NU664 EXAM 2 QUESTIONS WITH 100% CORRECT ANSWERS 2024, Exams of Advanced Education

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NU664 EXAM 2 QUESTIONS WITH 100%

CORRECT ANSWERS 2024

levels of anxiety - Correct Answer-1-normative, perceptual field broadened 2-normative, perceptual field mild narrow 3-pathological, VS changes 4-pathological, panic ataque de nervios - Correct Answer-a self-labeled syndrome found in Latinos in which they experience a mixture of anxiety, panic, depression, and anger older adult anxiety symptoms - Correct Answer-somatic concerns DSM5 anxiety disorders - Correct Answer-panic disorder agorabphobia social anxiety disorder generalized anxiety disorder selective mutism fear vs anxiety - Correct Answer-panic attacks are fear response fear is imminent threat anxiety is perceived/future 2 components of anxiety - Correct Answer-awareness of physiological sensations I.e. VS awareness of being nervous/frightened limbic system - Correct Answer-amygdala, hypothalamus, hippocampus thalamus mild anxiety - Correct Answer-eustress motivating normal ___% pts with GAD have 1 other psychiatric disorder - Correct Answer-90% ____ of people with GAD also have ____ - Correct Answer-2/3 also have MDD _____ is comorbid with BPD and body dysmorphic disorder - Correct Answer-social phobia medical conditions associated w/ anxiety - Correct Answer-migraines anemia IBS

PUD

RA

asthma/COPD CVD endocrine disorders fear panic phobia is ____ part of brain - Correct Answer-amygdala center circuit worry apprehension expectations, obsessions is what part of brain - Correct Answer- cohticostraital thalamic circuit fear responses triggers what part of brain? - Correct Answer-amygdala limbic system role - Correct Answer-emotions learning social behavior prefrontal cortex - Correct Answer-executive funcitoning/decision making what is no longer considered anxiety disorders per DSM5? - Correct Answer-OCD/obsessive common vitamin deficiency in anxiety - Correct Answer-B meds that induce anxiety symptoms - Correct Answer-anticholinergics sympathomimetics withdrawal syndromes that mimic anxiety sx - Correct Answer-SSRI discontinuation syndrome most common anxiety disorder <12 - Correct Answer-separation anxiety disorder important to consider "normal development" separation anxiety duration - Correct Answer-4 weeks in children 6 months in adults selective mutism essential feature - Correct Answer-will not initiate speech or reciprocate with others in social situations speak w/ immediate family members at home most common <5 YO duration 1 month separation anxiety essential feature - Correct Answer-excessive fear/anxiety focused on separation from home or attachment figures nightmares kidnapping,monsters, school avoidance,

specific phobia essential feature - Correct Answer-immediate reaction linked to "phobic stimulus" can occur in presence in or anticipation of coding for specific phobia based on phobic stimulus. Give codes - Correct Answer-1. animal

2. natural environment (heights, storms, water etc)
3. blood injection injury
4. situational (airplanes, elevators, small spaces)
5. other ____% of people will have more than one phobia - Correct Answer-75% what to look for in children with specific phobia (difficult to assess) - Correct Answer-rule out normal fear I.e. afraid of dark -may "freeze, cry, tantrum" bc they don't understand avoidance of phobic stimulus social anxiety disorder 2 types - Correct Answer-1. performance only
6. regular in all situations social anxiety essential feature - Correct Answer-fear/anxiety in social situations of being negatively scrutinized including fear of one's own responses I.e. excessive blushing self medication before event is common I.e. ETOH before event panic disorder essential feature - Correct Answer-recurrent, unexpected panic attacks and either fear of future attacks or modifying behavior to try and avoid future attacks (panic attacks alone is not criteria for panic attacks, must fear future or modify behavior to avoid" I.e. can't go to grocery store b/c what if I have a panic attack first panic attack features - Correct Answer-people often remembers typically occurs in situation of high stress associated with more medical visits than any other anxiety d/o will come to ER having "hear attack" if they don't know what's happening panic attack sx - Correct Answer-1. heart attack sx in chest
7. fear of dying, dizzy, detached from self
8. trembling/shaking/chills/hot flashes
9. choking
10. numbness/tingling in fingers/toes
11. nausea/abdominal distress panic attack duraiton - Correct Answer-typically 30 mins can last up to an hr but rare peak within mins (0-10)

agoraphobia essential features marked by ___ of 5 of the following situations: - Correct Answer-2 of 5:

