Stephanie is a 36-year-old female who presents to the clinic with a ÿhistory of anxiety. Social history is unremarkable. For the last 4 ÿyears, she has been well controlled on paroxetine, however she feels ?it ÿjust doesn’t work anymore.? You have decided to change her medication ÿregimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day ÿbased on tolerability. The patient asks, ?When can I expect this to ÿstart kicking in?? The best response is:a. ÿÿ3 or 4 days ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿ1 or 2 weeks ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿ3 or 4 weeks ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿ10 weeks3.75 pointsQuestion 2Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?a. ÿÿhaloperidol ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿlorazepam ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿbenztropine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿchlorpromazine3.75 pointsQuestion 3Sam is a 48-year-old male who presents to the clinic with signs ÿand symptoms consistent with GAD & MDD. Which of the following ÿmedications would be the LEAST appropriate choice when initiating ÿpharmacotherapy?a. ÿÿduloxetine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿsertraline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿmirtazapine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿbuproprion3.75 pointsQuestion 4Jason is a 6-year-old child whose mother presents to the clinic ÿwith him. The mother says that ?he’s not himself lately.” After a ÿthorough workup, you diagnose the patient as having GAD. Which of the ÿfollowing medications would be the LEAST appropriate to prescribe to ÿthis child?a. ÿÿSertraline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿParoxetine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿVenlafaxine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿBuspirone3.75 pointsQuestion 5Mirza is a 75-year-old patient with a long history of ÿschizophrenia. During the past 5 years, she has shown significant ÿcognitive decline consistent with dementia. The patient has been well ÿcontrolled on a regimen of risperidone 1mg BID. As the PMHNP, the most ÿappropriate course of action for this patient is:a. ÿÿIncrease the risperidone to 1mg QAM, 2mg QPM ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿDiscontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿDiscontinue risperidone and initiate therapy with clozapine. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿAugment the patient’s risperidone with brexpiprazole.3.75 pointsQuestion 6Amber is a 26-year-old female who presents to the clinic 6 weeks ÿpostpartum. The patient states that she has been “feeling down” since ÿthe birth of her son. She is currently breastfeeding her infant. You ÿdiagnose the patient with Postpartum depression. Which of the following ÿis the LEAST appropriate option in treating her PPD?a. ÿÿparoxetine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿescitalopram ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿcitalopram ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿsertraline3.75 pointsQuestion 7Jordyn is a 27-year-old patient who presents to the clinic with ÿGAD. She is 30 weeks pregnant and has been well controlled on a regimen ÿof sertraline 50mg daily. Jordyn says that “about once or twice a week ÿmy husband really gets on my nerves and I can’t take it.” She is opposed ÿto having the sertraline dose increased due to the risk of further ÿweight gain. You have decided to prescribe the patient a short-term ÿcourse of benzodiazepines for breakthrough anxiety. Which of the ÿfollowing is the LEAST appropriate benzodiazepines to prescribe to this ÿpatient?a. ÿÿdiazepam ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿalprazolam ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿclonazepam ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿlorazepam3.75 pointsQuestion 8Steve is a 35-year-old male who presents to the primary care ÿoffice complaining of anxiety secondary to quitting smoking cold turkey 2 ÿweeks ago. The patient has a 14-year history of smoking two packs per ÿday. The patient has an unremarkable social history other than a recent ÿdivorce from his wife, Brittany. Which of the following would be the ÿLEAST effective medication to treat Steve’s anxiety?a. ÿÿBuproprion ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿSertraline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿVarenicline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿAlprazolam3.75 pointsQuestion 9Rebecca is a 32-year-old female who was recently prescribed ÿescitalopram for MDD. She presents to the clinic today complaining of ÿdiaphoresis, tachycardia, and confusion. The differential diagnosis for ÿthis patient, based on the symptoms presenting, is:a. ÿÿPanic disorder ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿGastroenteritis ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿAbnormal gait ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿSerotonin syndrome3.75 pointsQuestion 10The patient in the previous question states, “I can’t even last 1 ÿmore day without feeling like my insides are going to explode with ÿanxiety.” The most appropriate course of action would be:a. ÿÿInform the patient to try yoga or other natural remedies until the vortioxetine takes effect. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿPrescribe a short-term course of low dose benzodiazepine, such as alprazolam. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿPrescribe an SNRI, such as venlafaxine, in addition to the vortioxetine. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿRecommend in-patient mental health for the foreseeable future.3.75 pointsQuestion 11John is a 41-year old-patient who presents to the clinic with ÿdiarrhea, fatigue, and recently has been having tremors. He was ÿdiagnosed 19 years ago with bipolar disorder and is currently managed on ÿLithium 300mg BID. As the PMHNP, you decide to order a lithium level ÿthat comes back at 2.3mmol/l. What is the most appropriate course of ÿaction?a. ÿÿInvestigate other differential diagnoses for his symptoms. