Psychiatric Disorders and Treatments, Exams of Nursing

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LMR - Georgette's questions with correct

answers

Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? Correct Answer-Native American Which ethnic group has the highest incidence of suicidal attempt and completion? Correct Answer-Native American Cultural syndrome is Correct Answer-A culturally expected response to a stressor A culturally expected response to a stressor is called Correct Answer-Cultural Syndrome How should multicultural teaching be conducted? Correct Answer-Ethnospecific If a patient is regularly taking Kava, what lab should you get? Correct Answer- LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? Correct Answer-Fever Which antipsychotic has the least weight gain? Correct Answer-Ziprasidone (Geodon) Which SGA is the least sedating? Correct Answer-Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? Correct Answer-Quetiapine (Seroquel)

Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? Correct Answer-nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? Correct Answer-ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? Correct Answer-Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? Correct Answer-Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? Correct Answer-HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? Correct Answer-DC lithium What is one of the most important teaching points you should make in a patient taking lithium? Correct Answer-Stay hydrated A patient with what medical condition is at risk for lithium toxicity? Correct Answer-Cardiac failure (hyponatremia)

What is the key indicator for NMS? Correct Answer-Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of Correct Answer-NMS What is the key indicator of Serotonin Syndrome? Correct Answer-Muscle jerks (myoclonic) Muscle jerks (myoclonic) are the key indicator of Correct Answer-Serotonin Syndrome If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? Correct Answer-Bupropion What is first line treatment for MDD? Correct Answer-SSRIs What are the 2 antidepressants of choice in a depressed patient with cancer? Correct Answer-Citalopram (Celexa) Escitalopram (Lexapro) What is the antidepressant of choice in a depressed patient with sexual dysfunction? Correct Answer-Bupropion What is the antidepressant of choice in a depressed patient with decreased energy? Correct Answer-Bupropion

What are 3 treatments for depressed patients with neuropathic pain? Correct Answer-SNRI (safety) TCA Gabapentin Which SSRI is most likely to cause insomnia? Correct Answer-Fluoxetine (Prozac) What question is important to ask in the social history with a depressed patient? Correct Answer-Alcohol intake (self-medicating) What BBW do all antidepressants have? Correct Answer-Suicidal ideation (< yrs.) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? Correct Answer-Antidepresssants What question should ask all adolescent patients at each visit? Correct Answer-Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit? Correct Answer-Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? Correct Answer-Few evidence-based studies What is the onset of schizophrenia in males? Correct Answer-18-

What is the onset of schizophrenia in females? Correct Answer-25- What question should ask schizophrenic patients at each visit? Correct Answer-SI What is the most likely diagnosis in a patient with homicidal ideation? Correct Answer-Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? Correct Answer-All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? Correct Answer-Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? Correct Answer-Prefrontal cortex Amygdala Hippocampus What is Assertive Community Treatment (ACT)? Correct Answer-Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to Correct Answer-Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? Correct Answer-No

Which services can be provided in the home for SMI patients? Correct Answer- Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? Correct Answer-Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? Correct Answer-Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? Correct Answer- Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? Correct Answer-20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? Correct Answer->100 mg (administer weekly if necessary) What is a delusion? Correct Answer-A firm belief despite contrary evidence A firm belief despite contrary evidence is Correct Answer-delusion How often is Haldol Decanoate typically adminitered? Correct Answer-monthly How do you conduct a MSE in a preschooler (3-5 yo) Correct Answer-Clinical observation (listen/observe)

What is thought content? Correct Answer-SI/HI, plan What are the 5 components of the MMSE (Folstein's) Correct Answer- Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? Correct Answer-5-HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? Correct Answer-5HT2-antagonism What antipsychotic should you give to a patient with their first psychotic episode? Correct Answer-SGA (IM) Which 4 SGAs are available in IM form? Correct Answer-Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? Correct Answer- Metoclopramide (Reglan)

What is a normal prolactin level in men? Correct Answer-< What is a normal prolactin level in women? Correct Answer-< What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? Correct Answer-Decrease olanzapine dose What effect does tobacco have on CYP450? Correct Answer-1A2 inducer What class of drugs are primarily inhibitors? Correct Answer-Antibiotics How does erythromycin and clarithromycin affect CYP240? Correct Answer- Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? Correct Answer-Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? Correct Answer-Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? Correct Answer-Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? Correct Answer- Insomnia Tremors

Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations) A patient who c/o pain after eating, bloating and fullness, what do you suspect? Correct Answer-Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? Correct Answer-Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? Correct Answer-H antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? Correct Answer-Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) What is a common side effect of SSRIs in the older population Correct Answer- Anxiety What is a paradoxical effect of benzodiazepines? Correct Answer-Increased anxiety (avoid in future) What is apotosis? Correct Answer-Cell death/neuronal loss

What is the name for cell death/neuronal loss? Correct Answer-apotosis What is the greatest risk factor for bipolar disorder? Correct Answer-genetics (very heritable) What is the first question you ask with a patient with suspected bipolar disorder? Correct Answer-family history What should you consider in a 45 yo patient that presents with manic symptoms? Correct Answer-Medical condition At what age should you consider a patient with manic symptoms to be medically- induced Correct Answer-45 and older What are 2 differences between mania and hypomania? Correct Answer-More severe Increased duration (7 days vs. 4 days) A patient that presents with grandiosity or exaggerated self-esteem is most likely to have Correct Answer-Mania or hypomania A patient who is manic, irritable mood, and uncooperative is most likely to have what disorder? Correct Answer-bipolar disorder What is a key symptom to consider in a patient you suspect of mania or hypomania? Correct Answer-Grandiosity or exaggerated self esteem

What is a hallmark feature of borderline personality disorder? Correct Answer- Self-harming behavior (recurrent) Self-harming behavior (recurrent) is a key factor in which disorder? Correct Answer-Borderline personality disorder What therapy in borderline personality disorder been shown to decrease suicidal ideation? Correct Answer-DBT Who developed DBT? Correct Answer-Marsha Linehan In DBT, diagnosis of borderline disorder requires activity? Correct Answer- journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed Correct Answer-Valproic acid When should valproic acid be prescribed in a patient with borderline personality disorder? Correct Answer-Depressed mood + lability A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? Correct Answer-Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? Correct Answer-Conduct Disorder Is a child with ODD or Conduct Disorder more likely to need medication? Correct Answer-Conduct Disorder

If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? Correct Answer-No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? Correct Answer-Not always What 3 neurotransmitters are involved with Tourette's? Correct Answer-DNS What is factitious disorder imposed on another? Correct Answer-Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? Correct Answer-Report to CPS Child abuse (duty to report) What is Factitious Disorder Correct Answer-Faking illness to get medical attention or sympathy A patient who feigns illness to get sympathy or attention is most likely to have Correct Answer-Factitious disorder A patient with factitious disorder is most likely to have what type of demographic? Correct Answer-Unmarried healthcare worker What is malingering? Correct Answer-Feigning illness for secondary gain ($) (not a psychiatric diagnosis)

A patient who claims disability or worker's comp when there is no injury is most likely Correct Answer-Malingering (not a psychiatric diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? Correct Answer-Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? Correct Answer-Reactive Attachment Disorder A disorder that presents like PTSD, but symptoms last less than a month is most likely to have Correct Answer-Acute Stress Disorder What is the required duration for a DSM-5 diagnosis of GAD? Correct Answer- months How does a panic attack differ from Panic Disorder? Correct Answer-acute, impending doom How does Panic Disorder differ from a panic attack? Correct Answer-Chronic, recurrent, unexpected How do you treat a patient with panic disorder who is taking albuterol for asthma? Correct Answer-SSRI or benzodiazepine (don't give beta blocker) What is the treatment of choice for acute symptoms of panic disorder? Correct Answer-Beta blocker (not addictive)

How do you treat test anxiety for maintenance therapy? Correct Answer-SSRI How do you treat text anxiety acutely? Correct Answer-Beta blocker Benzodiazepine What structure of the brain is involved with attention, executive function, and cognitive processes (working memory, problem solving) that affects ADHD? Correct Answer-Dorsolateral prefrontal cortex Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? Correct Answer-prefrontal Dysfunction of the prefrontal cortex is most likely in what type of ADHD? Correct Answer-Inattentive What do you recommend to a mother of a child with ADHD as an aftercare plan on admission? Correct Answer-Brief supportive therapy (not after dc) If a patient present with irritability, depression, and lability, which questionnaire do you administer? Correct Answer-Mood Disorder Questionnaire (MDQ) When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? Correct Answer-Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? Correct Answer-Disruptive Mood Dysregulation Disorder (DMDD)