1. public transportation
2. open spaces
3. closed spaces
4. being in a crowd/standing in line
5. being outside of home alone frequent comorbidity of agoraphobia - Correct Answer-panic d/o used to be coded with panic d/o but now always coded separately most common agoraphobic stimulus in children adults - Correct Answer-1. being outside the home (think of being lost)
6. standing in lines/being in a crowd (fear of falling or experiencing panic-like symptoms) GAD essential feature - Correct Answer-excessive anxiety and worry about a number of events or activities worry can "shift" and tends to be expansive "im a worrier, I was always a worrier" DSM5 GAD criteria ___ of 6 of the following symptoms for most days for ___ months - Correct Answer-3 or more of the 6 for 6 months
7. restlessness "on edge"
8. easily fatigued
9. difficulty concentrating
10. irritability (common)
11. muscle tensions
12. sleep disturbance big component of GAD assessment - Correct Answer-psych/social/family history is huge acute onset with no family history and previously high functioning and no hx of worry then investigate substance use/other causes rare but common example of cause of panic attack symptoms - Correct Answer- pheochromocytoma ____ is common example of medical diagnosis causing GAD symptoms - Correct Answer-hyperthyroidism SCARED screening tool - Correct Answer-anxiety screening for pediatric population 40 questions

30 more specific for diagnosis GAD-7 - Correct Answer-over 2 weeks bothered by 7 symptoms rated 0-

anxiety dx first line meds - Correct Answer-SSRIs buspar PRN hydroxyzine, clonidine, propranolol (performance social anxiety) treatments for specific symptoms

1. panic symptoms
2. general anxiety, excessive worries - Correct Answer-1. biofeedback
3. CBT tarasoff principle - Correct Answer-duty to warn NY 2013 mental health declaration of human rights by CCHR - Correct Answer-mental health treatment standards and guiding principles of citizen's commission on human rights
4. right to full consent
5. no tx against your will
6. no denial of civil liberty by reason of psychiatric illness w/out fair jury trial
7. no hospitalizations bc of beliefs/practices standards by which human rights violations are investigated and exposed in psychiatry - Correct Answer-mental health declaration of human rights by CCHR rouse v cameron - Correct Answer-right to treatment and standard quality care occonnor v donaldson - Correct Answer-right to refuse treatment harmless mentally ill patients can't be hospitalized MA 51A - Correct Answer-DCF report of child abuse must be written w/in 48 hours child protective services (CPS) process when report is filed - Correct Answer-1. report is "screened"
8. assigned a CPS response if report is "screened in"; determine reasonable cause to believe supported, unsupported reporter receives a letter from DCF of department response does DCF tell the family who made report of child abuse? - Correct Answer-not unless ordered by a court where to report elder abuse - Correct Answer-elder protective servies, 60 YO and older MA elder abuse hotline who to report abuse if under 60 - Correct Answer-disabled persons protection commission

who do you call to report abuse of patient by nursing home/hospital staff? - Correct Answer-MA department of public health who to call to report rape/sexual assualt - Correct Answer-department of criminal justice/local police but don't include victim's name section 12 A 1/2 - Correct Answer-reporting rape/sexual assault by clinician treating victim describe general area where attack occurred Bupert case - Correct Answer-PA duty to warn case mother asserts provider knew of patient's intention to kill a neighbor and should have warned all the neighbors parens patriae - Correct Answer-doctrine that allows the state to step in and serve as a guardian for children, the mentally ill, the incompetent, the elderly, or disabled persons who are unable to care for themselves section 8 - Correct Answer-commitment to Bridgewater state hospital section 7 - Correct Answer-civil commitment section 12 criteria - Correct Answer-3 day hospitalization of person's by reason of mental illness