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿTell John to skip his next four Lithium doses and resume therapy. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿTell John he needs to go to the hospital and call an ambulance to bring him. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿPrescribe loperamide to treat the diarrhea and ropinirole to treat the tremors3.75 pointsQuestion 12Mark is a 46-year-old male with treatment-resistant depression. He ÿhas tried various medications, including SSRIs, SNRI, and TCAs. You ÿhave decided to initiate therapy with phenelzine. Which of the following ÿmust the PMHNP take into consideration when initiating therapy with ÿphenelzine?a. ÿÿThere is a minimum 7-day washout period when switching from another antidepressant to phenelzine. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿPatient must be counseled on dietary restrictions. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿMAOIs may be given as an adjunctive therapy with SSRIs. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿA & B ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿe. ÿÿAll of the above3.75 pointsQuestion 13Thomas is a 28-year-old male who presents to the clinic with signs ÿand symptoms consistent with MDD. He is concerned about starting ÿantidepressant therapy, however, because one of his friends recently ÿexperienced erectile dysfunction when he was put on an antidepressant. ÿWhich of the following would be the most appropriate antidepressant to ÿstart Thomas on?a. ÿÿVilazodone ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿSertraline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿParoxetine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿCitalopram3.75 pointsQuestion 14Melvin is an 89-year-old male who presents to the clinic with ÿsigns/symptoms consistent with MDD. Which of the following would be the ÿLEAST appropriate medication to prescribe to this elderly patient?a. ÿÿnortriptyline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿamitriptyline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿdesipramine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿtrazodone3.75 pointsQuestion 15Jane is a 17-year-old patient who presents to the office with ÿsigns consistent with schizophrenia. She states multiple times that she ÿis concerned about gaining weight, as she has the perfect prom dress ÿpicked out and she finally got a date. Which of the following is the ÿleast appropriate choice to prescribe Jane?a. ÿÿAripiprazole ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿOlanzapine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿHaloperidol ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿBrexpiprazole3.75 pointsQuestion 16Richard is a 54-year-old male who suffers from schizophrenia. ÿAfter exhausting various medication options, you have decided to start ÿhim on Clozapine. Which of the statements below is true regarding ÿClozapine?a. ÿÿRegular blood monitoring must be performed to monitor for neutropenia. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿClozapine can only be filled by a pharmacy that participates in the REMS program. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿBradycardia is a common side effect of Clozapine. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿA & B ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿe. ÿÿAll of the above3.75 pointsQuestion 17Cindy is a 55-year-old patient who presents with symptoms ÿconsistent with Generalized anxiety disorder. The patient has an ÿunremarkable social history other than she consumes two or three glasses ÿof wine per night. Which of the following would be an appropriate ÿtherapy to start this patient on?a. ÿÿXanax 0.25mg BID PRN Anxiety ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿEscitalopram 10mg daily ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿBuspirone 10mg BID ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿAripiprazole 10mg daily3.75 pointsQuestion 18Martin is a 92-year-old male who presents to the clinic with ÿsigns/symptoms consistent with MDD. The patient suffers from glaucoma ÿand just recently underwent surgery for a cataract. Which of the ÿfollowing is the LEAST appropriate course of therapy when treating the ÿMDD?a. ÿÿsertraline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿamitriptyline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿduloxetine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿvilazodone3.75 pointsQuestion 19Which of the following statements are true?a. ÿÿFirst-generation (typical) antipsychotics are associated with a higher incidence of EPS. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿSecond-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿThere is evidence that atypical ÿantipsychotics are significantly more effective than typical ÿantipsychotics in the treatment of cognitive symptoms associated with ÿschizophrenia. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿA & B ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿe. ÿÿA, B, and C3.75 pointsQuestion 20Earle is an 86-year-old patient who presents to the hospital with a ÿCommunity Acquired Pneumonia. During stay, you notice that the patient ÿoften seems agitated. He suffers from cognitive decline and currently ÿtakes no mental health medications. Treatment for the CAP include ÿceftriaxone and azithromycin. The LEAST appropriate medication to treat ÿEarle’s anxiety is:a. ÿÿsertraline ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿb. ÿÿduloxetine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿc. ÿÿcitalopram ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿd. ÿÿvenlafaxine
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