NR 546 Midterm EXAM Psychopharmacology questions with complete verified solutions + rationales

A 22-year-old patient recently diagnosed with bipolar disorder and states "I'm not crazy" and is refusing to take his prescribed medication. Which type of factor is contributing to this patient's nonadherence?

A. Client factors

B. Clinician factors

C. Structural factors

D. Environmental factors

C. Structural factors

Using Dell'Osso et al.'s sequential framework of priorities to promote medication adherence, determine which step is being defined: The PMHNP explains the mechanism of action, anticipated time to experience effects, side effects, and lifestyle instructions to a patient after prescribing Wellbutrin.

A. Diagnosis

B. Medication education

C. Monitoring plan

D. Adherence reinforcement

B. Medication education

A patient recovering from a stroke has trouble with speech comprehension and works with a speech therapist twice a week. Which part of the patient's brain has been affected by the stroke?

A. The Broca's area

B. The Basal ganglia

C. The Limbic system

D. The Wernicke's area

D. The Wernicke's area

Which of the following poses a potential ethical concern when prescribing psychiatric medications?

A. The patient is homeless and uninsured

B. The patient poses a risk to themself as they state they are experiencing very scary auditory and visual hallucinations

C. The patient's family voices a stigma against psychiatric medications

D. The patient states they worry about the potential side effects of the medication

B. The patient poses a risk to themself as they state they are experiencing very scary auditory and visual hallucinations

What is the name of the lobe that controls visual processing?

A. Gyrus

B. Frontal Lobe

C. Occipital Lobe

D. Parietal Lobe

C. Occipital Lobe

The cerebellum, cerebrum, brain stem, and butterfly-shaped portion of the central spinal cord are comprised of _______________ which contains neural cell bodies, axon terminals, dendrites, and all nerve synapses.

A. Frontal lobe

B. White mater

C. Grey mater

D. Corpus callosum

C. Grey mater

What is the function of the central sulcus?

A. Separates the temporal from the occipital lobe

B. Separates the frontal from the parietal lobe

C. Involved in complex motor activities

D. Keeps us alert to our environment

B. Separates the frontal from the parietal lobe

Which of the following is associated with motor coordination?

A. Broca's Area

B. Olfactory Nerves

C. Frontal Cortex

D. Thalamus

D. Thalamus

Which lobe of the brain is in charge of handling memory and anxiety?

A. Frontal lobe

B. Anxiety center

C. Temporal lobe

D. Central sulcus

C. Temporal lobe

Damage to the anterior portion of which lobe can cause asterogenesis?

A. Frontal

B. Temporal

C. Parietal

D. Occipital

C. Parietal

What part of a neuron receives the signal?

A. Axon

B. Axon Terminal

C. Dendrites

D. Soma

C. Dendrites

Which of the following separates the frontal lobe from the parietal lobe?

A. The grey matter

B. The central sulcus

C. The Hippocampus

D. The Broca's area

B. The central sulcus

What lobe of the brain is responsible for higher-level executive functions such as expressive language and voluntary movement?

A. Occipital lobe

B. Parietal lobe

C. Frontal lobe

D. Temporal lobe

C. Frontal lobe

Which area of the brain is regulates long term memory?

A. Hippocampus

B. Parietal lobe

C. Temporal lobe

D. Occipital lobe

A. Hippocampus

Which area of the brain is associated anxiety and perception of odors?

A. Amygdala

B. Basal ganglia

C. Prefrontal cortex

D. Wernicke's area

A. Amygdala

The limbic system is associated with which of the following?

A. Executive function

B. Emotion and learning

C. Intelligence and movement

D. Expressive speech

B. Emotion and learning

Which channel membrane protein is specifically important in the process of neurotransmitter release?

A. voltage-sensitive sodium channels.

B. voltage-dependent (gated) calcium channels.

C. neurotransmitter receptor potassium channels.

D. voltage-dependent (gated) chloride channels.

B. voltage-dependent (gated) calcium channels.

A 76-year-old patient who is determined to be a poor 2D6 metabolizer is being prescribed vortioxetine for his depression. What does the PMHNP need to remember when prescribing this drug?

A. The dosage of the drug will need to be increased

B. The dosage needs to begin at half then increase over a 2-week period

C. The dosage should not exceed ½ of the usual recommended dose

D. An adjunct medication will need to be prescribed until the dosage can be reduced

C. The dosage should not exceed ½ of the usual recommended dose

Which of the following mechanisms would you associate with an antagonist drug action?

A. A drug that binds postsynaptic receptors and mimics the effect of the neurotransmitter.

B. A drug that binds and blocks normal auto receptor function.

C. A drug that increases the enzymatic synthesis of neurotransmitters.

D. A drug that binds postsynaptic receptors and blocks the normal action of the neurotransmitter.

D. A drug that binds postsynaptic receptors and blocks the normal action of the neurotransmitter.

A court order inpatient hospitalization was ordered for a patient who is considered a danger to themselves and other. Which ethical issue is being addressed?

