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NU 664 Set 1 Final Exam with verified solutions
ARRN |- |correct |answer |✔Clear |expectations |for |licensures |accreditation |certification |and |education |for |all |APRNs
Standards/scope |of |practice |- |correct |answer |✔Licensed |and |independent |practitioners, |assess, |diagnosis |and |treat |and |manage |acute |episodic |and |chronic |illnesses.
Statutory |Law |- |correct |answer |✔States |have |a |duty |to |protect |those |who |receive |nursing |care
Role |of |NONPF |- |correct |answer |✔the |National |Organization |of |Nurse |Practitioner |Faculties. |This |is |the |only |organization |specifically |dedicated |to |promoting |and |supporting |high |quality |nurse |practitioner |education. |The |NONPF |provides |ongoing |support |to |NP |educators |through |establishing |competencies, |methods |of |evaluation, |and |strategic |partnerships.
The |NONPF |primarily |concentrates |- |correct |answer |✔on |the |development |of |standards |necessary |to |foster |optimum |graduate |educational |programs. |This |network |continually |collects |data |and |utilizes |expert |knowledge |of |its |membership |to |seminally |publish |updated |curricular |frameworks
Clinical |interview |terms, |techniques, |and |goals |- |correct |answer |✔CC, |HPI, |PMH, |Assessment, |diagnosis, |structured |and |unstructured. |MMSE, |active |listening.
Case |formulation |- |correct |answer |✔Theoretically |based |explanation |or |conceptualization |of |the |information |obtained |from |a |clinical |assessment |which |offers |a |hypothesis |and |provides |a |framework |of |treatment.
Grief |process |and |treatment |- |correct |answer |✔Kubler |Ross: |denial, |anger, |bargaining, |depression, |and |acceptance.
Instrumental: |problem |solving
Intuitive |emotional
Risk |assessment |(suicide, |self-harm, |homicide, |etc.) |- |protective |and |risks
|factors |- |correct |answer |✔Highest |risk |group- |white, |middle-aged |males
Next |highest- |aged | 85 |and |older
Screening |tool- |Ask |Suicide-Screening |Questions |(ASQ) |- |correct |answer |✔made |of | 4 |questions |to |ask |youth |in |medical |settings
Common |screening |tools |- |correct |answer |✔PHQ-9 |for |depression
Columbia-Suicide |Severity |Rating |Scale |(C-SSRS)
SAFE-T |(Suicide |Assessment |Five-Step |Evaluation |and |Triage)
Highest |risk |for |self-injury |- |correct |answer |✔socioeconomic |disadvantage, |depression, |substance |abuse, |and |anxiety
Self-injury |increases |- |correct |answer |✔risk |of |later |suicide
Norepinephrine |- |correct |answer |✔concentration, |attention, |vigilance, |energy, |tachycardia, |HTN, |glucose |to |essential |organs
-Fear |increases |NE |to |brain, |epinephrine |to |blood
-Fight |or |flight
Glutamate |- |correct |answer |✔being |"on", |excitatory |(think |gluta-MATE |mating)
GABA |- |correct |answer |✔being |"off", |inhibitory, |relaxation, |euphoria, |decreases |muscle |activity, |slows |breathing, |decreases |anxiety |and |seizures |(think |gabapentin)
Acetylcholine |- |correct |answer |✔bradycardia, |GI |motility, |salivation, |lacrimation, |urination, |sexual |arousal, |muscle |contraction
- |In |the |hippocampus- |learning, |memory, |awakeness, |attention
Histamine |- |correct |answer |✔Hayfever
Itching
Sleeping
Think |Benedryl |helps |with |theses |(ANTIhistamine)
Limbic |System |- |correct |answer |✔· |emotion
- |Amygdala
· |Almond |shape
