ANCC PMHNP Board Exam Questions and Answers: Mood Disorders, Exams of Nursing

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ANCC PMHNP BOARD EXAM QUESTIONS AND

ANSWERS WITH VERIFIED SOLUTIONS 100%

CORRECT

MOOD D/O:

MDD CRITERIA A - ANSWER A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood daily
2. Loss of pleasure of joy in activities/inerests
3. Significant weight loss/gain
4. insomnia/hypersomnia
5. fatigue or loss of energy daily
6. psychomotor retardationagitation
7. feelings of worthlessness or guilt
8. diminished ability to think/concentrate, indecisiveness
9. recurrent thoughts of death, SI, or SI attempt MOOD D/O: MDD CRITERIA B-E - ANSWER B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition. D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition. MOOD D/O: MDD PREVALENCE - ANSWER Twelve-month prevalence of major depressive disorder in the United States is approximately 7%, with marked differences by age group such that the prevalence in 18- to 29- year-old individuals is threefold higher than the prevalence in individuals age 60 years or older. Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence. MOOD D/O: MDD DEVELOPMENT AND COURSE - ANSWER - Recovery typically begins within 3 months of onset for two in five individuals with major depression and within 1 year for four in five individuals.

• The risk is higher in individuals whose preceding episode was severe,

in younger individuals, and in individuals who have already experienced multiple episodes.

• The persistence of even mild depressive symptoms during remission is a powerful predictor of recurrence. MOOD D/O: MDD RISK FACTORS - ANSWER - Neuroticism (negative affectivity) is a well-established risk factor for the onset of major depressive disorder
• Adverse childhood experiences, particularly when there are multiple experiences of diverse types, constitute a set of potent risk factors for major depressive disorder.
• Stressful life events are well recognized as precipitants of major depressive episodes,but the presence or absence of adverse life events near the onset of episodes does not appear to provide a useful guide to prognosis or treatment selection.
• First-degree family members of individuals with major depressive disorder have a risk for major depressive disorder two- to fourfold higher than that of the general population.
• Relative risks appear to be higher for early-onset and recurrent forms. Heritability is approximately 40%, and the personality trait neuroticism accounts for a substantial portion of this genetic liability. MOOD D/O: PDD (DYSTHYMIA) DSM5 CRITERIA - ANSWER Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

B. Presence, while depressed, of two (or more) of the following:

1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness. C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent

depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode o MOOD D/O: DYSTHYMIA PREVALENCE - ANSWER The 12-month prevalence in the United States is approximately 0.5% for persistent depressive disorder and 1.5% for chronic major depressive disorder. MOOD D/O: DYSTHYMIA DEVELOPMENT COURSE - ANSWER Persistent depressive disorder often has an early and insidious onset (i.e., in childhood, adolescence, or early adult life) and, by definition, a chronic course. Among individuals with both persistent depressive disorder and borderline personality disorder, the covariance of the corresponding features over time suggests the operation of a common mechanism. Early onset (i.e., before age 21 years) is associated with a higher likelihood of comorbid personality disorders and substance use disorders. MOOD D/O: DYSTHYMIA RISK FACTORS - ANSWER - Factors predictive of poorer long-term outcome include higher levels of neuroticism (negative affectivity), greater symptom severity, poorer global functioning, and presence of anxiety disorders or conduct disorder.

• It is thus likely that individuals with persistent depressive disorder will have a higher proportion of first-degree relatives with persistent depressive disorder than do individuals with major depressive disorder, and more depressive disorders in general.

