NURSING 7350 PSYCHOPHARMACOLOGY ACROSS THE LIFESPAN EXAM Q & A 2024, Exams of Nursing

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NURSING 7350

Psychopharmacology

Across the Lifespan

Q & A w/ Rationales

1. A nurse is caring for an elderly patient who has been recently diagnosed with depression. Which of the following psychotropic medications would the nurse anticipate being prescribed due to its efficacy and reduced risk of adverse effects in older adults? a) Fluoxetine (Prozac) b) Venlafaxine (Effexor) c) Paroxetine (Paxil) d) Sertraline (Zoloft) Answer: d) Sertraline (Zoloft) Rationale: Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression. It is often preferred in older adults due to its reduced side effect profile and lower drug-drug interaction potential compared to other SSRIs.
2. A 30-year-old female patient with bipolar disorder presents with manic symptoms. Considering this patient's gender and reproductive stage, which mood stabilizer would be most appropriate to avoid negative effects on fertility and pregnancy? a) Lithium b) Carbamazepine (Tegretol) c) Valproate (Depakote) d) Lamotrigine (Lamictal) Answer: d) Lamotrigine (Lamictal) Rationale: Lamotrigine has demonstrated a lower risk of reproductive adverse effects and is considered a safe option

that does not interact significantly with warfarin. It is therefore safer to use in patients on warfarin therapy to avoid potential bleeding risks.

5. A middle-aged patient with schizophrenia has a history of poor adherence to oral antipsychotic medications. Which long-acting injectable antipsychotic would the nurse anticipate being prescribed to improve compliance? a) Haloperidol (Haldol) b) Quetiapine (Seroquel) c) Aripiprazole (Abilify Maintena) d) Clozapine (Clozaril) Answer: c) Aripiprazole (Abilify Maintena) Rationale: Abilify Maintena is a long-acting injectable form of aripiprazole. It is used to enhance treatment adherence and reduce the risk of relapse in individuals with schizophrenia who struggle with oral medication adherence.
6. A child with attention deficit hyperactivity disorder (ADHD) has not responded adequately to stimulant medications. Which non-stimulant medication would be an appropriate next option to consider? a) Methylphenidate (Ritalin) b) Atomoxetine (Strattera) c) Lisdexamfetamine (Vyvanse) d) Guanfacine (Intuniv) Answer: b) Atomoxetine (Strattera)

Rationale: Atomoxetine is a non-stimulant medication approved for the treatment of ADHD. It works by inhibiting norepinephrine reuptake and is often considered when stimulant medications have not resulted in satisfactory symptom control.

7. A pregnant patient with a history of panic disorder is experiencing severe panic attacks and requires immediate intervention. Which medication would be the best option in this scenario to provide rapid relief without posing substantial risks to the fetus? a) Alprazolam (Xanax) b) Clonazepam (Klonopin) c) Lorazepam (Ativan) d) Buspirone (Buspar) Answer: c) Lorazepam (Ativan) Rationale: While no medication is entirely risk-free during pregnancy, lorazepam is most commonly used due to its rapid onset of action and shorter half-life compared to other benzodiazepines. It can be used for acute symptom relief in panic disorder during pregnancy, especially if non- pharmacological interventions are insufficient.
8. A patient prescribed monoamine oxidase inhibitors (MAOIs) should adhere to dietary restrictions due to the risk of which potentially life-threatening reaction? a) Serotonin syndrome b) Neuroleptic malignant syndrome c) Hypertensive crisis

b) Constipation c) Orthostatic hypotension d) Tachycardia Answer: d) Tachycardia Rationale: TCAs can cause dose-dependent cardiac toxicity, including tachycardia, due to their anticholinergic and alpha-1 blocking effects. Aggressive assessment and intervention are necessary to prevent severe cardiac complications.

11. A nurse is providing education to a patient prescribed clozapine. Which serious adverse effect of this medication would require regular laboratory monitoring to ensure early recognition and intervention? a) Hyperglycemia b) Hyponatremia c) Hepatotoxicity d) Agranulocytosis Answer: d) Agranulocytosis Rationale: Clozapine carries a significant risk of agranulocytosis, which can lead to life-threatening infections. Regular monitoring of absolute neutrophil count (ANC) is necessary to identify potential agranulocytosis early and take appropriate actions.
12. A patient receiving antipsychotic medication develops involuntary lip smacking and grimacing movements. These symptoms are characteristic of which condition requiring

medical attention? a) Parkinsonism b) Dystonia c) Tardive dyskinesia d) Akathisia Answer: c) Tardive dyskinesia Rationale: Tardive dyskinesia is a persistent movement disorder that can develop after prolonged treatment with antipsychotic medications. Involuntary lip smacking and grimacing are common signs of tardive dyskinesia, necessitating awareness and reporting to prevent irreversible motor abnormalities.