A child with intense temper outbursts is most likely to have what DSM- diagnosis? Correct Answer-Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? Correct Answer-If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? Correct Answer-Persistent deficits in social communication and social interaction across multiple settings A child with persistent deficits in social communication and social interaction across multiple settings is most likely to have what DSM-5 diagnosis? Correct Answer-Autism A child that does not establish eye contact is likely to have Correct Answer-autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? Correct Answer-Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered Correct Answer-Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? Correct Answer-UA C/S

An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for Correct Answer-Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? Correct Answer-B Folic acid What is the initial treatment for a patient with dementia and psychosis? Correct Answer-Nonpharmacologic treatment If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? Correct Answer-Administer SGA What type of dementia is HIV-related? Correct Answer-Subcortical What are 3 early signs/symptoms of HIV-related dementia? Correct Answer- Cognitive deficit Motor abnormalities (decreased coordination) Behavioral symptoms A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? Correct Answer-HIV-related In a patient with suspected HIV-related dementia, what is your initial action? Correct Answer-Obtain HIV test

What is first-line pharmacologic treatment for a patient with HIV-related dementia? Correct Answer-Antiretroviral treatment An older adult who has had cognitive impairment for over a year and who tries to answer (may not be able to) or confabulates is most likely to have a diagnosis of Correct Answer-Dementia An older adult who has had cognitive impairment for less than 5 months and who answers your questions with "I don't know," most likely has a diagnosis of Correct Answer-Depression (pseudodementia) An older patient who has symptoms of irritability, agitation, hallucinations, and delusions is most likely to have Correct Answer-Depression (vs. dementia) What are 2 ways to determine whether an older person with decreased memory has depression or dementia? Correct Answer-SLUMS, Mini-Cog onset of symptoms What screening instrument can hep differentiate dementia from pseudodementia (depression)? Correct Answer-MMSE A patient with frontal lobe (Pick's) dementia is most likely to present with what 4 symptoms? Correct Answer-Executive dysfunction Slurred speech (expressive aphasia) Language comprehension (receptive aphasia) Personality and behavior changes Social skills

A patient who presents with difficulties with executive function, slurred speech, personality, and behavior changes, difficulties with language comprehension, and poor social skills is most likely to have what type of dementia? Correct Answer- Frontotemporal (Pick's) A patient with visual hallucinations is most likely to have what type of demenetia? Correct Answer-Lewy Body A patient with Lewy Body Dementia is most likely to have what presenting symptoms? Correct Answer-Visual hallucinations A patient with damage to the anterior cingulate will demonstrate what 3 symptoms? Correct Answer-Cognitive dysfunction (decision making) Lack of empathy Difficulty with impulse control and emotions A patient who presents with cognitive dysfunction (decision making), lack of empathy, and difficulty with impulse control and emotions is most likely to have damage in what brain structure? Correct Answer-Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? Correct Answer-Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? Correct Answer-Cerebellum What condition may cause pica (eating things that are not food - paint chips)? Correct Answer-Lead poisoning

What 5 neurotransmitters are associated with mood disorders? Correct Answer- Dopamine Norepinephrine Serotonin GABA Glutamate What do do yo do when an infant is about to die? Correct Answer-Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? Correct Answer- Family support Support groups (don't give prescriptive advice) What are 5 risk factors for osteoporosis? Correct Answer-Smoking Caffeine Low calcium/vitamin D in diet Decreased weight Lack of weight bearing exercises Smoking, Caffeine, Low calcium/vitamin D in diet, Decreased weight, and Lack of weight bearing exercises are risk factors for Correct Answer- Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? Correct Answer-Yes

