NR 547 WEEK 1-8 QUIZ QUESTIONS WITH 100% COMPLETE VERIFIED ANSWERS LATEST UPDATE 2024-2025, Exams of Nursing

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NR 547 WEEK 1- 8 QUIZ QUESTIONS WITH 100%

COMPLETE VERIFIED ANSWERS LATEST UPDATE 2024-

Psychiatric ROS - ANSWER✔✔Mood, anxiety, psychosis, other Psych ROS: Mood

• Depression - ANSWER✔✔-MDD (SIGECAPS) Sleep, interest, guilt, energy, concentration, appetite, psychomotor, agitation, or slowing, suicidality, sexual fx Psych ROS: Mood
• mania - ANSWER✔✔Impulsivity, grandiosity, recklessness, excessive energy, decreased need for sleep, increased spending beyond means, talkativeness, racing thoughts, hypersexuality Psych ROS: Mood Mixed other - ANSWER✔✔Irritability, viability

Psych ROS: Anxiety - ANSWER✔✔GAD, panic disorder, OCD, PTSD, social, anxiety, simple phobias Psych ROS: anxiety - GAD - ANSWER✔✔Where, wind, who, how long, how frequent Psych ROS: Anxiety-panic disorder - ANSWER✔✔How long until peak, somatic symptoms, including racing heart, sweating, shortness of breath, trouble, swallowing, sense of doom, fear of recurrence, agoraphobia Psych ROS: anxiety obsessive, compulsive - ANSWER✔✔Checking, cleaning, organizing, rituals, hangups, obsessive, thinking, counting, rational versus irrational beliefs Psych ROS Anxiety - PTSD - ANSWER✔✔Nightmares, flashbacks, startle response, avoidance Psych ROS: Anxiety social anxiety - ANSWER✔✔Avoidance Psych ROS anxiety simple phobias - ANSWER✔✔Heights, planes, spiders Psych ROS: Psychosis

• Types of delusions to ask about (5) - ANSWER✔✔Hallucinations, paranoia, delusions, patient's perception Psychosis: Hallucinations - ANSWER✔✔Sensory perception without an actual stimulus Auditory: usually in Schizophrenic patients Visual: can be in Schizophrenia, drug intoxication or delirium Olfactory: usually an aura associated with epilepsy Tactile: usually secondary to drug use or alcohol withdrawal Psychosis and paranoia - ANSWER✔✔can occur with prolonged use of strong stimulants, unreasonable fear Psychosis and delusions - ANSWER✔✔Fixed false beliefs. Bizarre delusions is a false belief that is impossible (FBI has sent Aliens from area 57 after me). Non-bizarre: can be possible (Neighbours are spying on me) TV, radio, thought broadcasting, mind control, referential, thinking

Psychosis patient perception - ANSWER✔✔Spiritual or cultural context of symptoms, reality testing, conspiracy theories Psych ROS other - ANSWER✔✔ADHD Eating disorder: binging, purging, excessive exercising MSE - ANSWER✔✔mental status examination- my parents and behavior, motor activity, speech, mood, affect, thought content, thought process, perceptual disturbances MSE: Appearance - ANSWER✔✔build, posture, dress, grooming, level of alertness, facial expression, attitude towards examiner, stated age MSE: Behavior - ANSWER✔✔Cooperative, agitated, disinhibited, disinterested-general statement of whether patient is exhibiting acute distress and patient's approach to the interview MSE: Motor Activity - ANSWER✔✔Describes the client's physical movements. Level of Activity: lethargic, tense, restless, or agitated. Type of Activity: tics, grimaces, or tremors Unusual gestures or mannerisms: compulsions- lip smacking tongue protrusions

