Which of the following statements reflect the current understanding of DA pathways and clinical symptoms in schizophrenia? -Symptoms are related to DA deficit in the cerebral cortex; + are related to DA excess in the substantia nigra and VTA
Which of the following findings would raise concern in a pre-school wellness exam for a 5 yo girl?
Height 43 in, weight 55 lbs (she is overwt)
A 24 yo mother of a 2 yo child presents to the clinic. Which of the following facial characteristics would lead to the PMHNP to believe child has Fetal ETOH syndrome? Small head, thin upper lip, smooth philtrum.
Patty is a 62 yo female with BPDO I and has been stable for 2 yrs on valproate and risperidone. She recently diagnosed with shingles, and her PCM started her on corticosteroids. As the PMHNP treating Patty, you are concerned the addition of steroids may cause: Manic episode.
Which mood stabilizer is most associated with potentially life threatening rash? Lamotrigine (Lamictal)
Which of the following statements most accurately reflects the predominant risk factors for ASD? Genetic of a first degree family member.
A 17yo female presents reporting anhedonia, decreased energy & hopelessness for the past 2 yrs. She denies ETOH, smoking or using illegal substances. Her physical exam results are WNL and she denies SI. As her PMHNP, you decide to prescribe bupropion. Which of the following is a contraindication for bupropion? Bulimia
You have a 17 yo female who suffers from BPDO. The pt has a hx of impulsive acting out and promiscuity. You make a decision to add folic acid .8 mg to her medication regimen of lamotrigine 200 mg Q HS and quetiapine XR 50 mg 1 PO QHS. Why is this important? FA supports neural tube development during the 1st month a woman is pregnant.
Which of the following medications has a unique mechanism of action that is both DA and NE - RI? Bupropion (Wellbutrin)
Which of the following pts with GAD is most likely to be a 2C19 poor metabolizer and have an exaggerated response to diazepam 5 mg TID with increased sedation, CNS & cognitive SE? 40 yo Asian male
Which of the following findings would raise concern in an annual sports exam for a 15 yo girl? Ht 67 in, wt 102 inch (under)
You are on call for your service. You arrive at the ED to find a 22 yo male complaining of having trouble with his eyes. His vitals are stable. He is 5’7”, weighs 140 lbs & his labs are WNL. He states he has been taking Abilify for the last 2 months for BPDO. He had the dose raised to 15 mg po QAM 4 days ago to manage a manic episode. He states that 1 and 2 times a day for the past 2 days his eyes roll up for 1015 m, he is able to open his eyes but he is not able to focus his eyes on you. His eyes are rolled upward about 2/3rds of the way towards his upper eyelid. After exam, you decide to: Discontinue the Abilify and give Cogentin 1mg IM. Have him return to his provider for a different medication for his BPDO the next day.
What direct acting DA agonist is recommended to be used in the treatment of NMS to help lower the DA receptor blockade? Bromocriptine (Parlodel)
A 43 yo male is treated for BPDO I on lithium. Which of the following hematologic changes are associated with lithium? Luekocytosis
Which of the following antidepressants is associated with dose-related cardiovascular adverse effects which require adherence to maximum recommended dosing, unless high doses are deemed appropriate despite risks? Citalopram (40 mg/day due to heart changes)
A client is suffering from schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing SE produced by DA antagonism in the tuberoinfundibular pathway? Breast discharge
When studying pharmacodynamics involving receptors, you know that inverse agonists produce: Opposite effect of an agonist, and causes the receptor to close the ion channel.
Which CYP enzyme is implicated as a tobacco inducer when an individual is treated with clozapine? 1A2
A week after raising the dose of Risperdal, a patient treated for schizophrenia presents with reports of acute change in mental status, fever and rigidity. The PMHNP you know these symptoms are consistent with: NMS.
NE is a neurotransmitter that is implicated in alertness and anxiety. What area of the brain has a large majority of NE neurons? Locus Coeruleus.
A 74 yo female presents for evaluation. PMHNP has the patient complete a MMSE exam and clock drawing. The pt is unable to correctly draw the face of the clock. Which area of the brain is likely to have compromised functioning? Right Hemisphere.
Mr. Smith is a 56 yo white male who has been successfully treated on Selegiline over 4 yrs. Mr. Smith is going in for an elective surgery. Which medication is contraindicated with Selegiliine. Meperidine.
Sandy, a 32 yo separated female presents for initial intake. Sandy states she recently left an abusive relationship, is living alone and experiencing fear, panic, and extreme anxiety. Which brain structure is activated in pts w/ severe anxiety, as expressed by Sandy? Amygdala
A 37 yo pt with schizophrenia is started on a high dose of chlorpromazine. The next day, he complains of lightheadedness after standing up. VS changes reflect significant decrease in BP and increase in HR. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing: Orthostatic HypoTN
Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiety disorders? Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety. (GABA is inhibitory)
Which of the following statements regarding disulfiram is correct? Avoid anything containing ETOH while using disulfiram and for 2 weeks after discontinuing.
If given during pregnancy, lithium can cause which of the following? Ebstein’s anomaly
While treating a 12 yo boy for ADHD, the PMHNP observes which of the following physical features that raise concern for genetic eval for Fragile X syndrome? Long head and ears, short stature, hyperextensible joints
The PMHNP would expect to see which of the following during a physical exam for a patient with bulimia nervosa? Erosion of dental enamel.
The risk of bleeding on SSRIs, NSAIDs or ASA, is example of which of the following principles? Pharmacodynamic.
In evaluating a 4 yo, one would expect which of the following delays in Asperger’s disorder? Social skills development.
Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? Decreased size of cerebral ventricles. (ventricle size increases as brain tissue shrinks)
Which of the following statements reflects current understanding of the neurodevelopment best explains risk-taking behavior of adolescent males? Maturation of the prefrontal cortex continues into mid-20s early 30s.
What is a rate but serious side effect of Trazodone? Priapism.
Arcus senilis when seen before 40 yrs is associated with which of the following? HLD
Which serotonin receptor antagonism makes an antipsychotic atypical? 5HT2A
As a PMHNP, you are aware of medication SE. Which of the following SE of antipsychotic medication has insidious, delayed onset typically 1-2 yrs after initial of medication? TD
Your patient comes into the office for her middle of the year appointment. She is dx with BPDO I. She has been maintained well for the past 3 years on oxcarbazepine 900 mg PO Q HS. Her labs are normal except for blood sugar of 114 and her HgA1c is 5.6. She has normal energy and states her mood is stable but complaints of excessive urination and thirst. You suspect: SE of Trilpetal.
When assessing an elderly pt that complains of tinnitus, the PMHNP would associate which of the following findings with an acoustic neuroma? Unilateral ringing in the ear.
Which area of the brain has been impacted to modulate pain and can help explain how TMS can decrease pain? Prefrontal cortex.
Domain 2
The WHO has predicted that depression will be the #1 world health problem in the 21st century.
Lifetime prevalence for MDD is 12% (With a 5-17% range). Which of the following individuals has the greatest risk factors for MDD? 43 yo divorced woman, school teacher, raising 3 children
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