Psych FNP Review LEIK 3rd Edition
All of the following patients are at higher risk of suicide, except: A 66-year-old White man whose wife of 40 years recently died A high school student with a history of bipolar disorder A depressed 45-year-old woman with a family history of suicide A 17-year-old teen who has only one close friend in school
A 17-year-old teen who has only one close friend in school Risk factors for suicide include (a) elderly White men (especially after the death of a spouse); (b) past history of suicide attempt; (c) family history of suicide; (d) plans for use of a lethal weapon such as a gun or knife; (e) gender (higher attempt rate in females, but higher success rate in males); and (f) personal history of bipolar disorder or depression
A 28-year-old male is evaluated by the nurse practitioner for frequent episodes of psychotic delusions and paranoia. He has taken risperidone (Risperdal) in the past but states that the drug was not effective. Which medication will the nurse practitioner prescribe? Clozapine (Versacloz) Amitriptyline (Elavil) Bupropion (Wellbutrin) Lithium carbonate (Eskalith)
Clozapine (Versacloz) Clozapine (Versacloz) has been shown to decrease psychotic symptoms and episodes in patients with resistance to fi rst-line antipsychotics. Amitriptyline (Elavil) is a tricyclic antidepressant that is used to treat symptoms of depression. Bupropion (Wellbutrin) is an antidepressant medication used to treat major depressive disorder and seasonal affective disorder. Lithium carbonate (Eskalith) is an antimanic agent used to treat manic-depressive disorder (bipolar disorder).
An older adult male with alcohol use disorder is scheduled for a physical exam and laboratory testing. The patient's laboratory blood test results may show: Increased serum creatinine levels and eGFR Decreased number of platelets and increased MCV Increased serum potassium and increased triglycerides Decreased AST and ALT levels
Decreased number of platelets and increased MCV Chronic alcohol use affects the MCV because of reduction of folate levels from dietary deficiency and/or impaired absorption due to excess use of alcohol. Alcohol also interferes with the production and function of white blood cells. Alcohol interferes with platelet production with diminished fibrinolysis resulting in thrombocytopenia. Alcoholics are at higher risk for bleeding. It can increase aspartate aminotransferase and alanine aminotransferase because of liver inflammation. Alcohol affects lipid metabolism in the liver, resulting in hypertriglyceridemia.
A 25-year-old man with schizophrenia comes in for a routine annual physical. He is a heavy smoker and has a body mass index (BMI) of 28. The patient has been on olanzapine (Zyprexa) for 10 years. Which of the following laboratory tests is recommended for monitoring the adverse effects of atypical antipsychotics? Fasting blood glucose and fasting lipid profile Urinalysis, serum creatinine, 24-hour urine for protein and creatinine clearance Liver function tests Complete blood count (CBC) with differential and liver function tests
Fasting blood glucose and fasting lipid profile Patients on atypical antipsychotics commonly gain weight and are at risk for obesity, hyperglycemia, and type 2 diabetes. Olanzapine (Zyprexa) will increase lipids (cholesterol, LDL, and triglycerides). Atypical antipsychotics also increase the risk of death among frail elders and older adults living in nursing homes.
A 40-year-old female bank teller has recently been diagnosed with obsessive-compulsive disorder by her therapist. Which of the following medications is indicated for the treatment of obsessive-compulsive disorder? Paroxetine (Paxil CR) Haloperidol (Haldol) Alprazolam (Xanax) Imipramine (Elavil)
Paroxetine (Paxil CR) The first-line medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). Paroxetine (Paxil CR) is in the SSRI drug class. Haloperidol (Haldol) is an antipsychotic, alprazolam (Xanax) is a benzodiazepine, and imipramine (Elavil) is a tricyclic antidepressant.
A 56 year-old male patient with a history of depression and seeing a psychiatrist, comes in to see the FNP and complains of being unable to sustain an erection long enough to ejaculate. The FNP Knows when she checks his medication list she will likely see which of the following medications that could be causing erectile dysfunction (ED). Levothyroxine Paroxetine Penicillin Digoxin
Paroxetine Out of the four medications, paroxetine (Paxil) is most likely to cause ED in a male patient. It can also affect female orgasm. Levothyroxine (Synthroid), penicillin, and digoxin usually do not cause ED in males. In addition to reducing interest in sex, SSRI medications can make it difficult to become aroused, sustain arousal, and reach orgasm. Some people taking SSRIs aren't able to have an orgasm at all. These symptoms tend to become more common with age. Paroxetine is an extensively used SSRI that has been shown to impair erectile function in patients, to induce erectile dysfunction and to inhibit nitric oxide synthase (NOS) activity and NO production in animal models. NO is a key mediator of penile erection.