· |Found |in |temporal |lobe
· |Part |of |limbic |system
· |Processes |fearful/anxious |emotions |and |positive |stimuli
·Emotional |memories
Prefrontal |cortex |- |correct |answer |✔Decision |making
Planning
Personality
Will |to |live
Expression
Social |behavior
Hippocampus |- |correct |answer |✔Memory
Involved |in |depression |and |Alzheimer's
Hypothalmus |- |correct |answer |✔Controls |hormone |release |via |anterior |pituitary
Can |exert |influence |over |bodily |states |to |maintain |homeostasis
Controls |pituitary |gland |and |various |hormones |(including |prolactin)
Major |Depressive |Disorder |Diagnostic |criteria: |(DSM-5) |- |correct |answer |✔Five |or |more |symptoms |present |during |the |same |2- |week |period |- |
Depressed |mood |most |of |the |day
Decrease |pleasure
Weight |loss
Insomnia
Persistent |Depressive |Disorder: |(Dysthymia) |Diagnostic |criteria: |(DSM-5) |-
|correct |answer |✔Depressed |mood |for |most |of |the |day |for |at |least | 2 |years:
Depressed |Mood
Poor |appetite |or |overeating
Insomnia |or |hypersomnia
Low |energy
Low |self-esteem
Poor |concentration
Feeling |of |hopelessness
Common |Differentials |of |Persistent |Depressive |Disorder(Dysthymia) |- |correct
|answer |✔Major |Depressive |Disorder
Psychotic |disorders
Depressive |or |Bipolar |related |disorder |due |to |another |medical |condition. |Substance/medication-induced |depressive |or |bipolar |disorder
Personality |disorders
Persistent |Depressive |Disorder: |(Dysthymia) |- |correct |answer |✔Affects |5.4 |% |of |the |U. |S. |population |age | 18 |or |older |or |10.9 |million |Americans. |Increase |risk |for |MDD |15% |to |25% |of |people |diagnosed |with |dysthymic |disorder |will |have |a |life |time |of |episode |of |MDD. |Women | 2 |to | 3 |times |more |than |men |will |develop |dysthymic |disorder
Premenstrual |Dysphoric |Disorder:
Diagnostic |criteria: |(DSM-5): |- |correct |answer |✔At |least | 5 |symptoms |must |be |present |in |the |final |week |before |onset |of |menese. | 1 |or |more |of |the |following |symptoms:
Mark |affective |liability
Anger
Marked |depressed |mood
Marked |anxiety
Overwhelmed
Breast |tenderness
Premenstrual |Dysphoric |Disorder |Common |Differentials |- |correct |answer
|✔Premenstrual |syndrome
Dysmenorrhea
Bipolar |disorder
Major |depressive |disorder
Persistent |depressive |disorder
Substance/medication-Induced |Depressive |Disorder |Diagnostic |criteria: |- |correct
|answer |✔Prominent |& |persistent |disturbance |mood
History, |physical |examination, |or |laboratory |findings
Substance |intoxication |or |withdrawal
Disturbance |does |not |occur |exclusively |during |the |course |of |delirium
Disturbance |causes |clinically |significant |distress |or |impairment |in |social, |occupational |or |other |important |areas |of |functioning
Substance/medication-Induced |Depressive |Disorder |Common |Differentials |-
|correct |answer |✔Substance |intoxication |and |withdrawal
Primary |depressive |disorder
Until |recently, |the |monoamine |neurotransmitters — |norepinephrine, |dopamine,
|serotonin, |and |histamine |- |correct |answer |✔were |the |main |focus |of |theories |and |research |about |the |etiology |of |these |disorders.
A |progressive |shift |has |occurred |from |focusing |on |disturbances |of |single
|neurotransmitter |systems |in |favor |of |- |correct |answer |✔studying |neurobehavioral |systems, |neural |circuits, |and |more |intricate |neuroregulatory |mechanisms.
