Course NURS-6630N Test Week 11 Final Exam
Question 1
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?
Answer: B.
Decrease his SSRI and add an MAOI.
Question 2
Which statement best describes a pharmacological approach to treating patients for impulsive
aggression?
Answer: B.
Atypical antipsychotics can increase subcortical dopaminergic stimulation.
Question 3
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?
Answer: B.
• Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism
• Possible treatment option: donepezil
Question 4
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?
Answer: A.
Donepezil (Aricept)
Question 5
The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP
include in the teaching?
Answer: D.
There will be continued effects into the evening.
Question 6
The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP
anticipate the drug to work?
Answer: A.
It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels.
Question 7
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?
Answer: D.
The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations.
Question 8
A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP
include when discussing the side effects with the patient?
Answer: C.
The medication can affect your blood pressure.
Question 9
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?
Answer: B.
“I am unable to fall asleep at night.”
Question 10
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?
Answer: C.
Prescribe lidocaine 5%
Question 11
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.
Answer: C.
Reduced ability to find the correct word is most problematic, and an appropriate treatment option would
be memantine.
Question 12
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:
Answer: A.
Evaluate the patient’s willingness to abstain from alcohol
Question 13
A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents
assist with ADHD symptoms. What is the appropriate response?
Answer: A.
They both increase signal strength output dopamine (DA) and norepinephrine (NE).
Question 14
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?
Answer: D.
This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness.
Question 15
When completing this exam, did you comply with Walden University’s Code of Conduct including the
expectations for academic integrity?
Answer: Yes
Question 16
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?
Answer: B.
“It can cause blurred vision.”
Question 17
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?
Answer: B.
Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly.
Question 18
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?
Answer: B.
The patient will have one or two doses a day.
Question 19
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?
Answer: D.
Both “A” & “B”
Question 20
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:
Answer: A.
The child will be prescribed 2.5 mg.
Question 21
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?
Answer: C.
Guanfacine ER (Intuniv)
Question 22
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?
Answer: C.
Temazepam (Restoril)
Question 23
A 71-year-old male patient comes to an appointment with his 65-yearold 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:
Answer: C.
Amnesia, apraxia, agnosia
Question 24
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?
Answer: C.
“Bath salt” intoxication
Question 25
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?
Answer: B.
Benzodiazepines
Question 26
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?
Answer: D.
Second-generation, atypical antipsychotics
Question 27
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?
Answer: D.
All of the above
Question 28
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?
Answer: A.
“The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal
horn.”
Question 29
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?
Answer: A.
Migraines
Question 30
Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following
conditions?
Answer: A.
Alcoholism
Question 31
The PMHNP understands that slow-dose extended release stimulants are most appropriate for which
patient with ADHD?
Answer: A.
8-year-old patient
Question 32
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?
Answer: A.
ADHD is often not the focus of treatment in adults with comorbid conditions.
Question 33
Which of the following is a true statement regarding the use of stimulants to treat attention deficit
hyperactivity disorder (ADHD)?
Answer: B.
Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine
(NE).
Question 34
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?
Answer: A.
“Naltrexone may be an appropriate option to discuss.”
Question 35
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?
Answer: D.
Comorbidities are more common in adults, impacting the prescription of additional agents.
Question 36
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?
Answer: A.
Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily.
Question 37
The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does
the PMHNP go about treating this patient?
Answer: C.
Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that
might mediate those symptoms
Question 38
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?
Answer: D.
Both “A” & “C.”
Question 39
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?
Answer: B.
Estazolam (ProSom)
Question 40
Why does the PMHNP avoid prescribing clozapine (Clozaril) as a firstline treatment to the patient with
psychosis and aggression?
Answer: A.
There is too high a risk of serious adverse side effects.
Question 41
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?
Answer: A.
Pregabalin (Lyrica)
Question 42
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?
Answer: D.
Non-benzodiazepine hypnotics
Question 43
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?
Answer: A.
Lithium (Lithane)
Question 44
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?
Answer: All of the above could potentially treat their son’s symptoms.
Question 45
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?
Answer: D.
Citalopram (Celexa) or Escitalopram (Lexapro)
Question 46
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?
Answer: C.
The doses are based on achieving 60% D2 receptor occupancy.
Question 47
The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking
cessation. Why is this medication effective for these patients?
Answer: C.
Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine.
Question 48
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?
Answer: D.
Both “A” & “C.”
Question 49
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?
Answer: C.
Give the medicine at night and lower the dose
Question 50
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?
Answer: A.
Orders liver function tests.
Question 51
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?
Answer: C.
Antipsychotics
Question 52
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?
Answer: A.
Kidney disease stage II
Question 53
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?
Answer: A.
Monitor liver function every 6 months for a year and then yearly thereafter.
Question 54
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?
Answer: A.
There is decreased activation of the prefrontal cortex.
Question 55
The PMHNP is caring for a patient with fibromyalgia. Which secondline treatment does the PMHNP
select that may be effective for managing this patient’s pain?
Answer: C.
Imipramine (Tofranil)
Question 56
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?
Answer: D.
Clonidine (Catapres)
Question 57
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?
Answer: D.
Both “A” & “C”
Question 58
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?
Answer: D.
“There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your
daughter can try.”
Question 59
A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP
tell the patient regarding bupropion?
Answer: C.
It can cause cardiac arrhythmias.
Question 60
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?
Answer: D.
Naltrexone
Question 61
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?
Answer: C.
Atomoxetine (Strattera)
Question 62
Which patient will receive a lower dose of guanfacine?
Answer: D.
Patient with kidney disease
Question 63
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?
Answer: C.
Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon.
Question 64
The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia),
Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)?
Answer: B.
Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts by inhibiting
appetite.
Question 65
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?
Answer: A.
Avoiding prescribing the patient a drug that blocks H1 receptors
Question 66
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?
Answer: C.
Prescribe desvenlafaxine (Pristiq), 50 mg daily
Question 67
A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does
the PMHNP prescribe an antiandrogen for this patient?
Answer: C.
It will block testosterone.
Question 68
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?
Answer: D.
All of the above
Question 69
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?
Answer: A.
Strattera
Question 70
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?
Answer: D.
“You can get melatonin over the counter, which will help with sleep onset.”
Question 71
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?
Answer: A.
Pregabalin (Lyrica)
Question 72
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?
Answer: Duloxetine (Cymbalta)
Question 73
The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP
exhibits proper care for this patient?
Answer: C.
Titrating the dose by increasing it every 5–7 days
Question 74
An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on selfreport from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is
suspected. What medication is the PMNHP most likely to prescribe?
Answer: A.
Methylphenidate (Ritalin, Concerta)
Question 75
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?
Answer: A.
Order hydroxyzine (Vistaril), 50 mg PRN or as needed
Question 76
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?
Answer: B.
“SSRIs only increase serotonin levels.”
