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MARYVILLE NURS 623 EXAM 3 VERIFIED
QUESTIONS & ANSWERS
1. What is the most common psychiatric disorder in the U.S?: Anxiety
2. What are the DSM-5 symptom criteria for a diagnosis of general anxiety
disorder?: excessive anxiety and worry of variety of things for at least 6 months
3. What are the DSM-5 symptom criteria for a major depressive disorder?: -
Five or more symptoms including at least one depressed mood or loss of interest present in the same two weeks and present nearly every day
4. differential diagnoses that would mimic the symptoms of depression?: -
*Anxiety *PTSD *Substance Abuse
5. What are the risk factors for major depression?: *Age
*Gender *Personal Hx (migrains, PUD, chronic pain) *Fx Hx (depression, suicide, alcholism, substance abuse)
6. What are the common presenting symptoms of depression in the geriatric
patient?: Somatic (general pain) Psychology (feeling of guilt/worry, suicidal, memory) Psychomotor (anxiety/agitation) Vegetative (poor appitite/sleep)
7. What are the NON-pharmacologic treatments for management for major
depressive disorder?: Interpersonal and cognitive behavior therapy
8. What are the pharmacologic treatments for management for major depres-
sive disorder?: SSRI, SNRI, TCA, MAO
9. Names of common SSRIs: Fluoxetine (Prozac)
Sertraline (Zoloft) Paroxetine (paxil) Citalopram (celexa) Escitalopram (Lexapro)
10. Names of common SNRIs: Duloxetine (Cymbalta)
Venlafaxine (Effexor) Desvenlafaxine (Pristiq)
11. What are concerns in elderly taking medication for major depression?: a
slower metabolism requires lower dosing; greater risk of falls, osteoporosis, frac- tures
E-thanol abuse R-ational thinking loss S-ocial support loss O-rganized plan N-o spouse S-ickness
18. How would you identify intimate partner violence?: *reluctant to speak in
front of partner *gives evasive answers *Overly protective or controlling partner
19. What are the stages of grieving? (DABDA): Denial
Anger Bargaining
Depression Acceptance
20. What are the phases of grief? (Aca): Avoid
Confront Accomadate Acknowledge the loss Reacting to the separation Recollecting and Re-experiencing the Relationship w/deceased
21. How would you identify intimate partner violence?: 1) a patient who is
reluctant to speak in front of her partner and gives evasive answers
- Overly protective or controlling partner
22. What is the clinical presentation of post-traumatic stress disorder
(PTSD)?: A: INTRUSIVE thoughts, nightmares or flashbacks B: AVOIDANCE any situation of activity that brings memories C: HYPERAROUSAL: Hypersensitive or on edge, unprovoked anger, jumpiness, and on guard
23. What are the DSM-5 criteria for a diagnosis of PTSD?: 1 SYMPTOM of
intrusive, avoidance, or hyper-arousal MUST HAVE PERSISTED FOR MORE THAN 1 MONTH
24. What is the management for PTSD?: PHARMACOLOGY: SSRI's paroxetine
(paxil) or sertaline (Zoloft), anxiolytic buspirone (BuSpar) NON-PHARMACOLOGICAL: cognitive behavioral therapies, brief eclectic psy- chotherapy, narrative exposure therapy
preoccupation with weight, calories, and food, wear baggy clothes history of excessive exercise
28. What do labs look like in anorexia?: leukopenia elevated BUN
anemic hypomagnesmia elevated TSH sinus bradycardia.
29. What are the warning signs that the patient has Bulemia?: Significant
weight gain tooth erosion calluses on back of hands esophageal erosion negative body image eats rapidly until uncomfortably full swollen salivary (parotid) glands irregular menses eat large amounts of food in isolation signs or symptoms of depression
30. What do labs look like in bulemia?: Hyponatremia, hypochloremia, elevated
amylase
31. Discuss sleep hygiene strategies for a patient complaining of insomnia-
: Maintain a regular sleep and wake schedule Eat regular meals every day
Develop a relaxing bedtime routine Limit amount of liquid consumed in evening Limit amount of caffeine consumed later in day Avoid tobacco and alcohol later in the day Avoid daytime naps Exercise regularly Limit exposure to bright lights or television in evening Bed should be used for sleeping and sex only Turn any clocks facing the bed away If not asleep after 20 mins get out of bed and engage in quiet activity before reattempting to fall asleep.
