Psychosocial/Psych questions and answeres latest 2022

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Psychosocial/Psych questions and answeres latest 2022 A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response? Correct Answer: 8-12... weeks Most learned authorities agree that if there is no response by 8-12 weeks at a maximal therapeutic dose, a different antidepressant should be tried. The 8-12 week period is the correct time frame because it will take this long to increase the dose and attempt to reach maximal dose for therapeutic response. 4-6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach and evaluate therapeutic dose. Which patient is most likely to exhibit depression related to his illness? A patient with: Correct Answer: Parkinson's disease Diseases associated with the central nervous system are associated with high rates of depression. These include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other illnesses associated with high rates of depression are cancer and cardiovascular illnesses like myocardial infarction. Depression worsens the outcome of any physical illness. A patient with an eating disorder may concomitantly exhibit: Correct Answer: Anxiety disorders Affective disorders, anxiety disorders, and substance abuse issues are common in patients who have eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with eating disorders are more likely to have a first or second degree relative with an eating disorder, affective disorder, or alcohol abuse. There is no evidence that patients with eating disorders exhibit a higher incidence of sleep disorders or liver disease. Thyroid disease should always be assessed in patients with eating disorders, but this does not represent the reason for weight loss when eating disorder is present. Which criterion below is a criterion for Alzheimer's Disease? Correct Answer: Impairment of executive function The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other organizations. The criteria are similar. Criteria include a gradual onset of cognitive decline. A rapid onset usually indicates another etiology, perhaps, delirium. Other criteria include impairment of recent memory, difficulty with language or finding words, the inability to execute skilled motor activities, disturbances of visual processing or disturbances in executive function that includes abstract reasoning and concentration. Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is not a criterion for diagnosis, though it may support the diagnosis of AD. There is no laboratory evidence of AD. An 80 year old adult has begun to use over the counter diphenhydramine to help him fall asleep. What common side effect can occur in older adults with use of this medication? Correct Answer: Next day sleepiness Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-cholinergic effects in patients who take this, but especially in older adults. Urinary retention is common (not incontinence) in older men with benign prostatic hyperplasia, but retention occurs in women too. Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect is cognitive impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying side effects like dry mouth and constipation. A 69 year-old female patient reports feelings of anhedonia for the last month. What should be part of the nurse practitioner's assessment? Correct Answer: Depression Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or interest. If this is the case, this patient should be screened for depression. Anhedonia is a red flag for depression. A 70 year-old male patient has an elevated MCV with an anemia. His triglycerides are 420. What should be suspected? Correct Answer: Alcohol abuse This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia. Common macrocytic anemias are B12 deficiency and folate deficiency. These are common in older patients, especially if they consume large quantities of alcohol. This patient also has elevated triglycerides. Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydrates. This patient's history indicates two elements that indicate alcohol abuse. He should be questioned regarding alcohol abuse. Which symptom listed below is typical of depression? Correct Answer: Early morning wakening Sleep difficulty is a common complaint among patients with depression. Patients with difficulty falling asleep are often anxious. Frequent waking and early morning wakening are often complaints by patients with depression. There is no agreed on physiologic explanation, but, this is a common symptom. Delirium differs from dementia because delirium: Correct Answer: often develops acutely Delirium is a change in consciousness or cognition. It may be accompanied by a physical diagnosis like urinary tract infection; or it may be due to consumption of a medication. Regardless, a change in cognition or consciousness needs immediate evaluation. The evaluation should include a medication review, physical exam and laboratory evaluation, and mental status exam. Which screen for alcohol abuse has been validated in the elderly? Correct Answer: CAGE CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for "have you ever felt you should CUT down" your alcohol consumption. The A stands for " does other's criticism of your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinking". The E stands for "have you ever had an EYE opener to steady your nerves or get rid of a hangover". A positive response on any question constitutes a positive screen. MMSE helps to identify patients with symptoms of: Correct Answer: dementia The mini mental status exam (MMSE) is a very common and easily administered cognitive evaluation for dementia. It tests orientation, recall, attention, calculation, language manipulation, and constructional praxis. It is not sensitive for mild dementia and may be influenced by educational level and age. Even with these limitations, the MMSE is the most widely used cognitive test for dementia in the US. An adolescent female patient with anorexia nervosa must exhibit 4 criteria for diagnosis. Which criterion listed below is NOT part of the diagnostic criteria? Correct Answer: Weight below 90% of ideal body weight Weight below 85% of ideal body weight is the correct criterion. This involves refusal to gain or maintain weight within normal range. Occasionally weight below ideal body range does not involve losing weight, but instead involves refusal to gain weight during a growth spurt. This is commonly observed during pubertal growth spurts and is more common in adolescent females than males. The other three criteria are correct as listed. Which statement about bulimia nervosa is accurate? Correct Answer: High dose SSRIs are used to treat this The medications of choice to treat bulimia nervosa are the SSRIs. Generally, high doses are required. Wellbutrin is not an SSRI and should not be given to patients with eating disorders because of great fluctuations in drug levels related to purging. Generally, this is more common in women than men. Loss of control IS a characteristic of this illness. The most common mental disorder in older adults is: Correct Answer: anxiety Anxiety is very common in older adults. Depression is very common too, and may accompany anxiety in older adults. The prevalence of anxiety may be due in part to other physical illnesses or serious diseases or disorders, like cancer, Parkinson's disease. New onset anxiety should prompt the examiner to consider withdrawal of medication or side effects of medication being taken at therapeutic levels. A 19 year-old college student is at least 15% below her ideal body weight. She reports doing well in classes but drinks alcohol nightly, and several cups of coffee throughout the day. She is bradycardic and gets dizzy when she stands. What may also be observed in this patient? Correct Answer: Amenorrhea This patient has anorexia nervosa. She is far below ideal body weight and exhibits evidence of poor nutrition and health. More than 90% of patients with anorexia are amenorrheic. These patients have low levels of leuteinizing hormone and follicle stimulating hormone. Because of prolonged hypoestrogenic states, they are highly susceptible to osteopenia and osteoporosis. It is not known why, but, many patients with anorexia also exhibit mitral valve prolapse, not mitral regurgitation. Because she is bradycardic, an EKG should be performed. QT prolongation is common in these patients, especially when bradycardia is present. Hypotension is more common than hypertension in anorexic patients. Serotonin syndrome may result from taking an SSRI and: Correct Answer: Dextromethorphan Serotonin syndrome is a potentially life-threatening condition. The syndrome occurs when there is too much serotonergic activity in the central nervous system. It can occur with an interaction between two medications, like an SSRI and dextromethorphan, an SSRI and a triptan, an intentional overdose, or with high doses of an SSRI in a particularly sensitive patient. Symptoms of serotonin syndrome include hyperreflexia, clonus, rigidity in the lower extremities, tachycardia, hypert [Show More]

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