DNRS-6630-14 DNRS-6630S-14 NURS-6630S-14 NURS 6630N 14 Approaches to Treatment 2021 Winter QTR Term Exam

Begin: Final Exam – Week 11

DNRS-6630-14 DNRS-6630S-14 NURS-6630S-14 NURS 6630N 14 Approaches to Treatment 2021 Winter QTR Term Exam

 INSTRUCTIONS

1. Timed Test

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3. Force Completion

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4. Due Date

This Test is due on February 14, 2022 1:59:00 AM EST.

Click Begin to start: Final Exam – Week 11. Click Cancel to go back.

Question 1

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?

	A.	Amitriptyline
	B.	Doxepin
	C.	Fluoxetine
	D.	Bupropion

C

Question 2

Which club drug is structurally similar to GABA?

	A.	3,4 – methylendedioxy-methamphetamine
	B.	Ketamine
	C.	γ-hydroxybutyrate
	D.	Ecstasy

A

Question 3

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

	A.	I, II, and III
	B.	I and II
	C.	II and III
	D.	IV only

C

Question 4

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

		Electrolytes, height, weight, white-blood cells
		ECHO, heart rate, pulse
		Height, weight, blood pressure, pulse
		Blood pressure and pulse

C

Question 5

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

	A.	AUDIT
	B.	AUDIT-C
	C.	SASQ
	D.	CAGE

D

Question 6

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

	A.	II only
	B.	III only
	C.	I and II
	D.	I and III

D

Question 7

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.

	A.	I and II
	B.	II and IV
	C.	III only
	D.	IV only

B

Question 8

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?

	A.	Alcohol
	B.	Adderall
	C.	Lorazepam
	D.	Butalbital

B

Question 9

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

	A.	I, and II
	B.	I, II, and IV
	C.	I, II, and III
	D.	III and IV

B

Question 10

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?

	A.	ß-∆ fibers
	B.	A-∆ fibers
	C.	A-ß fibers
	D.	C fibers

B

Question 11

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.?

	A.	T. K. needs the drug donepezil to help with her memory loss only.
	B.	T. K. needs the drug donepezil to help with her memory loss, but also needs her hypertension and hyperlipidemia controlled.
	C.	T. K. needs the drug donepezil to help with her memory loss, but also needs her hypertension controlled.
	D.	T. K. needs her hypertension controlled only.

B

Question 12

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.

	A.	Alzheimer’s Disease
	B.	Dementia with Lewy Bodies
	C.	Creutzfeldt-Jakob Disease
	D.	Frontotemporal Dementias

A

Question 13

What is the difference between Ritalin and Focalin?

	A.	Focalin is a D-isomer
	B.	Ritalin is the D-isomer
	C.	Focalin is the S-isomer
	D.	There is no difference other than the formulations involved.

A

Question 14

Choose the correct statement regarding medications used for alcoholism

	A.	Disulfiram: NMDA receptor antagonist & GABAA agonist
	B.	Naltrexone: µ-opioid receptor antagonist that reduces the reinforcement/euphoria produced by alcohol
	C.	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.
	D.	Lorazepam: inhibits alcohol dehydrogenase, leading to a buildup of acetaldehyde

B

Question 15

The experience of pain is ALWAYS subjective

	A.	True
	B.	False

A

Question 16

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

	A.	Memantine
	B.	Donepezil
	C.	Rivastigmine
	D.	Galantamine

A

Question 17

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

	A.	Buprenorphine
	B.	Naloxone
	C.	Clonidine
	D.	Methadone

A

Question 18

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

	A.	Naltrexone
	B.	Haloperidol
	C.	Propofol
	D.	Chlordiazepoxide

B

Question 19

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?

	A.	Memantine
	B.	Escitalopram
	C.	Donepezil
	D.	Risperidone

B

Question 20

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?

	A.	Guanfacine
	B.	Modafinil
	C.	Lisdexamfetamine
	D.	Bupropion

A

Question 21

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?

	A.	Administer a beta-blocker like labetalol to help bring his blood pressure down
	B.	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.
	C.	Blood pressure is not a concern right now, but supportive therapy should be provided in the incidence of respiratory depression.
	D.	Administer an alpha-blocker like phentolamine to help bring his blood pressure down.

D

Question 22

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.

	A.	Ritalin 10 mg twice daily
	B.	Focalin 10 mg twice daily
	C.	Daytrana 30 mg patch worn for 12 hours daily
	D.	Atomoxetine 60 mg once daily

D

Question 23

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

	A.	Norepinephrine
	B.	Serotonin
	C.	Dopamine
	D.	Acetylcholine

C

Question 24

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

	A.	The goal is to make the pain go completely away.
	B.	The goal is to make the patient feel numb so that the pain cannot be thought about.
	C.	There are no specific treatment goals that we should discuss with our patients, just so they don’t get their expectations too high.
	D.	The goal is to improve their function and to drop their pain scale to less than 5 out of 10.

D

Question 25

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

	A.	I and II
	B.	II and III
	C.	II and IV
	D.	I and IV

D

Question 26

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?

