NURS 6630 Final Exam

NURS 6630 Final Exam Week 11

 

Question 1                2 pts

Which of the following alcohol screening tools lack sensitivity to detect hazardous/problem drinking?

Group of answer choices

AUDIT

AUDIT-C

SASQ

CAGE

Question 2             2 pts

Which club drug is structurally similar to GABA?

Group of answer choices

3,4 – methylendedioxy-methamphetamine

Ketamine

γ-hydroxybutyrate

Ecstasy

Flag question: Question 3

Question 3                 2 pts

Daytrana is the MPH transdermal system of methylphenidate approved for the treatment of ADHD in children aged 6 years and older. What is the difference in terms of the metabolism compared to the other formulations in this class?

Group of answer choices

It is mainly metabolized by the enzyme carboxylesterase once absorbed.

It does not undergo first-pass metabolism by the enzyme carboxylesterase in the liver.

It can be cut up and sprinkled onto food so it can bypass first-pass metabolism in the liver.

It uses an osmotic releasing oral system technology to slowly deliver the drug to the enzyme carboxylesterase in order to make the drug last longer.

 

Question 4                    2 pts

Which medication below would you use in addition to benzodiazepine treatment if the patient is experiencing psychosis during alcohol withdrawal delirium?

Group of answer choices

Naltrexone

Haloperidol

Propofol

Chlordiazepoxide

Question 5                 2 pts

Which enzyme does disulfiram inhibit leading to a build-up of the ethanol metabolite acetaldehyde?

Group of answer choices

Alcohol dehydrogenase

Microsomal ethanol oxidizing enzyme

Aldehyde dehydrogenase

Aldehyde reductase

NURS 6630 Final Exam Question 6               2 pts

A new patient presents to your clinic today. The patient is a 13-year-old boy who complains that he has no interest in anything. The patient states, “I just want to sleep more than I normally do, and I don’t care much for playing my video games anymore.” His mother states he cannot focus on anything for more than a few minutes at a time, and that he often gets in trouble at school because he cannot sit still. What would you recommend at this time?

Group of answer choices

Recommend doing a full evaluation to distinguish if this patient is presenting with ADHD symptoms or depressive symptoms

Begin a stimulant at appropriate dose once patient’s weight is known

Refer to a behavioral counselor

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Question 7                  2 pts

Which of the following is the only Black Box Warning associated with the medication atomoxetine?

Group of answer choices

Increased risk for cardiovascular events

Suicidal ideation

Substance abuse potential

Slight growth inhibition

 

Begin an SSRI at lowest initial dose and provide counseling on the increased risk of suicide during the first few months of therapy

Question 82 pts

Which neurotransmitters are likely involved in the pathophysiology of withdrawal seizures?

1. Serotonin
2. Endorphins

• Glutamate

1. GABA
2. Dopamine

Group of answer choices

I and II

II and V

I and III

III and IV

Question 92 pts

Which of the following psychiatric conditions is present in both domains (i.e., core psychopathology & pain-related psychological symptoms) of chronic pain that will likely lead to an outcome of disability, pain, and poor quality of life?

Group of answer choices

Major depression

Personality disorder

Anger

Anxiety

 

Question 102 pts

Which of the following drugs is structurally similar to tramadol; thus, its opioid-mediated analgesia can be reversed by naloxone in mice?

Group of answer choices

Venlafaxine

Ketorolac

Duloxetine

Gabapentin

Question 112 pts

Of the following medications, which one is contraindicated with stimulants such as Ritalin or Adderall?

Group of answer choices

Atomoxetine

Clonidine

Amitriptyline

Phenelzine

Question 122 pts

Of the following neurotransmitters, which ones play a critical role in modulating attention in ADHD?

1. Dopamine
2. Epinephrine

• GABA

1. Norepinephrine
2. Glutamate

Group of answer choices

II, III, and V

II and IV

I and IV

III only

Question 132 pts

Which features are consistent with delirium?

1. Acute onset
2. Gradual onset

• Course of disease fluctuates

1. Course of diseases does not fluctuate
2. Impaired attention
3. Normal attention

Group of answer choices

II, IV, and VI

I and III

II and IV

I, III, and V

Question 142 pts

Which medication is a selective alpha-adrenergic agonist that works by mimicking norepinephrine binding in the pre-frontal cortex, which makes it particularly useful in the treatment of ADHD?

Group of answer choices

Guanfacine

Modafinil

Lisdexamfetamine

Bupropion

Question 152 pts

1. C. is an 88-year-old male who is diagnosed at your clinic with Dementia with Lewy Bodies. He currently has some debilitating gait issues, which makes his quality of life very poor. His memory is still intact with minor deficits. Which medication would likely benefit T. C. as his initial therapy?

