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NCA 622 MODULE 1 WITH COMPLETE
SOLUTIONS 100% VERIFIED!!
What must be ruled out before a mental illness is diagnosed? - ANSWER Rule out underlying non-psychological medical diseases (ex. thyroid disease, dementia)
What is the most consistent sign consistent with the diagnosis of depression? - ANSWER Diminished cognitive ability
What is the most common mental health problem of late life? - ANSWER Depression
What are signs and symptoms of vegetative major depressive disorder? - ANSWER Insomnia Anorexia Weight loss Constipation
What are some s/s of Major depression w seasonal onset/ seasonal affective disorder? - ANSWER -Depression that occurs in Fall and winter d/t decreased exposure to sun
-Carbohydrate cravings Lethargy -Hyperphagia -Hypersomnia
What does bipolar disorder have a higher incidence of? - ANSWER hypothyroidism
What is the difference between Bipolar I and bipolar II? - ANSWER -Bipolar I - pt has manic episodes -Bipolar II - pt have hypomanic episodes w/o frank mania
What is the difference between mania and schizophrenia? - ANSWER -Manic people have: -more effective interpersonal skills -More sensitive to social maneuvers of others -More able to utilize weakness and vulnerability in others to their own advantage
An NP is doing an assessment on a 30 yo F w suspected depression. What is most important to ask? - ANSWER Have you thought of harming yourself?
A pt w a history of bipolar depression is brought to the ER by his mother d/t change in behavior. He has been very impulsive and not sleeping for the past two weeks. What is the most appropriate question to ask? -How much sleep is he getting? -What kind of impulsive behavior is he exhibiting? -Is he still taking his bipolar meds? -How old was he when he was diagnosed? - ANSWER -Is he still taking his bipolar meds?
Which statement by the NP student shows a lack of understanding of the risk factors of suicide? -Losing one's job is a risk factor for committing suicide in a pt with depression -Someone who feels better after starting antidepressant is not a risk of committing suicide -Women attempt suicide at higher rates than men -Have a chronic medical condition is a risk factor for suicide - ANSWER -Someone who feels better after starting antidepressant is not a risk of committing suicide
-Mirtazapine (Remeron) - has a sedative effect along with trazadone
All these statements are correct regarding depression in the geriatric population, except? -When starting a med, choose a dose that you think is right for the patient -Loss of independence is attributed to depression -Elderly ppl w dementia may also have depression -Elderly individuals w depression are more successful at committing suicide - ANSWER -When starting a med, choose a dose that you think is right for the patient
-Start low
When considering medication options for treating a 40yo patient w new diagnosis of depression and no PMH, which of these medications would you consider first? -Lorazepam (Ativan) -Trazodone (Desyrel) -Citalopram (Celexa) -Quetiapine (Seroquel) - ANSWER Citalopram (Celexa) - SSRI
Which population are 10x more likely to attempt suicide and the greatest population to jump off a bridge? - ANSWER Schizophrenic ppl
What is the treatment for mild depression? - ANSWER Time and psychotherapy first!
-Unless PMH of depression in first-degree relative
What two medications are started most often for depression? - ANSWER -Sertraline (Zoloft) 25mg daily - SSRI -Venlafaxine (Effexor) 37.5mg daily - SNRI
What is the treatment of major depression w atypical features or seasonal onset? - ANSWER Buspar or an SSRI (sertraline) -MAOI can be used if above not effective
What is the treatment for Melancholic depression? - ANSWER ECT, TCAs, SNRIs (Venlafaxine)
What is citalopram? - ANSWER Celexa - SSRI
What is escitalopram? - ANSWER SSRI (Lexapro)
What is sertraline? - ANSWER SSRI - zoloft
What is paroxetine? - ANSWER Paxil - SSRI
What is duloxetine? - ANSWER Cymbalta - SNRI
What is velafaxine? - ANSWER Effexor - SNRI
-minimal anticholinergic effects and few drug-drug interactions -Dose related HTN so monitor BP close -Lethal arrhythmias w overdosing off med
What is desvenlafaxine? - ANSWER Pristiq - SNRI
What is amitriptyline? - ANSWER Elavil - TCA -Has anti-cholinergic effects
What is the most effective treatment for severe depression - ANSWER Electroconvulsive therapy (ECT)
-Contraindication - increased ICP -If pt has mania or catatonia - can qualify for ECT
What is acute mania initially treated with? - ANSWER -Urgent treatment - Haldol and Olanzapine
-For treatment long-term - second-generation antipsychotics like Olanzapine (Seroquel), Risperidone, or Aripiprazole in conjunction w a benzo
What is the first line treatment for mania, panic disorder, and migraine headaches?
