NR 547 Midterm Exam 2024-2025: Test Bank with Detailed Answers and Rationales, Exams of Health sciences

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NR 547 MIDTERM EXAM 2024-2025 ACTUAL

EXAM TEST BANK 200 QUESTIONS AND

CORRECT DETAILED ANSWERS WITH

RATIONALES (VERIFIED ANSWERS). GRADED A

5Ps to collect a client's sexual history: - ANS Partners Practices Protection from STDs Past History of STDs Prevention of Pregnancy *may consider adding another P for pleasure A 52-year-old client presents to the emergency department following a car accident. The emergency department (ED) physician is concerned that the client may have intentionally crashed her car and requests a stat PMHNP consult. In speaking with the PMHNP, the client describes persistent feelings of sadness and hopelessness. She states that she often wonders if her husband would be happier if she wasn't around anymore since she's never happy and sometimes thinks about what it would be like to just take a handful of sleeping pills and go to sleep

forever. The client reports a previous suicide attempt when she was 16 but denies that she is considering killing herself right now. Based on the client's ASQ score, what is the most appropriate response? No action is necessary as the client is not currently considering suicide. Provide a brief suicide safety assessment. Alert the client's primary care physician. Provide a ST - ANSProvide a brief suicide safety assessment. Rationale: While the client's responses do not indicate a need for a stat full safety and mental health evaluation, the client requires a brief suicide safety assessment to determine whether a full mental health evaluation in necessary. It is also important to notify the client's physician or the clinician responsible for the client's care. A client has been on clozapine for 9 months. Absolute neutrophil counts (ANC) have consistently been less than 1500/microliter? At what frequency should a CBC be drawn? daily weekly every 2 weeks

monthly - ANSevery 2 weeks Rationale: With a normal baseline ANC, the CBC should be monitored weekly for 6 months; every 2 weeks for months 6-12; and monthly thereafter Adjustment Disorder with Anxiety - ANSDSM-5 classifies adjustment disorder as a trauma- and stressor-related disorder -presents with nervousness, worry, or jitteriness -Adjustment disorder occurs in the presence of a specific and identifiable stressor

• common stressors include loss of employment, getting married, a new disability, or a natural disaster
• Symptoms begin within three months of the stressor and typically last no more than six months Agoraphobia - ANSintense fear, anxiety, or panic out of proportion to the situation that occurs in two or more of the following specific scenarios: -public transportation (bus) -open spaces (parking lot or bridge) -enclosed spaces (store, theater) -standing in a crowd or line (crowd)

-being outside of their home alogia - ANS-decrease in speech or speech content -symptom of schizophrenia. -AKA poverty of speech. American Geriatric Society (AGS) Beers Criteria - ANSAvoid the use of haloperidol, ziprasidone, and olanzapine due to an increased risk of CVA, cognitive decline, and death in persons with dementia and with dementia-related psychosis. anhedonia - ANSinability to experience pleasure anosognosia - ANSinability to realize that he or she is ill, which is caused by the illness itself. Antipsychotics: Potency low to high - ANSChlorpromazine - Low Mesoridazine - Low Thioridazine - Low Thiothixene - Medium Fluphenazine - Medium

Haloperidol - High Anxiety Disorders - ANSGeneralized Anxiety Disorder (GAD) Social Anxiety Disorder Panic Phobias Agoraphobia Adjustment Disorder with Anxiety Anxiety is often comorbid with _________________ as well as medical conditions such as ____________, ___________, and ___________ - ANSmajor depression, COPD, asthma, diabetes Anxiety rating scale: GAD-7 - ANSGeneral Anxiety Disorder- -answer question with several days (+1), more than half days (+2), nearly every day (+3)

• Feeling nervous, anxious, or on edge
• Not being able to stop or control worrying
• Worrying too much about different things
• Trouble relaxing

