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NURS 6521 Week 5 EmmaGarcia Diabetes and Drug Treatments Discussion

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

Diabetes and Drug Treatments

Diabetes is a chronic condition characterized by high levels of glucose (sugar) in the blood. The main types of diabetes are type 1 diabetes, type 2 diabetes, gestational diabetes, and juvenile diabetes (Rosenthal & Burchum, 2021).

Type 1 Diabetes

This type occurs when the body’s immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. As a result, the body cannot produce enough insulin, requiring individuals with type 1 diabetes to take insulin injections or use an insulin pump to manage their blood sugar levels. One drug commonly used to treat type 1 diabetes is insulin. Insulin can be administered through subcutaneous injections or via an insulin pump (Rosenthal & Burchum, 2021). Before injecting insulin, it is important to prepare the injection site by cleaning the area with an alcohol swab. The preparation and administration process may vary depending on the specific insulin product, so it is crucial to follow the instructions provided by the healthcare provider or the manufacturer.

Dietary considerations for individuals with type 1 diabetes involve monitoring carbohydrate intake and balancing it with insulin dosages. This helps to maintain stable blood sugar levels. Carbohydrate counting, meal planning, and timing insulin doses are important strategies in managing this type of diabetes. The short-term impact of type 1 diabetes can includes symptoms such as frequent urination, excessive thirst, weight loss, fatigue, and blurred vision. If left untreated or poorly managed, it can lead to a condition called diabetic ketoacidosis (DKA), which is a potentially life-threatening complication (Ho et al., 2021). Long-term effects of uncontrolled type 1 diabetes may include damage to the blood vessels, nerves, kidneys, eyes and an increased risk of heart disease.

Type 2 Diabetes

This type is characterized by insulin resistance, where the body becomes less responsive to the effects of insulin. It is often associated with lifestyle factors such as obesity and physical inactivity, although genetic factors also play a role. Initially, the pancreas produces extra insulin to compensate for the resistance, but over time, it may not keep up, resulting in high blood sugar levels. Various medications are used to treat type 2 diabetes, depending on the individual’s needs (Rosenthal & Burchum, 2021). One example is metformin, which helps reduce glucose production in the liver and improves insulin sensitivity in the body. Metformin is typically taken orally in tablet form, usually with meals or as directed by the healthcare provider.

In addition to medication, dietary considerations for type 2 diabetes involve adopting a balanced diet that includes whole grains, fruits, vegetables, lean proteins, and healthy fats. Limiting the intake of sugary foods, processed carbohydrates, and unhealthy fats is also essential. The short-term impact of uncontrolled type 2 diabetes may include symptoms similar to type 1 diabetes, such as frequent urination, increased thirst, fatigue, and blurred vision. In the long term, poorly managed type 2 diabetes can lead to complications like cardiovascular disease, kidney damage, nerve damage (neuropathy), and eye problems (retinopathy) (Rosenthal & Burchum, 2021).

References

Ho, J., Rosolowsky, E., Pacaud, D., Huang, C., Lemay, J. A., Brockman, N., Rath, M. & Doulla, M. (2021). Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID?19 pandemic. Pediatric Diabetes, 22(4), 552–557. https://doi.org/10.1111/pedi.13205

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Rajdev

NURS 6521 Week 6 Decision Tree for Neurologic and Musculoskeletal Disorders Example Solution Provided

Week 6: Neurologic and Musculoskeletal Disorders and Opioids

Sabrina is a 26-year-old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow-up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems.

Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives 

Students will:

• Evaluate patients for treatment of neurologic and musculoskeletal disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
• Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

To Prepare:

• Review the interactive media piece assigned by your Instructor. 
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

BY DAY 7 OF WEEK 8

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
• You will submit this Assignment in Week 8.

Learning Resources

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

o   Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)

o   Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)

o   Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)

o   Chapter 14, “Muscarinic Antagonists” (pp. 90-98)

o   Chapter 15, “Adrenergic Agonists” (pp. 99–107)

o   Chapter 16, “Adrenergic Antagonists” (pp. 108–119)

o   Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)

o   Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)

o   Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)

o   Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)

o   Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)

o   Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)

o   Chapter 24, “Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics” (pp. 183–194)

o   Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)

o   Chapter 60, “Drug Therapy of Gout” (pp. 528–536)

o   Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

• American Academy of Family Physicians. (2019). Dementia. Retrieved from https://www.aafp.org/pubs/afp/topics/by-topic.dementia.html

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

• Linn, B. S., Mahvan, T., Smith, B. E. Y., Oung, A. B., Aschenbrenner, H., & Berg, J. M. (2020). Tips and tools for safe opioid prescribing: This review–with tables summarizing opioid options, dosing considerations, and recommendations for tapering–will help you provide rigorous Tx for noncancer pain while ensuring patient safety. Journal of Family Practice, 69(6), 280–292.
• Document: Mid-Term Summary & Study Guide (PDF)Download Mid-Term Summary & Study Guide (PDF)

Required Media

• Walden University, LLC. (Producer). (2019b). Alzheimer’s diseaseLinks to an external site. [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

• Walden University, LLC. (Producer). (2019e). Complex regional pain disorder. [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

• Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)
  
  
• Speed Pharmacology. (2019). Drugs for Parkinson’s Disease (Made Easy). [Video]. https://www.youtube.com/watch?v=Z84iypHdftQ&t=13s

Note: This media program is approximately 9 minutes.