-What meds should be used w caution? - ANSWER Valproic acid
-Coumadin and ASA increase levels -Carbamazepine or phenytoin decrease levels -Main SE- GI and weight gain -Contraindicated in pregnancy
Before administering Lithium, what labs/tests need to be done? - ANSWER -EKG -BMP w Mag and Phos -CBC -TSH -Urinalysis
-Monitor levels on day 4 or 5 from initiation and w every dose change and then every few months until dosing stable then every 6-12 mo; check if volume depletion of any kind occurs -Has a lot of drug-drug interactions
What drug can be used for maintenance treatment of bipolar disorder but does NOT treat acute mania and another drug is required if given? - ANSWER Lamotrigine
How is lithium toxicity managed? - ANSWER Hemodialysis
What is the most common SE of loss of independence in elderly? - ANSWER Depression
What is the most prevalent psychiatric disorder? - ANSWER Anxiety
-in elderly it's twice as common as dementia and four - six times more common than depression
Which medication class is first line treatment for anxiety? - ANSWER SSRIs -Can prescribe some benzos for short acting meds while SSRI start working -Can also use Buspirone and Buproprion or gabapentin
What is the key to diagnosis of PTSD? - ANSWER History of exposure to life-threatening event, serious injury, or sexual violence
What is the treatment of PTSD? - ANSWER Sertraline (zoloft) or Paroxetine (Paxil) in combo with psychotherapy
-Beta blockers (Propranolol or Metoprolol) can be given for peripheral symptoms of anxiety (Heart palpitations, tremors)
-Nausea-Agitation/insomnia-Sexual dysfunction (anorgasmia)
-May increase risk of suicide -Death by overdose is extremely rare -Overdose does not cause cardiotoxicity
What are the signs of serotonin syndrome? - ANSWER Altered mental status, agitation, anxiety, confusion, hallucinations, tremor, myoclonus, hyperreflexia, fever, diaphoresis, and possibly death -D/c med like SSRI or MAOI
What is Fluoxetine? - ANSWER Prozac - SSRI
What are the most common adverse effects of tricyclic antidepressants (TCAs)? What is the most dangerous adverse effect? - ANSWER -Most common - sedation, orthostatic hypotension, anticholinergic effects -Most dangerous - Cardiac toxicity!
-When taken in overdose, can prove lethal! -May increase risk of suicide during early treatment
What happens when MAOIs are taken with TCAs? - ANSWER Severe HTN!
What does TCA toxicity look like? What is the treatment? - ANSWER -Dysrhythmias-Tachycardia -AV Blocks -Complete AV Block -VTach -Vfib
-Treatment - Gastric lavage -Ingestion of activated charcoal -IV sodium bicarb to treat dysrhythmias caused by cardiotoxicity
What class of medications is amitriptyline, clomipramine, imipramine? - ANSWER TCAs
What diet should be followed while taking MAOIs and why? - ANSWER Tyramine free - it can cause HTN crisis if not
What 3 classes of drugs are used in bipolar disorder? - ANSWER 1. Mood stabilizers (Lithium and Valproate)
- Antipsychotics (second gen preferred - used acutely to treat manic episodes and long term to help stabilize mood)
- Antidepressants (ALWAYS combined w a mood stabilizer when treating bipolar disorder) - Bupropion, venlafaxine and SSRIs
Why are sodium levels important for maintaining steady blood lithium levels? - ANSWER -Kidney processes lithium and sodium in the same way*if sodium is low, lithium can accumulate to toxic levels (retains lithium to compensate for low sodium)
What are signs of lithium toxicity? - ANSWER Drowsiness, confusion, blurred vision, and photophobia. With toxicity some of the side-effects signs worsen, such as tremors, muscle weakness, seizures may develop, or the cardiovascular system may collapse, resulting in coma or death.