The nurse practitioner is evaluating a 16-year-old female fatigue and headaches. The patient is wearing multiple layers of clothing and her hair is limp and dry. Upon examination, the nurse practitioner finds the patient's skin to have a yellow cast and a fine, downy hair on her body. Which diagnosis is most likely? Alopecia Anorexia nervosa Bulimia Amenorrhea
Anorexia nervosa Anorexia nervosa usually has an onset during adolescence and is characterized by an irrational preoccupation with weight gain that presents with a distorted perception of body weight and size. Anorexia nervosa is characterized by marked weight loss (body mass index [BMI] <18.5), lanugo, thinning hair, and general poor health, as the body is depleted of vital nutrients. Amenorrhea is a common symptom in young females. Purging, alopecia, and use of laxatives may be involved in the restriction of food intake, but based on the assessment data, it is not the primary diagnosis.
Signs and symptoms of depression include all of the following, except: Anhedonia Low self-esteem Apathy Apraxia
Apraxia Apraxia is characterized by loss of the ability to execute or carry out learned purposeful movements despite the desire and the physical ability to perform the movements. Apraxia is not a sign or symptom of depression; it is a disorder of motor planning caused by damage to specific areas of the cerebrum. Common signs of depression include: Anhedonia (loss of interest in activities that the patient finds pleasurable), Unintentional weight loss or gain, Fatigue, Change in appetite, Insomnia or hypersomnia, Feelings of guilt and worthlessness, Recurrent thoughts of suicide.
Which of the following drugs that are used to treat attention-deficit hyperactivity disorder (ADHD) is not classified as an amphetamine/stimulant? Dexmethylphenidate (Focalin XR) Mixed salts of amphetamine (Adderall) Methylphenidate (Ritalin) Atomoxetine (Strattera)
Atomoxetine (Strattera) Strattera is classified as a norepinephrine reuptake inhibitor. It is not a stimulant or an amphetamine. Strattera is contraindicated during/within 14 days of taking a monoamine oxidase inhibitor (MAOI) in patients with narrow-angle glaucoma or a heart disorder that will worsen with increases in blood pressure or heart rate or in those with pheochromocytoma. Children and teenagers should be monitored for suicidal thoughts/plans. Dexmethylphenidate (Focalin XR) Mixed salts of amphetamine (Adderall) Methylphenidate (Ritalin) Atomoxetine (Strattera)
A 24-year-old male presents with a history of major depression with occasional bouts of elevated mood. During the bouts of elevated mood, he reports racing thoughts and an intense desire for risky behaviors but denies hallucinations. He works a steady job and maintains a home. Which diagnosis is most likely? Schizoaffective disorder Bipolar disorder type II Dysthymia Bipolar disorder type I
Bipolar disorder type II Bipolar disorder is characterized by mania and depression. Bipolar disorder type II is associated with major depression and low levels of mania. Bipolar disorder type II is not usually associated with impairment of social function, and many patients maintain work and family requirements. Schizoaffective disorder is characterized by the combination of schizophrenia and major depression. Dysthymia is characterized by a constant depressed mood but does not meet the requirement of a major depressive disorder. Bipolar disorder type I is associated with a major depressive disorder and hypermania. Patients with bipolar disorder type I experience significant impairment with social function and work life.
A 40-year-old female bank teller has recently been diagnosed with obsessive-compulsive disorder by her therapist. Which of the following symptoms does NOT characterize this disorder? Ritualistic behaviors that the patient feels compelled to repeat Increased anxiety when attempting to ignore or suppress the repetitive behaviors Frequent intrusive and repetitive thoughts and impulses Disorganized speech or behavior
Disorganized speech or behavior Obsessive-compulsive disorder is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety. Signs and symptoms of obsessive compulsive disorder include ritualistic behaviors that are repeated, increased anxiety when the patient attempts to ignore repetitive behaviors, and frequent intrusive and repetitive thoughts and impulses. Disorganized speech or behavior is a symptom of schizophrenia.