The |monoaminergic |systems |- |correct |answer |✔are |now |viewed |as |broader, |neuromodulatory |systems, |and |disturbances |are |as |likely |to |be |secondary |or |epiphenomenal |effects |as |they |are |directly |or |causally |related |to |etiology |and |pathogenesis
Of |the |biogenic |amines |- |correct |answer |✔norepinephrine |and |serotonin |are |the |two |neurotransmitters |most |implicated |in |the |pathophysiology |of |mood |disorders.
NOREPINEPHRINE |The |clinical |effectiveness |of |antidepressant |drugs |with |noradrenergic |effects — for |example, |venlafaxine |(Effexor) |- |correct |answer
|✔further |supports |a |role |for |norepinephrine |in |the |pathophysiology |of |at |least |some |of |the |symptoms |of |depression
SEROTONIN |With |the |huge |effect |that |the |selective |serotonin |reuptake
|inhibitors |(SSRIs) — |for |example, |fluoxetine |(Prozac) |- |correct |answer |✔have |made |on |the |treatment |of |depression, |serotonin |has |become |the |biogenic |amine |neurotransmitter |most |commonly |associated |with |depression.
The |identification |of |multiple |serotonin |receptor |subtypes |has |also |- |correct
|answer |✔increased |the |excitement |within |the |research |community |about |the |development |of |even |more |specific |treatments |for |depression.
SSRIs |and |other |serotonergic |antidepressants |are |effective |in |the |treatment |of |-
|correct |answer |✔depression, |other |data |indicate |that |serotonin |is |involved |in |the |pathophysiology |of |depression
Depletion |of |serotonin |may |- |correct |answer |✔precipitate |depression, |and |some |patients |with |suicidal |impulses |have |low |cerebrospinal |fluid |(CSF) |concentrations |of |serotonin |metabolites |and |low |concentrations |of |serotonin |uptake |sites |on |platelets.
Although |norepinephrine |and |serotonin |are |the |biogenic |amines |most |often |associated |with |the |pathophysiology |of |depression, |- |correct |answer
|✔dopamine |has |also |been |theorized |to |play |a |role. |The |data |suggest |that |dopamine |activity |may |be |reduced |in |depression |and |increased |in |mania
Drugs |that |reduce |dopamine |concentrations — for |example, |reserpine
|(Serpasil) — |- |correct |answer |✔and |diseases |that |reduce |dopamine |concentrations |(e.g., |Parkinson's |disease) |are |associated |with |depressive |symptoms
Drugs |that |increase |dopamine |concentrations |- |correct |answer |✔such |as |tyrosine, |amphetamine, |and |bupropion |(Wellbutrin), |reduce |the |symptoms |of |depression
|blankets, |chlorpromazine |(Thorazine), |dantrolene |(Dantrium), |benzodiazepines, |anticonvulsants, |mechanical |ventilation, |and |paralyzing |agents.
The |use |of |specific |pharmacotherapy |- |correct |answer |✔approximately |doubles |the |chances |that |a |depressed |patient |will |recover |in | 1 |month.
All |currently |available |antidepressants |may |take |up |to |- |correct |answer |✔to | 3 |to | 4 |weeks |to |exert |significant |therapeutic |effects, |although |they |may |begin |to |show |their |effects |earlier.
Choice |of |antidepressants |is |determined |by |the |side |effect |profile |least
|objectionable |to |a |given |patient's |- |correct |answer |✔physical |status, |temperament, |and |lifestyle.
Numerous |classes |of |antidepressants |are |available, |many |with |different
|mechanisms |- |correct |answer |✔of |action, |represents |indirect |evidence |for |heterogeneity |of |putative |biochemical |lesions
Although |the |first |antidepressant |drugs, |the |monoamine |oxidase |inhibitors |(MAOIs) |and |tricyclic |antidepressants |(TCAs), |are |still |in |use |- |correct |answer
|✔newer |compounds |have |made |the |treatment |of |depression |more |"clinician |and |patient |friendly."
