NURS 6630 Assignments
NURS 6630 Assignments
Question Description
Link for the textbook below
http://stahlonline.cambridge.org.ezp.waldenulibrar…
ORDER HERE A PLAGIARISM-FREE PAPER HERE
Apa format. 3 academic references minimum but need 7 cited references total, no more than 5 years old
Remember this is a Pharmacology class that incorporatesPharmacotherapyand not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option) and why you did not choose the other options (I want you to defend your decision as if you were in open court). I would like 7 references cited with every assignment. I deduct 1 point per reference missing. Credible reference material only will be accepted. Sites such asWebMD and drugs.com (among others) will not be counted.
Cases from Stephen Stahl’s suite- Discussions
This week’s assignment is a Decision Tree
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.
The Assignment
Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select? I chose Zoloft 25mg daily as the answer
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. (Remember, a total of 7 cited references is what I am looking for)
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders
When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.
Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
REQUIRED READING
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 6, “Mood Disorders”
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
Magellan Health, Inc. (2013). Appropriate use of psychotropic
NURS 6630 Week 2 Assignment Assessing and Treating Pediatric Clients with Mood Disorders (Walden)
Assessing and Treating Pediatric Clients with Mood Disorders
Depression is a mental disorder that has a presentation of a depressed mood. Major depressive disorder (MDD) may be chronic or recurrent, leading to significant impairment in an …
Decision #1
• Which decision did you select?
• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
• Why did you select this decision? Support your response with evidence and
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
• Why did you select this decision? Support your response with evidence and
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
NURS 6630 Week 4 Assignment
For the Week 4 Assignment you are asked to choose a Quality Indicator (QI) that relates to a nursing topic that is of interest to you. The QIs can be found on the Agency for Healthcare Research and Quality’s (AHRQ) webpage:
AHRQuality Indicators
Once you’ve identified a QI of interest, you need to find two sources from the professional or scholarly literature to support how this QI can improve the quality, safety, and outcomes of your patients and their families.
The goal of this guide is to help you find peer-reviewed articles on QIs and the impact they have on quality, safety, and outcomes. Specifically, it will cover:
accessing the CINAHL Plus with Full Text database
searching for articles on Quality Indicators
limiting your search to only professional or scholarly literature
Quality indicators search
The Quality Indicators (QI) that the AHRQ mentions are:
Prevention
Inpatient
Patient Safety
Pediatric
Once you have selected a QI, here is an example of a search you can do in the CINAHL Plus with Full Text database to find articles on how this QI impacts patients and their families:
1. On the Library homepage, go to the Subject Resources box.
2. Click on Select a subject and choose: Nursing
3. Use the search box at the top of the page outlined in gold. Type in your topic. For example:
Quality Indicators AND improvement AND pediatric
4. Click the magnifying glass search button.
5. You now see a list of results. To find only peer reviewed articles, look to the left of your results to the Limit your results options. Click in the check mark box for Scholarly (Peer Reviewed) Journals.
6. Your results will automatically update to only show articles from peer reviewed journals. Browse through these to see which two would be most helpful to your paper.
NURS 6630 Week 7 Assignment
NURS 6630 Week 7 Discussion
Case 1: Volume 2, Case #16: The woman who liked a late-night TV
The patient is a 70-year-old woman who exhibits symptoms of depression due to loneliness. Her son and aide assist in her care. She is hard of hearing and has other cardiological problems. She also has a family history of depression. Her ailment worsened because she was unable to sleep and consequently has s restless leg syndrome.
The three questions I will ask the patient in my office are as follows;
1. Do you feel sleepy or do you have sleep attacks during the day and describe your usual night sleep (Hours of sleep, quality of sleep, etc.)? Lack of sleep results in more health problems and worsens depression.
2. Have any members in your family been depressed? Genetic loading in depression, anxiety or schizophrenia. Get medication effectiveness of family similar to patient’s disorder.
3. Have you ever suffered from depression, anxiety or similar problems? Pt exhibited symptoms of depression-crying, sadness etc. Patient’s mother has history of depression.