• Speed Pharmacology. (2019). Pharmacology- Drugs for Alzheimer’s Disease (Made Easy). [Video]. https://www.youtube.com/watch?v=euzRPrvrwj0&t=31s

Note: This media program is approximately 7 minutes.

Alzheimer’s Disease

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is a 76-year-old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. 

He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

Resources

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decision Point One

Select what you should do:

• Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks
• Begin Aricept (donepezil) 5 mg orally at BEDTIME
• Begin Razadyne (galantamine) 4 mg orally BID

Decision Point One : Begin Aricept (donepezil) 5 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• The client is accompanied by his son who reports that his father is “no better” from this medication
• He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors
• You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

Select what you should do next:

• Increase Aricept to 10 mg orally at BEDTIME
• Discontinue Aricept and begin Razadyne (galantamine) extended release 24 mg orally daily
• Discontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally daily

Decision Point Two: Increase Aricept to 10 mg orally at BEDTIME

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better
• He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three

Select what you should do next:

• Continue Aricept 10 mg orally at BEDTIME
• Increase Aricept to 15 mg orally at BEDTIME x 6 weeks, then increase to 20 mg orally at BEDTIME
• Discontinue Aricept and begin Namenda 5 mg orally daily

Decision Point Three: Continue Aricept 10 mg orally at BEDTIME

Guidance to Student

At this point, it would be prudent to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy. Disinhibition may improve in a few weeks, or it may not improve at all. This is a counseling point that you should review with the son.

There is no evidence that Aricept given at doses greater than 10 mg per day has any therapeutic benefit. It can, however, cause side effects. Increasing to 15 and 20 mg per day would not be appropriate.

There is nothing in the clinical presentation to suggest that the Aricept should be discontinued. Whereas it may be appropriate to add Namenda to the current drug profile, there is no need to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer’s disease. The key to using both medications is slow titration upward toward therapeutic doses to minimize negative side effects.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

NURS 6521 Week 6 Decision Tree for Neurologic and Musculoskeletal Disorders Assignment Rubric

CriteriaRatingsPtsThis criterion is linked to a Learning Outcome Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.
20 to >17.8 pts Excellent
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.
17.8 to >15.8 pts Good
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
15.8 to >13.8 pts Fair
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
13.8 to >0 pts Poor
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.20 ptsThis criterion is linked to a Learning Outcome Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
25 to >22.25 pts Excellent
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature. …
The response includes specific and relevant outside reference examples that fully support the explanation provided.
22.25 to >19.75 pts Good
The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature. …
The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
19.75 to >17.25 pts Fair
The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature. …
The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
17.25 to >0 pts Poor
The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing. …
The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.25 ptsThis criterion is linked to a Learning OutcomeWhat were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
20 to >17.8 pts Excellent
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned. …
The response includes specific and relevant outside reference examples that fully support the explanation provided.
17.8 to >15.8 pts Good
The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. …
The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
15.8 to >13.8 pts Fair
The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. …
The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
13.8 to >0 pts Poor
The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing. …
The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.20 ptsThis criterion is linked to a Learning Outcome Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.
20 to >17.8 pts Excellent
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. …
The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.
17.8 to >15.8 pts Good
The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. …
The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.
15.8 to >13.8 pts Fair
The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. …
The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.
13.8 to >0 pts Poor
Vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing. …
The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.20 ptsThis criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 to >4.45 pts Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4.45 to >3.95 pts Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.95 to >3.45 pts Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
3.45 to >0 pts Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.5 ptsThis criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.45 pts Excellent
Uses correct grammar, spelling, and punctuation with no errors
4.45 to >3.95 pts Good
Contains a few (1–2) grammar, spelling, and punctuation errors
3.95 to >3.45 pts Fair
Contains several (3–4) grammar, spelling, and punctuation errors
3.45 to >0 pts Poor
Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding5 ptsThis criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 to >4.45 pts Excellent
Uses correct APA format with no errors
4.45 to >3.95 pts Good
Contains a few (1–2) APA format errors
3.95 to >3.45 pts Fair
Contains several (3–4) APA format errors
3.45 to >0 pts Poor
Contains many (? 5) APA format errors5 ptsTotal Points: 100

NURS 6512 Week 8 Discussion – Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

NURS 6521 Week 6 Decision Tree for Neurologic and Musculoskeletal Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine the potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA-approved indications when referring to different medication classes used in the treatment of GAD.