A. Informed consent

B. Off labeling prescription

C. Compliance

D. Restrictive methods

C. Compliance

What is the expected outcome for a patient who is considered a "intermediate metabolizer"?

A. No need for medication dosage readjustments

B. Increased risk for drug to drug reactions

C. Provider increasing drug dosages

D. Subtherapuetic drug levels

B. Increased risk for drug to drug reactions

Which of the following is true regarding epigenetic changes?

A. Epigenetic changes are reversible.

B. Epigenetic changes, changes the DNA and how the body reacts to the DNA sequence.

C. Epigenetic changes are not linked to mental health conditions.

D. When combined with genetic risks, epigenetic changes decreased the risk for a psychiatric disease.

A. Epigenetic changes are reversible.

Which of the following brain structures is involved in voluntary motor movements?

A. Basal ganglia

B. Prefrontal cortex

C. Amygdala

D. Limbic system

A. Basal ganglia

Obtaining consent from from a the guardian of a patient who has limited cognitive capabilities or are incompetent to make decisions represents which ethical principle?

A. Informed consent

B. Compliance

C. Off label prescribing

D. Confidentiality

B. Compliance

Lack of medication access and the increasing costs of medication is which type of factor contributing to medication non adherence?

A. Provider

B. Environmental

C. Structural

D. Client

C. Structural

Which of the following is an enzyme inhibitor?

A. Sulfaurea

B. Smoking

C. Rifampin

D. Sulfamide

D. Sulfamide

Which of the following is an enzyme inducer?

A. Quinidine

B. Ketoconazole

C. Amiodarone

D. Carbamezpine

D. Carbamezpine

Which of the following definitions are correct?

A. Partial agonist- drug fully activates receptors

B. Antagonist- drug binds to receptor and activates a response

C. Inverse agonist- drug causes an opposite effect of the agonist

D. Agonist- drug binds to the receptor and does not activate a biological response

C. Inverse agonist- drug causes an opposite effect of the agonist

Ethical issues within mental health include which of the following?

A. Patient unable to afford medication

B. Patient unable to self-determine care

C. Patient's ethnic culture

D. Patients wanting to include family in treatment plan

B. Patient unable to self-determine care

A patient presents to the PMHNP with report of having anxiety, frequent occurrences of feeling frozen in place and like his heart is pounding out of his chest, as well as having difficulty sleeping. The PMHNP suspects the patient has an elevated level of which neurotransmitter?

A. Serotonin

B. GABA

C. Norepinephrine

D. Dopamine

C. Norepinephrine

Which best defines a patient who is a poor metabolizer?

A. This patient has a lower concentration of the necessary enzyme to metabolize a medication.

B. This patient will have lower blood concentrations of the medication.

C. This patient has a decreased risk of side effects and adverse reactions

D. This patient should not be prescribed antidepressants.

A. This patient has a lower concentration of the necessary enzyme to metabolize a medication,

Which part of the Brian activates fear?

A. Striatum

B. Amygdala

C. Limbic system

D. Basal ganglia

B. Amygdala

Which neurotransmitter is responsible for the regulation of the "fight or flight" response?

A. Dopamine

B. Norepinephrine

C. GABA

D. Histamine

B. Norepinephrine

An increase of which neurotransmitter can result in hallucinations and/or psychosis?

A. Serotonin

B. Acetycholine

C. Dopamine

D. GABA

C. Dopamine

Which of the following neurotransmitters is considered the chief inbibitory neurotransmitter?

A. Serotonin

B. Histamine

C. Glutamate

D. GABA

D. GABA

Increased levels of acetycholine result in

A. hallucinations

B. alhenizmers

C. depression

D. parkinson's

C. depression

SSRIs, SNRIs, and tricyclic antidepressants increase levels of which neurotransmitter?

A. Dopamine

B. Serotonin

C. GABA

D. Glutamate

B. Serotonin

Which medication class does not affect serotonin?

A. Benzodiazepines

B. MOAIs

C. SSRIs

D. Tricyclic antidepressants

A. Benzodiazepines

Which of the following is the best medication class for the PMHNP to prescribe to address elevated norepinephrine levels?

A. SSRI

B. MAOI

C. SNRI

D. Benzodiazepines

A. SSRI

Psychotropic drug metabolism may be impacted by many factors except for

A. age

B. profession

C. caffeine intake

D. smoking

B. profession

Which dopamine pathway is associated with galactorrhea and gynecomastia?

A. Mesocortical pathway

B. Mesolimbic pathway

C. Tuberoinfundibular pathway

D. NIgrostriatal pathway

C. Tuberoinfundibular pathway

An overactive mesolimbic pathway will result in

A.dystonia and akanthesia.