MSE: Speech - ANSWER✔✔Fluency, amount, rate, tone volume MSE: speech fluency - ANSWER✔✔Stuttering, word, fighting, difficulty, para phasic errors MSE speech amount - ANSWER✔✔Normal, increased (mania, or hypomania )decreased(anxiety depression, thought blocking,or psychosis), MSE speech rate - ANSWER✔✔Slowed(depressed), rapid, or pressured MSE speech tone/volume - ANSWER✔✔Irritability, anxious, dysphoric, loud, quiet, timid, angry, childlike MSE: Mood - ANSWER✔✔emotional state patient tells you they feel-subjective: sad, angry, guilty, anxious MSE: Affect - ANSWER✔✔emotional state we observe (quality, quantity, range, appropriateness, congruence)

MSE affect-quality - ANSWER✔✔Tone-Dysphoric, happy, euthymic, irritable, angry, agitated, tearful, sobbing, flat." MSE affect quantity - ANSWER✔✔Measure of intensity of affect MSE affect range - ANSWER✔✔Restricted (FLAT)normal, labile MSE affect appropriateness - ANSWER✔✔Whether the affect correlates to the setting... Laughing at a funeral MSE affect congruence - ANSWER✔✔Whether the affect correlates with described mood, or thought, Contant... Laughing while reporting depression MSE: Thought Content - ANSWER✔✔what the pt is thinking

• obsessions/compulsions
• phobias
• SI/HI delusions: false/fixed ideas

1. bizarre delusions: not plausible

2. non bizarre delusions:

• grandiose
• erotomanic
• jealous
• somatic
• persecutory
• paranoia MSE: thought process - ANSWER✔✔describes how a persons thoughts are formulated, organized, and expressed. (Normal, flight of ideas, circumstantial, tangential, Loose, perseveration, thought, blocking, neologisms, word, salad. MSE: thought process: normal - ANSWER✔✔Linear, organized, goal directed MSE: thought process: flight of ideas - ANSWER✔✔Rapid movement from one thought to another, a succession of multiple associations, so that thoughts seem to move abruptly from idea to idea, expressed through rapid pressured speech clang associations - ANSWER✔✔Thoughts are associated by the sound of words, rather than by their meaning, rhyming, or assonance

derailment - ANSWER✔✔A breakdown in both the logical connection between ideas, and the overall sense of goal directedNess MSE: thought process: circumstantial - ANSWER✔✔Over inclusion of details and material that is not directly relevant to the subject or an answer to the question, but does eventually return to address the subject or answer the question MSE thought process: tangential - ANSWER✔✔Patient does a reply that is appropriate to the general topic without actually answering the question... Have you had any trouble sleeping lately... I usually sleep in my bed, but now I'm on the sofa MSE thought process: Loose thoughts - ANSWER✔✔Thoughts that are difficult or impossible to see the connections between the sequential Contant MSE thought process: perseveration - ANSWER✔✔Tendency to focus on a specific idea or contact without the ability to move on to other topics. Repetition of out of context, words, phrases, or ideas. MSE thought process: blocking - ANSWER✔✔Disordered thought process in which patient appears to be unable to complete a thought- stops midsentence and then cannot remember what was being discussed

MSE thought process: neologisms - ANSWER✔✔That process, whereby patient refers to a new word or condensed combination of several words that is not a true word, and not readily understandable... Ginormous, MSE thought process: word salad - ANSWER✔✔Speech characterized by confused and often repetitious language with no apparent meaning, or relationship attached MSE: Perceptual Disturbances - ANSWER✔✔hallucinations, illusions, derealization, depersonalization Perceptual disturbances: hallucinations - ANSWER✔✔Perceptions in the absence of stimuli to account for them; auditory, visual, tactile, olfactory, and gustatory non-auditory hallucinations - ANSWER✔✔Neurological, medical, or substance withdrawal issue visual hallucinations originate in the ____ lobe - ANSWER✔✔temporal or occipital-most common form of hallucinations in schizophrenia illusion - ANSWER✔✔(n.) a false idea; something that one seems to see or to be aware that really does not exist. Water in the desert, wind rustling is people talking