32. What is the The most common long term effect of sexual assault: PTSD
higher prevalence in ethnic minorities & women
39. Risk factors of suicide in the elderly?: *male gender
*being single, divorced, or separated and without children *personal or family history of a suicide attempt *drug or alcohol abuse *severe anxiety or stress *physical illness *a specific suicide plan with access to firearms
40. In a female patient who presents with abdominal pain, what is the first
diagnostic test you would order?: HCG
41. risk factors for development of a peptic ulcer/PUD: *H. Pylori infection
*prolonged NSAID/ ASA use *smoking
42. Differentiate among diverticulosis and diverticulitis: Diverticula are pock-
ets that form in the lining of the colon. They can be present and simply an incidental finding (diverticulosis) or they can become infected or inflamed (diverticulitis)
43. What are the risk factors of diverticulitis?: *Having diverticulosis in
conjunc- tion with untreated constipation *Smoking *lack of exercise *obesity *NSAID and Opioid use
44. How would you differentiate between a diagnosis of gastroenteritis and
irritable bowel syndrome?: IBS: is chronic LLQ pain diarrhea, constipation, pass- ing mucous and occurs 1 or more times a week over 3 months. Gastroenteritis: (stomach bug) is caused by a bacteria, (no constipation) diarrhea, N/V symptom limited to several days
45. How do you treat travelers diarrhea?: azithromycin 1000mg 1 one dose; or
500mg x 3 d Cipro 750 mg one dose Levofloxacin 500 mg 1-3 days
46. differential diagnosis, for a patient presents with diarrhea: Acute: Gastritis,
medication induced, lactose intolerant Chronic: CRhons, IBS, IBD,
PSOAS: Pt on back and raise RT leg against pressure or on left side extend RT leg at hip; Positive if increased pain OBTURATOR: Pt on back with the right hip and knee flexed the examiner slowly rotates the right leg internally; Positive if pain over RLQ McBURNEY'S: pressure applied to McBurney's point (halfway between the umbilicus and the anterior spine of the ilium); Positive if pain with pressure applied
52. Describe the clinical presentation for Gastroesophageal Reflux Disease
(GERD)?: heartburn, regurgitation, water brash (reflex salivation), sour taste in morning, belching, coughing, and hoarseness. Objective: only sign may be occult blood in stool.
53. How is GERD diagnosed (when to refer to GI)?: With symptoms, sometimes
with upper endo; refer if failed treatment of step 2- after 6 weeks of treatment
54. Discuss the patient education regarding lifestyle changes for manage-
ment of GERD.: lifestyle changes including diet weight loss, raising the head of their bed 6-8 inches, avoid nicotine products avoid recumbency or sleeping for 3 to 4 hours after a meal, avoid bedtime snacks, avoid fatty and late meals, foods such as chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, and tomatoes, wearing loose comfortable clothing, and starting a routine exercise and weight loss program
55. Describe medical management of GERD?: step-up: LIFESTYLE changes,
PRN OTC H2ra and antacid; PPI; referral
Step-down: starts with PPI then step down until Sx under control
56. 46 year old male complains of dysphasia hoarseness and cough he states
he wakes up with a sour taste in his mouth. What is the most likely cause of the patient symptoms?: GERD
57. Managment of peptic/gastric ulcer: *relieve pain, heal the ulcer, and prevent
complications/reoccurrence *PHARMACOLOGICAL therapy is the foundation of management (H2Ra, PPI, antacids, antibx w/H-pylori)
58. Describe the diagnosis criteria IBS: 3 Criteria:
1. pain relieved by defacation or change in BMs for 3 months
2. BM with patterns of constipation/diarrhea 25% of the time
upper quadrant accompanied by nausea and vomiting and fever there is a positive Murphy sign what is the most likely diagnosis?: Cholecystitis
63. What elevated laboratory test is considered the gold standard for diag-
nosis of non-alcoholic pancreatitis?: Serum amylase, concurrent with Lipase
64. What is the clinical presentation of chronic pancreatitis?: LUQ can radiate
to lumbar area weight loss diarrhea N/V dyspepsia
65. PE findings with pancreatitis?: epigastric tenderness with no rebounding
tenderness, may feel pseudeocyst/mass mild jaundice.
66. What are the recommendations/guidelines for colon cancer screenings
for average risk?: Average Risk: 50-75 or African American 45+ fecal occult blood every 1 yr flex sig every 5 yrs Colonoscopy every 10 years
67. What are the recommendations/guidelines for colon cancer screenings
for high risk?: fecal occult blood every 1 yr At 40 y/o Barium enema or colonoscopy every 3-5 yrs
68. What is the clinical presentation of diverticular disease?: *LLQ pain
(worse after eating) relieved with passing stool or gas *colonic distention *W/itis: anorexia, vomiting, chills, tachycardic more common in elderly
69. How would you manage a patient with an incidental finding of uncom-
plicated diverticular disease?: Requires no further intervention and can be managed with a high-fiber diet or a daily fiber supplementation with psyllium
70. if antibx are needed with diverticulitis what would be used?: Flagyl & Cipro
or Bactrim
71. Which of the following best describes the dietary recommendations to
reduce the incidence of diverticular disease?: Increase the amount of fiber in the diet
72. True/False
A patient experiencing exacerbation of symptoms of ulcerative colitis should
76. s/s of an ingunal hernia: LLQ or RLQ pain and bulging, especially when
straining, coughing, or bending over; burning or aching sensation at the bulge
77. S/S of EPIDIDYMITIS: --Pain in lower abdomen
Swollen, red, warm scrotum. -Testicle pain and tenderness, usually only on one side that comes on gradually
78. s/s of prostatitis: Painful or difficult/frequency of urination
-Fever/chills -Blood in urine
79. S/S of endometriosis: -Abdominal and/or pelvic pain
-Painful periods -Pain with intercourse -Pain with BM or urination
80. S/S of colon cancer: -Hypogastrum or LLQ pain
-Blood in stool -Pencil-thin stools -Feeling of incomplete BM
81. What type of hernia has The transversus abdominis and internal oblique
muscles are attached, forming a high arch on the inferior border that results in a faulty shutter mechanism- : Direct inguinal
82. What type of hernia occurs at the fossa ovalis where the femoral artery
exits from the abdomen: Femoral
83. When you put someone on antidepressant what do you worry about?: -
Developing suicidal ideations
84. The DMS V criteria for major depressive disorder requires?: Five or more
symptoms including at least one depressed mood or loss of interest present in the same two weeks an present nearly every day
85. Physical examination of a patient diagnosed with anorexia nervosa in-
cludes: Emaciation/cachexia
