-known psychological test used to assess selective attention and the ability to inhibit cognitive interference. It involves presenting participants with color names printed in incongruent colors (e.g., the word "red" printed in blue ink), and the task is to say the color of the ink rather than reading the word itself. This test evaluates cognitive flexibility and attention control, particularly selective attention and the ability to focus on relevant information while ignoring distractions.
Correct Answer: A. Stroop Task Test
As a PMHNP, you have a 26-year-old male patient, admitted to your mental health facility. The patient has a well-documented history of ADHD and cocaine use. What is the best medication option for this patient, to assist with treatment of ADHD?
- Atomoxetine
- Adderall
- Ritalin
- Vyvanse
Explanation
The patient has a history of cocaine use, which makes stimulant medications like Adderall, Ritalin, and Vyvanse less ideal due to the risk of misuse or addiction. Stimulants work by increasing dopamine and norepinephrine levels, which can be reinforcing for someone with a substance use disorder, especially a history of stimulant abuse. Atomoxetine, on the other hand, is a non-stimulant medication that selectively inhibits the reuptake of norepinephrine. It is not addictive and carries no risk of abuse, making it a safer option for individuals with a history of substance use disorder, including those with ADHD and cocaine use.
Correct Answer: A. Atomoxetine
You have a 29-year-old patient with a history of Bipolar Disorder who comes in for a routine check-up; she is currently taking Lithium ER 450mg PO at HS. The patient's lithium level is 0.9. The patient reports nausea and vomiting for 24 hours. What is your next action as a nurse practitioner?
- Continue the medication as ordered and monitor lithium levels
- Discontinue Lithium and start Valproate
- Order an abdominal CT and discontinue Lithium
- Hold the Lithium and further explore patient symptoms
Explanation
The patient's lithium level is 0.9, which is within the therapeutic range (0.6 to 1.2 mEq/L), but the patient reports nausea and vomiting for the past 24 hours, which are early signs of lithium toxicity. Even though the lithium level is not above the therapeutic range, symptoms of toxicity can still occur if the patient is dehydrated or has renal impairment, both of which can lead to lithium accumulation in the body.
The most appropriate next step is to hold the lithium and further explore the patient's symptoms, including possible causes of nausea and vomiting, such as dehydration, gastrointestinal issues, or other underlying conditions. It's important to reassess the patient's hydration status and renal function before resuming lithium therapy.
Correct Answer: D. Hold the Lithium and further explore patient symptoms
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