Depersonalization - ANSWER✔✔feelings of detachment from one's mental processes or body Derealization - ANSWER✔✔the sense that one's surroundings are unreal or detached MSE: Cognition - ANSWER✔✔Alertness, orientation, concentration, memory, calculation, fund of knowledge, abstract, reasoning, insight, judgment. Intelligence versus cognitive impairment versus delirium versus dementia. MSE - alertness and orientation - ANSWER✔✔Observation and person place time context MSE: Concentration - ANSWER✔✔Serial sevens, letters of the alphabet backward, months of the year backward MSE: Memory - ANSWER✔✔immediate-number repeat, recent- what did you have for breakfast? Remember three words remote-address when you were in third grade summer between high school and college MSE calculation - ANSWER✔✔Simple and complex math calculations

MSE fund of knowledge - ANSWER✔✔Distance between New York and Los Angeles, body of water between South America and Africa MSE: Abstract Reasoning - ANSWER✔✔Which one of these does not belong? How are these related?- Ability to shift back-and-forth between general and specific concepts. MSE: Insight - ANSWER✔✔Clients understanding of own feelings, presenting, and functioning, as well as potential causes of psychiatric presentation MSE: Judgement - ANSWER✔✔ability to make sound and reasonable decisions e.g. what would you do if you smelt a fire on your street?

• evaluate recent situations (e.g. answers questions correctly but wears a jacket in 30 degrees) Physical Eval AIMS - ANSWER✔✔Abnormal involuntary movement scale end used to monitor for potential side effects of tardive dyskinesia with antipsychotic use psych interview - ANSWER✔✔Identifying data Chief complaint HPI Previous psychiatric mental disorders

Personal and social history Childhood Adolescence Adulthood Sexual history Family history Mental status exam childhood trauma - ANSWER✔✔Separation anxiety and school phobia are associated with adult, depression, and your recess associated with fire setting Adolescent trauma - ANSWER✔✔Horse school performance is an indicator of emotional disorder, schizophrenia begins in late adolescence Adulthood trauma - ANSWER✔✔Manic patients go into debt where are promiscuous. Overvalued religious ideas are associated with paranoid personality disorder. Family psych history - ANSWER✔✔Genetic loading and anxiety, depression, schizophrenia

Abnormal general appearance - ANSWER✔✔Unkempt and disheveled and cognitive disorder, pinpoint pupils in narcotic addiction, withdrawal, and stooped posture and depression Abnormal Motorik behavior - ANSWER✔✔Fixed posturing, odd behavior, and schizophrenia. Hyper active with stimulant abuse and mania. Saga motor, retardation and depression, tremors with anxiety or medication, side effect of lithium, minimal eye contact and schizophrenia, scanning of environment and paranoid states. Abnormal attitude - ANSWER✔✔Suspicion is in paranoia, seductive and hysteria, apathetic in conversion disorder, putting in frontal lobe syndromes Abnormal moods - ANSWER✔✔Suicidal ideas in 25% of depressive, elation in mania, early morning, awakening in depression, decreased need for sleep inn mania Abnormal affect - ANSWER✔✔Changes in affect with schizophrenia, loss of prosody, and cognitive disorder and catatonia Abnormal speech - ANSWER✔✔Pressured speech and manic patients, paucity of speech and depression, uneven or slurred speech in cognitive disorders

Abnormal perceptual disorders - ANSWER✔✔Visual hallucinations in schizophrenia, tactile, hallucinations in cocaine, delirium, tremens in alcohol, olfactory, hallucinations, and temporal lobe epilepsy Abnormal fat content - ANSWER✔✔Grandiose delusions with mania, incongruent, delusions with schizophrenia, illusions with delirium, thought insertion with schizophrenia Abnormal thought process - ANSWER✔✔Loose associations with schizophrenia, flight of ideas with mania, inability to abstract with schizophrenia and brain damage Abnormal sensorium - ANSWER✔✔Clouded or wandering sensorium associated with delirium or dementia impaired remote memory - ANSWER✔✔Gaps in memory filled in with confabulatory details in dementia, patients, hypermnesia with paranoid personality Impaired immediate memory - ANSWER✔✔Immediate memory impairment occurs with cognitive dissociative or conversion disorder. PTSD or anxiety can impair, immediate retention and recent memory. Enterra grade, memory, loss or amnesia occurs with benzodiazepines or GHB. Retrograde memory loss occurs after head trauma.