• Being so restless that it's hard to sit still
• Becoming easily annoyed or irritable
• Feeling afraid as if something awful might happen 0-4: No anxiety disorder 5-9: Mild anxiety disorder 10-14: Moderate anxiety disorder 15-21: Severe anxiety disorder Anxiety rating scale: HAM-A - ANSHamilton Anxiety Scale -mild (+1), moderate (+2), severe (+3), very severe (+4)
• Anxious mood
• Tension
• Fears
• Insomnia
• Intellectual
• Depressed mood
• Somatic (muscular)
• Somatic (sensory)

• Cardiovascular symptoms
• Respiratory symptoms
• Gastrointestinal symptoms
• Genitourinary symptoms
• Autonomic symptoms
• Behavior at interview 0-17: Mild anxiety 18-24: Mild to moderate anxiety 25-30: Moderate to severe anxiety 31-56: Severe anxiety armodafinil (Nuvigil) - ANSFDA Indications: -excessive sleepiness (OSA, narcolepsy, shift-work) RX Status: Schedule IV Normal Dosage: 150-250 mg/daily

avolition - ANSlack of motivation Basic Laboratory Interpretation - ANSComplete Blood Count Comprehensive Metabolic Panel (CMP) Thyroid Function Tests Vitamin B12 Level Vitamin D Level Toxicology Screen Urinalysis (UA) Basic Laboratory Interpretation: Complete Blood Count - ANS-measures RBCs, WBCs, hemoglobin, hematocrit, and platelets -includes a differential of the WBCs -In mental health, the CBC is used to rule out medical conditions that may present with symptoms that can be attributed to both medical and psychiatric diagnoses

• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes RBCs: 4.5-6.0 million/microliter Hemoglobin: 12-18 grams/100 mL

Hematocrit: 38%-48% Reticulocytes: 0%-1.5% WBCs (total): 5000-10,000/microliter Neutrophils: 55%-70% Eosinophils: 1%-3% Basophils: 0.5%-1% Lymphocytes: 20%-35% Monocytes: 3%-8% Platelets: 150,000-300,000/microliter Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) - ANScommon blood test used to determine general health status -fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function -used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels -rule out medical conditions that could cause symptoms

• Ex: changes in mood or cognition Sodium (Na+): 136-145 mEq/L

Postassium (K+): 3.5-5.0 mEq/L Chloride (Cl-): 95-105 mEq/L Bicarbonate (HCO3-): 22-28 mEq/L Calcium, serum (Ca 2+) 8.4-10.2 mg/dl Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl Cholesterol, serum: REC<200 mg/dl Total Protein 6.0-7.8 g/dl Albumin 3.5-5.5 g/dl -Kidney Tests

• Creatinine, serum 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl -Liver Tests
• Alanine aminotransferase (ALT), serum: 8-20 U/L
• Aspartate aminotransferase (AST), serum: 8-20 U/L
• Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
• Phosphatase (alkaline), serum: 20-70 U/L Basic Laboratory Interpretation: Thyroid Function Tests (TFTs) - ANSused to rule out thyroid disorders as a cause for symptoms

• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings, sleeping difficulties, difficulties with concentration, short-term memory lapses, and lack of mental alertness Normal TFT levels TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL Basic Laboratory Interpretation: Toxicology Screen - ANS-rule out substance use as a cause for symptoms -used before starting therapy involving controlled substances -used to monitor medication adherence -used in the diagnosis of substance use disorder Basic Laboratory Interpretation: Urinalysis (UA) - ANSUrinary tract infections are associated with a variety of neuropsychiatric symptoms -acute mental status changes
• UA may be used to rule out a UTI as the cause.

Basic Laboratory Interpretation: Vitamin B12 Level - ANSDeficiency of vitamin B can affect mood and other brain functions -psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms, and cognitive impairment normal: 190-950 picograms/mL

• 200-300/mL indicates a borderline level with a possible need for additional testing Basic Laboratory Interpretation: Vitamin D Level - ANSaffects functions such as neurotransmission, neuroprotection, & neuroimmunomodulation -high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression, seasonal affective disorder, and cognitive impairment -Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain development 25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a deficiency Benzodiazepines - ANSapproved for use with insomnia