• A number of brain regions (e.g., prefrontal cortex, anterior cingulate, amygdala, hippocampus) have been implicated in persistent depressive disorder. Possible polysomnographic abnormalities exist as well. CN I - ANSWER olfactory-smell sensory CN II - ANSWER Optic - vision sensory CN III - ANSWER Oculomotor Nerve- Motor Controls eye movement, pupil constriction, & eyelid movement CN IV - ANSWER trochlear nerve-down and inward eye movement motor CN V - ANSWER trigeminal nerve-muscles of mastication; sensation of face, scalp cornea, mucus membranes and nose
• assess the face for strength and sensation sensory and motor CN VI - ANSWER abducens nerve-lateral eye movement

motor CN VII - ANSWER facial nerve-move face, close mouth and eyes, taste, saliva and tear secretion

• assess mouth for taste
• assess the face for symmetrical movement sensory and motor CN VIII - ANSWER acoustic sensory: hearing and equilibrium CN IX - ANSWER glossopharyngeal-PHONATION, GAG REFLEX CAROTID REFLEX SWALLOWING TASTE
• assess mouth for taste
• assess mouth for movement of soft palate and the gag reflex
• assess swallowing and speech sensory and motor CN X - ANSWER vagus-TALKING, SWALLOWING, GENERAL SENSATION FROM THE CAROTID BODY, CAROTID REFLEX
• assess mouth for movement of soft palate and the gag reflex
• assess swallowing and speech sensory and motor

CN XI - ANSWER spinal accessory-movement of trapezius and sternomastoid muscles

• assess the shoulders for strength motor CN XII - ANSWER hypoglossal-tongue movement motor UDS alcohol detection period - ANSWER 7 - 12 hrs UDS amphetamine detection period - ANSWER 24 - 48 hrs UDS barbiturates detection period - ANSWER 24 hrs: short acting 3 weeks UDS benzos - ANSWER 3 days or wks w/ heavy use UDS cannabis - ANSWER 3 days to 4 wks: depends on use UDS cocaine - ANSWER 6 - 8 hrs; metabolites 2 to 4 days UDS heroin - ANSWER 36 - 72 hrs UDS methadone - ANSWER 3 days

UDS Methaqualone mf quaaludes!!!!! - ANSWER 7 days UDS Morphine - ANSWER 46 - 72 HRS UDS - PCP - ANSWER 8 days CPK & AST often elevated UDS Propoxyphene - ANSWER 6 - 48 hrs CHILDREN: routine checkups - ANSWER Start: 1 to 2 weeks How often: every month x 4, 6, 9, 12, 15, 18, 24 mo, annually after 3 yrs CHILDREN: anemia - ANSWER 9 - 12 mo, as needed CHILDREN: blood test for lead - ANSWER 9 to 12 mo, annually after if in high risk area CHILDREN: UA - ANSWER age 5, as needed CHILDREN: BP - ANSWER age 3, annually CHILDREN: hearing and vision - ANSWER start:prior to discharge or 1 mo, prior to discharge and by 6 mo how often: annually at age 4/3, screen for strabismus btwn 3 and 5

Tanner Stage 1 (boys and girls) - ANSWER Boys: preadolescent testes, scrotum, penis Girls: preadolescent breasts Pubic hair: Preadolescent Tanner Stage 2 (boys and girls) - ANSWER Boys: Enlargement of scrotum, testes; scrotum roughens and reddens Girls: Breast buds w/ areolar enlargement Pubic hair: Sparse, pale, fine Tanner Stage 3 (boys and girls) - ANSWER Boys: Penis elongates Girls: Breast enlargement without separate nipple contour Pubic hair: Darker, increased amount, curlier Tanner Stage 4 (boys and girls) - ANSWER Boys: Penis enlarges in breadth and development of glans; rugae appear Girls: Areola and nipple project as secondary mound Pubic hair: Adult in character but not as voluminous Tanner Stage 5 (Boys and girls) - ANSWER Boys: Adult shape and appearance Girls: Adult breast; areola recedes, nipple retracts Pubic hair: Adult pattern Trust vs. Mistrust - ANSWER Erikson:

