NR 547 Week 4 Midterm Study Guide Chamberlain College of Nursing 2024/2025, Exams of Nursing

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NR 547 MIDTERM STUDY GUIDE

The NR547 exam questions are taken from the Course

Activities, lectures, linked resources and required readings.

Mid-Term Exam: The Mid-Term has 75 questions worth two points each. You will have one

attempt to complete the exam with a time limit of 75 minutes.

Week 1: Foundations in Differential Diagnosis Formulation

1. The differential diagnosis:

1. Importance of the differential diagnosis

2. Analysis of:

a) presenting symptoms

b) clinical data such as physical exam

c) laboratory analysis.

d) Medical history including medications

3. Evidence-based screening tools and psychiatric rating scales

a) Scoring

b) Advantages and disadvantages

c) Components

d) When to use (i.e., when is a brief screening tool inappropriate)

4. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (American Psychiatric

Association [APA], 2022) criteria.

a) Know diagnostic criteria for various problems, such as Schizophrenia, sleep disorder, sexual

disorders and anxiety disorders

5. Rule out physical and substance-related causes for psychological symptoms.

6. Understand differences between the workup and treatment for new onset symptoms versus pre-

existing symptoms

a) New patients or new onset symptoms require full workup

b) Pre-existing conditions and diagnosis should be taken into account when formulating your

differentials

c) Pre-existing conditions may exclude some differentials

2. Social determinants of health and the psychiatric mental health nurse practitioners (PMHNPs) role in

addressing SDOH at the individual and population levels. SDOH have a significant impact on health, quality of

life, and life expectancy in relation to mental health. Social and environmental factors can influence genetic

determinants of health and illness and affect the risk for mental illness and substance use disorders.

3. Review basics of laboratory analysis including:

1. CBC – WBCs 5-10k, platelets 150-300k, RBCs 4.5-6, Hgb 12-18, Hct 38-48%

2. CMP – Na 136-145,K 3.5-5, Cl 95-205, Ca 8.4-10.2, Create 0.6-1.2, BUN 7-18, ALT 8-20, AST 8-

20, Bili 0.1-1.0, Phos 20-

3. Thyroid function tests – TSH 0.4-4.5, T3 100-200, T4 5-

4. Vitamin B12 levels – 190-

5. Vitamin D levels – 20-50, deficiency <

4. Know terms

1. Alogia – lack of speech caused by disruption in the thougt process. “poverty of speech” seen in

dementia, schizophrenia, and some mood disorders.

2. Avolition – total lack of motivation making it difficult to get things done. Considered a “negative”

symptom.

3. Anosognosia – deficit of self-awareness.

4. Affective flattening – gross lack of emotional response to a given situation.

Week 2: Differential Diagnosis of Anxiety

1. Anxiety

a) GAD

1. Depression is a common comorbidity

b) OCD - characterized by persistent, uncontrollable thoughts or actions that occur over an hour or

more per day, know comorbidities

1. Compulsions typically performed in response to an obsessive thought

2. Subclinical versus clinical symptoms

c) Panic disorder – know diagnostic criteria and physiological symptoms

d) Social phobias – know various phobias and diagnostic criteria

e) Agorophobia – know definition and symptoms

f) General phobias

1. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (American

Psychiatric Association [APA], 2022) criteria.

2. Remember to rule out physical and substance-related causes. for psychological symptoms.

g) Please review general anxiety versus your specific anxieties/phobias

h) Know definition of

1. Excoriation disorder –picking skin

2. Hoarding disorder – keeping items

3. Body dysmorphic disorder – distorted view of oneself

4. Trichotillomania disorder – hair pulling

i) Tourette’s – remember this is closely related to OCD and anxiety

j) Review lifespan manifestations and treatment of various anxiety disorders.

