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Question 20
A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?
a) order herpes simplex virus (HSV) antibody testing
b) Order a blood urea nitrogen (BUN) and creatinine STAT
c) Prescribe lidocaine 5%
d) Prescribe hydromorphone (dilaudid) 2mg
Question 21
The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 
a) Increase the dose of lamotrigine (Lamictal) to 25mg twice daily
b) Ask if the pt has been taking the medication as prescribed
c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient
d) Order a CBC to assess for an infection
Question 22
An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do?
a) order an X-ray because it is possible that she dislocated her hip
b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon
c) Order naproxen because she may havarthritis and chronic pain is not uncommon
d) Order morphine and physical therapy
Question 23
The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 
a) Orders liver function tests
b) Educate the patient on avoiding grapefruits when taking this medication
c) Encourage this patient to keep fluids to 1500ml/day until the swelling subside
d) Order BUN/Creatinine test
Question 24
The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?
a) Prescribe estrin FE 24 birth control
b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain
c) Prescribe desvenlafaxine (Pristiq) 50mg daily
d) Prescribe Risperdal 2mg TID
Question 25
A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 
a) “the SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”
b) “the SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”
c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex”
d) “the SNRI can increase neurotransmission to descending neurons”
Question 26
A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 
a) Venlafaxine (Effexor)
b) Duloxetine (Cymbalta)
c) Clozapine (Clozaril)
d) Phenytoin (Dilantin)
Question 27
The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 
a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels
b) It will induce synaptic changes, including sprouting
c) It will act on the presynaptic neuron to trigger sodium influx
d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain
Question 28
Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? 
a) Venlafaxine (Effexor)
b) Armodafinil (Nuvigil)
c) Bupropion (Wellbutrin)
d) All of the above
Question 29
The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?
a) Methylphenidate (Ritalin)
b) Viloxazine (Vivalan)
c) Imipramine (Tofranil)
d) Bupropion (Wellbutrin)
Question 30
The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 
a) Pregabalin (Lyrica)
b) Duloxetine (Cymbalta)
c) Modafinil (Provigil)
d) Atomoxetine (Strattera)
Question 31
A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?
a) Pregabalin (Lyrica)
b) Gabapentin (Neurontin)
c) Duloxetine (Cymbalta)
d) B and C 
Question 32
The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?
a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog”
b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex
c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms
d) None of the above
Question 33
The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 
a) “SSRIs only increase norepinephrine levels” 
b) “SSRIs only increase serotonin levels”
c) “SSRIs only increase serotonin and norepinephrine levels”
d) “SSRIs do not increase serotonin or norepinephrine levels”
Question 34
A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 
a) Antipsychotics
b) Lithium
c) SSRI
d) Naltrexone
Question 35
Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 
a) “Naltrexone may be an appropriate option to discuss”
b) “there are many medicine options that treat Kleptomania”
c) “Kevin may need to be prescribed antipsychotics to treat this illness”
d) “Lithium has proven effective for treating kleptomania”
Question 36
Which statement best describes a pharmacological approach to treating patients for impulsive aggression?
a) Anticonvulsant mood stabilizers can eradicate limbic irritability
b) Atypical antipsychotics can increase subcortical dopaminergic stimulation
c) Stimulants can be used to decrease frontal inhibition
d) Opioid antagonists can be used to reduce drive
Question 37
A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?
a) It will prevent feelings of euphoria
b) It will amplify impulse control
c) It will block testosterone
d) It will redirect the patient to think about other things
Question 38
Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?
a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders”
b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences”
c) “When it comes to internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods”
d) “there are no evidence-based treatments for internet addiction, but there are behavioral therapies your daughter can try”
Question 39
Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction?
a) There is decreased activation of the prefrontal cortex
b) There is increased sensation of the reactive reward system
c) There is reduced activation of regions that process palatability
d) There are amplified reward circuits that activate upon consumption
Question 40
The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?
a) Histamine 2 receptor antagonist
b) Benzodiazepines
c) Stimulants
d) Caffeine 
Question 41
The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?
a) Avoiding prescribing the patient a drug that blocks H1 receptors
b) Prescribing the patient a drug that acts on H2 receptors
c) Stopping the patient from taking medicine that unblocks H1 receptors
d) None of the above

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