1. imminent risk to harm self/others
2. substantial risk of physical harm to other persons manifested by homicidal/violent behavior
3. substantial risk of physical impariment/injury to person by evidence of impaired judgment Roger's guardian - Correct Answer-psychiatric med administration lawyer only appointed by probate/family court MPC 120 form - Correct Answer-form to file petition for guardianship of incapacitated person (Roger's) suicide rates increased by more than ___% in 25 states in 2018 - Correct Answer- ___% of individuals who died by suicide did not have known mental health condition - Correct Answer-54 (male/firearm) ___% made healthcare visit week before suicide attempt and ___% the month before - Correct Answer-38, 64 screening for suicide - Correct Answer-PHQ-

SBQ-R: suicide behaviors questionnaire revised SAFE-T - Correct Answer-Suicide Assessment Five-step Evaluation and Triage

1. risk factors
2. protective factors
3. suicide inquiry
4. determine risk level
5. appropriate interventions
6. document who is at the highest risk of suicide? - Correct Answer-males over 85 YO
7. judge determines _____
8. NP determines ____ - Correct Answer-1. competency (legal concept)
9. capacity CDC most frequent suicide precipitants (top 5) - Correct Answer-1. relationship problems
10. crisis in past or upcoming 2 weeks
11. problematic substance use
12. physical health problem
13. job/financial problems aspects of suicide inquiry assessment - Correct Answer-1. ideation: frequency/intenisity in last 48h, month or ever
14. plan: time, location, availability, preparation
15. behaviors: past attempts, aborted attempts
16. intent: will they carry it out? explore ambivalence suicide intervention for medium risk level - Correct Answer-IOP program or partial program imminent risk is section 12 obvs SBQ-R cut off score - Correct Answer-suicide assessment risk, cut off score is 8 for psychiatric population 7 for general population SAD PERSONS - Correct Answer-Risk factors for Suicide Sex Age Depression Previous attempts Ethanol loss of Rational thinking Sickness

Organized plan No social support Stated future intent how is disorganized thinking assessed? - Correct Answer-by speech patterns of clients I.e. tangental, circumstantial, word salad, loose association what is the cause of positive symptoms of schizophrenia? - Correct Answer-excessive dopamine in mesolimbic pathway what is the cause of negative symptoms of schizophrenia? - Correct Answer-decreased dopamine in mesocortical pathway routine monitoring for schizophrenia pts on AS meds - Correct Answer-A1C lipid profile BMI CBC height/weight brief psychotic disorder duration - Correct Answer-at least 1 day but less than 1 month "placeholder" schizophrenia diagnosis - Correct Answer-schizophreniform d/o 1 mo but less than 6 mo WIRED 'N MIRED - Correct Answer-Catatonia pneumonic waxy flexibility immobility/stupor refusal to eat/drink excitement deadpan staring negativism mutism impulsivity rigidity echolalia/echopraxia direct observation catatonia treatment - Correct Answer-amantadine or BZDs schizoaffective d/o criteria - Correct Answer-major mood episode concurrent w/ criterion A of schizophrenia delusions/hallucinations for 2 weeks or more in absence of mood episode tx with AS schizophrenia onset age men vs women - Correct Answer-men 18- women 25-30s

most abused drug in patients with schizophrenia? - Correct Answer-alcohol dementia precox - Correct Answer-kraeplin/bueler schizophrenia theory chronic sx no fluctuating course blubber 4 A's - Correct Answer-associations affect autism ambivalence 5th A: accessory sx (hallucinations/delusions) who is Kurt Schneider and what is his contribution? - Correct Answer-coined Schneiderian sx of schizophrenia first rank sx (emphasized the positive sx) high risk schizophrenia births - Correct Answer-spring and early winter (viral exposure in utero) too much dopamine in what part of brain results in positive sx of schizophrenia? - Correct Answer-basal ganglia (movement and emotions, integrating sensory info); D receptors too little dopamine in what part of brain results in negative symptoms of schizophrenia?