To Prepare:

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history with GAD.

BY DAY 3 OF WEEK 8

Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

BY DAY 6 OF WEEK 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients diagnosed with GAD. In addition, suggest different treatment options you would suggest to treat a patient with the topic of discussion.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply! 

Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder Example Solution

Generalized anxiety disorder (GAD) can be a debilitating problem as those suffering from anxiety disorders face constant worry. Symptoms of generalized anxiety disorder are related to hyperarousal effects such as insomnia, irritability, restlessness, and lack of concentration (Melaragno, 2021). GAD can affect those of all ages, and as for treatment, clinicians have to consider various factors such as age, underlying co-morbidities, and prior treatments and their effects (Strawn, Geracioti, Rajdev, Clemenza, & Levine, 2018).

Different pharmacologic options are available to treat GAD, including serotonergic reuptake inhibitors, selective serotonin reuptake inhibitors, benzodiazepines, and non-benzos (Rosenthal & Burcham, 2021). Aside from pharmacologic treatment, psychotherapy, such as outdoor activity and therapy sessions, helps to amplify pharmacotherapy (Strawn, Geracioti, Rajdev, Clemenza, & Levine, 2018).

SSRIs and SNRIs

SSRIs and SSNIs have been named the first line of treatment for GAD and include venlafaxine, duloxetine, paroxetine, and escitalopram (Rosenthal & Burcham, 2021). SSRIs are also used when there is underlying depression but are also helpful when depression is not apparent (Rosenthal & Burcham, 2021). This group of medications does not take effect immediately and should not be used as needed, instead should be used daily to help decrease the effects of anxiety; in contrast to benzodiazepines, SSRIs and SNRIs are not habit-forming (Rosenthal & Burcham, 2021). However, this group of medications must be tapered off due to unpleasant withdrawal symptoms (Rosenthal & Burcham, 2021).

Benzodiazepines and Non-benzodiazepines

The most common medications in the group of benzodiazepines are alprazolam, diazepam, and lorazepam, which are used for acute onsets of anxiety as they work relatively fast after administration in contrast to SSRIs or SNRIs (Strawn, Geracioti, Rajdev, Clemenza, & Levine, 2018). The current best practice limits the use of benzodiazepines to short-term use due to their habit-forming components (Strawn, Geracioti, Rajdev, Clemenza, & Levine, 2018). In contrast, a nonbenzodiazepine commonly used is buspirone.

Buspirone is an anxiolytic that does not affect the central nervous system and does not carry the potential for abuse. like benzodiazepines do (Strawn, Geracioti, Rajdev, Clemenza, & Levine, 2018). It is comparable to the group of SSRIs and SNRIs in terms of its onset time, as it takes a week or more for therapeutic effects to occur (Rosenthal & Burcham, 2021).

Clinical Experience

Previous experience as a mental health nurse in an outpatient clinic has helped me to have a deeper understanding of the issues faced by those who suffer from GAD. I recall a lady in her upper seventies who was dependent on lorazepam for the past ten years. She was on the highest dose, and her Psychiatrist retired, leaving her to see another clinician within the office who did not feel comfortable continuing to prescribe lorazepam to her at her age. 

After talking it over with her, she realized she was dependent on the medication, had been taking more than prescribed, and would run out of her medication before it was time, which was a problem. The plan was to send her to a geriatric behavioral unit to detox so she could be titrated off lorazepam under medical supervision. She agreed and went, and once she returned to the office for a follow-up visit, she was now only taking half of what she had previously been prescribed as they were unsuccessful in having her entirely off of lorazepam; however, it was a step in the right direction. 

Unfortunately, she reverted to her old ways and began abusing lorazepam once again and suffered a traumatic fall leaving her with a brain bleed, later passing away. According to the American Geriatric Beers Criteria, lorazepam is not an appropriate medication for the geriatrics population due to its central nervous system suppression and increased risk of instability related to falls (Ghiasi, Bhansali, & Marwaha, 2023). An alternative care plan may have made a difference in this patient’s life, such as using an SSRI combined with venlafaxine. 

Venlafaxine is commonly used for GAD and panic disorders; as I recall, she would call the office several times a day in a panic state. These medications and cognitive behavioral therapy could have produced a better outcome. In conclusion, lorazepam should have never been prescribed to this patient due to physiological factors associated with her age.

References

Ghiasi, N., Bhansali, R. K., & Marwaha, R. (2023). Lorazepam. StatPearls.

Melaragno, A. J. (2021). Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance. Focus, 19(2), 143-263.