Group of answer choices

Levodopa/carbidopa

Galantamine

Memantine

Benztropine

Question 162 pts

Choose the correct statement regarding medications used for alcoholism

Group of answer choices

Disulfiram: NMDA receptor antagonist & GABAA agonist

Naltrexone: µ-opioid receptor antagonist that reduces the reinforcement/euphoria produced by alcohol

Acamprosate: enhances the effect of the inhibitory neurotransmitter gamma-aminobutyric acid on the GABA receptors by binding to a site that is distinct from the GABA binding site in the central nervous system. NURS 6630 Final Exam

Lorazepam: inhibits alcohol dehydrogenase, leading to a buildup of acetaldehyde

 

Question 172 pts

1. B., a 55-year-old female, is a patient at your clinic today who has a past medical history significant for breast cancer, hypertension, hepatic cirrhosis, type 2 diabetes, and a recent diagnosis of alcohol use disorder. She has no known drug allergies. She states she is ready to quit drinking but fears the cravings that it may bring. Which medication would you recommend for E. B. to begin?

Group of answer choices

Naltrexone

Acamprosate

Any benzodiazepine

Thiamine

Question 182 pts

Which of the following drugs is often used in the management of opioid addiction due to its ceiling effect?

Group of answer choices

Buprenorphine

Naloxone

Clonidine

Methadone

Question 192 pts

In the pathophysiology of Alzheimer’s Disease, there are certain proteins that lead to the plaques and tangles that result in this progressive, irreversible brain disorder. Choose the appropriate protein with its corresponding pathology.

1. Tau – tangles
2. Beta-amyloid – tangles

• Tau – plaques

1. Beta-amyloid – plaques

Group of answer choices

I and II

II and III

II and IV

I and IV

Question 202 pts

Patient is a 10-year-old female with diagnosed ADHD who was started on Ritalin 5 mg twice a day over 2 months ago. She is still experiencing the triad of symptoms associated with ADHD (impaired attention, impulsivity, and excessive motor activity). Her mother reports that she is now having difficulty in falling asleep since starting the medication. She has been on no other anti-ADHD medications and the mother reports full compliance with medication regimen. What is the appropriate recommendation to make based on this scenario?

Group of answer choices

Recommend psychotherapy in addition to current treatment

Switch to low dose Focalin

Add Clonidine

Switch to low-dose Adderall and titrate as appropriate in addition to psychotherapy

Question 212 pts

A 59-year-old male has been admitted to the E. D. due to a methamphetamine overdose. The patient’s friend reported he ingested up to 2 grams because “he thought cops were coming to get him.” The patient’s vitals are all within normal limits, except his blood pressure is 180/110. What is the best recommendation to make at this time?

Group of answer choices

Administer a beta-blocker like labetalol to help bring his blood pressure down

Patient’s blood pressure is considered a hypertension urgency, but it is probably due to the drug overdose. No action is needed at this time until the drug has cleared his system.

Blood pressure is not a concern right now, but supportive therapy should be provided in the incidence of respiratory depression.

Administer an alpha-blocker like phentolamine to help bring his blood pressure down.

Question 222 pts

SSRIs can be used in alcohol use disorder and offer modest drinking reduction through an anti-craving effect.

Group of answer choices

True

False

Question 232 pts

This medication cannot be used for more than 5 days, it is a non-steroidal, anti-inflammatory drug, and it is often substituted for morphine due to its rapid onset and high potency. What is this medication?

Group of answer choices

Naproxen

Ketorolac

Sulindac

Etodolac

Question 242 pts

FILL IN THE BLANK: ___________ is the main neurotransmitter behind reward systems in the brain, which usually leads to addiction when altered in any way.

Group of answer choices

Norepinephrine

Serotonin

Dopamine

Acetylcholine

Question 252 pts

The patient is a 16-year-old girl with a past history of substance use disorder. She has been known to abuse prescription opioids and smokes one pack of cigarettes every day. She has been in and out of recovery for the past year. During her last admission into a recovery center, she was diagnosed with ADHD, which may have contributed to her addictive personality. She presents to your clinic today to initiate pharmacotherapy for her new diagnosis. What would you recommend in this patient? Her current weight is 55 kg.

Group of answer choices

Ritalin 10 mg twice daily

Focalin 10 mg twice daily

Daytrana 30 mg patch worn for 12 hours daily

Atomoxetine 60 mg once daily

Question 262 pts

What baseline levels should you perform before initiating an anti-ADHD medication?