Patient’s son and the home health aide are the persons assisting with his care. So, I will direct my questions to his mother as well as her home health aide about depression history, sleeping pattern, the activity of daily living and patient’s compliance with the medication regimen.
physical exams and diagnostic tests
Actigraphy is a device that measures and records movement. It is worn on the wrist and can be used as a rough measure of the sleep-wake cycle. It is useful for assessing insomnia, circadian rhythm disorders, movement disorders and an assortment of rare events (Sadock, 2015).
Polysomnography is the continuous attended, comprehensive recording of the biophysiological changes that occur during sleep. It is recorded at night and lasts between 6 and 8 hours. Brainwave activity, eye movements, submental electromyography activity, nasal-oral airway flow, respiratory effort, oxyhemoglobin saturation, heart rhythm, and leg movement during sleep are measured (Sadock, 2015).
Three differential diagnoses
1. Major Depressive Disorder (MDD)
A major depressive disorder is a depressed mood that persists for least two weeks duration or longer. Signs and symptoms of major depression include poor appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, lack of concentration or difficulty making decisions, and feelings of hopelessness, significant weight loss or weight gain and recurring thought of death or suicide (Sadock, 2015). The predisposing factors to this illness include responses to a significant loss such as grief, a financial ruin from natural disaster, or severe medical illness or disability and other factors such as environmental (stressful life events), genetic and physiological or other psychosocial factors. All currently available antidepressants may take 3 to 4 weeks to exert significant therapeutic effects, although they may begin to show their effects earlier. Examples of antidepressant medications include SSRIs, TCAs, and MAOIs.
2. Insomnia
Sleep is regulated by basic mechanisms, and when these systems go awry, sleep disorders occur. Sleep disorders are both dangerous and difficult to treat. Obstruction Sleep Apnea (OSA) Insomnia is defined as difficulty initiating sleep. DSM-5 defines insomnia disorder as dissatisfaction with sleep quantity or quality with one or more of the following symptoms: difficulty in maintaining sleep with frequent awakenings and early morning inability to return to sleep. Primary insomnia is a condition resulting from too much arousal both at night and day time and may progress to a first major depressive episode (Stahl, 2013). Pharmacologic treatment includes Benzodiazepines, zolpidem, eszopiclone, zaleplon, and Trazodone.
3. Restless Leg Syndrome (RLS)
RLS also known as Ekbom syndrome is an uncomfortable, subjective sensation of the limbs. Usually, the legs, sometimes described as a “creepy crawly” feeling, and the irresistible urge to move the legs when at rest or while trying to fall asleep. Patients often report the sensation or any walking on the skin and crawling feelings in their legs. It worsens at night and moving the legs or walking helps to alleviate the discomfort. RLS is associated with fibromyalgia, rheumatoid arthritis, diabetes, thyroid diseases and COPD. Treatment for RLS includes levodopa, benzodiazepine, opiates, and antiepileptic (Gabapentin) drugs. Non- pharmacological treatment is massage, hot baths, hot/cold compress to affected areas, moderate exercises and alcohol avoidance at bedtime (Sadock, 2015).
Insomnia is the major diagnosis for this Patient because it is an ongoing issue.
Two pharmacologic agents for the patient’s sleep/wake therapy
The patient is on Citalopram for depression. Insomnia, fatigue and multiple painful physical complaints are side effects the medication. Citalopram increases in serotonin concentrations at serotonin receptors in parts of the brain and body other than those that cause therapeutic actions. For example, the unwanted actions of serotonin in sleep centers cause insomnia in the patient. These symptoms cause the disorder not to go into remission. Hypnotics medications will enhance remission rates for both patients with major depression and generalized anxiety disorder with insomnia. For example, Eszopiclone added to SSRI will lead to higher remission rate among the clients. Slow wave sleeping enhancing agents can also be administered to augment SSRIs/ SNRIs. These include gabapentin and Trazadone (Stahl, 2013).
1.Eszopiclone
Eszopiclone is a class of non-benzodiazepine hypnotic; alpha 1 isoform selective agonist of GABA-A/benzodiazepine receptors. Eszopiclone is an effective treatment for Primary insomnia, Chronic insomnia, Transient insomnia, Insomnia secondary to psychiatric or medical conditions and Residual insomnia following treatment with antidepressants. Inhibitory actions in sleep centers may provide sedative-hypnotic effects. While Eszopiclone is a hypnotic agent with a chemical structure unrelated to benzodiazepines, barbiturates, or other drugs with known hypnotic properties, it interacts with the gamma-aminobutyric acid-benzodiazepine (GABA-BZ) receptor complex. Eszopiclone binds selectively to the brain alpha subunit of the GABA A omega-1 receptor. Side effects include unpleasant taste, Sedation, Dizziness, Dose-dependent amnesia, Nervousness, Dry mouth, headache. Dosages include 2-3mg at bedtime (Drugbank.ca, 2018).
