Exam 1: NURS663/ NURS 663 (Latest 2023/
2024 Update) – Psychiatric Mental Health
Diagnosis and Management II Exam |
Questions and Verified Answers| Grade AMaryville
Q: what is something you should watch out for if a patient is on multiple antidepressants?
Answer:
SIADH
Q: what medical problems mimic mood disorders?
Answer:
hypothyroid- depression
hyperthyroid- mania
Q: involuntary admission
Answer:
hurt yourself
hurt someone else
inability to care for self
Q: Carbamazepine (Tegretol)
Answer:
mood stabilizer
indication: bipolar disorder
major side effects:
CYP 450: (inducer- speeds up metabolism of other drugs)
patient education:
Q: what 3 medications must have blood draws associated with them?
Answer:
carbamazepine, lithium, valproic acid
Q: Mood Disorder Questionnaire
Answer:
Screens for Bipolar Disorder
7+ is a positive screening
4-5 might be hypomania
Q: how is the PHQ-9 scored
Answer:
1-4 minimal depression
5-9 mild depression
10-14 moderate depression
15-19 moderately severe
20 + severe
Q: PHQ-9
Answer:
assessment that evaluates the degree of depression
Q: What is the DSM criteria for Major Depressive Disorder?
Answer:
**no history of mania, hypo, or mixed symptoms
symptoms >2 weeks
must have: sadness, anhedonia (loss pleasure/interest)
4 of following: – appetite/sleep changes, psychomotor retardation, lack of energy,
guilt/worthlessness, issues w/ concentration, thoughts suicide/death
Q: What are the “frequency” modifiers for MDD?
Answer:
episodic: symptoms dissipate over time
recurrent: likely to reappear in future
subclinical: sadness + 3 symptoms > 10 days (full criteria not met)
Q: how is the severity of depression rated?
Answer:
- Mild: no suicidal thoughts/death wishes
- Moderate: some thoughts of death/self-harm
- Severe: plan/attempted
Q: what other modifiers might be present with diagnosis of MDD?
Answer:
- With psychotic features: hallucinations, paranoia
- In partial remission: some symptoms still present, but full criteria not met; period without any
significant
symptoms lasting less than 2 months - In full remission: no signs/symptoms >2 months
- Unspecified: symptoms vague, hard to tell
Q: DSM 5 for bipolar I disorder
Answer:
depression + mania
Q: DSM 5 for bipolar 2 disorder
Answer:
depression + hypomania
Q: what is the #1 predictor of suicide?
Answer:
Hopelessness and loneliness
Q: what are risk factors for suicide?
Answer: - Gender: men are more likely to complete suicide
- Age: men 45 years +; women 55 years +
o Suicide is the 3rd leading cause of death in 15-24-year-olds - Race: Caucasian, Native American, Alaskan native, and immigrants
Exam 3: NURS663/ NURS 663 (Latest 2023/
2024 Update) – Psychiatric Mental Health
Diagnosis and Management II Exam |
Questions and Verified Answers| Grade AMaryville
Q: What neurotransmitter is the reward pathway
Answer:
Dopamine
Q: Kids who have lack of remorse have this disorder
Answer:
Conduct Disorder
Q: By what age most teens tried alcohol
Answer:
13
Q: With Alcohol consumption, Vitamin B1 or thiamine deficient causes what
Answer:
Wornicke-Korsakoff syndrome
Q: Heroin withdrawal
Answer:
peaks 1-3 days, subside in 1 week
Q: Cocaine withdrawal begins
Answer:
within 90 minutes
Q: Cocaine and Nicotine have an effect on this
Answer:
Dopamine reward feeling
Q: Example of date rape drugs
Answer:
Rohypnol, GHB, Ketamine, Chloral hydrate
Q: This drug is known as ice
Answer:
meth
Q: Most common reason adolescent has eval
Answer:
Suicidal
Q: What is the origin of ADHD
Answer:
Hereditary, Biological
Q: Best treatment for borderline personality
Answer:
DBT
Q: For diagnosis of ODD the symptoms must be present for how long
Answer:
6 months
Q: This parenting style relates to conduct disorder
Answer:
Harsh/ Punitive
Q: Why is ketamine a date rape drug, what is onset and length
Answer:
15 minutes and 30-60 minutes
Q: Children who receive grossly negligent care and no emotional attachment are subject to
what disorder
Answer:
Reactive Attachment disorder
Q: Symptoms of Reactive Attachment Disorder
Answer:
Social anxiety, regression
Q: PTSD neuropsych
Answer:
- noradrenergic and endogenous opiate systems, as well as the HPA axis, are hyperactive in at
least some - increased activity/responsiveness of the autonomic nervous system, AEB elevated HR rates
and BP and by abnormal sleep architecture - increased 24-hour urine epinephrine concentrations in veterans
- increased urine catecholamine concentrations in sexually abused girls
- platelet α2- and lymphocyte β-adrenergic receptors are downregulated in _ possibly in
response to chronically elevated catecholamine concentrations
Q: PTSD HPA axis
Answer: - low plasma and urinary free cortisol concentrations.