Rosenthal, L. D., & Burcham, J. R. (2021). Lehne’s Pharmacothe

NURS 6551 Week 5 Assignment 2: Journal Entry #1

Assignment 2: Journal Entry #1

On any given day, a nurse can play a pivotal role in someone’s life. Experienced nurses often share stories of previous experiences and draw upon these experiences when circumstances warrant.

Hence, reflection can be a valuable tool. It serves as a tool for not only recalling experiences but also for applying lessons learned from those experiences. Keeping a nursing journal provides these benefits and more.

To prepare for NURS 6551 Week 5 Assignment 2: Journal Entry #1:

• Refer to the current Clinical Guidelines found in this week’s Learning Resources and consider how these guidelines inform your clinical experience.
• Refer to your FNP or AGPCNP Clinical Skills and Procedures Self-Assessment Form you submitted in Week 1, and consider how your self-assessment might inform your Assignment.
• Refer to your Patient Log in Meditrek and reflect on Weeks 1–5 of your clinical experience. Consider your observations and experiences with patients during this time.

Journal Entry #1 (450–500 words):

In your journal entry, answer the following questions:

Learning from Experiences

Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each.

• What did you learn from this experience?
• What resources did you have available?
• What evidence-based practice did you use for this patient?
• What new skills are you learning?
• What would you do differently?
• How are you managing patient flow and volume?
• Communicating and Feedback

Respond to the following reflective questions:

• How might I improve on my skills and knowledge, and how to communicate that back to my Preceptor?
• How am I doing? What is missing?
• What type of feedback am I receiving from my Preceptor?

NURS 6551 Week 5 Assignment 2: Journal Entry #1 Instructions

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized NURS 6551 Week 5 Assignment 2: Journal Entry #1.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page NURS 6551 Week 5 Assignment 2: Journal Entry #1. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Journal Entry #2: Most Challenging Patient Encounter

Case 1: A Rape Victim

The most challenging patient encounter in my experience was a thirteen-year old rape victim. The resources I used for handling this case were Rape, Abuse & Incest National Network (RAINN), National Sexual Violence Resource Center (NSVRC), Sexual Assault Awareness (SAA) and SafeBAE (Before Anyone Else). The physical, emotional and psychological implications of rape on the victim cannot be overlooked. Gynecological complications related to rape include vaginal infection and bleeding, fibroids, genital irritation, diminished sexual desire, urinary tract infections and chronic pelvic pain (Bates, 2017). Moreover, victims of physical and sexual abuse suffer more adverse effects compared to victims of sexual violence alone.

Regarding evidence-based practice, I applied emerging approaches in trauma therapy. First, cognitive processing therapy is a principal component of the practice, owing to the mental and emotional trauma the victims experience. The skills am acquiring currently are establishing trust and rapport, providing strict patient confidentiality, approaching the client in non-judgmental perspectives, encouraging verbalization and explaining the signs or symptoms the victim may experience in the short-term and long-term (Strunk, 2017).

Several areas exist that I would do differently. In approaching the client from non-judgmental perspectives, I would avoid expression of emotions such as horror, disbelief or disgust that could create a mental-emotional barrier. Also, I would apply words such as reported instead of alleged, declined instead of refused and penetration instead of intercourse.

The management of patient flow and volume was possible via incorporation of a multidisciplinary team. On documentation, the nurse took the vital signs for each client, after which the client proceeded to the clinician’s office for consultation. During consultation, the clinician conducted a physical examination on the client and performed a high-vaginal swab that was sent to the laboratory for microscopic, biochemical and genetic analysis. While one client was being checked for vital signs, another was doing consultation at the clinician’s office while yet another was having her samples being analyzed at the laboratory.

The significance of communication and feedback cannot be overemphasized. During an encounter with the victim, I applied both verbal and non-verbal cues of communication, including maintenance of proper eye contact, observing the client’s postures, gestures and facial expressions, noting the intonation and using the therapeutic conversation (Vrees, 2017). Also, I ensured patient education took place effectively by asking a few questions after the talk to confirm comprehension.

Several options are available for improving on my skills and knowledge. First, attending seminars and workshops of sexual and domestic violence would boost my expertise in handling the victims. Also, practicing under supervision of sexual assault specialists would be resourceful. This information could be communicated to my Preceptor via an email detailing the requirements.

A relevant PowerPoint presentation could be attached to the email. The current feedback from my Preceptor is encouraging; that my progress is commendable. Nonetheless, I need improvement in communicating with rape victims, particularly how to get emotionally involved in the conversation and how to more effectively apply the cognitive processing therapy. I also need exposure to a client with rape trauma syndrome to be competent in managing the syndrome.