Psychosocial |Therapy |Three |types |of |short-term |psychotherapies |- |correct
|answer |✔cognitive |therapy, |interpersonal |therapy, |and |behavior |therapy — have |been |studied |to |determine |their |efficacy |in |the |treatment |of |major |depressive |disorder
Although |its |efficacy |in |treating |major |depressive |disorder |is |not |as |well |researched |as |these |three |therapies, |psychoanalytically |oriented
|psychotherapy |- |correct |answer |✔has |long |been |used |for |depressive |disorders, |and |many |clinicians |use |the |technique |as |their |primary |method.
What |differentiates |the |three |short-term |psychotherapy |methods |from |the
|psychoanalytically |oriented |approach |are |the |- |correct |answer |✔active |and |directive |roles |of |the |therapist, |the |directly |recognizable |goals, |and |the |end |points |for |short-term |therapy.
·Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders
Diagnostic |criteria |- |correct |answer |✔Obsessions |(thoughts) |or |Compulsions |(behaviors) |or |both
The |thoughts |are |often |intrusive |and |unwanted |and |cause |distress; |not |usually |involving |real-world |worries
The |behaviors |are |repetitive |and |an |attempt |to |suppress |/ |cope |with |/ |eliminate |the |thoughts
Time |consuming
Common |obsessions |include: |worries |about |contamination, |repeated |doubts, |need |to |have |things |in |a |specific |order, |aggressive |or |horrific |thoughts, |may |occur |during |pregnancy |as |intrusive |thoughts |about |baby |that |are |ego-dystonic |and |sexual |imagery
· |Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders
|screening |tools, |assessment |acronyms |- |correct |answer |✔Yale-Brown |Obsessive-Compulsive |Scale |(YBOCS)
10-items
10-15 |mins |completion |time
More |common |among |adolescent |boys |than |girls
More |common |among |singles |than |married |ind
Less |often |among |blacks |than |whites
Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders |onset,
|progression |- |correct |answer |✔Mean |age |of |onset |about | 20 |years
Most |have |onset |before |age |25, |less |have |onset |over |age | 35 |years
Can |occur |in |adol |and |childhood |as |early |as |age | 2 |years
High |comorbidity |with |depression |(about |67%)
Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders |etiology
|- |correct |answer |✔Biological |factors: |Serotonin |more |likely |involved |as |SSRIs |more |effective |in |tx; |NE |less |involved |although |given |clonidine's |efficacy |NE |may |be |partially |involved |as |clonidine |lowers |NE |amount |released |from |PreS |neurons.
Genetics: |3-5 |fold |higher |probability |if |familial |link
Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders
|pharmacological |treatment |- |correct |answer |✔SSRIs, |clomipramine, |and |if |needed |augment |with |Depakote, |lithium, |tegretol
Buspar, |Effexor, |pindolol
Among |children, |sertraline |+ |therapy |more |effective |than |either |alone
CBT |should |be |tried |prior |to |initiation |of |meds
For |children: |FDA |approved |(at |least | 6 |yrs), |sertraline
Fluoxetine |(at |least |7)
Fluvoxamine |(at |least |8)
Clomipramine |(at |least |10) |(first |anti-dep |studied |and |only |TCA |FDA |approved |for |tx |of |anxiety |d/os |in |children, |but |not |rec |as |first |line |due |to |SE |profile |as |compared |to |other |SSRIs
Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders
|therapeutic |treatment |- |correct |answer |✔Behavior |therapy, |exposure, |desensitization, |flooding, |aversion, |thought |stopping, |implosion |therapy, |resolving |underlying |aggressive |impulses, |ECT, |DBS