- More glucocorticoid receptors are found on lymphocytes
- challenge with exogenous corticotropin-releasing factor (CRF) yields a blunted corticotropin
(ACTH) response
Q: PTSD other neuropsych
Answer:
Exam 2: NURS663/ NURS 663 (Latest 2023/
2024 Update) – Psychiatric Mental Health
Diagnosis and Management II Exam |
Questions and Verified Answers| Grade AMaryville
Q: Environment where BED is often screened for is the _ patients electing for
surgery
Answer:
bariatric
Q: When assessing patient’s appetite (for BED), Ask: “Have you ever eaten more than you
___?” follow up with, “Did you feel like it wasn’t to stop?”
Answer:
intended, possible
Q: The only FDA approved med for BED
Answer:
vyvanse
Q: Tell patient that the goal of vyvanse is to decrease the __ of binge episodes, it’s
not prescribed for weight loss/obesity
Answer:
frequency
Q: main side effect of vyvanse?
Answer:
dry mouth
Q: Topiramate is an anticonvulsant that does work in reducing _ and
weight gain, BUT leads to _ __ when dosed for effectiveness
Answer:
binge eating, cognitive impairment
Q: Anti-obesity agents: Targets appetite/weight, but not BED _.
Answer:
behavior
Q: ___: hit or miss, NEI says didn’t work well for BED
Answer:
Naltrexone
Q: _: Some evidence it reduces automatic behavior (for BED), but can’t stop
abruptly due to (took NEI guy 4-5 months to titrate off)
Answer:
Baclofen, psychosis
Q: ____: In phase 3, dual acting DA and NE reuptake inhibitor. For BED
Answer:
Dasotraline
Q: Bulimia and BED both require a loss of control, binge eating frequency, and a duration of at
least _ .
Answer:
3 months
Q: In BED, body fat is greater than _ in about half of patients Answer: 30% Q: In bulimia, patient’s should be prescribed a low dose of ___. But if they have a
comobidity like depression, they’ll need a higher dose.
Answer:
prozac
Q: BED and bulimia are both treated with behavioral interventions, CBT, dynamic
psychotherapy, and therapy
Answer:
individual
Q: ________is the least prevalent, ___ is the 2nd most prevalent, and BED is the
most prevalent.
Answer:
Anorexia, bulimia
Q: _ could be good for a patient with insomnia and anorexia
Answer:
Remeron
Q: In rumination, how long does it take material to come out
Answer:
1 hour
Q: Purging disorder is an
Answer:
OSFED
Q: Purging disorder: Recurrent purging behavior to influence weight or shape (self induced
vomiting, misuse of laxatives, diuretics, or other medications in the ___ of
___.
Answer:
absence, binge eating
Q: People with purging disorder are normally __ weight.
Answer:
Normal
Exam 1: NURS663/ NURS 663 (Latest 2023/
2024 Update) – Psychiatric Mental Health
Diagnosis and Management II Exam Review |
Questions and Verified Answers| 100%
Correct- Maryville
Q: Tricyclic mechanism of action?
Answer:
Inhibit 5HT2, norepinephrine, dopamine and reuptake slows. Amino group interferes with ASP –
98 in HSERT. Causing down regulation of receptors.
Q: Tricyclic side effects?
Answer:
Anticholinergic effects (dry mouth, blurred vision, constipation, urine retention, impotence).
Histamine effects (sedation, increased weight). Adrenergic alpha receptor (postural hypotension).
Direct membrane effects (decrease seizure threshold and arrhythmias). 5HT2 receptor (increase
weight and decrease anxiety).
Q: Amitriptyline dosing/Class?
Answer:
Start at 25 to 50 mg per day, titrate 25 to 50 mg per day per week, Max dose is 300 mg per
day/TCA
Q: Names of tricyclics 10?
Answer:
Amitriptyline, nortriptyline, clomipramine, imipramine, protriptyline, doxepin, amoxapine,
desipramine, mapratiline, tripramine
Q: Tricyclics are useful-2?
Answer:
Pain, migraine
Q: Tricyclics adverse effects-2?
Answer:
Overdoses are cardiotoxic, high potency increases the risk of mania
Q: Nortriptyline mnemonic?
Answer:
No-triptyline equals less sedation and hypotension
Q: Tricyclics mnemonic-2?
