Week 5 Assignment 2
: 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
Anorexiants may cause tolerance and should
only be prescribed for six months.
Patients should be monitored for postural
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
To get an annual eye exam while on
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
Potentially fatal agranulocytosis
Question 5. Prior
to starting antidepressants, patients should have laboratory testing to rule
Low estrogen levels
Question 6. An
appropriate first-line drug to try for mild to moderate generalized anxiety
disorder would be:
Question 7. Monitoring
for a child on methylphenidate for ADHD includes:
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
Altered renal function, including renal
Blood dyscrasias, which are uncommon but
CNS excitement, leading to insomnia
Question 9. An
appropriate first-line drug for the treatment of depression with fatigue and
low energy would be:
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
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:
Question 13. Levetiracetam
has known drug interactions with:
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
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:
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
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
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
She can get pregnant while taking valproate,
but she should take adequate folic acid.
Valproate is not safe at any time during
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: