Jake, a forty-five-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance

Question

Question 1. Jake, a forty-five-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with intramuscular (IM) long-acting haloperidol. Besides being monitored for his schizophrenia symptoms, the patient should be assessed by his primary care provider:

For excessive weight loss

With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) symptoms

Monthly for tolerance to the haloperidol

Only by the mental health provider as most nurse practitioners in primary care do not care for mentally ill patients

Question 2. Sarah, a forty-two-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include understanding that:

Obesity is a contraindication to prescribing phentermine.

Anorexiants may cause tolerance and should only be prescribed for six months.

Patients should be monitored for postural hypotension.

Renal function should be monitored closely while the patient is on anorexiants.

Question 3. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:

To not abruptly discontinue levetiracetam due to the risk of withdrawal seizures

To wear a sunscreen due to photosensitivity from levetiracetam

To get an annual eye exam while on levetiracetam

To report weight loss if it occurs

Question 4. A nineteen-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:

Bradykinesia, akathisia, and agitation

Excessive weight gain

Hypertension

Potentially fatal agranulocytosis

Question 5. Prior to starting antidepressants, patients should have laboratory testing to rule out:

Hypothyroidism

Anemia

Diabetes mellitus

Low estrogen levels

Question 6. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:

Alprazolam (Xanax)

Diazepam (Valium)

Buspirone (Buspar)

Amitriptyline (Elavil)

Question 7. Monitoring for a child on methylphenidate for ADHD includes:

ADHD symptoms

Routine height and weight checks

Amount of methylphenidate being used

All of the above

Question 8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:

Increased seizure activity as this drug may auto-induce seizures

Altered renal function, including renal failure

Blood dyscrasias, which are uncommon but possible

CNS excitement, leading to insomnia

Question 9. An appropriate first-line drug for the treatment of depression with fatigue and low energy would be:

Venlafaxine (Effexor)

Escitalopram (Lexapro)

Buspirone (Buspar)

Amitriptyline (Elavil)

Question 10. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:

Fluoxetine (Prozac)

Paroxetine (Paxil)

Amitriptyline (Elavil)

Duloxetine (Cymbalta)

Question 11. A sixty-six-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner managing his primary healthcare needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):

He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex).

MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce.

Symptoms of hypertensive crisis (headache, tachycardia, sweating, etc.) require immediate treatment.

All the above options are .

Question 12. Patients who are prescribed olanzapine (Zyprexa) should be monitored for:

Insomnia

Weight gain

Hypertension

Galactorrhea

Question 13. Levetiracetam has known drug interactions with:

Oral contraceptives

Carbamazepine

Warfarin

Few, if any, drugs

Question 14. When a patient is on selective-serotonin reuptake inhibitors:

The complete blood count must be monitored every three to four months

Therapeutic blood levels must be monitored every six months after a steady state is achieved.

Blood glucose must be monitored every three to four months.

There is no laboratory monitoring required.

Question 15. In choosing a benzodiazepam to treat anxiety, the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is:

Chlordiazepoxide (Librium)

Clonazepam (Klonopin)

Alprazolam (Xanax)

Oxazepam (Serax)

Question 16. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective-serotonin reuptake inhibitors.What is the initial dosage adjustment when starting a taper off antidepressants?

Change the dose to every other day dosing for a week.

Reduce the dose by 50% for three to four days.

Reduce the dose by 50% every other day.

Escitalopram (Lexapro) can be stopped abruptly due to its long half-life.

Question 17. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD, the nurse practitioner will need to monitor:

The blood pressure

Blood glucose levels

Urine ketone levels

Liver function

Question 18. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

Valproate is safe during all trimesters of pregnancy.

She can get pregnant while taking valproate, but she should take adequate folic acid.

Valproate is not safe at any time during pregnancy.

Valproate is a known teratogen but may be taken after the first trimester if necessary.

Question 19. Jack, eight years old, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:

Slurred speech and insomnia

Bradycardia and confusion

Dizziness and orthostatic hypotension

Insomnia and decreased appetite

Question 20. The tricyclic antidepressants should be prescribed cautiously in patients with:

Eczema

Asthma

Diabetes

Heart disease