0 - 18 mo: If needs are dependably met, infants develop a sense of basic trust Failure: Difficult receiving and giving Autonomy vs. Shame and Doubt - ANSWER Erikson: 18 mo-3 yrs: Erikson's stage in which a toddler learns to exercise will and to do things independently; Goal: self-control, will power, control of body Failure: lack of self-confidence and rage against ones' self Initiative vs. Guilt - ANSWER Erikson: 3 - 6 yrs: Goal: to identify and direct his/her activities Failure: feelings of inadequacy and guilt Industry vs. Inferiority - ANSWER Erikson: 6 - 12 y.o. (school age): Goal: Self-confidence and peer recognition Failure: Low self-esteem and poor interpersonal relations identity vs. role confusion - ANSWER Erikson's stage during which teenagers and young adults search for and become their true selves 12 - 20 y.o. Failure: Lack of direction and confidence in self

schema (Piaget's theory of cognitive development) - ANSWER A mental structure of patterns and thinking assimilation (Piaget) - ANSWER Incorporating new information into current schemas according to new environmental stimuli perceived Accommodation (Piaget) - ANSWER adjusting to new information by creating new schemas Equilibrium (Piaget's Theory) - ANSWER symbiosis of sensory information and accumulated knowledge Equilibration (Piaget) - ANSWER search for mental balance between cognitive schemes and information from the environment sensorimotor stage (Piaget) - ANSWER 0 - 2 yrs

1. reflexive movements 2.understanding of action and result
2. differentiate self from other objects
3. hold mental image preoperational stage (Piaget) - ANSWER 2 - 7 yrs
4. Symbolic play and understanding
5. Only in present-no clear understanding of time
6. non-contested respect for authority

4. cannot distinguish real from fantasy Concrete Operational stage (Piaget) - ANSWER 7 - 12 years Understanding of concrete relationships (math and quantity); development of conservation (knowing changes in shape are not changes in volume), spacial relationships, think about past and present, begins to value others Formal Operational stage (Piaget) - ANSWER 11 - 15+ y.o.
5. Future thinking
6. Abstract thinking
7. Complex problem solving Reflex: rooting and sucking - ANSWER Appears: Newborn Disappears: 3-4 mo Reflex: Moro (startle) - ANSWER Appears: Newborn Disappears: 3-4 mo Elicit by striking a flat surface while infant is lying or allow head and trunk to fall backward to an angle of 30. Reaction: infants arms and legs symmetrically extend and then abduct while her fingers spread to form a C shape. Grasp (palmar, plantar) reflex - ANSWER Appears: Newborn Disappears: 3-6 mo; 4 mo

Pacing/stepping reflex - ANSWER appears: Newborn disappears 1-2mo Hold baby upright w/hand across chest - baby steps Tonic neck reflex (fencer position) - ANSWER BIRTH TO 3 or 4 MONTHS Turn newborn head turned to the right: Right arm/leg EXTEND Left arm/leg flex Turn newborn head to the left: Left arm/leg EXTEND Right arm/leg flex Babinski reflex - ANSWER Appears: Newborn Disappears: 12 mo or when walking Reflex in which a newborn fans out the toes when the sole of the foot is touched cerebral cortex (cerebrum) - ANSWER - grey, wrinkled surface that is densely packed with neurons

• located in upper forebrain
• connections between neurons grow as we learn and develop
• surface is wrinkled to increase surface area (convolutions)
• 2 hemispheres

right hemisphere functions - ANSWER - Receives somatic sensory signals from and controls muscles on left side of body.

• Musical and artistic awareness
• Space and pattern perception
• Recognition of faces and emotional content of facial expressions
• Generating emotional (negative) content of language
• Generating mental images to compare spatial relationships
• processes interacting w/ the environment
• attention capacity
• intuition
• Identifying and discriminating among odors left hemisphere functions - ANSWER - sequential processing, analytic thought, logic, language, science and math
• positive emotions Microsystem - ANSWER direct patient care Macrosystem - ANSWER hospitals, skilled nursing facilities, clinics megasystem - ANSWER American Healthcare system Metasystem - ANSWER economic, political, social level of society