If a patient is reluctant to participate in group therapy, what do you do? Correct Answer-Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? Correct Answer-CBT What are 5 techniques used in behavioral therapy? Correct Answer-Problem- solving Skills training Exposure therapy Role-playing/modeling Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in Correct Answer-Behavioral Therapy What are 2 common techniques used in CBT? Correct Answer-Cognitive restructuring Journaling Cognitive restructuring and journaling are common techniques used in Correct Answer-CBT 2 key concepts of Humanistic (person-centered) therapy are Correct Answer-Self- directed growth Self-actualization

Self-directed growth and self-actualization are key concepts of what type of therapy? Correct Answer-Humanistic (person-centered) Which therapy is based on the principle that each person has the potential to self- actualize and find meaning in life? Correct Answer-Humanistic (person-centered) What is the best therapy for dealing with conflicts with others (e.g., spouse, co- workers)? Correct Answer-Interpersonal therapy Interpersonal therapy is recommended in what situation? Correct Answer-conflict and relationship (marital) problems How long does interpersonal therapy typically last? Correct Answer-12-16 weeks If a patient is noncompliant, what is a technique that is used in Strategic Therapy? Correct Answer-Paradoxical directive/intervention When is a paradoxical directive/intervention given in Strategic Therapy? Correct Answer-With a noncompliant member If a patient is compliant, what is a technique that is used in Strategic Therapy? Correct Answer-Straight Forward Directive When is a Straight Forward Directive given in Strategic Therapy? Correct Answer- When a member is compliant

What type of therapy is a therapist using when he asks "what worked before when you had this problem" Correct Answer-Solution-focused Meditation is a form of Correct Answer-Muscle relaxation What 4 positive effects does physical activity have on children? Correct Answer- Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? Correct Answer-Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened- ended question? Correct Answer-Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? Correct Answer-talk to parents What therapeutic factor does open-ended questions instill? Correct Answer- empathy If only the wife shows up for a couple appointment, what do you do? Correct Answer-Reschedule the appointment

A mother reports that her child was sodomized. What 2 things do you do? Correct Answer-Contact CPS Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? Correct Answer-crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis Correct Answer-ESR When is an ESR indicated? Correct Answer-Patient with rheumatoid arthritis What does PICO stand for? Correct Answer-P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? Correct Answer-Have access to current journals A baby with a shrill cry is likely to have Correct Answer-Increased intracranial pressure A sign of increased intracranial pressure in a baby is Correct Answer-shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? Correct Answer-That is normal between 3-6 yrs old (Phallic stage)

What do you tell an adolescent who is concerned about nipple swelling and tenderness and breast enlargement? Correct Answer-This is normal between 9-16 yo. It will disappear within 6 mo. How do you treat decreased sexual drive in a older female patient? Correct Answer-Testosterone (improves blood flow to pelvic region) Why are women more likely to get intoxicated and have alcohol-induced hepatotoxicity? Correct Answer-Decreased alcohol dehydrogenase What are the 2 effects of decreased alcohol hydrogenase in women Correct Answer-Increased intoxication Increased alcohol-induced hepatotoxicity What is the grasp/palmar reflex? Correct Answer-infant grabs anything put into his or her hand What primitive reflex causes a newborn to grasp vigorously any object touching the palm or fingers or placed in the hand? Correct Answer-Grasp/palmar reflex When does the palmar grasp reflex disappear? Correct Answer-5-6 months What is the moro (startle) reflex? Correct Answer-Loud noise or sudden loss of support will cause infant to abduct/extend UE's and trunk followed by a return to flexion

Infant reflex where a baby will startle in response to a loud sound or sudden movement is called Correct Answer-Moro/startle reflex When does the Moro reflex disappear? Correct Answer-5-6 months What is the Babinski (Plantar) reflex? Correct Answer-the big toe is extended and the other toes fan in response to the brushing of the sole of the foot When does the Babinski (Plantar) reflex disappear? Correct Answer-2 years What is the absorption rate of PDE-5 inhibitors (Viagra)? Correct Answer-Rapid What 2 deficiencies are associated with macrocytic anemia? Correct Answer-Folic acid B12 Folic acid deficiency creates what type of anemia? Correct Answer-Macrocytic With normocytic, macrocytic anemia, what 3 labs do you obtain? Correct Answer- B12, folic acid, Fe B12 deficiency creates what type of anemia? Correct Answer-Macrocytic What deficiency is associated with microcytic anemia? Correct Answer-Iron