psychiatric emergency room

1.      The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder?

A.

Insomnia

B.

Suicidal ideation

C.

Problems concentrating

D.

A and C

1 points  

QUESTION 42

1.      Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

A.

Neuronal firing rates are not dysregulated in depression.

B.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

C.

Upon the acute administration of a SSRI, 5HT decreases.

D.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1.      The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

A.

Both have a sedative-like, calming effect.

B.

Both contribute to antipsychotic actions.

C.

Both demonstrate favorable findings in treating depression in the elderly.

D.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points  

QUESTION 44

1.      A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?

A.

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

B.

The patient cannot take any antihistamines.

C.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

D.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points  

QUESTION 45

1.      After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?

A.

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

B.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

C.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

D.

All of the above.

1 points  

QUESTION 46

1.      A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?

A.

First onset in puberty or early adulthood

B.

Late onset of menses

C.

Premenstrual syndrome

D.

A and C

1 points  

QUESTION 47

1.      A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen:

A.

MAOI plus SNRI

B.

SSRI/SNRI plus NDRI

C.

NDRI/SNRI plus mirtazapine

D.

NDRI plus modafinil

1 points  

*Q/UESTION 48

1.      Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

A.

She may experience withdrawal symptoms.

B.

She may experience increased trauma.

C.

Effects of abrupt cessation are unknown.

D.

It can lead to difficulties with concentration.

1 points  

QUESTION 49

1.      A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

A.

Weight gain can be problematic.

B.

Sedation is very common.

C.

Induction of mania is rare.

D.

Seizures are not unusual.

1 points  

QUESTION 50

1.      The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

A.

Stop the venlafaxine

B.

Lower the dose of venlafaxine by 50%

C.

Lower the dose of venlafaxine by 25-40%

D.

Increase the dose of venlafaxine by 50%

1 points