Question 1

Carbamazepine has a black box warning due to life threatening:

Accepted Answer

A)  Renal toxicity, leading to renal failure
B)  Hepatotoxicity, leading to liver failure
C)  Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis
D)  Cardiac effects, including supraventricular tachycardiaE) None of the above
F) C) and D)

Question 2

An adult is taking lithium for bipolar disorder. They should be taught to:

Accepted Answer

A)  Take lithium with food
B)  Eat a diet with consistent levels of salt (sodium) 
C)  Drink at least two quarts of water if they are in a hot environment
D)  Monitor blood glucose levelsE) A) and C)
F) All of the above

Question 3

A patient is taking lamotrigine (Lamictal)  and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

Accepted Answer

A)  Reassuring her she has a viral infection and telling her to call if she isn't better in four or five days
B)  Ruling out a hypersensitivity reaction that may lead to multiorgan failure
C)  Rapid strep test and symptomatic care if strep test is negative
D)  Observation only, with further assessment if she worsensE) A) and D)
F) A) and C)

Question 4

A patient is taking levetiracetam (Keppra)  to treat seizures. Routine education for levetiracetam includes reminding them:

Accepted Answer

A)  To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
B)  To wear sunscreen due to photosensitivity from levetiracetam
C)  To get an annual eye exam while on levetiracetam
D)  To report weight loss if it occursE) C) and D)
F) All of the above

Question 5

Monitoring for a child on methylphenidate for attention-deficit/hyperactivity disorder (ADHD)  includes:

Accepted Answer

A)  ADHD symptoms
B)  Routine height and weight checks
C)  Amount of methylphenidate being used
D)  All of the aboveE) None of the above
F) B) and D)

Question 6

A patient fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

Accepted Answer

A)  Ibuprofen (Advil) 
B)  Acetaminophen with hydrocodone (Vicodin) 
C)  Oxycodone (Oxycontin) 
D)  Oral morphine (Roxanol) E) A) and B)
F) A) and C)

Question 7

Patients should be instructed regarding the rapid onset of zolpidem (Ambien)  because:

Accepted Answer

A)  Zolpidem should be taken just before going to bed.
B)  Zolpidem may cause dry mouth and constipation.
C)  They may need to double the dose for effectiveness.
D)  They should stop drinking alcohol at least 30 minutes before taking zolpidem.E) A) and D)
F) None of the above

Question 8

Anticholinergic agents, such as benztropine (Cogentin) , may be given with a phenothiazine to:

Accepted Answer

A)  Reduce the chance of tardive dyskinesia
B)  Potentiate the effects of the drug
C)  Reduce the tolerance that tends to occur
D)  Increase CNS depressionE) A) and B)
F) A) and D) B

Question 9

When prescribing Adderall (amphetamine and dextroamphetamine)  to adults with ADHD the NP will need to monitor:

Accepted Answer

A)  	Blood pressure
B)  	Blood glucose levels
C)  	Urine ketone levels
D)  	Liver functionE) None of the above
F) A) and C)

Question 10

Long-term monitoring of patients who are taking carbamazepine includes:

Accepted Answer

A)  Routine testing of troponin levels to assess for cardiac damage
B)  Annual eye examinations to assess for cataract development
C)  Monthly pregnancy tests for all women of childbearing age
D)  Complete blood count every three to four monthsE) None of the above
F) A) and B)

Question 11

Before prescribing phentermine, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs)  and St. John's Wort due to:

Accepted Answer

A)  Additive respiratory depression risk
B)  Additive effects affecting liver function
C)  The risk of serotonin syndrome
D)  The risk of altered cognitive functioningE) All of the above
F) A) and D)

Question 12

A 66-year-old male was prescribed phenelzine (Nardil)  while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner (NP)  managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs) :

Accepted Answer

A)  He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) .
B)  MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce.
C)  Symptoms of hypertensive crisis (headache, tachycardia, sweating)  require immediate treatment.
D)  All of the aboveE) A) and B)
F) C) and D)

Question 13

A patient sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:

Accepted Answer

A)  Ibuprofen (Advil) 
B)  Acetaminophen with hydrocodone (Vicodin) 
C)  Oxycodone (Oxycontin) 
D)  Oral morphine (Roxanol) E) None of the above
F) A) and B)

