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NURS 6501 Final Exam Study Guide
1. What is the role of the primary care provider in mental health?: - Screen for mental health
issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable severe mental disorders
- From strong links with mental health specialty care for complex cases Sharing patient info (ex: meds used)
2. about PHQ
- what does it screen for, what are the questions, scoring: - Screens for MDD
- It is the first two questions of the PHQ
- In the last two week, have you been feeling these (not at all, several days, more than half the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless? Scoring: A single yes or score >3 (out of 0-6) = possible clinical depression Òd u e the PHQ If the pt screens (+) Òc o n t i n u e to eval with the PHQ
3. about PHQ
- what its used for, questions, scoring: Used for screening, diagnosing, and treating
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- It asks about functioning impairments which is needed for the DSM-based diagnosis Includes asking about suicide or hurting self Scoring: 0-27 available 0-4: Minimal/none Monitor; may not require treatment 5-9: Mild Use clinical judgment; follow-up in one month 10-14: Moderate Use clinical judgment; may need meds if functionally impaired 15-19: Moderately Severe Warrants active treatment with psychotherapy, meds, or combo 20-27: Severe Warrants active treatment with psychotherapy, meds, or combo
4. What is the appropriate initiation dose for fluoxetine for adults and geriatric adults?:
20mg PO once daily in the AM
- May ‘daily dose after several weeks if inadequate response
- Full therapeutic ettect may be delayed 4 weeks or longer
- Max dose: 80mg/day
5. What labs would be appropriate to draw if you initiate fluoxetine in a geriatric patient?:
Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs, previous hx of antidepressant-induced hypona- tremia, low body weight, concomitant use of thiazides or other hyponatremia-inducing agents)
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8. What is serotonin syndrome?: - Increased serotonergic activity in the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-OD Serotonin in the Body: CNS: Modulates attention, behavior, and thermoregulation PNS: Regulates GI motility, vasoconstriction, uterine contraction, and bronchoconstriction, promotes PLT aggregation
9. PE of serotonin syndrome 11: - Hyperthermia, flushed skin, diaphoresis
- Agitation
- Slow, continuous, horizontal eye movements (ocular clonus)
- Dilated pupils
- Tremor, akathisia
- Deep tendon hyperreflexia (common)
- Inducible or spontaneous muscle clonus (common)
- Muscle rigidity
- Bilateral babinski
- Dry mucus membranes
- Increased bowel sounds
10. What is discontinuation syndrome (from SSRIs)?
"FINISH": 2-3 days after stopping SSRIs abruptly F: flu-like SS I: insomnia N: nausea
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11. Bupropion
- MOA
- BENFITS
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12. RF for ETOH abuse 4: Younger adults (18-29 yrs)
Men > women Native americans Genetics (low response to ETOH), environment (peer influences), specific personality traits (impulsivity, extroversion), cognitive fxn
13. What are predisposing factors impacting the likelihood of someone develop- ing a SA
issue?: Predisposing Factors:
- Unhealthy use of one substance increases the likelihood of unhealthy use of other substances
- Family history
- Social history
- Partner or friends with SA, living in a community with poverty, violence, and/or high ETOH/drug use Use of:
- Caffeine, tobacco, ETOH, prescription meds, marijuana, illicit drugs
- Mental health disorders
- Highest in personality disorders
14. What is withdrawal: process of removal of the drug of dependence from the body
15. SS of substance abuse withdrawal 3: Can last days to weeks
- NVD
- Flu-like SS: lacrimation, rhinorrhea, diaphoresis, shivering, piloerection
- SNS/CNS Arousal: mydriasis, mild HTN and tachy, anxiety, irritability, insomnia, agitation, restless leg, general restlessness, tremor, low grade temp
16. Which medications are central nervous system sedatives?: Include sedatives, tran-
quilizers, hypnotics
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- Good for treating anxiety, panic, acute stress reactions, sleep disorders Examples: Benzos:
- Diazepam (valium), clonazepam (klonopin), alprazolam (xanax) Non-Benzo Sedative Hypnotics
- Zolpidem (ambien) Barbiturates
- Mephobarbital
17. Initiation Strategies for Antidepressants:: Antidepressants are considered equivalent in efficacy for
depression Decide on med by:
- History of response
- Family history of response
- Symptoms
- Medical history
- Interactions
- AE
18. which antidepressant is good for smoking cessation, weight loss, and ADD?-