13. An older adult patient with moderate to severe Alzheimer's disease exhibits significant behavioral disturbances, including aggression and agitation. What atypical antipsychotic medication has an FDA "black box" warning due to an increased risk of mortality in elderly patients with dementia-related psychosis? a) Risperidone (Risperdal) b) Olanzapine (Zyprexa) c) Quetiapine (Seroquel) d) Aripiprazole (Abilify) Answer: a) Risperidone (Risperdal) Rationale: Risperidone and other atypical antipsychotics have an FDA "black box" warning due to their increased risk of mortality in elderly patients with dementia-related psychosis. These medications should only be used when

Rationale: Benzodiazepines should be gradually tapered to avoid withdrawal symptoms, rebound anxiety, and potential withdrawal seizures. Abrupt discontinuation can be associated with severe withdrawal symptoms, including increased anxiety and potential medical complications. B: A 60-year-old patient presents with symptoms of depression and anxiety. Which of the following classes of medications is most appropriate for this patient? a) Selective serotonin reuptake inhibitors (SSRIs) b) Stimulants c) Antipsychotics d) Benzodiazepines Answer: a) Selective serotonin reuptake inhibitors (SSRIs) Rationale: SSRIs are commonly used to treat depression and anxiety in older adults due to their favorable side effect profile and lower risk of adverse events compared to other classes of medications. A 25-year-old female patient is diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following medications is a first-line treatment for ADHD in adults? a) Bupropion b) Methylphenidate

c) Quetiapine d) Lithium Answer: b) Methylphenidate Rationale: Methylphenidate is a central nervous system stimulant and is considered a first-line treatment for ADHD in adults due to its efficacy in managing symptoms of inattention and hyperactivity. A 70-year-old male patient with schizophrenia is prescribed an atypical antipsychotic medication. Which of the following adverse effects should the nurse monitor for in this patient? a) Hypertensive crisis b) Extrapyramidal symptoms c) Sedation d) Hepatotoxicity Answer: b) Extrapyramidal symptoms Rationale: Atypical antipsychotics are associated with a lower risk of extrapyramidal symptoms compared to typical antipsychotics; however, the nurse should monitor for these adverse effects, especially in older adult patients. A 40-year-old pregnant patient seeks treatment for moderate to severe depression. Which of the following antidepressants is generally considered safe to use during pregnancy? a) Paroxetine b) Venlafaxine c) Fluoxetine d) Sertraline

insomnia due to its shorter half-life and reduced risk of tolerance and dependence compared to benzodiazepines. A 70-year-old patient with chronic pain is prescribed an opioid medication. Which of the following adverse effects should the nurse prioritize monitoring for in this patient? a) Hypotension b) Respiratory depression c) Hyperglycemia d) Visual disturbances Answer: b) Respiratory depression Rationale: Respiratory depression is a potentially life- threatening adverse effect of opioid medications, especially in older adult patients, and should be closely monitored by the healthcare team. A 30-year-old patient with post-traumatic stress disorder (PTSD) is prescribed a selective serotonin and norepinephrine reuptake inhibitor (SNRI) for the management of symptoms. Which of the following SNRIs is commonly used in the treatment of PTSD? a) Duloxetine b) Desvenlafaxine c) Venlafaxine d) Milnacipran Answer: c) Venlafaxine Rationale: Venlafaxine is often used in the treatment of PTSD due to its dual mechanism of action in increasing serotonin and norepinephrine levels, which may help alleviate symptoms of the disorder.

A 65-year-old patient with dementia-related psychosis is prescribed a medication to manage hallucinations and delusions. Which of the following atypical antipsychotic medications is approved for this indication in older adults? a) Risperidone b) Olanzapine c) Aripiprazole d) Quetiapine Answer: a) Risperidone Rationale: Risperidone is approved for the treatment of dementia-related psychosis in older adults, and its use should be carefully monitored due to an increased risk of cerebrovascular adverse events. A 20-year-old patient with a history of alcohol use disorder is prescribed a medication to support abstinence and prevent relapse. Which of the following medications is a partial opioid agonist commonly used for this purpose? a) Naltrexone b) Disulfiram c) Acamprosate d) Buprenorphine Answer: d) Buprenorphine Rationale: Buprenorphine is a partial opioid agonist that can help reduce cravings and withdrawal symptoms in individuals with alcohol use disorder, supporting their efforts to maintain abstinence. A 45-year-old patient is diagnosed with generalized anxiety