	A.	It is mainly metabolized by the enzyme carboxylesterase once absorbed.
	B.	It does not undergo first-pass metabolism by the enzyme carboxylesterase in the liver.
	C.	It can be cut up and sprinkled onto food so it can bypass first-pass metabolism in the liver.
	D.	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.

B

Question 27

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

	A.	Atomoxetine
	B.	Clonidine
	C.	Amitriptyline
	D.	Phenelzine

D

Question 28

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?

	A.	Oxycodone
	B.	Amitriptyline
	C.	Ibuprofen
	D.	Duloxetine

C

Question 29

Select the correct description of a somatoform disorder.

	A.	Somatization disorder – manifests as a pain syndrome with a significant loss of or alteration in physical function that mimics a physical disorder
	B.	Conversion disorder – pain that causes significant impairment in occupation or social function, induces marked distress, or both
	C.	Hypochondriasis – persistent belief that one has a serious illness, despite extensive medical evaluation
	D.	Pain disorder – intentional production or feigning of physical symptoms

C

Question 30

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

	A.	Memantine
	B.	Donepezil
	C.	Rivastigmine
	D.	Galantamine

C

Question 31

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

	A.	As soon as the patient is stabilized
	B.	It should be administered as soon as you find the patient unconscious
	C.	Right after naloxone is administered to prevent the patient from going back into opioid overdose
	D.	When the patient is experiencing mild-to-moderate symptoms of withdrawal

D

Question 32

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?

	A.	Recommend doing a full evaluation to distinguish if this patient is presenting with ADHD symptoms or depressive symptoms
	B.	Begin a stimulant at appropriate dose once patient’s weight is known
	C.	Refer to a behavioral counselor
	D.	Begin an SSRI at lowest initial dose and provide counseling on the increased risk of suicide during the first few months of therapy

A

Question 33

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?

	A.	Levodopa/carbidopa
	B.	Galantamine
	C.	Memantine
	D.	Benztropine

A

Question 34

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

	A.	Increased risk for cardiovascular events
	B.	Suicidal ideation
	C.	Substance abuse potential
	D.	Slight growth inhibition

B

Question 35

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

	A.	Alcohol withdrawal seizures
	B.	Korsakoff’s Psychosis
	C.	Wernicke’s encephalopathy
	D.	Alcohol withdrawal delirium

D

Question 36

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

	A.	True
	B.	False

A

Question 37

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

	A.	Methylphenidate – blocks reuptake of dopamine in the pre-synaptic neuron and promotes release of dopamine from their storage sites in the pre-synaptic neuron
	B.	Amphetamines – blocks reuptake of norepinephrine and dopamine into presynaptic neurons
	C.	Clonidine – blocks reuptake of dopamine in the pre-synaptic neuron and promotes release of dopamine from their storage sites in the pre-synaptic neuron
	D.	Atomoxetine – acts by blocking the norepinephrine pump on the pre-synaptic membrane
	E.	Guanfacine – blocks reuptake of norepinephrine and dopamine into presynaptic neurons

D

Question 38

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

	A.	Alcohol dehydrogenase
	B.	Microsomal ethanol oxidizing enzyme
	C.	Aldehyde dehydrogenase
	D.	Aldehyde reductase

C

Question 39

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?

	A.	Recommend psychotherapy in addition to current treatment
	B.	Switch to low dose Focalin
	C.	Add Clonidine
	D.	Switch to low-dose Adderall and titrate as appropriate in addition to psychotherapy

D

Question 40

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?

	A.	Naproxen
	B.	Ketorolac
	C.	Sulindac
	D.	Etodolac

B

Question 41

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?

	A.	Naltrexone
	B.	Acamprosate
	C.	Any benzodiazepine
	D.	Thiamine

B

Question 42

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?

	A.	Inhibition on dopamine beta-hydroxylase
	B.	Inhibition on aldehyde dehydrogenase
	C.	Inhibition on alcohol dehydrogenase
	D.	Inhibition on aldehyde reductase

A

Question 43

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

1. Serotonin
2. Endorphins

• Glutamate

1. GABA
2. Dopamine

	A.	I and II
	B.	II and V
	C.	I and III
	D.	III and IV

D

Question 44

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

1. Dopamine
2. Epinephrine

• GABA

1. Norepinephrine
2. Glutamate

	A.	II, III, and V
	B.	II and IV
	C.	I and IV
	D.	III only

C

Question 45

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

	A.	Venlafaxine
	B.	Ketorolac
	C.	Duloxetine
	D.	Gabapentin

A

Question 46

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?

	A.	Major depression
	B.	Personality disorder
	C.	Anger
	D.	Anxiety

D

Question 47

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

	A.	II, IV, and VI
	B.	I and III
	C.	II and IV
	D.	I, III, and V

D

Question 48

Select the correct treatment regarding drugs involved in addiction management and their corresponding mechanism of action.

	A.	Benzodiazepines – GABA antagonist
	B.	Buprenorphine – opioid antagonist
	C.	Naltrexone – partial opiate agonist
	D.	Flumazenil – GABA antagonist

D

Question 49

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

	A.	True
	B.	False

B

Question 50

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

	A.	I only
	B.	II only
	C.	III only
	D.	I and II

A

Question 50

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

	A.	I only
	B.	II only
	C.	III only
	D.	I and II

A

Question 51

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes

No

A