A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient
has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks
what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse
she will treat the patient with the following regimen:
Selected Answer: B.
SSRI/SNRI plus NDRI
• Question 60
1 out of 1 points
During gene expression, what must occur prior to a gene being expressed?
Selected A.
Answers:
Transcription factor must bind to the regulatory region within the cell’s nucleus.
• Question 61
1 out of 1 points
Fluoxetine (Prozac) has been prescribed for a client with depression. Which of the following statements is true
regarding the action of this medication?
Selected Answer: B.
Fluoxetine inhibits the serotonin transporter (SERT).
• Question 62
1 out of 1 points
A 45 year old female client with allergic rhinitis and normal blood pressure has had no reduction in depressive
symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed when considering
phenelzine in treating her depression?
Selected Answer: B.
The client will need to minimize dietary intake of foods that are high in tyramine.
• Question 63
,1 out of 1 points Why is the cytochrome P450 enzyme system of significance to the PMHNP?
Selected Answer: B.
The bioavailability of the medication after it passes through the stomach and liver can be
altered.
• Question 64
Mr. Ruby is a 33-year-old single father who is requesting 1 out of 1 points
pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent
diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40–50
hours a week as a contractor and “manages his stress” by smoking 3–4 cigarettes a day and having 8–10 drinks of
alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby?
Selected Answer: C.
He uses alcohol.
• Question 65
1 out of 1 points
Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of
norepinephrine will affect Ms. Boeckh’s serotonin levels?
Selected Answer: B.
Norepinephrine inhibits 5HT release through a2 receptors.
• Question 66
1 out of 1 points
Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target
paranoid psychosis?
Selected Answer: B.
“I have to talk to the President because I’m the only one who can help him.”
• Question 67
1 out of 1 points
,A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and
citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the
Clonazepam (klonopin) the best response is:
Selected Answer: C.
Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to
citalopram (celexa)
• Question 68
It is important for the PMHNP to recognize differences in 1 out of 1 points
pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the
competent PMHNP identify as true?
Selected Answer: A.
About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and
antipsychotics.
• Question 69
1 out of 1 points
Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports “I take
my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP understand about this patient?
Selected Answer: C.
Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in
three doses.
• Question 70
1 out of 1 points
A client who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a
mood stabilizer. What is the appropriate response?
Selected Answer: C.
Mood stabilizers can treat either manic phases or depressive phases of bipolar disorder.
• Question 71
, 1 out of 1 points
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