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Maryville Nurs 663 Exam 2 UPDATED
ACTUAL QUESTIONS AND CORRECT
ANSWERS
Lithium labs - CORRECT ANSWER level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH bipolar meds: depression - CORRECT ANSWER lurasidone (13+), olanzapine + fluoxetine (10+)(symbyax) bipolar acute and mixed mania - CORRECT ANSWER aripiprazole, risperidone, olanzapine (13+), quetiapine (acute only), asenapine (10+) classic mood stabilizers - CORRECT ANSWER Lamotrigine (excellent medication to use), lithium, Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no evidence for true Bipolar disorder) anti-depressants - CORRECT ANSWER class not used w/bipolar disorder lithium - CORRECT ANSWER Anti-manic, antidepressant, anti-suicidal Lithium side effects - CORRECT ANSWER Frequent urination, increased thirst, weight gain, sedation lithium toxicity - CORRECT ANSWER sudden onset tremors, N/V/D, muscle weakness, slurred speech, confusion, seizures (slowing down, feel really out of it) Persistent Motor or Vocal Tic Disorder - CORRECT ANSWER pt in front of you only has one or the other but not both—they usually don't even know it is a tic, it is only meaningful if it's affecting their quality of life
Tourette's d/o - CORRECT ANSWER Multiple motor and at least one vocal tic (some tics come and go, they don't have them all at the same time to receive the diagnosis) HRT - CORRECT ANSWER habit reversal training can be used to manage tics Tics tx - CORRECT ANSWER Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt Developmental Coordination Disorder - CORRECT ANSWER a motor disorder characterized by marked impairment in the development of motor coordination; movement isn't consistent w/age Stereotypic Movement Disorder - CORRECT ANSWER a motor disorder characterized by repetitive, seemingly driven, and apparently purposeless motor behavior, such as hand waving or head banging, but not include ASD sx Specific Learning Disorders - CORRECT ANSWER difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities; dx by other professionals w/specialized training; NP tx comorbid d/o Anorexia nervosa - CORRECT ANSWER an eating disorder in which an irrational fear of weight gain leads people to starve themselves; restrictive or binge/purge/exercise Bulimia nervosa - CORRECT ANSWER an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise Binge-eating disorder - CORRECT ANSWER significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise
Major Depressive Disorder Dx - CORRECT ANSWER 5+ for at least a 2-week period; either #1 or 2 req
- Depressed mood most of the day, nearly every day (can be irritability in children & adolescents)
- Diminished interest or pleasure in all, or almost all, activities
- Change appetite/weight; kids not wt goals Insomnia or hypersomnia nearly every day
- Up or down Psychomotor
- Fatigue or loss of energy
- Worthlessness/excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness (don't confuse with ADHD, address mood first)
- Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2 wk not req. SLAP - CORRECT ANSWER Social supports; lethal; access to means; plan and previous attempt Suicide risk: IS PATH WARM - CORRECT ANSWER Ideation, substance abuse, purpose to live gone; anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reckless, dramatic moods SIGECAPS - CORRECT ANSWER Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide bipolar vs unipolar: look at bipolar if - CORRECT ANSWER 1. family hx: 1st degree relatives
- Substance use: chasing high or low
- Response to SSRI: no resp to multiple tries or evidence of mania with use (not diagnostic) coprolalia - CORRECT ANSWER involuntary utterance of obscenities or inappropriate remarks
Bipolar I criteria - CORRECT ANSWER One manic episode required Mania - CORRECT ANSWER elevated, expansive, energetic + 3, (unless irritable mood then requires 4+)
- SX Lastat least one week-any duration if hosp
- Inflated self-esteem, grandiosity
- Decreased need for sleep
- More talkative, pressure to keep talking
- Flight of ideas or racing thoughts
- Distractibility: r/o ADHD (constant) intermit w/BD
- Increase in goal-directed activity
