Download NR 547 Differential Dx Midterm Questions & Revised Correct Answers (2025 / 2026) and more Exams Nursing in PDF only on Docsity!
NR 547 Differential Dx Midterm Questions &
Revised Correct Answers (2025 / 2026)
What are risk factors for developing anxiety? - Answer:- 1) family Hx
- being female
- recent life stressors
- chronic physical illness
- lack of support during childhood Increased brain activity in prefrontal cortex is a sign of? - Answer:- Anxiety According to NIMH approximately % of US adults will experience GAD in the past year and approximately ____% of the US adults will experience GAD at some point in their lifetime **- Answer:-** 3, 6 GAD is twice as common in ___________ than in __________ **- Answer:-_** Women, men
How is GAD characterized by? - Answer:- Persistent, uncontrollable worry about ordinary everyday situations Functional neuroimaging studies of GAD show? - Answer:- Functional neuroimaging studies of GAD show increased activation of the amygdala and reduced activation in the prefrontal cortex, indicating heightened activation of the fear response with diminished capacity for reasoning GAD often presents with physical symptoms, including: - Answer:- restlessness or edginess fatigue difficulty concentrating irritability muscle tension sleep disturbance Thyroid Function Tests - Answer:- In psychiatric diagnosing, TFTs are used to rule out thyroid disorders as a cause for symptoms. Common symptoms related to thyroid disorders include anxiety,
What may individuals with SAD resort to? - Answer:- Drugs or alcohol to reduce social inhibitions In the past year SAD has impacted approximately ____% of adults and _____% of adolescents - Answer:- 7, 9 Risk Factors for SAD - Answer:- HX of abuse or Neglect Close relative with SAD SAD causes distress in what kind of social situations? - Answer:- Making small talk with other Meeting new people Performing in front of other (called performance anxiety) Greta who is clingy to her mom when meeting adults but does not have anxiety in peer setting. Would this meet DSM-5 criteria? - Answer:- Greta displays anxiety when meeting adults in a social situation. Her anxiety is expressed as clinging to her mother and not speaking. The anxiety has been present for several years; however,
Greta does not have anxiety in peer settings. Therefore, she does not meet DSM-5 criteria for social anxiety disorder Panic attacks - Answer:- is a brief episode of acute anxiety during which an individual develops an intense fear of negative outcomes accompanied by a feeling of imminent danger. Panic attacks can be unpredictable, often occurring in familiar places where there are no apparent threats. The feelings are often accompanied by physiological symptoms. While symptoms typically peak within ten to twenty minutes, some may last for hours Physical symptoms of a panic attack include? - Answer:- Palpitations, pounding heart, or accelerated heart rate Trembling or shaking Paresthesias (numbness or tingling sensations) Sensation of shortness of breath or smothering Derealization (feelings of unreality) or depersonalization (feeling detached from oneself) Feeling of choking Feeling of chest pain or discomfort
A) Yes B) No - Answer:- B) No Rationale: Fabrizia meets diagnostic criteria for a panic attack, but not for panic disorder. During her panic attack, she reported having four cardinal symptoms associated with a panic attack. She has only had one panic attack, and although she has expressed worry about symptoms recurring, it is not persistent concern or worry. Phobia - Answer:- phobia is an intense fear of a specific situation or object. The fear associated with a phobia is not in proportion to the actual danger associated with the situation or object. The prevalence of specific phobias is approximately 8%. Specific phobias often occur after experiencing or witnessing a traumatic event and typically develop in childhood. Clients who have specific phobias often fear more than one object or situation. Each specific phobia is diagnosed separately Ella is a 17-year-old who presents to the clinic with her mother. Her mom reports that Ella will not go to the basement in their home, and she is concerned about the behavior. During the interview, Ella
confirms that even thinking about going to the basement causes her extreme anxiety because she knows that there are spiders in the basement. She has had her phone taken away in the past because she will not go to the basement to gather her laundry, but she states, "I will take the punishment because it is better than being around those spiders." She states she has been afraid of spiders for as long as she can remember Which of the following is the most appropriate ICD- 10 - CM code for Ella? 40.2 Specific phobias 40.218 Specific phobia - animal F40.298 Other specified phobia F40.9 Phobia, phobic - Answer:- 40.218 Specific phobia - animal Rationale: Ella meets diagnostic criteria for F40.218 Specific Phobia: Animal.