meta-analysis - ANSWER a scientific study that statistically analyzes a collection of quantitative studies; use statistics to discover patterns that would be otherwise undetectable Metasynthesis - ANSWER a scientific study that analyzes a collection of qualitative studies, summarize results in a narrative format systematic review - ANSWER scientific study that gathered multiple studies and analyze them to draw a large conclusion Medicare Part A - ANSWER coverage for hospitalizations (up to 90 days), skilled nursing facility (100 days), hospice (up to 6 mo for terminally ill), and some home health care Medicare Part B - ANSWER Coverage for ambulatory practitioner service; physical, occupational, and speech therapy; medical equipment; diagnostic tests; and some preventative care Medicare Part C (Medicare Advantage) - ANSWER • Replaces and covers expenses found in Part A and B •Medicare private fee-for-service plans (PFFS) •Medicare managed care plans (HMOs and PPOs) •Medicare specialty plans Medicare—Part D Prescription Drug Coverage - ANSWER - gives pt a discount 11 - 17% and not free drugs

• pay a premium and a copay

• optional coverage for outpt pharmaceuticals inferential statistics - ANSWER numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population examples: t-test, analysis of variance, Pearson's correlation, probability, p-value descriptive statistics - ANSWER numerical data used to measure and describe characteristics of groups. basic features of data in a study examples: mean, standard deviation, variance Aaron Beck - ANSWER pioneer in Cognitive Therapy. Suggested negative beliefs cause depression. Gerald Klerman and Myrna Weissman - ANSWER interpersonal therapy Sigmund Freud - ANSWER founder of psychoanalysis Carl Rogers - ANSWER person-centered therapy Humanistic; self-concept and unconditional positive regard drive personality Viktor Frankl - ANSWER existential therapy-encourages reflection on life and self-concentrafion durable power of attorney - ANSWER - a legal agreement that allows an agent or representative of the patient to act on behalf of the patient

• can cover physical, mental and terminal illnesses EMDR (eye movement desensitization and reprocessing) - ANSWER - created by Francine Shapiro having people imagine traumatic scents and using a finger to trigger eye movements Freud: Oral stage (birth to 1 year) - ANSWER Pleasure is focused on oral activities: feeding and sucking. Chewing, crying Failure=envy, excessive dependence on others, schizophrenia, substance abuse, paranoia Freud: Anal - ANSWER 1.5-3 yrs Sphincter control, expulsion and retention success=achieve autonomy and independence Failure=shame from loss of control depressive disorders Freud:Phallic Stage - ANSWER (3 to 6 yrs) Identification with parent of same sex; development of sexual identity; focus is on genital organs success=curiosity without embarrassment, mastery over impulses, sense of sexual identity Failure=sexual identity disorders Freud: Latency - ANSWER 6 - puberty Peer relationships, learning, motor skills, socialization

Failure=inability to socialize or form relationships, failure of interest to learn or work Freud: Genital - ANSWER Puberty on Integration and synthesis of behaviors from early stages (primarily general based sexuality) Failure=sexual perversion disorders neurological soft signs - ANSWER - dysdiadochokinesia (posterior lobe of cerebellum lesion) *can't complete rapid alternating movements

• astereognosis (lesion of parietal lobe)
• choreiform movements
• tics
• agraphesthesia (can't recognize letters/numbers drawn on hand)
• facial grimacing
• impaired fine motor skills
• abnormal blinking
• abnormal motor tone
• EPS MDD risk factors - ANSWER - genetic loading
• prior episode of MDD
• female
• postpartum period
• medical co-morbidity

• single
• significant environmental stressor, especially multiple losses MDD incidence - ANSWER Approximately 5% of U.S. population in 18+ 15% will die by suicide Beck Depression Inventory (BDI) - ANSWER The 21 symptoms and attitudes contained in the BDI reflect the intensity of the depression; items receive a rating of zero to three to reflect their intensity and are summed linearly to create a score which ranges from 0 to 63. The 21 items included reflect a variety of symptoms and attitudes commonly found among clinically depressed individuals scores from 0 through 9 indicate no or minimal depression; scores from 10 through 18 indicate mild to moderate depression; scores from 19 through 29 indicate moderate to severe depression; scores from 30 through 63 indicate severe depression. PHQ- 9 - ANSWER 0 - 27 5to 9=mild 10 - 14=moderate 15 - 19=mod severe 20+=severe Hamilton Depression Rating Scale (HDRS) - ANSWER In general the higher the total score the more severe the depression. HAM-D score level of depression: 10 - 13 mild; 14-17 mild to moderate; >17 moderate to severe. Assessment is recommended at two weekly intervals.