Group of answer choices

Electrolytes, height, weight, white-blood cells

ECHO, heart rate, pulse

Height, weight, blood pressure, pulse

Blood pressure and pulse

Question 272 pts

Drug addiction includes many prescription medications and illegal substances. Of the drugs listed, which ones can be withdrawn abruptly WITHOUT medical intervention to prevent withdraw seizures?

Group of answer choices

Alcohol

Adderall

Lorazepam

Butalbital

Question 282 pts

Of the axons involved in the transmission of pain, which one is thinly myelinated and conducts that first feeling of pain that is often felt as coming on as a sharp, rapid feeling?

Group of answer choices

ß-∆ fibers

A-∆ fibers

A-ß fibers

C fibers

Question 292 pts

There are many different types of dementia. Which dementia is NOT a direct result of disrupted neurotransmitters, but a result of degeneration of different regions in the brain? Onset of the disease is typically before the age of 60, and very rare after the age of 75.

Group of answer choices

Alzheimer’s Disease

Dementia with Lewy Bodies

Creutzfeldt-Jakob Disease

Frontotemporal Dementias

Question 302 pts

What is the difference between Ritalin and Focalin?

Group of answer choices

Focalin is a D-isomer

Ritalin is the D-isomer

Focalin is the S-isomer

There is no difference other than the formulations involved.

Question 312 pts

Disorientation, tremor, hyperactivity, fever, hallucinations, marked wakefulness, and increased autonomic tone are all features that are consistent with which part of alcohol withdrawal?

Group of answer choices

Alcohol withdrawal seizures

Korsakoff’s Psychosis

Wernicke’s encephalopathy

Alcohol withdrawal delirium

Question 322 pts

Which of the following drugs in the treatment of Alzheimer’s Disease helps normalize glutamate by antagonizing the NMDA receptor?

Group of answer choices

Memantine

Donepezil

Rivastigmine

Galantamine

Question 332 pts

Select the correct description of a somatoform disorder.

Group of answer choices

Somatization disorder – manifests as a pain syndrome with a significant loss of or alteration in physical function that mimics a physical disorder

Conversion disorder – pain that causes significant impairment in occupation or social function, induces marked distress, or both

Hypochondriasis – persistent belief that one has a serious illness, despite extensive medical evaluation

Pain disorder – intentional production or feigning of physical symptoms

NURS 6630 Final Exam

Question 342 pts

1. K. is a 72-year-old female who has suffered many strokes in the past, likely due to uncontrolled hypertension and hyperlipidemia. She has now been diagnosed with vascular dementia due to memory loss and motor system slowing. What is the recommended treatment for T. K.?

Group of answer choices

1. K. needs the drug donepezil to help with her memory loss only.
2. K. needs the drug donepezil to help with her memory loss, but also needs her hypertension and hyperlipidemia controlled.
3. K. needs the drug donepezil to help with her memory loss, but also needs her hypertension controlled.
4. K. needs her hypertension controlled only.

Question 352 pts

Of the following neurotransmitters, which one(s) are known to be severely disrupted in the disease Dementia with Lewy Bodies?

1. Acetylcholine
2. Glutamate

• Dopamine

1. GABA
2. Norepinephrine

Group of answer choices

II only

III only

I and II

I and III

Question 362 pts

What should our treatment goal be with our patients when it comes to managing chronic pain?

Group of answer choices

The goal is to make the pain go completely away.

The goal is to make the patient feel numb so that the pain cannot be thought about.

There are no specific treatment goals that we should discuss with our patients, just so they don’t get their expectations too high.

The goal is to improve their function and to drop their pain scale to less than 5 out of 10. NURS 6630 Final Exam

Question 372 pts

1. J. is a 55-year-old male who attended a funeral and found himself laughing during the service, but later that evening he was irritated with himself for what he had done. His wife said this was abnormal behavior and took him to his doctor to be evaluated. After L. J.’s MRI was reviewed, he was diagnosed with frontotemporal dementia. Which medication is recommended to help L. J. with his emotional outbursts?

Group of answer choices

Memantine

Escitalopram

Donepezil

Risperidone

NURS 6630 Final Exam

Question 382 pts

When can buprenorphine be initiated in a patient who is suffering from an opioid overdose?

Group of answer choices

As soon as the patient is stabilized

It should be administered as soon as you find the patient unconscious

Right after naloxone is administered to prevent the patient from going back into opioid overdose

When the patient is experiencing mild-to-moderate symptoms of withdrawal

Question 392 pts

If a patient suffers from a multitude of small strokes and later begins experiencing mood disturbances in an acute fashion that sometimes resolve, from what type of dementia would you think that patient may suffer?