- Risky, impulsive behaviors (sex, money, pot for harm) hypomania vs mania - CORRECT ANSWER a milder form of elevated mood that are less severe and cause less impairment than ______ and (usually) don't require hospitalization Mania impairment - CORRECT ANSWER severe in work, social activities, or relationships or to necessitate hosp or there are psychotic features Hypomania impairment - CORRECT ANSWER cause a change in functioning but not severe Mood disorder r/o - CORRECT ANSWER No symptoms can be due to a substance or general medical condition Most common anxiety disorder in children - CORRECT ANSWER separation anxiety disorder-per p 193 & 222 in DSM-V
SSRI mechanism of action - CORRECT ANSWER Blocking reabsorption / reuptake, of serotonin, leaves more serotonin available, which improves mood SNRI mechanism of action - CORRECT ANSWER Inhibit reuptake of both serotonin and norepinephrine Anti-depressant education - CORRECT ANSWER Always teach the Black Box warning for incr SI risk up to 24 y/o. Schizophrenia - CORRECT ANSWER a psychological disorder characterized by 2 of the following for at least 1 mo; must include at least one of first 3:
- delusions,
- hallucinations,
- disorganized speech
- Grossly disorganized/catatonic behavior
- diminished, inappropriate emotional expression
- IF have ASD or comm d/o then delu or hall a must bizarre delusions - CORRECT ANSWER clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences; do not play into delusions positive symptoms of schizophrenia - CORRECT ANSWER Delusions of reference, delusions of persecution, delusions of grandeur, thought broadcasting, though insertion, hallucinations, disorganized thought, disorganized behavior, catatonia negative symptoms of schizophrenia - CORRECT ANSWER Diminished emotions expression of face exp, eye contact, prosody, other non-verbal comm (hand, head, face movements; Avolition: dec self-motivated behav Alogia: diminished speech
Anhedonia: diminished pleasure/interest Asociality: lack of interest in soc interation Prosody - CORRECT ANSWER intonation and rhythm of speech Positive symptoms - CORRECT ANSWER something is added Negative symptoms - CORRECT ANSWER something is removed Prodromal phase of schizophrenia - CORRECT ANSWER disorganized behavior, loss of interest, no hallucination, anxious, diffi making decisions acute phase of schizophrenia - CORRECT ANSWER meets criteria for diagnosis residual phase of schizophrenia - CORRECT ANSWER apparent psychosis has subsided, but symptoms remain (ex. Delusional thought content is still there) recovery phase of schiz - CORRECT ANSWER does not currently meet criteria and appears to not be in the midst of an episode Schizophrenia treatment - CORRECT ANSWER SGAs most common because they are better for neg sx; FGA better for pos sx. Pos sx respond better to tx. Most commonly used in children - CORRECT ANSWER risperidone, aripiprazole, olanzapine Third generation anti-psychotics (TGA) - CORRECT ANSWER Abilify, Vraylar and Rexulti--partial dopamine agonists
suicide attempts, academic problems, philosophical brooding, OCD symptoms, multiple somatic complaints, marked irritability resulting in fights Sadock p Incidence of C/A living with SUD adult - CORRECT ANSWER Eight million children younger than age 18 live with at least one adult who has a ____;that is a rate of more than one in 10 children Families w/SUD - CORRECT ANSWER 1. Disrupts attachment, rituals, roles routines, communication soc life and finances
- Secrecy, loss, conflict, violence, abuse, emo chaos, role reversal and fear
- Impairs eye contact, tone, volume/rhythm of voice, soothing touch, read needs of infant: impaired attachment EMDR: reprocessing phases - CORRECT ANSWER focuses momentarily on past memories, present triggers or anticipated future experiences while simultaneously focusing on a set of external stimuli: tones, tapping, eye movement EMDR - CORRECT ANSWER combining rapid eye movement with recall of traumatic experience to reduce distress from that memory; cognitive restructure = beh/emo change interpersonal therapy (IPT) - CORRECT ANSWER treatment that strengthens social skills and targets interpersonal problems, conflicts, and life transitions, or change their perspectives of same DBT - CORRECT ANSWER 1.Acceptance and validation of behavior as it is in the moment
- Treating therapy‐interfering behaviors of both client and therapist
- The assumption that the therapeutic relationship is essential to the treatment