An elderly diabetic female with peripheral neuropathy and coronary artery disease is recently diagnosed with major depression. The patient refuses psychotherapy and wants medication. She denies suicidal and homicidal ideation. Which of the following pharmacologic agents is the best choice for this patient? Quetiapine (Seroquel) Duloxetine (Cymbalta) Escitalopram (Lexapro) Amitriptyline (Elavil)
Duloxetine (Cymbalta) Duloxetine (Cymbalta) is an SNRI that is used for depression, chronic anxiety, and the management of diabetic peripheral neuropathy. The patient has diabetic peripheral neuropathy and depression. Escitalopram (Lexapro) is an SSRI that is used for depression and generalized anxiety disorder, but it does not have an indication for peripheral neuropathy.
Which of the following individuals is at higher risk for suicide? Obese teenager who fails an exam in high school Black middle-aged female who is newly diagnosed with type 2 diabetes Elderly White male whose wife of 40 years recently died Asian adult whose mother has a chronic illness
Elderly White male whose wife of 40 years recently died Elderly White males who are recently widowed are at very high risk of suicide. Whites are more likely to commit suicide compared with other racial groups.
The nurse practitioner is completing a health assessment on a 16-year-old female patient who is in the office for her annual physical. The patient reports feelings of hopelessness and sadness for several months, no history of suicidal/homicidal ideations, and a struggle with anorexia. The patient scores an 11 on Beck's Depression Inventory. The nurse practitioner will prescribe: Sertraline (Zoloft) Lithium carbonate (Eskalith) Bupropion (Wellbutrin) Escitalopram (Lexapro)
Escitalopram (Lexapro) Escitalopram (Lexapro) is a safe antidepressant for an adolescent who has severe depression and no history of suicidal ideations. Sertraline (Zoloft) is not a safe option for patients <24 years of age due to increased risk of suicidal ideation. Bupropion (Wellbutrin) is an atypical antidepressant and is not a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium carbonate (Eskalith) is indicated for patients with bipolar disorder.
The FNP who prescribes an antipsychotic medication, understand that this medication is most likely to produce extrapyramidal effects? Sertraline (Zoloft) Citalopram (Celexa) Aripiprazole (Abilify) Haloperidol (Haldol)
Haloperidol (Haldol) The conventional, or first-generation, antipsychotic drugs (e.g., haloperidol [Haldol]) are potent antagonists of D2, D3, and D4 receptors. This makes them effective in treating target symptoms, but they also produce many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical, or second-generation antipsychotic drugs and third-generation drugs (e.g., aripiprazole [Abilify]) are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications. Sertraline (Zoloft) and citalopram (Celexa) are antidepressants NOT Antipsychotics!
The nurse practitioner is treating an elderly female patient with recurrent depression. The patient refuses to take her medication. The patient's daughter states, "She seems worse than ever. What should we do?" Which of the following is the most appropriate response? Let's try a different pharmacotherapeutic regimen Can you bring her in for one-on-one counseling sessions? I will refer your mother to a psychiatric-mental health nurse practitioner The nurse practice act will not allow me to continue care for your mother
I will refer your mother to a psychiatric-mental health nurse practitioner It is a breach of standard of practice if the family nurse practitioner demonstrates a failure to monitor patient outcomes and refer patients to a psychiatric-mental health nurse practitioner, psychologist, or psychiatrist if symptoms have not improved, the patient is getting worse (acute decompensation) or is noncompliant, or the nurse practitioner disregards family members who have raised concerns about a patient. Patients with mental illnesses, such as depression, anxiety, and attention-deficit hyperactivity disorder, are often initially treated by primary care providers such as nurse practitioners. Nurse practitioners are well positioned to provide mental health care, from mental health screening to initial intervention, which dovetails with the nurse practitioner philosophy of patient-centered care. However, nurse practitioner education covers only some aspects of mental health care and may not sufficiently prepare providers to treat patients with complex mental illnesses, compared with psychiatric mental health nurse practitioners or other behavioral health specialists. Nurse practitioners should be aware of potential scenarios where the care they provide could breach their standard operating procedure. Trying a different drug regimen or one-on-one counseling sessions may exceed the scope of practice for a nurse practitioner. The best response would be to consult with a mental health professional. The nurse practice act does not preclude a nurse practitioner from continuing to care for the patient; however, the nurse practitioner should refer the patient to a specialist.