Group of answer choices

Vascular Dementia

Frontotemporal Dementias

Alzheimer’s Disease

Dementia with Lewy Bodies

NURS 6630 Final Exam Question 40 2 pts

Select all the criteria for what is considered “At-Risk Drinking.”

1. Women: > 7 drinks in any given week
2. Men: > 4 drinks per day

• Women: > 4 drinks per day

1. Men: > 14 drinks per week

Group of answer choices

I, and II

I, II, and IV

I, II, and III

III and IV

Question 412 pts

Patient is a 75-year-old female with a confirmed diagnosis of Alzheimer’s Disease. She is currently on Donepezil 10 mg daily. She is accompanied to your clinic today by her daughter, who informs you that her mother has recently had an increase in depressive symptoms. She has no history of mood disorders. She has a history of hypertension and tonic-clonic seizures, but both are controlled. Assuming this patient will be thoroughly evaluated for the diagnosis of depression, what would you recommend as initial therapy?

Group of answer choices

Amitriptyline

Doxepin

Fluoxetine

Bupropion

 

Question 422 pts

1. B. is a 55-year-old male who has diagnosed with type 2 diabetes 10+ years ago. He has since had complications from the disease and is suffering from severe neuropathy. On top of that, T. B. is struggling with his mental health and was recently told he could be depressed but he had refused treatment at that time. Besides getting his blood sugar under control, what medication(s) can we use that may be useful in helping T. B.?
2. Nortriptyline
3. Venlafaxine

• Duloxetine

1. Fluoxetine

Group of answer choices

I, II, and III

I and II

II and III

IV only

NURS 6630 Final Exam Question 43 2 pts

Which medication(s) requires a test dose to determine accurate use of the drug (i.e., how addicted the patient truly is on a certain drug) before beginning a titration schedule to withdrawal the patient?

1. Butalbital
2. Lorazepam

• Hydrocodone

Group of answer choices

I only

II only

III only

I and II

Question 442 pts

Which of the following drugs in the treatment of Alzheimer’s Disease requires administration with food?

Group of answer choices

Memantine

Donepezil

Rivastigmine

Galantamine

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Question 452 pts

1. R. is a 35-year-old woman who presents to your clinic today complaining of ankle pain. She said she was running the trail when she saw a snake. During a quick turn to run away from the snake, she twisted her ankle. Which of the following medications may be a good choice in helping Y. R. with her pain?

Group of answer choices

Oxycodone

Amitriptyline

Ibuprofen

Duloxetine

Question 462 pts

If a patient is being managed for chronic pain and is not getting better after months of therapy with multiple agents (i.e., NSAIDs with opioids, muscle relaxants with NSAIDs, etc.), what should be your next step in helping the patient?

1. Add a high-dose opioid if patient is not already on the maximum dose.
2. Assess for a co-morbid psychiatric condition.

• Tell the patient you have exhausted all your options and there is nothing more you can do.

1. Refer the patient for a second opinion.

Group of answer choices

I and II

II and IV

III only

IV only

Question 47                  2 pts

The experience of pain is ALWAYS subjective

Group of answer choices

True

False

NURS 6630 Final Exam Question 48           2 pts

Disulfiram has been proven effective in the treatment of alcoholism, but recently it has been trialed in the management of cocaine addiction. What is the mechanism of action that likely helps produce these aversive effects?

Group of answer choices

Inhibition on dopamine beta-hydroxylase

Inhibition on aldehyde dehydrogenase

Inhibition on alcohol dehydrogenase

Inhibition on aldehyde reductase

Question 49          2 pts

Choose the correct statement regarding an anti-ADHD medication and its respectful mechanism of action

Group of answer choices

Methylphenidate – blocks reuptake of dopamine in the pre-synaptic neuron and promotes release of dopamine from their storage sites in the pre-synaptic neuron

Amphetamines – blocks reuptake of norepinephrine and dopamine into presynaptic neurons

Clonidine – blocks reuptake of dopamine in the pre-synaptic neuron and promotes release of dopamine from their storage sites in the pre-synaptic neuron

Atomoxetine – acts by blocking the norepinephrine pump on the pre-synaptic membrane

Guanfacine – blocks reuptake of norepinephrine and dopamine into presynaptic neurons

Question 50         2 pts

Benzodiazepines can be withdrawn abruptly despite duration of therapy/abuse.

Group of answer choices

True

False

NURS 6630 Final Exam