References

• Bates, C. K. (2021). Evaluation and management of adult and adolescent sexual assault victims. Accessed February 2021 from https://www.uptodate.com/contents/evaluation-and-management-of-adult-and-adolescent-sexual-assault-victims
• Strunk, J. L. (2017). Knowledge, attitudes, and beliefs of prenursing and nursing students about sexual assault. Journal of Forensic Nursing, 13(2), 69-76. https://doi.org/10.1097/jfn.0000000000000152
• Vrees, R. A. (2017). Evaluation and management of female victims of sexual assault. Obstetrical & Gynecological Survey, 72(1), 39-53. https://doi.org/10.1097/ogx.0000000000000390

Case 2: Diabetic Foot Care

The lessons learnt from foot care of persons with diabetes include identification of the at-risk foot, regular inspection and examination of the at-risk foot, education of the patient, family and healthcare providers, routine wearing of appropriate footwear and treatment of pre-ulcerative signs. The afore-mentioned were the preventive measures for foot problems in diabetics (Armstrong, Boulton & Bus, 2017). The resources for this case were the New England Journal of Medicine, the Annals of New York Academy of the Sciences, and the Association of South East Nations Management of Diabetic Foot Wounds. The evidence-based practice studies consisted of Cochrane reviews pertaining to diabetic foot ulcers, some of which directed the international guidelines. The reviews analyzed several reports on foot care in persons with diabetes and compared to the International Working Group on the Diabetic Foot to provide guidance in scenarios devoid of expert advice.

New skills learnt in the diabetic foot case are as follows: relieving the pressure while protecting the ulcer, restoring the skin perfusion, treating any underlying infection and improving the metabolic control while treating existent co-morbidities. Also, local wound care approaches, educating the patient and relatives; and measures to prevent recurrence were learned (Everett & Mathioudakis, 2018). In my opinion, I would do several things differently. First, in relieving the pressure, I would recommend the non-removable casts as recent evidence proves them to be more effective than dressings alone or removable casts. Also, in treating infections, I would begin with a broad-spectrum antibiotic before the definitive cause of the infection is identified by laboratory culturing, microscopic and biochemical analysis. Once the results are available, I would start the patient on medication which is specific for the identified organism, to provide optimum treatment and more efficacious effects.

The management of patient flow and volume was also challenging. Nonetheless, I achieved by integrating a mutli-disciplinary team that attended to different aspects of patient needs at particular times. For instance, while one patient was undergoing the consultation process with the clinician, I took the vitals: blood pressure, temperature and pulse rate for another patient. At the same time, another patient was having his random blood glucose being tested while yet another patient with a diabetic foot ulcer was having a sample of the ulcer taken for microscopy, culture and biochemical analysis.

The importance of appropriate communication and feedback cannot be overlooked. I practiced communication skills by maintaining appropriate eye contact with the patient, assessing the non-verbal cues of communication such as facial expression, posture and gestures and engaged in therapeutic conversation. Also, I educated the patient and family on the measures of preventing diabetic foot ulceration.

Improving my skills and knowledge would be possible via attending seminars and workshops relating to diabetes and diabetic foot ulcer. Also, working closely with diabetic foot ulcer specialists would prove to be resourceful, besides reviewing emerging studies pertaining to the presentation, complications and care of diabetic wounds (Nather et al., 2015). These perspectives could be communicated to my Preceptor through a formal email with an attached presentation of the subject.  At the moment, I am actively analyzing recent trends and international guidelines on management of diabetic wounds. My Preceptor is providing trustworthy feedback that my learning process is commendable. However, the feedback also points out other areas that I need to improve on such as patient motivation and what details to include or exclude in patient education.

References

• Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 376(24), 2367-2375. https://doi.org/10.1056/nejmra1615439
• Everett, E., & Mathioudakis, N. (2018). Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences, 1411(1), 153. https://doi.org/10.1111/nyas.13569
• Nather, P.A., Soegondo, D.S., Adam, D.J.M.F., Nair, D.H.K.R., Zulkilfly, D.A.H., Villa, D.M.A.A., Tongson, D.L.S., Yeng, D.B.C.S., Wijeyaratne, P.M., Somasundaram, D.N., Mutirangura, D.P. & Chuangsuwanich, D.A. (2015). Best practice guidelines for ASEANPlus: Management of diabetic foot wounds. Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 5(1), 1–37. DOI: http://doi.org/10.4038/sjdem.v5i1.7277

NURS 6630 Mid Term Exam Solved Questions 1 to 10

Question 1 2 pts

Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY.

Group of answer choices

Ibuprofen – decrease lithium levels

Hydrochlorothiazide – decrease lithium levels

Naproxen – increase lithium levels

Chlorthalidone – increase lithium levels

Question 2 2 pts

M. M. is 27-year-old female student pharmacist who presents to the ER after experiencing extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and HR of 45. What medication below is likely the cause of these symptoms?

Group of answer choices

Tranylcypromine

Clonazepam

Propranolol

Fluoxetine

Question 3 2 pts

K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T. states the new medication has been helping a lot but worries about all the side effects that come with it. She wants to discontinue the medication. What is the appropriate next step to help K. T.?