Abnormal concentration in calculation - ANSWER✔✔Medical cause versus anxiety, depression, pseudo dementia Abnormal information and intelligence - ANSWER✔✔Mental retardation, borderline intellectual functioning Abnormal judgment - ANSWER✔✔Brain, disease, schizophrenia, borderline, intellectual functioning disorder, intoxication Abnormal insight - ANSWER✔✔Delirium, dementia, frontal, lobe syndrome, psychosis, borderline intellectual functioning Interventions - ANSWER✔✔Reinforcement, reflection, summarizing, education, reassurance, encouragement, acknowledgment of emotion, humor, silence, nonverbal, communication, expanding interventions, clarifying, associations, leading, probing, transitions, redirecting Reinforcement - ANSWER✔✔I see, go on, yes, tell me more Reflection - ANSWER✔✔Restating with a client says with a call for clarification

Summarizing - ANSWER✔✔Restating with the client says well, providing an opportunity for clarification or modification Education, intervention - ANSWER✔✔Interrupting the interview to educate on a topic Reassurance intervention - ANSWER✔✔This will be hard, but we can do it together Encouragement, intervention - ANSWER✔✔Positive reinforcement about efforts with statement there is more work to be done Acknowledgment of emotion intervention - ANSWER✔✔Verbal or nonverbal Humor intervention - ANSWER✔✔Can decrease tension and anxiety Silence as intervention - ANSWER✔✔Allowing the client time to think about statements Expanding interventions - ANSWER✔✔Redirecting to encourage the client to talk about other issues Associations as intervention - ANSWER✔✔Using one symptom to talk about another issue

Leading intervention - ANSWER✔✔But when where who Probing as intervention - ANSWER✔✔Asking about an area of conflict Transitions intervention - ANSWER✔✔Using one topic to move to another with a bridge Redirecting as intervention - ANSWER✔✔Redirecting back to the problem at hand when a client gets off topic Nonverbal Intervention - ANSWER✔✔The teacher's use of techniques including body language, facial expressions, gestures, or physical proximity to keep learners on task with a minimum of attention being drawn to the situation Obstructive Interventions - ANSWER✔✔Closed ended questions, compound questions, why questions, judgmental, questions, or statements, minimizing, patient's concerns, premature advice, premature interpretation, transitions, nonverbal, communication most common mental illness in the United States - ANSWER✔✔Anxiety disorders

• Anxiety impacts approximately 18% of the adult population and 25% of children ages 13- 17 each year

Obsessive-compulsive disorder (OCD) - ANSWER✔✔characterized by persistent, uncontrollable thoughts or actions that occur over an hour or more per day

• one of the top 20 illness-related disabilities worldwide first line medication treatment: Generalized anxiety disorder - ANSWER✔✔-SSRIs
• SNRIs
• Buspirone
• Drug Therapy at least 12 months first line medication treatment: Panic disorder - ANSWER✔✔-Paroxetine
• Sertraline
• Fluoxetine
• Drug therapy 6-9 months first line medication treatment: Obsessive compulsive disorder - ANSWER✔✔-Fluoxetine
• Fluvoxamine
• Sertraline
• Paroxetine

• Clomipramine (TCA)
• Drug therapy for at least 1 year first line medication treatment: Social anxiety disorder - ANSWER✔✔-Sertraline
• Paroxetine
• Drug therapy takes 4 weeks to see effects first line medication treatment: Post-traumatic stress disorder - ANSWER✔✔-Paroxetine
• Sertraline Anxiety is often comorbid with _________________ as well as medical conditions such as ____________, ___________, and ___________ - ANSWER✔✔major depression, COPD, asthma, diabetes Generalized anxiety disorder (anxiety) - ANSWER✔✔neurological condition
• characterized by persistent, uncontrollable worrying that causes emotional distress
• show symptoms on most days, for a period of at least six months
• common symptoms of anxiety include restlessness, irritability, muscle tension, fatigue, and sleep disturbances
• GAD is twice as common in women as in men