• Correct Answer-prefrontal cortex (executive functioning); D1 receptors biological abnormalities of brain in schizophrenia - Correct Answer-1. reduced cerebral ventricles

2. reduced density of PFC, thalamus, cingulate gyrus
3. abnormal cell migration in hippocampus and PFC phencyclidine model of schizophrenia - Correct Answer-neurotransmitter hypothesis of too much glutamate schizophrenia is a developmental brain d/o involving specific pathways r/t _____ in brain - Correct Answer-prefrontal cortex _____ have protective effect in schizophrenia which could lead to delayed onset - Correct Answer-estrogen cyp3a4 AS meds - Correct Answer-quetiapine ziprasidone haldol treatment for akathisia - Correct Answer-inderal (BB)

what causes EPS symptoms for FGA? - Correct Answer-dopamine blockade in nigrostrital dopamine pathway EPS sx - Correct Answer-dystonia psuedoparkinsonism akathisa akinesia (loss of voluntary movement) tardive dyskinesia symptoms - Correct Answer-involuntary movements of the facial muscles, tongue, and limbs; grimacing, tongue protrusion, lip smacking, lip puckering AIMS scale - Correct Answer-The National Institute of Mental Health (NIMH) developed the Abnormal Involuntary Movement Scale (AIMS) The AIMS is a brief test for the detection of Tardive Dyskinesia and other involuntary movements The AIMS Examines facial, oral extremity, and trunk movement EPS side effects are more common in what generation of AS? - Correct Answer-FGA but possible in SGA new tx for TD only - Correct Answer-ingrezza, doesn't work for any other sx of EPS what causes NMS? - Correct Answer-excessive dopamine-2 receptor blockage NMS - Correct Answer--NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool NMS treatment - Correct Answer-Dantrolene D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles FGAs with highest weight gain - Correct Answer-clozapine olanzapine when do you initiate schizophrenia tx with clozapine? - Correct Answer-failure of at least 2 other meds

refractory schizophrenia high risk for suicide goal BMI and weight circumference for men + women on FGAs - Correct Answer-BMI 25- MEN: under 32 inch waist women: under 40 inch waist Antipsychotics FDA approved for ages 13-17? - Correct Answer-risperidal and aripiprazole SGA's main risks - Correct Answer-weight gain/metabolic syndrome (CATIE study-43% develop metabolic syndrome) increased CV disease anticholinergic sedation why do SGA have lower risk for EPS side effects? - Correct Answer-dopamine has inverse relationship with acetylcholine, when serotonin is blocked in nigrostriatal pathway by SGA, dopamine increases which causes ACh to decrease (EPS are caused by increased ACh) DSM5 outline for cultural formulation categories - Correct Answer-1. cultural identity of individual

2. cultural concept of distress
3. psychosocial stressors and cultural features of vulnerability and resilience
4. cultural features of the relationship between individual and clinician
5. overall cultural assessment CSF four domains of assessment - Correct Answer-1. cultural perceptions of cause, context, support
6. cultural factors affecting self coping nd past help seeking
7. cultural factors affecting current help seeking
8. cultural definition of the problem cultural syndromes - Correct Answer-clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of experience cultural idioms of distress - Correct Answer-terms or phrases used to describe suffering or distress within a given cultural context doesn't not involve specific symptoms I.e. "nerves" "depressed" but doesn't explain specifically how cultural explanations - Correct Answer-culturally recognized descriptions of what causes the symptoms, distress, or disorder

3 areas of cultural concepts of distress aka "culture bound syndromes" - Correct Answer-idioms of distress syndromes explanations why is it important to understand cultural concepts? - Correct Answer-1. Understanding that some mental distress may have unique presentations that are cultural in origin can assist with mental health screening and help avoid misdiagnosis.