-not considered a first-line treatment due to the potential for misuse

• when first-line agents fail, benzodiazepines may be used with caution for insomnia. Body dysmorphic disorder - ANS-Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. -At some point during the course of the disorder, the individual has performed repeti-tive behaviors or mental acts in response to the appearance concerns. -The preoccupation causes clinically significant distress or impairment in social, occu-pational, or other important areas of functioning. -The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder Breathing-related sleep disorders - ANSobstructive sleep apnea (OSA) -most common -caused by upper airway obstruction during sleep
• leads to periods of apnea and heavy snoring -commonly diagnosed in adults aged 40- -Risk factors: obesity and family hx

central sleep apnea (CSA) sleep-related hypoventilation Breathing-related sleep disorders -typically present with excessive daytime sleepiness -trouble concentrating during the day, mood changes, awakening with a dry mouth or sore throat, morning headaches, or decreased libido -Partners may endorse snoring, apneic periods, and abrupt awakenings accompanied by gasping or choking. Brief Psychiatric Rating Scale (BPRS) - ANS-used to assess clients who present with symptoms of psychosis. -consists of 24 categories, each scored between 1-7. -scale varies, scores may be broadly interpreted with higher numbers indicating more severe illness -may be used over time to evaluate treatment. Brief Psychotic Disorder - ANSan acute psychosis, often precipitated by stress

-Symptoms last for less than 1 month -clients experience full remission with a full return to function 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 to a large state university to pursue a law degree. During the law program's orientation attended by 300 students, she learned that only 100 students would be selected out of 300 applications for the fall admission. She began feeling inferior that she would not be one of the students accepted. She also started thinking about "plan B," assuming that her grades are not "good enough" to get her selected for the program. She told the PMHNP that she was preparing for the rejection because she does not measure-up to the other appli - ANSgeneralized anxiety disorder Rationale: Callie has persistent symptoms of anxiety accompanied by restlessness and irritability. The thoughts are unrealistic since she has pre-determined that she is not good enough for the law program without evidence to support that feeling. She also compares herself to strangers where she automatically assumes that they are better prepared for the program than she is. She decides not to apply to the law program based on these unsubstantiated thoughts.

Catatonia - ANSpsychomotor syndrome that presents as a decreased reactivity to one's environment -typically occurs in tandem with other medical or psychiatric disorders

• most often associated with schizophrenia, affective disorders, autism, and infectious disease -Clinical signs:
• immobility, mutism, withdrawal, refusing to eat, staring, negativism, posturing, and rigidity. -failure to recognize and treat can lead to increased mortality CDC recommends that adults sleep ____ hours per night - ANS7- Changing from one antipsychotic medication to another: - ANS-req specific dosage adjustments. -Guidelines include:
• DAYS 1 - 7, Approx. 25% of target dose
• DAYS 8 - 21, Approx. 50% of target dose
• DAYS 22 - 35, Approx. 75% of target dose
• DAY 36, Target dose

Example: RX: aripiprazole 5 mg Dispense: # Sig: Take ½ tablet once a day for 7 days; then, take 1 tablet once a day for 14 days; then, take 1 ½ tablets once a day for 14 days; then, take 2 tablets once a day. Refills: 0 Circadian Rhythm Sleep-Wake Disorders - ANSoccurs when this endogenous, 24- hour cycle is disrupted, causing excessive daytime sleepiness, insomnia, or both -Disruptions in sleep schedule due to illness or shift work may cause transient disorder, while non-24-hour sleep-wake disorder may cause chronic disturbances in sleep -common disorder of clients with blindness due to their inability to see light. Clinician-Rated Dimensions of Psychosis Symptom Severity Scale - ANS-can help the provider to determine the degree of impairment from (+), (-), and cognitive symptoms -Each item is scored & interpreted independently -may be used to monitor tx success & the need for additional follow-up

CUS - ANSchronic unpredictable stress Delusional Disorder - ANSinvolves a person having prominent delusions without hallucinations -tend to have false beliefs that involve real-life situations