A 29-year-old male has a 2-year history of deep depression alternating with periods of high energy levels, which has impacted his ability to hold a job. After changing jobs for the third time in 2 years, he seeks assistance. Which medication will the nurse practitioner prescribe? Haloperidol (Haldol) Phenelzine (Nardil) Diazepam (Valium) Lithium carbonate (Eskalith)
Lithium carbonate (Eskalith) The patient is exhibiting signs of bipolar disorder I, including alternating periods of euphoria and high energy levels with periods of extreme depression and exhaustion, so the treatment of choice would be lithium carbonate (Eskalith). Haloperidol (Haldol) is not first-line treatment due to serious side effects such as neuroleptic malignant syndrome and cardiovascular dysfunction. Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI) antidepressant that is not used to treat bipolar disorder alone, so it is not first-line treatment. Diazepam (Valium) is a sedative.
A middle-aged male was the sole survivor of a fatal car crash that occurred 3 years ago. After a long recovery, he returned to his job but reports nightmares and visions of the crash. He reports excessive drinking to deal with these recurrent flashbacks, and his lack of sleep and drinking have caused him to miss a significant amount of work. Which drug class is first-line treatment for this patient? Selective serotonin reuptake inhibitors (SSRIs) Antimanic mood stabilizers Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs)
Selective serotonin reuptake inhibitors (SSRIs) The patient is experiencing posttraumatic stress disorder (PTSD). PTSD occurs after an exposure to a traumatic event and often causes nightmares, recollection of the event, and feelings of helplessness and hopelessness. The first-line prescriptive treatment for PTSD is an SSRI. Antimanic mood stabilizers (e.g., lithium) are used to treatmanic episodes such as those experienced with bipolar disorder. MAOIs are used to treat depression and anxiety disorders that are not responsive to other medications. TCAs are used to treat depression and chronic pain disorders.
A 30-year-old male patient with bipolar disorder is unhappy with his prescription and is no longer taking his medications. He comes to the clinic and asks the nurse practitioner what the FNP can do about his medication. Which of the following is the best course of action? The FNP should take time to discuss the patient's concerns and find out if there are any specific medications or side effects upsetting the patient. Reassure the patient that he will be fine after taking the medicine Fire the patient from the practice they are non-compliant Change the medications to what the patient wants and discontinue the mood stabilizer.
The FNP should take time to discuss the patient's concerns and find out if there are any specific medications or side effects upsetting the patient. What if this was your brother? Uncle? Friend? Neighbor? We need to do better at Mental Health care. Instead, of whining about "why" ask "What happened?" Is this temporary? Did this patient ever "agree" to "comply" with "the plan" Did someone take the time to personalize "the patient plan" in the first place? You can't label someone as non-compliant and fire them if you never take the time to find out what happened! The patient has a side and is a stakeholder in their own care! The old way was to label as Non-compliant or some other inappropriate way to file the patient as difficult instead of addressing the upstream concern and find out what happened. Please do better.
All of the following are true statements regarding Munchausen syndrome, EXCEPT: It is considered a mental illness The patient has a medical illness that causes an anxiety reaction and denial The patient fakes an illness in order to gain attention from health care providers The patient has an inconsistent medical history along with a past history of frequent hospitalizations
The patient has a medical illness that causes an anxiety reaction and denial Munchausen syndrome is a psychiatric disorder in which the patient fakes a medical illness or disorder to gain attention from healthcare providers. These patients often use the emergency department to gain attention.
The nurse practitioner is assessing an 84-year-old patient suffering from an acute onset of confusion. The patient is brought to the office by their adult child caregiver who states the patient has become combative and threatening. Which medication will the nurse practitioner prescribe? Disulfiram (Antabuse) Varenicline (Chantix) Haloperidol (Haldol) Temazepam (Restoril)
This is a NASTY question! I hope your first thought was shouldn't we rule out and infection or POLYpharmacopia first before jumping to an antipsychotic!?!? WTF!! Here's what the book says... Haloperidol (Haldol) The patient is experiencing delirium. Delirium is a short-term condition; the removal of the illness and/or circumstances will typically resolve the delirium. When a patient becomes combative, healthcare providers must seriously consider a medication option to alleviate the risk of violence to self or others. Haloperidol (Haldol), a neuroleptic given either orally or by injection, is most commonly used for symptoms of delirium. Disulfiram (Antabuse) is used to treat alcoholism. Varenicline (Chantix) is used to decrease smoking. Temazepam (Restoril) is used to treat insomnia.