2. Cultural understanding of these symptoms can help build a therapeutic alliance with a patient.
3. While cultural concepts of distress alone do not indicate the presence of a diagnosable mental disorder, they do indicate vulnerable individuals or populations that could benefit from mental health promotion initiatives and other public health activities. socialization - Correct Answer-the lifelong process of social interaction through which individuals acquire a self-identity and the physical, mental, and social skills needed for survival in society -inherit customs, values, ideologies acculturation - Correct Answer-(n.) the modification of the social patterns, traits, or structures of one group or society by contact with those of another; the resultant blend -process of adopting a different culture of interest; assimilation is the actual adoption of new culture assimilation - Correct Answer-the social process of absorbing one cultural group into harmony with another individual loses nearly all aspects of previous culture segmented assimilation is when you belong and communicate with new and old culture ethnocentrism - Correct Answer-Belief in the superiority of one's nation or ethnic group. xenophobia - Correct Answer-a fear or hatred of foreigners or strangers dislike of people from other cultures/countries SAMSHA TIP core elements of cultural competence - Correct Answer-1. cultural awareness
4. cultural knowledge
5. cultural knowledge of behavioral health (interventions/services effective for specific cultures)
6. cultural skill development 6 concepts of culture - Correct Answer-1. beliefs/values
7. passed on heritage/history
8. similar socialization patterns
9. common communication/language

5. geographic location of residence
6. dress and food race - Correct Answer-a socially constructed category of people who share similar physical characteristics I.e. asian eye slits in non-asians not genetically based ethinicity is explicitly ______ phenomenon - Correct Answer-cultural ethnicity vs race - Correct Answer-ethnicity is based on shared values/beliefs and race is based on physical characteristics what is the outcome of acculturation? - Correct Answer-assimilation RESPECT pneumonic for culturally responsive attitude - Correct Answer-respect explanatory model sociocultural influence power empathy concerns/fears trust/therapeutic alliance which cultural group is least likely to have confidence in their medical practitioners? - Correct Answer-asians anxiety tx in children - Correct Answer-CBT clonidine guanfacine best med for panic d/o with comorbid depression? - Correct Answer-fluoxetine when should venlafaxine be used for GAD tx? - Correct Answer-muscle rigidity insomnia irritability most effective therapy for phobias? - Correct Answer-behavior therapy what is kyal? - Correct Answer-Cultural anxiety syndrome "wind attacks" Cambodian and asian neck soreness/tinnitus Ataque de nervios - Correct Answer-a self-labeled syndrome found in Latinos in which they experience a mixture of anxiety, panic, depression, and anger

Hamilton Rating Scale for Anxiety - Correct Answer-(HAM-4) was developed in 1959 by Max Hamilton primarily as a means of assessing anxiety symptoms in people who were already diagnosed with anxiety disorders. it is not intended as a means of detecting or diagnosing anxiety, but is most useful in helping clinicians measure patient improvement over time. what labs rule out other causes of anxiety? - Correct Answer-CBC, thyroid, B12, chemistry (BMP) which BZDs have longer half lives? - Correct Answer-klonopin valium advantages of shorter half life BZDs? - Correct Answer-quicker onset action less daytime sedation insomnia tx increased risk of addiction xanax, Ativan schizophrenia rating scales - Correct Answer-brief psychiatric rating scale (BPRS) positive and negative symptoms scale (PANSS) panic attacks must be what to meet DSM5 criteria? - Correct Answer-out of the blue, unexpected otherwise may signify specific phobia