B. sexual dysfunction

C. negative symtoms

D. hallucinations and psychosis

D. hallucinations and psychosis

Decreased levels of dopamine in which pathway is responsible for negative symptoms of schizophrenia?

A. Nigrostriatal pathway

B. Tuberoinfundibular pathway

C. Mesolimbic pathway

D. Mesocortical pathway

D. Mesocortical pathway

A patient on Haldol 10mg daily is noted to have and extreme form of slowness. The PMHNP understands which dopamine pathway is associated with this?

A. Tuberoinfundibular pathway

B. Mesocortical pathway

C. Nigrostriatal pathway

D. Mesolimbic pathway

C. Nigrostriatal pathway

Which neurotransmitter in considered the chief inhibitory neurotransmitter?

A. Histamine

B. Dopamine

C. GABA

D. Glutamate

C. GABA

Which of the following teaching provided by the PMHNP is correct when teaching a patient about EPS?

A. EPS may cause dystonia which feels like inner restlessness that may lead to locking or finger tapping.

B. EPS may cause tardive dyskinesia which may cause abnormal facial and tongue movements.

C. EPS may cause akathisia which is involuntary muscle contractions which may be painful.

D. EPS may cause bradykinesia which is involuntary movements or shaking.

B. EPS may cause tardive dyskinesia which may cause abnormal facial and tongue movements.

A patient who recently started on a first generation antipsychotic reports sexual dysfunction and nipple discharge. Which of the following actions by the PMHNP is appropriate?

A. The PMHNP orders blood test to examine the patient's prolactin level.

B. The PMHNP states this is a normal response to treatment and these symptoms will decrease with time.

C. The PMHNP asks the patient if they are taking any OTC supplements.

D. The PMHNP educated the patient on EPS and informs the patient that they will have to discontinue their medication.

A. The PMHNP orders blood test to examine the patient's prolactin level.

The PHMNP recognizes which of the following medication as an atypical antipsychotic?

A. chlorpromazine

B. aripiprazole

C. haloperidol

D. mesoridazine

B. aripiprazole

Which of the following mediation is a first generation antipsychotic?

A. risperidone

B. olanzapine

C. thiothixene

D. cariprazine

C. thiothixene

Which second-generation antipsychotic requires routine absolute neutrophil count monitoring?

A. Brexpiprazole

B. Clozapine

C. Risperidone

D. Ziprasidone

B. Clozapine

What is the contraindication for ziprasidone?

A. Daytime sedation

B. Obseity due to high risk of weight gain

C. Liver disease and hepatic failure

D. QT, myocardial infarction, heart failure

D. QT, myocardial infarction, heart failure

Which of the following second generation antipsychotics is available sublingually or as transdermal patch?

A. Clazapine

B. Quetiapine

C. Asenapine

D. Olanzapine

C. Asenapine

Which of the following is the most appropriate option for an obese patient ?

A. Clozapine

B. Quetiapine

C. Asenapine

D. Olanzapine

C. Asenapine

Which medication is a better choice for a patient who is overweight?

A. Aripiprazole

B. Clozapine

C. Olanzapine

D. Lurasidone

A. Aripiprazole

Which medication should the PMHNP avoid prescribing for their schizophrenic elderly patient with a history of falls?

A. Brexiprazole

B. Aripiprazole

C. Risperidone

D. Quetiapine

D. Quetiapine

Which medication should the PMHNP rule out for a male patient who experienced sexual dysfunction and the development of breasts with a previous prescription of first generation antipsychotic?

A. Lurasidone

B. Risperidone

C. Olanzapine

D. Cariprazine

B. Risperidone

Which medication is not used in the treatment of OCD?

A. sertraline

B. paroxetine

C. fluvoxamine

D. duloxetine

D. duloxetine

The PMHNP recognizes which of the following medication is best used to treat PTSD?

A. atenolol

B. lorazepam

C. paroxetine

D. fluoxetine

C. paroxetine

Which medication is best used to treat the somatic symptoms of anxiety?

A. hydroxyzine

B. propanolol

C. citalopram

D. buspirone

B. propanolol

Which of the following statements is false related to buspirone?

A. Buspirone is habit forming and can cause withdrawal symptoms.

B. Can be prescribed short term, alone or adjunct.

C. Binds to serotonin and dopamine receptors.

D. Usually presided BID or TID due to short 1/2 half.

A. Buspirone is habit forming and can cause withdrawal symptoms.

All of the following medications is an SNRI expect for:

A. duloxetine

B. venlafaxine

C. desvenlafaxine

D. sertaline

D. sertaline

The patient reports a history of QT prolongation. Which medication is QT prolongation considered a contraindication?

A. buspirone

B. hydroxyzine

C. gabapentin

D. paroxetine

B. hydroxyzine

The patient reports a history of hypertension. Which medication should the PMHNP avoid prescribing in the treatment of anxiety for this patient?

A. diazepam

B. atenolol

C. venlafaxine

D. escitalopram

C. venlafaxine