• ex: belief that they are being followed or that others are plotting against them -often retain their personalities and are more functional socially Delusions: - ANSfixed false, irrational beliefs -persecution: delusions r/t being threatened, victimized, or spied on -reference: delusions r/t receiving personal messages from tv, radio, or actions of others -somatic: delusions r/t the body, including illness or the presence of foreign objects
• may believe there are objects in their body (may think they are infested with insects.) -grandeur: delusions r/t beliefs of special abilities or powers -control: delusions that actions & thoughts are controlled by others

Diagnostic Testing when diagnosing mental health disorders - ANS-Diagnostic tests and labs are most used to rule out physical conditions that may cause psychiatric symptoms and to evaluate the effects of treatment Differential Diagnoses for anxiety: - ANSObsessive-compulsive disorder. Panic disorder Major depressive disorder Social phobia Phobias Adjustment disorder with anxiety Social Anxiety Disorder Substance-related disorders Medical Disorders differential diagnosis - ANSThe provider's initial hypothesis -a working list of potential problems that can be associated with the initial or chief complaint -Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

• provides guidance for identifying psychiatric diagnoses

DSM-5 criteria for GAD - ANSexcessive anxiety and worry occurring more days than not for at least six months. The person finds it difficult to control and experiences at least three symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance DSM-5 Criteria for Schizophrenia - ANS-Two (or more) of the following, each present for a significant portion of time during a 1-month period. At least one of these must be (1), (2), or (3):

1. Delusions.
2. Hallucinations.
3. Disorganized speech
4. Grossly disorganized or catatonic behavior. 5. Negative symptoms -For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset -Continuous signs of the disturbance persist for at least 6 months. -Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out

-The disturbance is not attributable to the physiological effects of a substance or another medical condition -If there is a hx of autism spectrum disorder or a communication disorder of child- hood onset, the additional dx of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month 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 - ANS40.218 Specific phobia - animal enuresis - ANSinvoluntary discharge of urine -children: tx anticholinergic Erectile dysfunction - ANSAKA impotence -the inability to get and/or maintain a penile erection that is firm enough for sexual relations -can be due to physical or psychological causes

• affect any of the areas of the brain, reproductive hormones, emotions, nerves, muscles, and/or blood vessels that are involved with the phenomenon of erection
• most common physical causes include heart disease, atherosclerosis (clogged blood vessels), high blood pressure, nerve damage, and stroke
• most common psychological causes include stress, anxiety, depression, or communication issues with the sexual partner Erica is a 24-year-old with a newly diagnosed schizophreniform disorder. She is a current smoker. She does not use alcohol or other drugs. She has no medical history. Which of the following would be the least appropriate initial medication for Erica?

aripiprazole lurasidone olanzapine quetiapine - ANSolanzapine Rationale: Olanzapine requires up to 30% increased dosage for clients who smoke concurrently. Initiating a medication that does not interact with smoking is preferable. Esme is a 22-year-old client who presents to the clinic with her mother. Esme appears quiet and withdrawn with very little emotional expression. Her mother reports that for the last couple of years, Esme has gradually disengaged from all her friends. After graduating from high school, she left for college but started hearing voices telling her that she was ugly and stupid. She stopped attending class or completing her work. When asked directly about her symptoms, Esme provides very short, one-to-two-word responses in a monotone voice. Which of the following symptoms is Esme exhibiting? Select all that apply. anosognosia alogia avolition

asociality blunted affect depersonalization catatonia anhedonia hallucinations delusions - ANSalogia avolition asociality blunted affect hallucinations Rationale: Esme is experiencing the following symptoms of psychosis: alogia: short answers, using few words to communicate avolition: lack of initiative, withdrawal from work/school asocialtiy: lack of relationships, reduced social interactions blunted affect: decreased facial expressions and voice inflections hallucinations: perceptual experiences in the absence of external stimuli

Esme has not provided enough information to support the following symptoms at this time: anhedonia: inability to experience pleasure anosognosia: functional inability to recognize illness depersonalization: a perception that the body is floating, changing, or detached catatonia: lifeless, trance-like state with lack of response or movement delusions: fixed false, irrational beliefs Excitatory vs sleep-promoting neurotransmitters - ANSExcitatory -acetylcholine -norepinephrine -histamine -serotonin -orexin -dopamine Sleep-promoting -GABA