2. Trazodone
Trazodone binds at the 5-HT2 receptor; it acts as a serotonin agonist at high doses and a serotonin antagonist at low doses. Like fluoxetine, trazodone’s antidepressant activity likely results from blockage of serotonin reuptake by inhibiting serotonin reuptake pump at the presynaptic neuronal membrane. If used for long time periods, postsynaptic neuronal receptor binding sites may also be affected. The sedative effect of trazodone is likely the result of alpha-adrenergic blocking action and modest histamine blockade at the H1 receptor. It weakly blocks presynaptic alpha2-adrenergic receptors and strongly inhibits postsynaptic alpha1 receptors. Trazodone does not affect the reuptake of norepinephrine or dopamine within the CNS (Drugbank.ca, 2018).
Dosing for Depression as a monotherapy: initial 150 mg/day in divided doses; can increase every 3–4 days by 50 mg/day as needed; maximum 400 mg/day (outpatient) or 600 mg/day (inpatient), split into two daily doses. Initial 25–50 mg at bedtime; increase as tolerated, usually to 50–100 mg/day, but some patients may require up to full antidepressant dose range. Augmentation of other antidepressants in the treatment of depression: dose as recommended for insomnia (Stahl, 2013). Side effects include Nausea, vomiting, edema, blurred vision, constipation, dry mouth, Dizziness, sedation, fatigue, headache, incoordination, tremor, Hypotension, syncope, Occasional sinus bradycardia (long-term), Rare side effects are rash, and priapism.
Check points
The patient responded positively to faxes received from therapies. Now that she had her cochlear implant inserted, she can hear people thus ending some of her frustrations. She needs to get involved in different activities with people her age. In addition to her medication, the patient will benefit more from non-pharmacological interventions such as psychosocial therapies, social skills training, family-oriented therapies, case management, group therapy, and cognitive behavioral therapy (Sadock, 2015).
Lessons learned
From psychopharmacology point of view, I will not prescribe anti-stimulant to patient. She will be on hypnotics, and I will augment with another SSRIs/SNRIs and gabapentin for neuropathic pain. As prescribed medications become effective, she will sleep well at night and the leg pain or spasm will melt away.
Reference
Drugbank, ca (2018). Hypnotics medications. Retrieved July 10th, 2018 from https://www.drugbank.ca/drugs/DB00402
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x.
NURS 6630 Week 8 Assignment
NURS 6630 Week 10 Assignment
Walden University NURS 6630 Pharma wk 10 quiz
· 1
1 out of 1 points
A patient is receiving radiotherapy for an overactive thyroid gland and asks whether her milk is safe for her baby. If her treatment cannot be discontinued, what should the nurse recommend?
· Question 2
1 out of 1 points
A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient?
· Question 3
1 out of 1 points
A nurse is assigned to a patient who is at 32 weeks’ gestation and is receiving terbutaline (Brethine) IV for 24 hours to control preterm labor. Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus?
· Question 4
1 out of 1 points
· Question 5
1 out of 1 points
A female patient has been prescribed estrogen therapy. Which of the following will the nurse advise the patient is a common adverse effect of estrogen therapy?
· Question 6
1 out of 1 points
A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is?
· Question 7
1 out of 1 points
A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as
· Question 8
1 out of 1 points
A postmenopausal patient is prescribed bisphosphonates to treat osteoporosis. The nurse will instruct the patient to take the drug
· Question 9
0 out of 1 points
A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse?
· Question 10
1 out of 1 points
Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to
· Question 11
1 out of 1 points
A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug?
· Question 12
1 out of 1 points
A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?
· Question 13
1 out of 1 points
A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?
· Question 14
1 out of 1 points
A nurse is providing patient education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the patient to avoid which of the following drugs?
· Question 15
1 out of 1 points
A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient?
· Question 16
1 out of 1 points
Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen?