Question 14

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

Accepted Answer

A)  Insomnia
B)  Weight gain
C)  Hypertension
D)  GalactorrheaE) C) and D)
F) All of the above

Question 15

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

Accepted Answer

A)  Orthostatic hypotension
B)  Agitation and irritability
C)  Drowsiness and nausea
D)  Painful urination and abdominal distentionE) A) and D)
F) C) and D)

Question 16

A 19-year-old male was started on risperidone. Monitoring for risperidone includes watching for common side effects, including:

Accepted Answer

A)  Bradykinesia, akathisia, and agitation
B)  Excessive weight gain
C)  Hypertension
D)  Potentially fatal agranulocytosisE) A) and C)
F) A) and D) A

Question 17

A 45-year-old patient with schizophrenia was recently hospitalized for acute psychosis due to medication noncompliance. They were treated with intramuscular (IM)  long-acting haloperidol. Besides monitoring schizophrenia symptoms, the patient should be assessed:

Accepted Answer

A)  By his primary care provider, for excessive weight loss
B)  By his primary care provider, using the Abnormal Involuntary Movement Scale (AIMS)  for extrapyramidal symptoms (EPS) 
C)  By his primary care provider, monthly for tolerance to the haloperidol
D)  Only by a mental health provider, as most NPs in primary care do not care for mentally ill patientsE) None of the above
F) A) and B)

Question 18

A patient has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be:

Accepted Answer

A)  Increase her dose
B)  Assess for suicidal ideation
C)  Discontinue the medication immediately
D)  Decrease her dose to half then slowly titrate up the doseE) A) and B)
F) A) and C) B

Question 19

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

Accepted Answer

A)  Fluoxetine (Prozac) 
B)  Paroxetine (Paxil) 
C)  Amitriptyline (Elavil) 
D)  Duloxetine (Cymbalta) E) All of the above
F) A) and C)

Question 20

A child, Dwayne, has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels may be:

Accepted Answer

A)  Dwayne hasn't been taking his carbamazepine because it causes insomnia.
B)  Carbamazepine autoinduces metabolism, leading to lower levels in spite of good compliance.
C)  Dwayne was not originally prescribed the correct amount of carbamazepine.
D)  Carbamazepine is probably not the right antiseizure medication for Dwayne.E) A) and D)
F) B) and C)

Exam 12: Drugs Affecting the Central Nervous System

Carbamazepine has a black box warning due to life threatening:

Correct AnswerverifiedShow Answer

An adult is taking lithium for bipolar disorder. They should be taught to:

Correct AnswerverifiedShow Answer

A patient is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

Correct AnswerverifiedShow Answer

A patient is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding them:

Correct AnswerverifiedShow Answer

Monitoring for a child on methylphenidate for attention-deficit/hyperactivity disorder (ADHD) includes:

Correct AnswerverifiedShow Answer

A patient fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

Correct AnswerverifiedShow Answer

Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:

Correct AnswerverifiedShow Answer

Anticholinergic agents, such as benztropine (Cogentin) , may be given with a phenothiazine to:

Correct AnswerverifiedB

When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the NP will need to monitor:

Correct AnswerverifiedShow Answer

Long-term monitoring of patients who are taking carbamazepine includes:

Correct AnswerverifiedShow Answer

Before prescribing phentermine, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St. John's Wort due to:

Correct AnswerverifiedShow Answer

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner (NP) managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs) :

Correct AnswerverifiedShow Answer

A patient sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

Correct AnswerverifiedShow Answer

A 19-year-old male was started on risperidone. Monitoring for risperidone includes watching for common side effects, including:

Correct AnswerverifiedA

A 45-year-old patient with schizophrenia was recently hospitalized for acute psychosis due to medication noncompliance. They were treated with intramuscular (IM) long-acting haloperidol. Besides monitoring schizophrenia symptoms, the patient should be assessed:

Correct AnswerverifiedShow Answer

A patient has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having "strange" thoughts. The appropriate initial action would be:

Correct AnswerverifiedB

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

Correct AnswerverifiedShow Answer

A child, Dwayne, has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels may be:

Correct AnswerverifiedShow Answer

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B

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A

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B

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