Answer:
Think car goes over tricycle to remember that an overdose is cardiotoxic. Do you remember
mechanism think trans =serotonin and norepinephrine Chans= Na+ and Ca+ Ans= ACH and
histamine
Q: Clomipramine mnemonic/class?
Answer:
TCA- think comipramine for obsessive compulsive disorder
Q: Imipramine- pneumonic and class?
Answer:
I’m peeingamine- nocturnal enuresis
Q: Unilateral electrode in ECT indications?
Answer:
Typically first line because it has less cognitive side effects but has less efficacy
Q: What is ECT??
Answer:
The use of electrical shock current delivered to the brain to induce a seizure that treats
depression. Goal is to reverse atrophy.
Q: ECT is FDA approved for what?
Answer:
Bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant
syndrome, treatment resistant refractory major depressive disorder
Q: What is ECT schedule?
Answer:
Typically Monday Wednesday Friday for 6 to 12 sessions
Exam 4: NURS663/ NURS 663 (Latest 2023/
2024 Update) – Psychiatric Mental Health
Diagnosis and Management II Exam |
Questions and Verified Answers| Grade AMaryville
Q: which medications are in Suboxone
Answer:
buprenorphine and naloxone
Q: buproprion; dosing
Answer:
for smoking cessation: begin 7-14d before stop date; 150mg SR in am x6 days then increase to
150mg SR BID
tx for 7-9 weeks
Q: chlordiazepoxide; MOA, what for, dosing
Answer:
MOA: enhances GABA
for acute alcohol withdrawal
50-100mg injectable every 2hrs
Q: clonidine; MOA
Answer:
alpha 2 receptors
Q: clonidine for opiate withdrawal
Answer:
blocks autonomic symptoms; palpitations, sweating
Q: clonidine for etoh withdrawal
Answer:
decrease bp, decrease HR, tremors
Q: disulfiram; MOA
Answer:
inhibits acetalhydine and leads to buildup of acetaldehyde and causes immediate hangover effect
after alcohol consumption
Q: disulfiram dosing
Answer:
250-500mg/d
Q: flumazenil; MOA, use, dosing, se
Answer:
MOA: blocks benzo receptors at GABA
use: benzo antidote
dosing: 0.4mg-3mg
se: dizzy, sweating, seizures, death
Exam 4: NURS663/ NURS 663 – Psychiatric
Mental Health Diagnosis and Management II
Exam Review | Study Guide with Verified
Answers| 100% Correct (Latest 2023/ 2024
Update) – Maryville
Q: Clonidine pt. ed
Answer:
Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the
extended-release tablets whole; do not split, chew or crush them.
Q: Disulfiram (Antabuse) MOA
Answer:
Irreversibly blocks ALDH which prevents metabolism of alcohol and acetylaldehyde builds up in
the body. is given in daily doses of 250 mg before the patient is discharged from the intensive
first phase of outpatient rehabilitation or from inpatient care. The goal is to place the patient in a
condition in which drinking alcohol precipitates an uncomfortable physical reaction, including
nausea, vomiting, and a burning sensation in the face and stomach.
Q: Disulfiram side effects
Answer:
- purpose of the drug: skin flushing, increased pulse, diaphoresis, increased respiration,
hypotension, chest pain, nausea, copious vomiting, blurred vision
Q: disulfiram pt education
Answer:
Never give to a patient in a state of alcohol intoxication or without the patient’s full knowledge.
The patient should not take for at least 12 hours after drinking. A reaction may occur for up to 2
weeks after it has been stopped
Q: Flumazenil (Romazicon)
Answer:
Benzodiazepine antagonist, antidote
Q: Flumazenil SE
Answer:
nausea, vomiting;
headache, mild dizziness;
flushing (warmth, redness, or tingly feeling);
increased sweating;
blurred vision; or
pain where the medicine was injected.
Q: Flumazenil pt. ed
Answer:
cause seizures (convulsions), especially in people who have sedative-addiction withdrawal
symptoms or recent antidepressant overdose, people who have recently received injectable
benzodiazepines, or people who had symptoms of a seizure just before receiving flumazenil.
Talk to your doctor if you have concerns about the risk of seizure.
Q: Lorazepam MOA
Answer:
binds to benzodiazepine receptors; enhances GABA effects
Q: Lorazepam side effects
Answer:
- drowsiness
- lightheadedness
- hyotension
4.hepatic dysfunction - increased salivation
Q: Lorazepam pt. ed
Answer:
Advise patient to decrease dose gradually to minimize withdrawal symptoms; abrupt withdrawal
may cause tremors, nausea, vomiting, and abdomi- nal and muscle cramps. Teach other methods
to decrease anxiety, such as increased exercise, support groups, relaxation techniques.