What drugs should be avoided on lithium? - ANSWER -Diuretics - promote sodium loss, increasing risk for lithium toxicity-NSAIDs (can increase lithium levels)-Anticholinergics
What is divalproex sodium? Compare it to lithium. - ANSWER Valproate-Antiepileptic drug/mood stabilizer
C - bananas, smoked fish, and cheese
-Avoid yeast extracts, most cheeses, fermented sausages, aged fish or meat
A patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms? A. Insomnia, increased appetite, and abdominal distention B. Dry cough, hyperactive reflexes, and hypertension C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, asterixis, and generalized edema - ANSWER C - polydipsia, slurred speech, fine hand tremors
What is the disordered thinking and reduced ability to comprehend reality? - ANSWER Schizophrenia
-Can have positive, negative, or cognitive symptoms
What are extrapyramidal symptoms? - ANSWER -Early reactions - -acute dystonia - spasm of muscles of tongue, face, neck, and back -Parkinsonism - Bradykinesia, tremor, rigidity, shuffling gate, drooling, etc -Akathisia - compulsive, restless movement; symptoms of anxiety, agitation
-Late reaction - Tardive dyskinesia - oral-facial dyskinesias, choreoathetoid movements
What is ziprasidone? - ANSWER Geodon - SGA
What is aripiprazole? - ANSWER Abilify - SGA
What are the cardinal symptoms of Parkinson's Disease? - ANSWER *Dyskinesias and akinesia -Tremor at REST -Rigidity -Postural instability -Slowed movement
-Bradykinesia (slowed movement) -Autonomic disturbances -Depression -Psychosis and dementia
What is the histopathological hallmark sign of Parkinsons? - ANSWER Lewy bodies
What are the 4 drugs/classes used to treat Parkinsons? - ANSWER 1. Levodopa
- Dopamine agonists (Pramipexole, ropinirole, rotigotine)
- Selective MAOIs (Rasagiline, Safinamine, Selegiline)
- Amantadine
Which drugs are used to treat mild Parkinsons in a young patient? - ANSWER Amantadine - taken BID or TID
-Dopamine promotor w anticholinergic effects
What food can decrease levodopa absorption? - ANSWER -High protein meals -protein consumption evenly throughout day
-Coreg -Lasix - ANSWER Benadryl
All of these are management options for delirium in a 80yo, EXCEPT? -Lorazepam -Family or sitter -Quetiapine -Reorientation - ANSWER Lorazepam - avoid benzos in older age patients
-Benzos should be reserved for patients with DTs
Due to high risk of extrapyramidal symptoms, which of these medications is not considered first line treatment for patient with psychosis without any other known medical problems
Haloperidol Ziprasidone Ariprazole Quetiapine - ANSWER Haloperidol
Which of the following best describes the main cause of Parkinson's disease? -Deterioration of neurons in the brain stem -Degradation of myelin surrounding nerve fibers -Excessive production of ACT in CSF -A change in the levels of dopamine in the brain - ANSWER A change in the levels of dopamine in the brain
A NP is providing medication education to a patient. Which of the following comments shows an understanding of how medications used to treat Parkinson's disease work?
-The meds will cure PD -The med will help with the tremors -The med will slow down the disease process -Take the meds on an empty stomach - ANSWER -The med will help with the tremors
-PD meds treat the symptoms, they don't slow down or treat the disease -They can cause N/V, GI upset so can take with food
All of the following are treatment for Parkinson's disease, except? -Amantadine -Yoga -Physical therapy -Lobectomy - ANSWER Lobectomy
What do antipsychotics have a black box warning for? - ANSWER CANNOT be used with patients who have dementia - increases mortality
What is Sinemet? - ANSWER levodopa + carbidopa
What is rotigotine? - ANSWER (Neupro) Dopamine agonist used for Parkinson's Disease -Transdermal patch
What is pramipexole? - ANSWER a dopamine agonist used to treat parkinsonism
What is ropinirole? - ANSWER (Requip) - Dopamine agonist used to treat Parkinson's disease
What are neurodegenerative and non-neurodegenerative causes of dementia? - ANSWER -Neurodegenerative -Alzheimers (most common) -Parkinson's disease dementia -Frontotemporal dementia
-Non-neurodegenerative - vascular dementia
How should an evaluation of dementia be done? - ANSWER -Should be corroborated by a family member or care-giver over MANY office visits -Should occur when patient is healthy and well rested
What mental illness often accompanies dementia? - ANSWER Depression
What is the Kats Scale? - ANSWER Assesses patient's ability to perform basic ADLs -assess functional capacity in the elderly
What is the Lawton Scale? - ANSWER Assess patient's ability to perform more complex ADLs -assess functional capacity in the elderly
All of the following statements shows an understanding of dementia by the NP when he says, EXCEPT. -Patients w dementia are not at a risk of depression -Dementia diagnosis cannot be done in one office visit -The Katz and Lawton scales are used to assess functional capacity in the elderly -The evaluation of dementia should be done when patient is medically stable - ANSWER -Patients w dementia are not at a risk of depression
What is the MMSE (Mini Mental Status Exam)? What is the scoring? - ANSWER -This is the most extensively used cognitive assessment tool. -Addressed LOC, orientation, attention, memory, language, thought process, concentrations/calculation (gets one point per question correct)
-Max Score = 30 -Intact MMSE > -Mild dementia - MMSE 21- -Moderate dementia: 10- -Severe dementia - 0-
Know the scoring
A psychiatric NP calculates an MMSE score of 15 for one of her new patients. She understands that this score correlates to? - ANSWER Moderate dementia
-> 25 = intact -21-24 = mild dementia -10-20 = moderate dementia -0-9 = severe dementia
What is the DSM and what is it used for? - ANSWER DSM 5 - used to help diagnose dementia
What is the leading cause of dementia? - ANSWER Alzheimer's dementia
Individuals who are diagnosed with Alzheimer's disease develop loss of function within 10 years of diagnosis? True or false - ANSWER False - not all people develop loss of