emphasize to the patient while on this medication? a) Limiting intake of foods rich in tyramine b) Avoiding foods high in vitamin K c) Restricting sodium intake d) Avoiding foods containing histamine Answer: a) Limiting intake of foods rich in tyramine Rationale: MAOIs can interact with tyramine-containing foods and beverages, potentially leading to hypertensive crisis; therefore, patients should be educated about dietary restrictions to prevent adverse events. A 65-year-old patient with Parkinson's disease is prescribed a medication to manage motor symptoms. Which of the following medications is a dopamine agonist commonly used in the treatment of Parkinson's disease? a) Levodopa-carbidopa b) Pramipexole c) Amantadine d) Selegiline Answer: b) Pramipexole Rationale: Pramipexole is a dopamine agonist that can help manage motor symptoms of Parkinson's disease by stimulating dopamine receptors in the brain. A 30-year-old patient with bipolar disorder is prescribed lithium for mood stabilization. Which of the following electrolyte imbalances should the nurse monitor for in this patient while on lithium therapy? a) Hyponatremia b) Hypokalemia

c) Hypercalcemia d) Hypernatremia Answer: a) Hyponatremia Rationale: Lithium therapy can lead to the development of hyponatremia, emphasizing the importance of regular monitoring of sodium levels to prevent potential complications. C:

1. A 65-year-old woman with a history of hypertension and depression is prescribed fluoxetine (Prozac) by her primary care provider. She reports feeling more energetic and less sad after taking the medication for two weeks. However, she also complains of insomnia, headache, and tremor. What is the most likely explanation for these adverse effects? a) She is experiencing serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin levels in the brain. b) She is experiencing a hypertensive crisis, a severe elevation of blood pressure that can lead to stroke or heart attack. c) She is experiencing an interaction between fluoxetine and her antihypertensive medication, which can increase the risk of bleeding and hypertension. d) *She is experiencing activation syndrome, a paradoxical increase in anxiety, agitation, and insomnia that can occur

adolescents with ADHD. However, these effects are usually mild and transient, and can be minimized by timing the medication administration to avoid interfering with meals, providing high-calorie snacks before or after taking the medication, and monitoring the growth parameters regularly. Stopping or skipping the medication can compromise the efficacy and consistency of treatment, and switching to a non-stimulant medication may not be as effective or well-tolerated.

3. A 25-year-old woman with bipolar disorder is prescribed lithium carbonate (Lithobid) by her psychiatrist. She takes the medication as directed and reports feeling more stable and less irritable. However, she also notices that she has increased thirst, urination, and tremor. She wonders if these are normal side effects of lithium or signs of toxicity. What is the best way to determine this? a) She should measure her blood pressure and pulse regularly and report any abnormal readings to her psychiatrist. b) She should check her urine color and specific gravity regularly and report any changes to her psychiatrist. c) She should have her blood lithium level checked periodically and report any symptoms of toxicity to her psychiatrist. d) She should monitor her mood and behavior closely and report any signs of relapse or worsening to her psychiatrist. Rationale: Lithium is a mood stabilizer that can be very effective for bipolar disorder, but it has a narrow therapeutic window, meaning that there is a small

difference between an effective dose and a toxic dose. Therefore, it is essential to monitor the blood lithium level regularly (usually every 1-3 months) to ensure that it stays within the target range of 0.6-1.2 mEq/L. Symptoms of lithium toxicity include nausea, vomiting, diarrhea, confusion, drowsiness, slurred speech, muscle weakness, tremor, ataxia, seizures, coma, and death.

4. A 35-year-old man with schizophrenia is prescribed clozapine (Clozaril) by his psychiatrist after failing to respond to several other antipsychotics. He takes the medication as directed and reports significant improvement in his positive symptoms (hallucinations, delusions) and negative symptoms (apathy, social withdrawal). However, he also develops a fever, sore throat, and malaise after two weeks of treatment. What is the most urgent action for him to take? a) He should stop taking the medication immediately and go to the emergency department. b) He should have his blood count checked as soon as possible and contact his psychiatrist. c) He should continue taking the medication and wait for the symptoms to subside. d) He should take an over-the-counter analgesic and antipyretic and drink plenty of fluids. Rationale: Clozapine is a second-generation antipsychotic that can be very effective for treatment-resistant schizophrenia, but it has a serious risk of causing agranulocytosis, a potentially fatal condition characterized by a severe reduction in white blood cells that can lead to