types of situations make her fear that she will be trapped in the event of an emergency. To cope, she has been walking rather than using public transportation and using an online ordering app for grocery delivery. She has not been to a concert or movie theater in years and feels that she has lost some friends because of her reluctance to attend. Based on the DSM- 5 - TR, does Sigourney meet diagnostic criteria for agoraphobia? A) Yes B) No - Answer:- A) Yes Rationale: Sigourney meets the following diagnostic criteria for agoraphobia: she has marked anxiety about using public transportation and being in enclosed spaces and crowds. She fears a situation because she worries about her ability to escape. She has changed her behaviors to avoid situations that cause her anxiety, and she has caused social impairment in her life. Adjustment Disorder with Anxiety - Answer:- The DSM-5 classifies adjustment disorder as a trauma- and stressor-related disorder; however, symptoms of adjustment disorder with anxiety are similar
to those found in anxiety disorders. Adjustment disorder with anxiety presents with nervousness, worry, or jitteriness. Adjustment disorder occurs in the presence of a specific and identifiable stressor. The distress experienced is out of proportion to the severity of the stressor. Adjustment Disorder with Anxiety examples - Answer:- Examples of common stressors include loss of employment, getting married, a new disability, or a natural disaster. When does Adjustment Disorder with anxiety usually appear? - Answer:- Symptoms begin within three months of the stressor and typically last no more than six months. Callie is an 18-year-old college student who reports to the healthcare provider that she feels anxious "about everything." Her restlessness and irritability have impacted her relationship with her significant other. She reports no significant past medical or mental health history. She states that her anxiety started about 8 months ago when she decided to transfer from her local community college
longer deemed essential. Because of the automatic self-check-out systems, there is no longer the need to employ as many cashiers as possible. Jeremy has been given the task of notifying his employees of this major change in staffing. He plans to share these decisions at next week's staff meeting. From the moment Jeremy received this directive, he started to feel fearful of the possibility of announcing the decision to downsize as well as deciding on who would be eliminated. On the day of the staff meeting, his employees were present. As he started the staff meeting, he began to feel nausea. He even noticed his heart pounding. When he was questioned by an employee on - Answer:- C) panic attack Rationale: Jeremy's anxiety is associated with a stressful situation (delivering the bad news) and a fear that something bad will happen (staff's reaction to the announcement). He experiences physical symptoms of heart pounding, nausea, dizziness, and inability to formulate an organized answer to the question. The setting is also in a familiar place among colleagues where no real threat exists. Sari is a 34-year-old female who is engaged to be married in one month. This will be her second marriage. She has been divorced for three years. Her fiancé, who is also divorced, has arranged for Sari to meet his three teenagers. Sari learns through a mutual friend of hers
and the fiancé, that his teenagers, although hesitant, are willing to meet her. On the day of the arranged meeting, Sari is asked to arrive to the restaurant to meet the teens prior to the fiancé's arrival because he has been held up at a meeting. Sari agrees but starts to feel uneasy about it. She is concerned that they will not accept her because of her previous divorce and the fact that she is not their mother although they were willing to meet her. The closer she got to the restaurant, the more uneasy she felt to the point of disorientation. Just before entering the restaurant, she turned around and called her fiancé to inform him that her car - Answer:- D) Social Anxiety Rationale: Sari feels like she will be judged by the teens because she is not their mother. She avoids the situation by creating an excuse for not meeting them at the restaurant. The feelings are unwarranted since the teens agreed to meet with Sari. Complete the case study below by utilizing the HAM-A scale. Rashard, a 5 4 - year-old, presents for a walk-in visit with the PMHNP due to increased anxiety and requests an early refill of his clonazepam. He reports his brother died a week ago and he is very
Intellectual- 2 (poor memory) Depressed mood- 3 (daily loss of interest, lack of pleasure) Cardiovascular symptoms- 3 (tachycardia, chest pain) Respiratory symptoms- 2 (pressure or constriction in chest, dyspnea) Behavior at interview- 3 (fidgeting, restlessness, or pacing) Rashard's total HAM-A screening score is 28, indicating moderate to severe anxiety. Which of the following medical conditions is likely to present with symptoms that mimic anxiety? A) hypothyroidism B)hyperthyroidism (C C)dysrhythmias (Correct answer) D) irritable bowel syndrome (Correct answer) E) anemia F) diabetes type 2 G)migraine headache (Correct answer)
H) Covid- 19 I) rheumatoid arthritis (Correct answer) J) menopause (Correct answer) - Answer:- B)hyperthyroidism C)dysrhythmias D) irritable bowel syndrome G)migraine headache I) rheumatoid arthritis J) menopause Rationale: Medical conditions that commonly present with symptoms that mimic anxiety include endocrine disorders including hyperthyroidism and adrenal dysfunction cardiac disorders including angina and dysrhythmias, GI conditions including irritable bowel syndrome and GERD, inflammatory conditions including lupus and rheumatoid arthritis, neurological disorders including migraine headaches and seizures, and respiratory conditions including asthma and COPD. Changes in the menstrual cycle, including PMS and menopause, may also cause symptoms that mimic anxiety.
H)alcohol (Correct answer) I)caffeine (Correct answer) Rationale: Medications with side effects mimicking anxiety disorder include nasal decongestants, antidepressant medications, synthetic thyroid hormones, beta-adrenergic agonists, and hormones such as androgens and estrogens. Substances with effects that may mimic anxiety include cocaine, ecstasy, marijuana, psychoactive compounds, and caffeine. What is the Tx of GAD? - Answer:- Pyschotherapy, medication, or both What is the most widely studied and efficacious form of Tx of GAD? - Answer:- Serotonergic antidepressants in combinations with CBT If symptoms are severe of GAD what is the line of Tx? - Answer:- Short course of a benzodiazepine at the beginning of treatment may be indicated Anxiolytic Pros vs Cons - Answer:- PROS:
↓ adverse effects ↓ drug interactions CONS limited effectiveness Anxiolytic time to efficacy? - Answer:- 2 - 4 weeks Anxiolytic agents? - Answer:- Buspirone SSRIs/SNRIs Pros vs Cons - Answer:- PROS: Highly effective CONS: ↑ drug interactions risk of hyponatremia SSRIs/ SNRIs time to efficacy? - Answer:- Up to 6 months SSRIs/ SNRIs Agents - Answer:- escilatopram (Lexapro)