Group of answer choices

A. Inform her that the therapy is working and there is no need to discontinue.

B. Begin a slow taper of clonazepam and talk about alternative medications to help with her new diagnosis.

C. Discontinue clonazepam at this visit and begin Escitalopram 5 mg daily.

D. Change her scheduled dosing to as needed to help with anxiety symptoms.

Question 4 2 pts

The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized?

Group of answer choices

Locus Coeruleus

Raphe Nuclei

Nucleus Basalis

Substantia Nigra

Ventral Tegmental Area

Also Read:

NURS 6630 Week 3 Quiz Which Neurotransmitter is Considered the Major Excitatory Neurotransmitter?

NURS 6630 Week 2 Explain the Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents

Question 5 2 pts

John presents with both autonomic symptoms and physical hyperarousal after abruptly stopping his chronic opioid therapy. He claims that he is afraid of taking his medication because of what he is seeing on the news regarding opioid-related deaths. You know that John is experiencing symptoms due to an increase in norepinephrine. You decide to treat John with a medication to dampen the symptoms of opioid withdrawal. Which medication do you prescribe John?

Group of answer choices

Duloxetine

Clonidine

Diphenhydramine

Zolpidem

Question 6 2 pts

You have been consulted to evaluate a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you recommend as first-line?

Group of answer choices

A. Fluoxetine

B. Atomoxetine

C. Nortriptyline

D. Imipramine

Question 7 2 pts

Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder?

Group of answer choices

Psychosis

Grandiose

Distractible

Flight of ideas

Question 8 2 pts

Jamie has major depressive disorder and you decide to prescribe an SSRI. Jamie wants to make sure her medication is covered by her insurance plan. You review a list of SSRIs and notice that one medication listed on the list is not FDA-approved for the treatment of depression. Which of the following medications do you decide to NOT prescribe for Jamie’s depression?

Group of answer choices

citalopram

fluoxetine

fluvoxamine

paroxetine

Question 9 2 pts

A 23-year-old female was just diagnosed with major depressive disorder and is being started on escitalopram 10 mg daily. The patient should be counseled about which Black Box warning?

Group of answer choices

Myocarditis

Sexual dysfunction

Decreased seizure threshold

Suicidal thinking and behavior

Question 10 2 pts

Close-ended questions will help identify when patients are taking medications incorrectly.

Group of answer choices

True

False

NURS 6630 Mid Term Exam Solved Questions 11 to 20

Question 112 pts

M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the following would be a first-line treatment option for M. B.?

1. Duloxetine
2. Quetiapine
3. Diazepam
4. Escitalopram

Group of answer choices

I only

II only

IV only

I and III

I and IV

Question 122 pts

Which of the following disease states contributes to a greater risk for substance use, violence, and victimization as well as worse overall quality of life?

Group of answer choices

Parkinson’s Disease

Multiple Sclerosis

Schizophrenia

Major depressive disorder

Question 132 pts

Which of the following syndromes is characterized by disorientation + confusion, agitation, fever, diarrhea, and ataxia? This syndrome can occur when an MAOI is given with an SSRI

Group of answer choices

Neuroleptic Malignant syndrome

Serotonin syndrome

ICU delirium

Toxic encephalopathy

Question 142 pts

Which neurotransmitter is considered the major inhibitory neurotransmitter?

Group of answer choices

Glutamate

Glycine

GABA

Acetylcholine

Question 152 pts

A 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar disorder and was previously prescribed valproic acid by another doctor. What is your concern with this medication in this specific patient?

Group of answer choices

The drug causes weight gain, therefore, I would likely not want patient on it for her disease state.

This drug is safe to use by this patient.

This drug is used more for seizures than bipolar disorder, therefore, I would want to look at other options first.

This drug is a teratogen, therefore, I would need to counsel on avoidance of this medication while trying for a baby, and to follow-up with the doctor who prescribed it.

Question 162 pts

Austin is one of your clients and he asks you why exercise makes him feel better and lifts his mood. You tell him that his body is releasing _____________ which you know is a naturally occurring _______________. 

Group of answer choices

Histamine; peptide

Acetylcholine; peptide

Adrernocorticotropic hormones; monoamine

Endorphins; peptide

Question 172 pts

Of the following medications used in the treatment of social anxiety disorder, which one would you AVOID in a patient who has uncontrolled hypertension?

Group of answer choices

Citalopram

Lorazepam

Phenelzine

Atenolol

Question 182 pts

It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of an acute manic episode in bipolar disorder.

Group of answer choices

True

False

Question 192 pts

A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and has now spread to covering her whole body. She has a past medical history significant for type 2 diabetes, hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be causing this severe rash?  

Group of answer choices

Ziprasidone

Quetiapine

Risperidone

Lamotrigine

Question 202 pts

An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of the following medications, which one is likely contributing to these side effects?