: Bupropion
19. which antidepressant is good for fibromyalgia: Duloxetine
20. which antidepressant is good for migraine prevention: Amitriptyline
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- unstable angina
- decompensated HF
- High-grade AV block
- symptomatic ventricular arrhythmias
- supraventricular arrhythmias with uncontrolled ventricular rates
- severe valvular disease
27. intermediate risk factors that increase surgical risk 4: - mild angina
- previous MI by history or pathologic Q waves, compensated or previous HF
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- DM (especially 1)
- renal insufficiency
28. minor risk factors that increase surgical risk 6: - advanced age
- abnormal EKG
- rhythm other than sinus
- low functional capacity
- history of stroke
- uncontrolled HTN
29. How far in advance should herbal medications be held before a planned surgery?:
All herbals should be stopped two weeks prior
30. List the potential complication of spinal or regional anesthesia: HA, nerve damage,
infection, limb loss
31. presurgical guidelines for metformin: - take day before surgery, then resume it afterwards when
patient is eating again
- If procedure involves IV contrast or long surgical time Òmetformin is stopped when the preop fasting begins and restarted postop with normal diet resumption
- If renal dysfunction found preop or postop ÒDC metformin until renal function normalizes
32. SGLP2i presurgical guidelines: Stop immediately if undergoing emergency procedure
Hold med 24h prior to elective surgery
13 / 24 A: Age ’>50yrs N: Neck size large ’measured around Adam's apple Men: shirt collar ’17 inches/43cm or larger Women: shirt collar ’16inches/41cm or larger G: Gender ’male
38. scoring for STOP BANG: - Low risk: yes to 0-2 questions
Intermediate risk: yes to 3-4 questions
- High risk: yes to 5-8 questions OR yes to 2 or more STOP questions + male gender OR yes to 2 or more STOP questions + BMI > OR yes to 2 or more STOP questions + neck circumference
39. What is your responsibility as a health care provider to do when a patient informs
you that they have recently been sexually assaulted? (IF WITHIN 72H): - PCP should defer a PE and refer the pt to the ER if the sexual assault occured within the last 5 day, preferably within 72h
- Ensures proper measures are taken and comply with standardized protocols
- Support the patient's current or future desire for legal pursuits
- PCP doesn't need to request specific info about the assault ’this will be done in the ED
40. what's the role of the PCP if sexual assault happened > 5 days?: - Medical care can be
managed in the outpatient setting
- Get a detailed hx and perform a full PE and gyn exam
- 40% of rape victims sustain a collateral injury; 5% sustain a severe injury
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- Injuries most common in >30yrs old
- Gyn injuries: vaginal or anal tearing, rectal bleeding, bruising, soreness
- Use face of a clock for documenting locations
- Other SS: GI irritability, dysmenorrhea, pelvic pain, UTIs
- Get a gonorrhea, chlamydia, HepB/C, HIV, and pregnancy tests
41. Does your responsibility change for sexual assault if the patient is under the age of
18?: Children and adolescents would need collaboration with agencies that are specific to this age group to prevent lifelong complications of the abuse
42. what are the variables worth 1 point each in the CAD clinical decision rule: Men
> 55 yrs, women > 65 yrs Known CAD aor CVA Pain not reproducible by palpation Pain worse during exercise Patient assumes pain is cardiogenic
43. what would you do for low risk of CAD using the clinical decision rule (0-1 score):
Evaluate for noncardiac causes unless pt has other reasons for concern (murmur, dyspnea, arrhythmia)
44. what would you do for moderate risk of CAD using the clinical decision rule (2-
score): - Findings consistent with ischemic heart disease (new ST ,²new LBBB, Q wave, or T wave hyperacuity
- ^^ yes or no would determine if they go to the ER vs checking troponins vs determining a nonischemic cause
45. what would you do for high risk of CAD using the clinical decision rule (4-5 score):
Order EKG; give O2 and ASA; arrange EMS to ER
46. anaphylaxis ss: Occurs within 5-30 minutes of exposure to:
Generalized itching with or without hives
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8. Short course of PO steroids is recommended after treatment of moderate to severe reactions Consider
prescription for injectable Epi
48. What is the typical dose of epinephrine for the treatment of anaphylaxis? How
often can it be repeated?: Epi 1:1000 (0.01mL/kg IM)
- Adult > 45 lb: Epi 0.3mL (Epipen or Twinject) Repeat Epi x5 minutes if necessary
49. what is neuropsychological testing used for?