k) Role of social determinants in the development of anxiety

2. Non-pharmacological treatments of anxiety, including counseling methods

3. Pharmacological management including antidepressants and beta-blockers

4. Medications (including antidepressants) to avoid with acute anxiety.

5. Screening Tools for various anxiety disorders

a) KNOW SCORING

b) Know strengths and shortcomings of screening tools

c) HAM-A

d) GAD-

e) YBOC

3. Basic treatment options including counseling strategies

a) Treatments often reflect concomitant depression treatment

b) Review which antidepressants are effective as anxiety management

c) Review basic counseling strategies

Week 3: Differential Diagnosis of Psychoses

1. Etiology of schizophrenia and psychoses
   1. Understand the role of genetics in the development of schizophrenia (primary cause)
   2. Which neurotransmitters, neuropeptides and receptor systems are implicated in schizophrenia?
2. Risk factors for the development of schizophrenia including age and stress
3. Initial or prodromal phase of schizophrenia – symptoms
4. Criteria for diagnosis of schizoaffective disorder
5. Prognostic indicators – including male gender and young age of onset
6. Differentiate types of psychosis
   1. Psychosis diagnostic criteria a) Review DSM5-TR criteria b) Review Kaplan and Sadock c) Review modifiers d) Schizophrenia vs. e) Schizoaffective vs. f) Schizophreniform disorder
7. Common delusions and hallucinations with schizophrenia (often derogatory)
8. Understand the role of genetics in the development of schizophrenia (primary cause)
9. Brief psychotic episode – what is diagnostic criteria
10. Diagnostic criteria and qualifiers
    1. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (American Psychiatric Association [APA],
       2022. criteria.
    2. Remember to rule out physical and substance-related causes for psychological symptoms. REVIEW DIAGNOSTIC CRITERIA FOR PSYCHOTIC ILLNESSES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
11. Screening Tools, general knowledge and scoring
    1. Positive & Negative Syndrome Scale (PANSS): ...
    2. Scale for the Assessment of Negative Symptoms (SANS): ...
    3. Brief Psychiatric Rating Scale (BPRS): ...
    4. Clinical Global Impression-Schizophrenia (CGI-SCH): ...
    5. Calgary Depression Scale for Schizophrenia (CDSS):
12. Lab monitoring with medication management
    1. Know labs monitoring with antipsychotic medications
       1. Lipids
       2. Blood sugar including fasting glucose and HgbA1C
       3. BMI
13. Basics of medication management
14. Treatment of acute psychoses
15. Medication management across the lifespan
16. Medications effect on weight
17. Effect of steroids on symptoms
18. Treatment of catatonia
19. Cognitive symptoms of schizophrenia
20. Positive versus negative symptoms of psychoses/schizophrenia
21. Treatment of side effects
22. Tardive dyskinesia
23. Akathesia
24. Sexual dysfunction
25. Weight gain
26. Diabetes
27. Sedation
28. Know domains associated with symptoms (review Canvas reading materials)
29. Review catatonia, symptoms associated with and pharmacological treatment

10. Know clozapine monitoring schedule

Week 4: Differential Diagnosis of Sleep Wake Disorders & Sexual Dysfunction

1. Sleep disorders to review a. Circadian rhythm disruption b. Obstructive versus central sleep apnea c. Sleep-wake disorders commonalities d. Narcolepsy e. Restless legs syndrome f. Review enuresis in pediatric patients g. Sleepwalking (Common comorbidities)
2. Review Comorbidities that effect sleep disorders (both physical and mental) a. Comorbidities are the rule in sleep disorders b. Include depression and substance abuse
3. Review the stages of sleep
4. Sleep disorders a. Review work-up for sleep disorders b. Evidence based treatment options for circadian rhythm disruption c. Evidence based treatment options for shift work related sleep disorders d. Remember behavioral/conservative options are first option e. Review common comorbidities with sleep disorders
5. Testing and work up a. Laboratory tests (review basics and specific tests) b. Diagnostics (which are informative)
6. Non-pharmacological measures (should consider conservative measure as first line treatment) a. Review behavioral means of assisting sleep i. Sleep diary ii. Chronotherapy iii. Light therapy iv. Stress reduction v. Melatonin
7. Sleep and medications a. Review pharmacology of sleep medications and classes i. Benzodiazepines as sleep medication b. Review Medications that might interfere with sleep
8. Non-pharmacological measures a. Review behavioral means of assisting sleep i. Sleep diary ii. Chronotherapy iii. Light therapy iv. Stress reduction
9. Narcolepsy review
   1. Including medications used such as Modafinil and Amphetamines
10. Sexual Dysfunction a. What are the essential features of sexual dysfunction? b. Male versus female i. Common male and female sexual disorders c. Pharmacological causes d. Physiological causes e. Mental health causes
11. Define a. genito-pelvic pain/penetration disorder b. female sexual interest/arousal disorder c. female orgasmic disorder d. male hypoactive sexual desire disorder e. male sexual interest/arousal disorder
12. Contributing factors to erectile dysfunction a. Untreated medical problems (know) b. Substance abuse issues
13. Collecting a sexual history (best practices)

14. Diagnostic criteria for sexual disorders