Group of answer choices

Escitalopram

Duloxetine

Bupropion

Nortriptyline

NURS 6630 Mid Term Exam Solved Questions 21 to 30

Question 21 2 pts

Which of the following is an appropriate strategy for managing treatment-resistant depression?

Group of answer choices

Switch from one SSRI to another SSRI

Switch from one SSRI to a SNRI

Combine two antidepressants with different mechanisms of action

Augment with lithium

Any of the above would be an appropriate strategy

Question 222 pts

You are currently evaluating a patient with major depressive disorder. One of his major complaints is insomnia. He states that he is awake all night and cannot get any rest. You decide to prescribe an antidepressant that will help his depression and his insomnia. The best option is _______________.

Group of answer choices

Trazodone

Fluoxetine

Temazepam

Phenelzine

Question 232 pts

What is the strongest established risk factor for bipolar disorder?

Group of answer choices

Being diagnosed with ADHD as a child

Family history of bipolar disorder

Male > female

Being diagnosed with Major Depressive Disorder

Question 242 pts

Which answer choice includes all the components of patient-focused interventions to enhance adherence?

1. Education
2. Motivation
3. Skills
4. Logistics

Group of answer choices

I, II, and III only

I, II, III, and IV

II and III only

I and IV only

Question 252 pts

Choose the appropriate pair regarding acetylcholine receptors.

Group of answer choices

Nicotinic – ion; muscarinic – ion

Nicotinic – G-protein; muscarinic – ion

Nicotinic – G-protein; muscarinic – G-protein

Nicotinic – ion; muscarinic – G-protein

None of the above is correct

Question 262 pts

Alprazolam, phenobarbital, and alcohol all bind allosterically to GABAA receptors. What occurs to the GABAA receptor when these substances bind to the receptor?

Group of answer choices

The receptor’s sensitivity to GABA decreases

The receptor becomes more sensitive to GABA

The substance prevents GABA from binding to the receptor

Nothing occurs since the substances mentioned do not bind to the GABAA receptor

Question 272 pts

Glia cells play a supportive role in the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia or macroglia. Of the macroglia cells, which one plays a role in myelinating axons, which may contribute to mood disorders if altered?

Group of answer choices

Astrocytes

Oligodendrocytes

Schwann cells

Ependymal cells

Question 282 pts

R.J. never felt relief from his depressive symptoms, even after appropriate time and dose titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today. He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.” Because he is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy?

Group of answer choices

? 12 months

3 months

? 6 months

4–12 weeks

Question 292 pts

Which one of the anticonvulsants mentioned below has sufficient data to support its use in bipolar disorder?

Group of answer choices

Gabapentin

Zonisamide

Pregabalin

Carbamazepine

Question 302 pts

Which of the following medications used for treatment of bipolar disorder may increase stroke risk among older patients, particularly those with dementia?

Group of answer choices

Carbamazepine

Lithium

Bupropion

Olanzapine

NURS 6630 Mid Term Exam Solved Questions 31 to 40

Question 312 pts

Which amino acid is involved in the synthesis of both norepinephrine and dopamine?

Group of answer choices

Tyrosine

Glutamic acid

Tryptophan

Phenylalanine

Question 322 pts

A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and nervousness. He wishes to stop this medication due to side effects. What do you recommend?

Group of answer choices

Taper Paroxetine over 2–4 weeks and then he can switch to another antidepressant, such as fluoxetine.

Continue for 2 more weeks so the therapy can be considered adequate before discontinuing.

Switch to Bupropion 150 mg daily.

Do not restart the medication because this is considered treatment failure and another antidepressant should be started right away.

Question 332 pts

Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why?

Group of answer choices

Valproate, because it is only used in the treatment of acute manic episodes.

Lithium, because it is only used in the treatment of acute manic episodes.

Venlafaxine, because it can possibly increase frequency of mood episodes.

Lamotrigine, because it is only used in initial treatment of bipolar depression, but not maintenance.

Question 342 pts

Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)?

1. Nortriptyline
2. Citalopram
3. Duloxetine
4. Fluoxetine
5. Venlafaxine

Group of answer choices

i, iii, and v only

iii and v only

i only

ii and iv only

i, ii, iii, iv, and v

Question 352 pts

Which anticonvulsant below induces its own metabolism over time?

Group of answer choices

Lamotrigine

Gabapentin

Valproate

Carbamazepine

Question 362 pts

Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-resistant depression?

Group of answer choices

Sertraline + Bupropion

Fluoxetine + Citalopram

Desvenlafaxine + Bupropion

Fluoxetine + Mirtazapine

Question 372 pts

Of the following medications, which ones are considered first-line in treatment of an acute manic episode of bipolar disorder (assuming monotherapy)?