Patients with anxiety disorders often show increased activity in the ______________ and _______________ - ANSWER✔✔amygdala and prefrontal cortex Positron emission tomography (PET) scans have shown reduced ___________________ in patients with anxiety - ANSWER✔✔serotonin binding Risk factors for developing anxiety: - ANSWER✔✔-genetic predisposition (family history of anxiety)

• being female
• recent life stressors
• chronic physical illness
• lack of support during childhood Anxiety Disorders - ANSWER✔✔Generalized Anxiety Disorder (GAD) Social Anxiety Disorder Panic Phobias Agoraphobia Adjustment Disorder with Anxiety

GAD often presents with physical symptoms, including: - ANSWER✔✔restlessness or edginess fatigue difficulty concentrating irritability muscle tension sleep disturbance Functional neuroimaging studies of GAD show: - ANSWER✔✔increased activation of the amygdala and reduced activation in the prefrontal cortex, indicating heightened activation of the fear response with diminished capacity for reasoning Harold is a 32-year-old who presents to the clinic with complaints of fatigue, difficulty concentrating, and difficulty falling asleep at night. He states he worries about finances, his performance at work, and his relationship, and his worries have been "almost constant" for 8 months. He denies substance use and recently had a normal physical exam. He feels that his relationship is suffering due to his constant worry. Based on the DSM- 5 - TR, does Harold meet diagnostic criteria for generalized anxiety disorder? - ANSWER✔✔Yes Rationale: Harold meets the following diagnostic criteria for generalized anxiety disorder: He has three symptoms associated with worry, including fatigue, difficulty concentrating, and sleep

difficulties. He has experienced anxiety more days than not for over 6 months, and his worries are impacting his relationship. Social Anxiety Disorder - ANSWER✔✔AKA social phobia

• condition in which typical, everyday social interactions cause significant anxiety, self- consciousness, fear of embarrassment, or a feeling of being judged negatively by others
• may worry about the presence of physical symptoms that others may notice such as trembling or blushing
• derealization, or a feeling of "spacing out," may occur
• Causes likely include a combination of genetic and environmental factors
• past year: 7% of adults and 9% of adolescents
• DSM- 5 - TR defines social anxiety disorder as an individual's fear of acting in a way that might cause judgment by others
• anxiety is persistent, lasting greater than six months Usually, social anxiety disorder causes distress and anxiety in specific social situations such as: - ANSWER✔✔-making small talk with others
• meeting new people
• performing in front of others (called performance anxiety)

Panic attack - ANSWER✔✔brief episode of acute anxiety during which an individual develops an intense fear of negative outcomes accompanied by a feeling of imminent danger

• can be unpredictable
• feelings are often accompanied by physiological symptoms
• symptoms typically peak within ten to twenty minutes, some may last for hours Symptoms of Panic Attacks: - 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
• Nausea or abdominal stress
• Feeling dizzy, unsteady, light-headed or faint
• Chills or heat sensations Panic disorder - ANSWER✔✔occurs when a person experiences repeated panic attacks
• Anxiety about future attacks may lead to behavioral changes

• avoid situations that might trigger attacks Fabrizia is a 27-year-old graphic designer who presents to the clinic two months after an emergency department visit for complaints of chest pain, palpitations, nausea, and dizziness. Her electrocardiogram (ECG) and cardiac enzyme panels showed no abnormalities. She states that the symptoms began while she was watching a movie with her boyfriend and lasted about 15 minutes. She has never experienced anything like this in the past, but since the episode, she has worried occasionally about the symptoms recurring, as her father died of a heart attack at age 45. Based on the DSM- 5 - TR, does Fabrizia meet diagnostic criteria for panic disorder? - ANSWER✔✔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✔✔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
• often occur after experiencing or witnessing a traumatic event
• typically develop in childhood

• Types of phobias:
• natural or environmental (lightning, water, tornado)
• injury (dentist, injections)
• animal (specific animals, insects)
• situational (enclosed spaces)
• other (loud noises, clowns) 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