Serotonin |syndrome |- |correct |answer |✔Migraines, |myoclonus, |agitation |and |confusion |on |the |mild |side |to |hyperthermia, |seizures, |coma, |cardiovascular |collapse, |permanent |hyperthermic |brain |damage |and |even |death |on |the |severe |end
PANS |- |correct |answer |✔a |clinical |diagnosis |given |to |children |who |have |a |dramatic |- |practically |overnight |- |onset |of |neuropsychiatric |symptoms |including |Obsessive |Compulsive |Disorder |(OCD) |and/or |eating |disorder
PANDAS |- |correct |answer |✔Pediatric |Autoimmune |Neuropsychiatric |Disorders |Associated |with |Streptococcal |Infections; |this |is |a |subset |of |PANS
In |Obsessive |and |compulsive/Anxiety/trauma |and |stress |related |disorders |it |is
|wise |to |rule |out |- |correct |answer |✔underlying |medical |disorders |and |tx |of |comorbid |conditions |- |Hair |pulling |and |skin |picking. |Substance |induced, |depressive |d/o
Major |and |Minor |Neurocognitive |Disorders |- |correct |answer |✔Significant |decline |from |previous |level |of |performance |in |one |or |more |cognitive |domains
a. |Concern |of |the |individual, |a |known |informant, |or |clinician |that |has |witnessed |the |decline
b. |A |modest |impairment |in |cognitive |performance |documented |by |neuropsychological |testing
With |Mild |neurocognitive |Disorder |- |correct |answer |✔The |cognitive |deficits |do |not |interfere |w/independence |in |everyday |activities |(i.e. |paying |bills) |but |require |greater |effort
The |cognitive |deficits |do |not |occur |exclusively |in |the |context |of |delirium |or |better |explained |by |another |mental |health |d/o.
Mild |neurocognitive |Disorder |Specifiers |- |correct |answer |✔a. |Without |behavioral |disturbances
b. |With |behavioral |disturbances
Major |and |Minor |Neurocognitive |Disorders |Due |to |Alzheimer's |Diagnosis
|Criteria |- |correct |answer |✔1. |Criteria |for |major |or |mild |neurocognitive |disorder |is |met
- |Insidious |onset |and |gradual |progression |in |one |or |more |cognitive |domains
Specifiers |of |Major |neurocognitive |disorder, |probable |Alzheimer's |- |correct
|answer |✔i. |Evidence |of |Alzheimer's |genetic |mutation |via |testing |or |family |history |and;
ii. |Decline |in |memory |and |learning |and |at |least |one |other |cognitive |domain |and;
iii. |Steadily |progressive, |gradual |decline |in |cognition, |w/o |extended |plateaus |and;
iv. |No |evidence |of |other |causative |factor
Specifier |of |Mild |neurocognitive |disorder, |probable |Alzheimer's |- |correct
|answer |✔i. |Evidence |of |Alzheimer's |genetic |mutation |via |testing |or |family |history
i. |Decline |in |memory |and |learning |and |at |least |one |other |cognitive |domain |and;
ii. |Steadily |progressive, |gradual |decline |in |cognition, |w/o |extended |plateaus |and;
iii. |No |evidence |of |other |causative |factor
Genetic |mutation |of |apolipoprotein |E4 |- |correct |answer |✔increases |risk |of |Alzheimer's
Assessment |tools |of |Major |and |Minor |Neurocognitive |Disorders |Due |to
|Alzheimer's |- |correct |answer |✔Mini-Cog, |Memory |impairment |screen, |mini- mental |status |exam, |general |practitioner |assessment |of |cognition, |activities |of |daily |living, |functional |activities |questionnaire.
Medication |used |in |Major |and |Minor |Neurocognitive |Disorders |Due |to
|Alzheimer's |- |correct |answer |✔a. |Cholinesterease |inhibitors |(Aricept, |Exelon, |razadyne)
i. |Binds |to |acetylcholinesterase
b. |Memantine- |cognitive |symptoms
|- |Binds |NMDA, |slows |calcium |influx
Differential |for |Major |and |Minor |Neurocognitive |Disorders |Due |to |Alzheimer's |-
|correct |answer |✔includes |other |neurogenerative |diseases |or |MDD
