Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
An 83-year-old man presents to the community behavioral health clinic, where he is diagnosed with Alzheimer's disease by the PMHNP. He currently smokes two packs of cigarettes a day and declines help with smoking cessation. Which medication for Alzheimer's disease is contraindicated in this patient due to smoking status?
A. None
"None" is incorrect because certain medications can interact with metabolic pathways affected by smoking.
B. Galantamine (Razadyne)
Galantamine is metabolized by the CYP1A2 enzyme, which is induced by smoking. This induction can reduce therapeutic levels of the drug, potentially making it less effective or requiring dose adjustment, thus contraindicating its use without careful monitoring.
C. Donepezil (Aricept)
Donepezil is metabolized primarily by CYP2D6 and CYP3A4 and is not significantly affected by smoking; it remains safe for use in smokers.
D. Rivastigmine (Exelon)
Rivastigmine is metabolized by esterases, not CYP enzymes, so smoking does not alter its metabolism, making it safe in this patient.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: "None" is incorrect because certain medications can interact with metabolic pathways affected by smoking.
Choice B reason: Galantamine is metabolized by the CYP1A2 enzyme, which is induced by smoking. This induction can reduce therapeutic levels of the drug, potentially making it less effective or requiring dose adjustment, thus contraindicating its use without careful monitoring.
Choice C reason: Donepezil is metabolized primarily by CYP2D6 and CYP3A4 and is not significantly affected by smoking; it remains safe for use in smokers.
Choice D reason: Rivastigmine is metabolized by esterases, not CYP enzymes, so smoking does not alter its metabolism, making it safe in this patient.
Similar Questions
Based on her understanding of the etiologic risk factors for Parkinson’s disease, the PMHNP asks about family history and:
A. History of heavy drinking
Heavy alcohol consumption has not been consistently linked to an increased risk of Parkinson’s disease and is not considered a primary etiologic factor.
B. History of smoking
Smoking has actually been associated with a lower risk of developing Parkinson’s disease in epidemiological studies, possibly due to neuroprotective effects of nicotine.
C. Exposure to environmental toxins
Exposure to environmental toxins, such as pesticides or herbicides, is a recognized risk factor for Parkinson’s disease. These toxins can cause dopaminergic neuron damage, contributing to disease development.
D. Early childhood hypoxia
Early childhood hypoxia may contribute to neurological vulnerabilities but is not a primary recognized risk factor for Parkinson’s disease.
Full Explanation
Choice A reason: Heavy alcohol consumption has not been consistently linked to an increased risk of Parkinson’s disease and is not considered a primary etiologic factor.
Choice B reason: Smoking has actually been associated with a lower risk of developing Parkinson’s disease in epidemiological studies, possibly due to neuroprotective effects of nicotine.
Choice C reason: Exposure to environmental toxins, such as pesticides or herbicides, is a recognized risk factor for Parkinson’s disease. These toxins can cause dopaminergic neuron damage, contributing to disease development.
Choice D reason: Early childhood hypoxia may contribute to neurological vulnerabilities but is not a primary recognized risk factor for Parkinson’s disease.
A 13-year-old girl begins to have episodes of temper outbursts that are out of proportion to the situation. Which of the following is a possible diagnosis?
A. Bipolar disorder
Bipolar disorder involves mood swings between mania and depression, but frequent temper outbursts that are persistent and disproportionate are more characteristic of disruptive mood dysregulation disorder than classic bipolar episodes.
B. Disruptive mood dysregulation disorder
Disruptive mood dysregulation disorder is defined by severe, recurrent temper outbursts that are inconsistent with developmental level, occurring frequently over time. This diagnosis accounts for chronic irritability and is appropriate for this patient’s presentation.
C. Schizophrenia
Schizophrenia involves psychotic symptoms such as delusions and hallucinations and does not typically present with recurrent temper outbursts alone.
D. Brief psychotic disorder
Brief psychotic disorder involves sudden onset of psychotic symptoms that last less than one month, which does not align with chronic temper outbursts.
Full Explanation
Choice A reason: Bipolar disorder involves mood swings between mania and depression, but frequent temper outbursts that are persistent and disproportionate are more characteristic of disruptive mood dysregulation disorder than classic bipolar episodes.
Choice B reason: Disruptive mood dysregulation disorder is defined by severe, recurrent temper outbursts that are inconsistent with developmental level, occurring frequently over time. This diagnosis accounts for chronic irritability and is appropriate for this patient’s presentation.
Choice C reason: Schizophrenia involves psychotic symptoms such as delusions and hallucinations and does not typically present with recurrent temper outbursts alone.
Choice D reason: Brief psychotic disorder involves sudden onset of psychotic symptoms that last less than one month, which does not align with chronic temper outbursts.
A 22-year-old Asian man has been diagnosed with a seizure disorder. Prior to initiating treatment with an anticonvulsant, what should his nurse practitioner consider?
A. Obtain a complete blood count (CBC), thyroid studies, and HbA1c
CBC, thyroid studies, and HbA1c are not standard pre-treatment requirements for anticonvulsants unless indicated by comorbid conditions.
B. Obtain a CSF analysis, urinalysis, electrolyte level, glucose level
CSF analysis and urinalysis are typically reserved for diagnostic workup of seizures, not pre-treatment pharmacogenomic risk assessment.
C. Obtain a pharmacogenomic profile to determine if he has one of the HLA alleles that make him more susceptible to Stevens-Johnson syndrome
Certain anticonvulsants, such as carbamazepine, carry a risk of severe cutaneous reactions like Stevens-Johnson syndrome. Individuals of Asian descent may carry HLA alleles (e.g., HLA-B*1502) that increase susceptibility. Screening reduces risk.
D. Refer to a psychiatrist to rule out factitious disorder
Referral to psychiatry is unnecessary unless there is suspicion of non-epileptic seizures; it is not a standard consideration prior to anticonvulsant initiation.
Full Explanation
Choice A reason: CBC, thyroid studies, and HbA1c are not standard pre-treatment requirements for anticonvulsants unless indicated by comorbid conditions.
Choice B reason: CSF analysis and urinalysis are typically reserved for diagnostic workup of seizures, not pre-treatment pharmacogenomic risk assessment.
Choice C reason: Certain anticonvulsants, such as carbamazepine, carry a risk of severe cutaneous reactions like Stevens-Johnson syndrome. Individuals of Asian descent may carry HLA alleles (e.g., HLA-B*1502) that increase susceptibility. Screening reduces risk.
Choice D reason: Referral to psychiatry is unnecessary unless there is suspicion of non-epileptic seizures; it is not a standard consideration prior to anticonvulsant initiation.