- Dialectic process: persuasive dialogue, focus on reality
Pregnancy risks for meds - CORRECT ANSWER SSRIs generally okay Depakote: for any woman of child bearing age Mood stabilizers: cardiac anomolies, neural tube defects Drugs in 3rd tri rarely teratogenic Lithium uses - CORRECT ANSWER 1. manic episodes of manic-depressive illness
- maintenance treatment for manic-depressive pts with a hx. of mania
- bipolar depression
- MDD (adjunctive)
- treatment - resistant depression
- Reduces suicide risk
- Works well in combination with atypical antipsychotics and/or mood stabilizing anticonvulsants such as valproate lithium common SE - CORRECT ANSWER 1. tremor, ataxia, dysarthria, delirium memory problems
- polyuria, polydipsia,
- diarrhea, nausea, vomiting
- Weight gain Lithium: Life-Threatening SE's - CORRECT ANSWER 1. toxicity
- Renal impairment
- Nephrogenic diabetes insipidus
- Arrhythmia, CV changes, sick sinus syndrome, bradycardia, hypotension, T-wave flattening and inversion
- rare seizures Lithium mgmt - CORRECT ANSWER 1. Lower the dose
- Take at night
- Change to different preparation (e.g. controlled-release)
Clang Associations - CORRECT ANSWER Uses rhyming words; "I am cold and bold. The gold has been sold." Word Salad - CORRECT ANSWER flow of unconnected words that convey no meaning to the listener Circumstantiality - CORRECT ANSWER Speech that is delayed in reaching the point and contains excessive or irrelevant details Tangentiality - CORRECT ANSWER inability to get to the point of communication due to introduction of many new topics Mutism - CORRECT ANSWER inability or refusal to speak Perseveration - CORRECT ANSWER persistent repetition of the same word or idea in response to different questions cognitive symptoms of schizophrenia - CORRECT ANSWER problems with working memory, attention, verbal and visual learning and memory, reasoning and problem solving, processing, and speech Suicide risk factors C/A - CORRECT ANSWER 1. Suicidal ideation
- Precipitating events
- Peer coping skills
- Maladaptive family environment
- Previous attempts
- Prior threats and gestures
- Cognitive constriction
- Emotional turmoil
- Cognitive desperation
- Sudden behavioral changes
- Preoccupation with death
- Lack of perceived support
- Conduct problems/antisocial behavior
- Use of drugs and/or alcohol
- Psychomotor agitation/poor impulse control Suicide evaulation - CORRECT ANSWER 1. Is there active plan?
- Any steps towards activation (accessed gun),
- given away possessions, completed unfinished tasks,
- comments to peers/others: no longer being around
- said "goodbye" or written notes GAD-7 scale - CORRECT ANSWER 7 item anxiety screening tool for in clinic use. 0=not at all; 3=nearly everyday; uses DSM criteria: nervous, anxious, can't control anxiety, worrying too much, trouble relaxing, restless, annoyed, irritable, something terrible will happen GAD 7 scoring - CORRECT ANSWER Score 0-4: Minimal Anxiety Score 5-9: Mild Anxiety Score 10-14: Moderate Anxiety Score greater than 15: Severe Anxiety Child Mania Rating Scale - CORRECT ANSWER 1. 21-item to identify symptoms of mania in children and adolescents aged 9- 17
- assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month Positive and Negative Symptom Scale - CORRECT ANSWER 1. positive symptoms include delusions and hallucinations, for example, and negative symptoms include social
Bipolar risk factors for bipolar - CORRECT ANSWER 1. more common in high- income than low income countries.
- Separated, widowed, divorced persons higher risk for bipolar I but not sure why. 3.genetic and physiological: family history is one of the strongest and most consistent risk factors; Magnitude incr with incr of kinship. Schizophrenia and ____________share genetic origin: co-aggregation of both in families.
- Responses to trialed SSRIs (NOT a dx confirmation)
- comorbid substance use
- Anxiety disorder bipolar and females - CORRECT ANSWER more likely to experience rapids cycling and mixed states and more likely to experience depression Bipolar age of onset - CORRECT ANSWER 5 - 50 y/o with average around 30 y/o MDD age of onset - CORRECT ANSWER 20 - 50 y/o with average around 40y/o metabolic risk with SGAs - CORRECT ANSWER 1. High risk - clozapine, olanzapine: Both of these are clearly high risk..