when should PCPs use it?: - can identify deficits r/t stages of dementia
- indicated for best PCP practice for medical conditions that have a high propensity for cognitive decline
50. pharm for grief: - Antidepressants shouldn't be used for acute grief ’reserve for subsequent major
depression
- A sedative to help sleep may be used for NO MORE than 2 weeks at a time Òg o a l is to re-establish a healthy sleeping pattern
51. What are the principal symptoms and characteristics of concussion?: - HA, fatigue,
dizziness, NV (self-limited), unsteadiness when standing/walking, feeling mentally slowed or foggy
- Anterograde amnesia (Difficulty remembering the events AFTER to the event- Coming off the field, going to the hospital)
- Retrograde Amnesia (Diflculty remembering things that happened PRIOR to the event- Who they're playing, score of game, what they ate prior to game)
- Sleep Disturbances
- Emotional changes
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- Occur immediately after blunt head trauma
52. Bell's Palsy
- definition, etiology, SS, PE, treatment: DEFINITION
- Acute, unilateral weakness or paralysis of the facial nerve with an onset of , 72h and unknown cause ETIOLOGY
- genetics, vascular, nerve compression, infectious, and metabolic ²
- HSV, VZV Òc a u s e latent infections in nerves Òreactivation of these can cause Bell's SS
- may have pain behind the ipsilateral ear preceding the paralysis by 1-2 days
- may have altered taste and ‘sensitivity to sound
- presents within 38-72h
- slower, progressive, or relapsing is a ditterent entity PE
- must do a complete CNS exam to r/o stroke, tumor
- must find that CN7 is the primary peripheral source of the facial weakness
- will cause a unilateral, full-face paralysis with an ipsilateral source indicating a peripheral nerve problem
- lack of eyelid closure and absence of wrinkling forehead
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- head trauma Central Disorders:
- brainstem or cerebellar ischemia/ hemorrhage
- tumors
- MS
- migrainous syndrome
55. What is the Hallpike-Dix maneuver, and why would it be used?: Hallpike-Dix
Maneuver can be diagnostic for BPPV
1. Check for spontaneous nystagmus while they're seated on exam table
2. Bring pt quickly back to supine position with head extended 30-45 degrees over the end of the table and head tilted 30-45 degrees
to one side
3. Repeat this x2 with head L and R
4. Observe pt for latency, duration, direction, and fatiguability of nystagmus
Vertigo without nystagmus is not indicative of BPPV
56. Tension HA
PAIN, DURATION, PRECIPITATING FX: - Most common Pain:
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- moderate, non-throbbing
- headband distribution
- Scalp tingling Duration:
- minutes to hours, usually just one day
- Episodic or chronic
- Chronic occurs >15x/mo Precipitating fx:
- eye strain, aggravation, frustration, daily stresses, sleep disturbances
57. Migraine
PAIN, DURATION, PRECIPITATING FX: - With or w/o aura
- Mainly occur in women Pain:
- Throbbing, mod-severe
- Unilateral, bilateral Assoc SS:
- N/V, neck pain
- photophobia, phonophobia