· Question 17
1 out of 1 points
On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate?
· Question 18
1 out of 1 points
A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include
· Question 19
1 out of 1 points
A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with
· Question 20
1 out of 1 points
A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications?
· Question 21
1 out of 1 points
A nurse is caring for a patient who is at 28 weeks’ gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize?
· Question 22
1 out of 1 points
A 73-year-old woman has osteoporosis and is prescribed alendronate. She takes calcium and vitamin D supplements, drinks lots of water, and has just quit smoking. The nurse should advise the patient to also
· Question 23
1 out of 1 points
A nurse is working with a patient in the clinic who has erectile dysfunction. The patient has been prescribed sildenafil (Viagra). The patient wants to do everything he can to promote effectiveness of the drug. The nurse will instruct him to
· Question 24
1 out of 1 points
A man is prescribed ciprofloxacin to treat a sexually transmitted infection. The nurse will instruct the patient to
· Question 25
1 out of 1 points
A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for which of the following?
· Question 26
1 out of 1 points
A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize?
· Question 27
1 out of 1 points
The nurse has established peripheral IV access and begun an infusion of magnesium sulfate on a 29-year-old antepartum patient who is 35 weeks pregnant. Which of the following assessment findings most likely prompted the patient’s physician to order magnesium sulfate for this patient?
· Question 28
1 out of 1 points
A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group?
· Question 29
1 out of 1 points
A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to
· Question 30
1 out of 1 points
A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following?
· Question 31
1 out of 1 points
A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend
· Question 32
1 out of 1 points
A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which of the following diagnostic and history findings would have prompted the woman’s care provider to prescribe a bisphosphonate?
· Question 33
1 out of 1 points
A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy?
· Question 34
1 out of 1 points
The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during
· Question 35
1 out of 1 points
A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit?
· Question 36
1 out of 1 points
A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is
· Question 37
1 out of 1 points
After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from
· Question 38
1 out of 1 points
Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects?
· Question 39
1 out of 1 points
A patient is pregnant and is at 7 weeks’ gestation. She has type 1 diabetes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be
· Question 40
1 out of 1 points
A patient has acquired primary hypogonadism and has been prescribed testosterone transdermal (Androderm) patches. When educating the patient on how to administer the drug, the nurse will instruct him to
NURS 6630 Week 11 Assignment
Solution- (2020) NURS 6630 pharm final exam Test Week 11 Final Exam
NURS 6630 pharm final exam Test Week 11 Final Exam / NURS6630 pharm final exam Solution- (2020) NURS 6630 pharm final exam Test Week 11 Final Exam • Question 1 1 out of 1 points What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? Antipsychotics • Question 2 1 out of 1 points The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? Second-generation, atypical antipsychotics • Question 3 1 out of 1 points The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? The doses are based on achieving 60% D2 receptor occupancy. • Question 4 1 out of 1 points Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? There is too high a risk of serious adverse side effects. • Question 5 1 out of 1 points The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? </p? Titrating the dose by increasing it every 5–7 days • Question 6 1 out of 1 points The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? Lithium (Lithane) • Question 7 1 out of 1 points The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? Strattera • Question 8 1 out of 1 points The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 8-year-old patient • Question 9 1 out of 1 points A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? The medication can affect your blood pressure. • Question 10 1 out of 1 points The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? The second dose should be taken at lunch. • Question 11 1 out of 1 points A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? “I am unable to fall asleep at night.” • Question 12 1 out of 1 points A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? The patient will have one or two doses a day. • Question 13 0 out of 1 points The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: The child will be prescribed a 10-mg tablet. • Question 14 1 out of 1 points A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? It can cause cardiac arrhythmias. • Question 15 1 out of 1 points Which patient will receive a lower dose of guanfacine? Patient with kidney disease • Question 16 1 out of 1 points An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? Migraines • Question 17 1 out of 1 points The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? Split the daily dose into two doses after the first day. • Question 18 1 out of 1 points The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? Order hydroxyzine (Vistaril), 50 mg PRN or as needed • Question 19 1 out of 1 points The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. • Question 20 1 out of 1 points A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? Prescribe lidocaine 5% • Question 21 1 out of 1 points The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. • Question 22 0 out of 1 points An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? Order an X-ray because it is possible that she dislocated her hip. • Question 23 1 out of 1 points The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? Orders liver function tests. • Question 24 1 out of 1 points The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? Prescribe desvenlafaxine (Pristiq), 50 mg