- Moderate risk - risperidone, paliperidone, quetiapine, iloperidone (weight only)
- Low risk - ziprasidone, aripiprazole, lurasidone, iloperidone (low for dyslipidemia), asenapine, brexpiprazole?, cariprazine? (new meds) all atypical antipsychotics - CORRECT ANSWER share a class warning for causing weight gain and risks for obesity, dyslipidemia, diabetes, accelerated cardiovascular disease, and even premature death, there is actually a spectrum of risk among the various agents First generation antipsychotics (FGAs) - CORRECT ANSWER dopamine receptor antagonists (DRAs) Second generation antipsychotics (SGAs) - CORRECT ANSWER 1. Serotonin- dopamine antagonists (SDAs)
- Block dopamine receptors more selectively than conventional
- Decreases the likelihood of extrapyramidal (motor) adverse effects
- Lower risk of tardive dyskinesia
- May cause less cognitive blunting
- Increase prolactin; med dependent--high for risperdal lower for others Anoresia nervosa info - CORRECT ANSWER 1. Mortality 5% from medical or suicide...most lethal mental health disorder.
- Prevalent in rich, industrial countries, less in Latino culture
- Comorbid with anxiety, OCD, and SUD
- Perfectionist, low self-esteem, trouble recognizing feelings (alexithymia)
- 85% of normal weight
- Restrict food, fear of fat
- Severity of Dx by BMI measure: <.17 mild, <16 moderate, >15 severe, >14 extreme Eating Disorders are - CORRECT ANSWER on the same neural system of self-control and reward as SUD PICA info - CORRECT ANSWER 1. non-food consumption x 1 month like paper, hair, soil, paint
- Often comorbid and is only separated as a unique disorder when symptoms are severe
- Prevalence: ID, low social functioning
- Can happen during pregnancy, often sign of neglect
- m=f prevalence
- Test: x-ray and blood test
- Some comorbidities: Klein Levin syndrome, ASD, ED, schizophrenia.
- Poison, malnutrition Rumination Disorder - CORRECT ANSWER 1. Regurgitation almost daily x 1 month
- The food can be rechewed and swallowed, or spit out
MDD with seasonal pattern - CORRECT ANSWER episodes that occur at characteristic times of the year. Commonly, fall or winter months, and remit in the spring. Less commonly, there may be recurrent summer episodes MDD with psychotic features - CORRECT ANSWER includes the presence of delusions and/or hallucinations. MDD with anxious distress - CORRECT ANSWER Feelings of restlessness, anxiety, and worry accompany the _____________ mood. MDD with mixed features - CORRECT ANSWER accompanied by intermittent symptoms of mania or hypomania. MDD with melancholic features - CORRECT ANSWER profound despondency and despair. There is an absence of the ability to experience pleasure and expression of feelings of excessive or inappropriate guilt. Psychomotor agitation or retardation and anorexia or weight loss are evident MDD with atypical features - CORRECT ANSWER Includes the ability for cheerful mood when presented with positive events. There may be increased appetite or weight gain and hypersomnia. Additional symptoms include long-standing sensitivity to interpersonal rejection and heavy, leaden feelings in the arms or legs MDD with catatonia - CORRECT ANSWER accompanied by additional symptoms associated with catatonia (e.g., stupor, waxy flexibility, mutism, posturing MDD with peripartum onset - CORRECT ANSWER occurs during pregnancy or in the 4 weeks following delivery Disruptive Mood Dysregulation Disorder - CORRECT ANSWER 1. chronic, severe, and persistent irritability.
- Frequent, developmentally inappropriate temper outbursts and persistently angry mood that is present between the severe temper outbursts.
- Present for 12 or more months, and occurs in more than one setting.
- Onset before age 10 years, but not applied to children younger than 6 years Cyclothymic Disorder - CORRECT ANSWER 1. Chronic mood disturbance of at least 2 years,
- numerous periods of elevated mood;
- do not meet the criteria for a hypomanic episode
- numerous periods of depressed mood of insufficient severity or duration not meet criteria MDD
- The individual is never without the symptoms for more than 2 months ADHD and bipolar similarities - CORRECT ANSWER 1. increase of activity, impulsivity and poor concentration--inconsistent in one; consistent in the other
- mood changes: several days for one; within the day for the other
- emotional dysregulation spectrum in one; while the other is more cognitive in nature
- One is more agitated; the other is more hyperactive
- One is pressured/diff to stop/may not make sense; the other is just hypertalkative
- One may not need sleep; the other usually not impaired sleep SSRIs starting doses - CORRECT ANSWER Prozac 10mg Sertraline 25mg Lexapro 5mg SSRI side effects - CORRECT ANSWER insomnia or sleepiness, sexual dysfunction, and weight gain. Lamotrigine MOA - CORRECT ANSWER blocks voltage gated sodium channels
