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A 63-year-old patient with schizophrenia presents with new-onset rigidity, bradykinesia, and a resting tremor after several months of treatment with a high-potency first-generation antipsychotic. Neurologic examination reveals impaired motor coordination and slowed voluntary movements. The PMHNP recognizes that these symptoms are related to dopamine blockade affecting a specific brain structure responsible for movement and coordination.Which of the following structures is primarily responsible for movement and coordination and is most affected by antipsychotic-induced dopamine antagonism in this patient?

Mr. R., a 36-year-old man, presents to your outpatient clinic seeking treatment for opioid dependence. He reports using 30–50 mg of oxycodone daily for the past two years following an injury, and has recently experienced withdrawal symptoms including rhinorrhea, myalgias, anxiety, insomnia, and abdominal cramps.He expresses motivation to stop but reports previous failed attempts “cold turkey,” citing intense cravings and restlessness. He denies polysubstance use, has stable housing, and works full-time. His urine drug screen is positive only for oxycodone, and LFTs are within normal limits.He states, “I don’t want to be high, I just don’t want to feel sick.”As the PMHNP, which of the following medications is most appropriate to initiate for this patient’s treatment?

A 34 year old female is diagnosed with bipolar 1 disorder is exhibiting severe manic behaviors. A PMHNP-BC prescribes lithium carbonate and olanzapine. The client’s spouse asks the PMHNP-BC how olanzapine works. Which is the appropriate nursing response

A 10 year old elementary school student is given a trial of methylphenidate for attention deficit hyperactivity disorder (ADHD) inattentive type. The dose is titrated appropriately by the psychiatrist, but the student continues to complain of the core symptoms of ADHD. The next medication to be tried should be______________________.

Mr. D., a 28-year-old man with schizophrenia, presents to the outpatient clinic after being discharged from an inpatient unit where he was treated with haloperidol 10 mg daily. He reports that his hallucinations and delusions have improved significantly, but he now feels “stiff,” has a “mask-like face,” and finds it hard to move his neck. On exam, he exhibits bradykinesia, rigidity, and mild resting tremor, consistent with drug-induced parkinsonism.He denies fever, confusion, or autonomic instability. Labs are normal.You decide to transition him to an antipsychotic with a lower risk of extrapyramidal side effects (EPS) while maintaining strong efficacy for both positive and negative symptoms.Which of the following antipsychotics would be most appropriate to initiate, and what pharmacologic mechanism explains its lower EPS risk?

Which pathway is responsible for positive symptoms?

A pregnant client reports to the clinic seeking a refill on her medications she has been noncompliant with for several of month. The PMHNP should refer the client to her OBGYN/Gynecologist.

Ms. R., a 29-year-old woman recently diagnosed with Bipolar I Disorder, is started on divalproex sodium (Depakote) for mood stabilization. During medication education, she asks, “How does this medication actually work to stabilize my mood?”As her PMHNP, you explain that valproate’s mood-stabilizing effects are related to its actions on neuronal excitability and neurotransmitter regulation.Which of the following best describes the mechanism of action of valproate?

You are the Family PMHNP-BC caring for Ms. Trottier who is in the office for a follow up appointment. Ms. Tottier has a medical history of epilepsy and hypertension.  In the prior visit, the client’s Effexor XR was increased to 150 mg daily for depressive symptoms. As the Family-PMHNP-BC for this patient, which of the following would you consider. Please choose the best option. 

Ropinirole is a dopamine agonists used to treat restless leg syndrome and does not cause somnolence or nausea.