daily • Question 25 1 out of 1 points A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” • Question 26 1 out of 1 points A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? Selected Answer: Duloxetine (Cymbalta) • Question 27 1 out of 1 points The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. • Question 28 1 out of 1 points Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? All of the above • Question 29 1 out of 1 points The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? Imipramine (Tofranil) • Question 30 1 out of 1 points The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? Pregabalin (Lyrica) • Question 31 1 out of 1 points A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? Duloxetine (Cymbalta) • Question 32 1 out of 1 points The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms • Question 33 1 out of 1 points The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? “SSRIs only increase serotonin levels.” • Question 34 1 out of 1 points A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? Naltrexone • Question 35 1 out of 1 points Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? “Naltrexone may be an appropriate option to discuss.” • Question 36 1 out of 1 points Which statement best describes a pharmacological approach to treating patients for impulsive aggression? Opioid antagonists can be used to reduce drive. • Question 37 1 out of 1 points A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? It will block testosterone. • Question 38 1 out of 1 points Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” • Question 39 1 out of 1 points Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? There is decreased activation of the prefrontal cortex. • Question 40 1 out of 1 points The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? Benzodiazepines • Question 41 1 out of 1 points The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? Avoiding prescribing the patient a drug that blocks H1 receptors • Question 42 1 out of 1 points The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. • Question 43 1 out of 1 points The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? Non-benzodiazepine hypnotics • Question 44 1 out of 1 points The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? Triazolam (Halcion) • Question 45 1 out of 1 points The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? Triazolam (Halcion) • Question 46 1 out of 1 points A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? “You can get melatonin over the counter, which will help with sleep onset.” • Question 47 1 out of 1 points A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? Give the medicine at night and lower the dose • Question 48 1 out of 1 points The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? “It can cause blurred vision.” • Question 49 1 out of 1 points Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? Selected Answer: All of the above could potentially treat their son’s symptoms. • Question 50 1 out of 1 points An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? Atomoxetine (Strattera) • Question 51 1 out of 1 points An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? Methylphenidate (Ritalin, Concerta) • Question 52 1 out of 1 points A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? Guanfacine ER (Intuniv) • Question 53 1 out of 1 points A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? All of the above. • Question 54 1 out of 1 points A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? Comorbidities are more common in adults, impacting the prescription of additional agents. • Question 55 1 out of 1 points A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? ADHD is often not the focus of treatment in adults with comorbid conditions. • Question 56 1 out of 1 points Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). • Question 57 1 out of 1 points The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? Both “A” & “C” • Question 58 1 out of 1 points A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: Amnesia, apraxia, agnosia • Question 59 0 out of 1 points The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine • Question 60 1 out of 1 points A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? Both “A” & “C.” • Question 61 1 out of 1 points The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? Both “A” & “B” • Question 62 1 out of 1 points A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? All of the above • Question 63 1 out of 1 points A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. • Question 64 1 out of 1 points A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? Citalopram (Celexa) or Escitalopram (Lexapro) • Question 65 1 out of 1 points The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? Both “A” & “C.” • Question 66 1 out of 1 points An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? Donepezil (Aricept) • Question 67 1 out of 1 points The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. • Question 68 1 out of 1 points Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? Alcoholism • Question 69 1 out of 1 points A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? Clonidine (Catapres) • Question 70 1 out of 1 points A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? Decrease his SSRI and add buspirone (Buspar). • Question 71 1 out of 1 points The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed? Cardiovascular disease • Question 72 1 out of 1 points The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)? Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts by inhibiting appetite. • Question 73 1 out of 1 points The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and sees people chasing him. The PMHNP identifies these symptoms to be associated with which of the following? “Bath salt” intoxication • Question 74 1 out of 1 points The PMHNP is caring for a patient who openly admitted to drinking a quart of vodka daily. Prior to prescribing this patient disulfiram (Antabuse), it is important for the PMHNP to: Evaluate the patient’s willingness to abstain from alcohol • Question 75 1 out of 1 points An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ? The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations. • Question 76 0 out of 0 points When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Selected Answer: Yes NURS 6630 Assignments