Symptoms of hypertensive crisis - ANSWER Sudden, explosive-like headache, usually in occipital region; increased BP, facial flushing, palpitations; pupillary dilation; diaphoresis and fever. Treatment of hypertensive crisis - ANSWER Dc MAOI give phentolamine-blocks norepinephrine Stabilize fever Reevaluate diet and adherence, reiterate med guidelines Tyramine - ANSWER A precursor to norepinephrine Indirectly acting sympathomimetic prototype: releases or displaces norepinephrine from stores in nerve endings. Usually inactive by the oral route because of high first pass effect but will cause potentially lethal hypertensive responses in patients taking MAO inhibitors Serotonin syndrome symptoms - ANSWER Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity Agitation Restlessness Rapid heart rate and elevated body Headache Diaphoresis, shivering, goosebumps Confusion, fever, seizures, unconscious

discontinuation syndrome - ANSWER a condition that can occur following the interruption, dose reduction, or discontinuation of antidepressant drugs, including selective serotonin re-uptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Flu like symptoms Fatigue and lethargy Myalgia Decreased concentration N/V Impaired memory Paresthesias Irritability, anxiety, insomnia Crying Dizziness and vertigo kindling - ANSWER - The process of neuronal membrane threshold sensitivity dysfunction

• brain is overly sensitive to electrical stimuli neuronal firing occurs even w/o stimuli bipolar disorder incidence and demographics - ANSWER 0.7% of general population affects 2.3 million American adults mean onset is early 20s

Ataques de nervios (Culture-bound syndromes) - ANSWER Latino cultural bound syndrome-Usually provoked by disruptions in family bonds and may have s/s of trembling,crying,and screaming Khyal attacks - ANSWER Wind attacks are a common manifestation among Cambodian and other Asian cultures, commonly manifest in neck soreness and tinnitus Anxiety incidence and demographics - ANSWER Lifetime prevalence of 29% in u.s. More common in women and girls Median age of onset=11 CIWAA SCORING - ANSWER 0 - 9=absent or very mild withdrawal 10 - 15=mild withdrawal 16 - 20=moderate withdrawal 21 - 67=severe withdrawal and possible DTs SLUMS exam; What is it and scoring - ANSWER 11 items measures cognition, including orientation, short term memory, calculations, naming of animals, clock drawing, geometric figures 27 - 30=normal in person w/ h.s. diploma 21 - 26=mild neurocognitive disorder 0 - 20=dementia

mood disorder questionnaire; what is it and scoring - ANSWER screens for bipolar d/o positive screen if: 7/13 yes responses in part I, yes to #2, and moderate or serious response to part 3 Hamilton Depression Rating Scale - ANSWER measures depression 0 to 76 very severe=>23 severe=19- 22 moderate=14- 18 mild=8- 13 none=0- 7 Beck Depression Inventory (BDI) - ANSWER a questionnaire useful for determining the level of depressive symptoms that a person is reporting 0 - 9: none 10 - 18: mild to mod 19 - 29:mod to severe 30 - 63:severe depression PHQ-9 (Patient Health Questionnaire) - ANSWER screens for depression 1 - 4=minimal depression 5 - 9=mild depression 10 - 14=mod depression 15 - 19=moderately severe

20 - 27=severe depression on old Olympus towering top a Finn and German viewed some Hops - ANSWER Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Glossopharyngeal Vagus Spinal Accessory Hypoglossal Gestalt therapy - ANSWER created by Frederick Perls has the goal of helping the client become aware of his or her thoughts, behaviors, experiences, and feelings and to "own" or take responsibility for them family systems theory - ANSWER Murray Bowen

• Triangles a theory that views the family as a system of interacting parts whose interactions exhibit consistent patterns and unstated rules