1. Lithium
2. Fluoxetine
3. Aripiprazole
4. Risperidone
5. Ziprasidone
6. Venlafaxine
7. Quetiapine
8. Valproate

Group of answer choices

II, III, and VIII only

I, III, IV, V, VII, and VIII only

II, III, and VI only

I only

All that are listed are appropriate in treating the acute episode.

Question 382 pts

Choose the appropriate statement regarding lamotrigine dosing.

Group of answer choices

If adding carbamazepine decrease lamotrigine dose

If adding valproic acid decrease lamotrigine dose

If adding carbamazepine no dose change is needed

If adding valproic acid no dose change is needed

Question 392 pts

Scott is a 70-year-old man that is taking citalopram 40 mg daily. You discuss changing citalopram to another medication or decreasing the dose. He is hesitant to change medications since citalopram works for him. You end up decreasing his dose to 20 mg/day. He asks why you are wanting to change his medication or lower his dose. Which of the following reasons is the main reason you made the decision to decrease his dose.

Group of answer choices

doses above 40 mg/day increases the patient’s risk of sexual dysfunction

you want to save the patient money since higher doses are not typically covered by the patient’s insurance plan

a maximum daily dose of 20 mg is recommended in patients > 60 years of age due to the risk of QT prolongation

doses above 20 mg can cause insomnia

Question 402 pts

Which medication has been studied and recommended in patients with a social anxiety disorder who also suffer from an alcohol use disorder?

Group of answer choices

Citalopram

Paroxetine

Sertraline

Sertraline

NURS 6630 Mid Term Exam Solved Questions 41 to 50

Question 41 2 pts

Is this a TRUE or FALSE statement? The following patient case is considered an example of treatment-resistant depression.

B. B. is a 26-year old-female at your clinic today with the diagnosis, “treatment-resistant depression.” She is currently on Bupropion 300 mg daily and has been at this dose for 6 weeks with no alleviation in depressive symptoms.

She has trialed the following medications in the past with treatment duration listed:

– Paroxetine 40 mg daily for 6 weeks

– Citalopram 20 mg daily for 2 weeks

Group of answer choices

True

False

Question 422 pts

In order for the NMDA receptor to fully open and allow an influx of calcium, both glutamate and glycine must bind to cause a depolarization of the cell that will ultimately displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor?

Group of answer choices

Sodium – ionotropic

Sodium – metabotropic

Magnesium – metabotropic

Magnesium – ionotropic

Question 432 pts

Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin-norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder?

Group of answer choices

Symptom remission is expected within 1 week.

Symptoms may worsen initially with SSRI treatment.

They are considered second-line therapy.

Start at the usual starting dose that is consistent with depression treatment.

Question 442 pts

What is the therapeutic plasma level of carbamazepine?

Group of answer choices

4 to 12 µg/mL

4 to 12 mg/mL

0.8–1.2 mEq/mL

0.6 to 0.8 mEq/L

Question 452 pts

A patient presents to your clinic with generalized anxiety disorder. Her past medical history is significant for type II diabetes and uncontrolled hypertension. Which of the following agents would be least appropriate to start her on?

Group of answer choices

sertraline

paroxetine

venlafaxine

citalopram

Question 462 pts

Ronnie presents to your clinic with tremor, bradykinesia, and rigidity. The symptoms are very similar to what you would see in a patient with Parkinson’s disease. The client was prescribed risperidone several weeks ago. What is the reason for Ronnie’s symptoms?

Group of answer choices

Risperidone blocks dopamine receptors in the striatum

Risperidone increases dopamine concentrations in the striatum

Risperidone blocks serotonin receptors in the striatum

Risperidone increases serotonin concentrations in the striatum

Question 472 pts

Choose the correct option regarding the major classes of GABA receptors and the ions involved in inhibition of the neurotransmitter pathway

Group of answer choices

GABAA – ionotropic – calcium and potassium

GABAB – ionotropic – chloride

GABAB – metabotropic – Calcium and potassium

GABAA – metabotropic – chloride

Question 482 pts

K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic response?

Group of answer choices

2–4 weeks

4–12 weeks

? 6 months

? 1 week

Question 492 pts

Patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He reports starting lithium 600 mg at bedtime about 5 days ago and thinks that may be the cause. What is the appropriate next step for this patient?

Group of answer choices

Start propranolol for the tremor.

Tell patient to cut dose in half to stop the tremor.

Verify labs to determine appropriate lithium level.

Tell patient to discontinue the medication all together due to lithium toxicity.

Question 502 pts

When initiating lithium, how long should you wait before checking a lithium level? What is the therapeutic goal level of lithium?

Group of answer choices

5 days; 0.6 to 0.8 mEq/L

4–6 weeks; 0.6 to 0.8 mEq/L

3 days; 0.8 – 1.2 mEq/L

No need to check until patient experiences symptoms of lithium toxicity

Question 510 pts

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Group of answer choices

True

False