Q: Methadone MOA
Answer:
long acting opioid agonist
Q: Methadone side effects
Answer:
Drowsiness, sedation
N/V anorexia
respiratory depression
consitpation, cramps
orthostatic hypotension
confusion, headache
rash
arrhythmias
syncope
agitation
Exam 3: NURS663/ NURS 663 – Psychiatric
Mental Health Diagnosis and Management II
Exam Review | Guide with Questions and
Verified Answers| 100% Correct| Rated A
(Latest 2023/ 2024 Update) – Maryville
Q: Benzodiazepines (class)
Answer:
- also called the “Z’ drugs. Their clinical effects results from interactions with GABA-receptor
complexes at binding domains located close to or coupled to benzodiazepine receptors.
Q: Benzodiazepines are FDA approved to tx what dxs?
Answer:
· Generalized anxiety disorder (GAD)
· Social phobia
· Panic disorder
· Insomnia
· Status epilepticus/seizures
· Premedication for anesthetic procedures
Q: Benzodiazepines NON-FDA APPROVED USES
Answer:
· Agitation
· Alcohol withdrawal symptoms
· Muscle spasms
· Sedation
· Restless legs syndrome
· Sleepwalking disorder
Q: Benzodiazepines MOA
Answer:
enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA
receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety),
anticonvulsant, and muscle relaxant properties
Q: Benzodiazepines indication of use
Answer:
Can be used for insomnia, anxiety disorder, panic disorder, social phobia, mixed anxietydepressive disorder, bipolar I disorder, akathisia, Parkinson’s disease, and overdose.
Q: Benzodiazepines side effects
Answer:
o Anterograde amnesia
o Confusion
o Dizziness
o Depression
o Sedation
Q: Benzodiazepines Patient teaching
Answer:
Avoid alcohol, avoid driving
Q: Buspirone (Buspar) MOA
Answer:
Binds to serotonin type 1A receptors. Partial agonist actions postsynaptically may theorectically
diminish serotonergic activity and contribute to anxiolytic actions. Partial agonist actions of
presynaptic somatodendritic serotonin autoreceptors may theorectically serotonergic activity and
contribute to antidepressant actions.
Q: Buspirone (Buspar) use
Answer:
anxiety, Management of anxiety disorders
Short-term treatment of symptoms of anxiety
Mixed anxiety and depression
Treatment-resistant depression (adjunctive)
Generally takes within 2-4 weeks to achieve efficacy
Q: Buspirone (Buspar) side effects
Answer:
Dizziness, headaches, nervousness, sedation, excitement, nausea, restlessness.
Q: Buspar Usual Dosage
Answer:
20-30 mg/day
Q: Buspar Potential Advantages:
Answer:
lack of dependence, withdrawal
Lack of sexual dysfunction or weight gain
Q: Buspar Disadvantages
Answer:
Takes 4 weeks for results, whereas benzodiazepines have immediate effect.
*Buspirone does not appear to cause dependence and shows virtually no withdrawal symptoms.
May have less severity side effects than benzodiazepines. Buspirone generally lacks sexual
dysfunction
Q: Buspar Pt.s Ed
Answer:
Use with caution with MAOIs, including 14 days after MAOIs are stopped. Buspirone may
increase plasma concentration of haloperidol. CYP450 3A4 inhibitors (e.g. fluxotine,
fluvoxamine, nefazodone) may reduce clearance of buspirone and raise its plasma levels, so the
dose of buspirone may need to be lowered when gives concomitantly with these agents.
Q: Clomipramine (Anafranil) MOA
Answer:
Boosts neurotransmitters serotonin and norepinephrine/noradrenaline. Blocks serotonin reuptake
pump (serotonin transporter) presumably increasing serotonergic neurotransmission. Blocks
norepinephrine reuptake pump (norepinephrine transporter), presumably increasing
noradrenergic neurotransmission.
Q: Clomipramine (Anafranil) use
Answer:
Obsessive-compulsive disorder
Depression
Severe and treatment-resistant depression
Cataplexy syndrome
Anxiety
Insomnia
Neuropathic pain/chronic pai
Exam 2: NURS663/ NURS 663 – Psychiatric
Mental Health Diagnosis and Management II
Exam Review | Complete Guide with
Questions and Verified Answers| 100%
Correct| Rated A (Latest 2023/ 2024 Update)
- Maryville
Q: Enuresis Prevalence
Answer:
· Prevalence is 5-10% of five-year-old’s
· 1.5-5% of 9-10-year-old
· Nocturnal enuresis more common in boys
Q: Enuresis
Diagnostic Criteria
Answer:
· Must be at least 5 years old
· Voiding in bed or clothes, either intentional or unintentional
· Must occur twice weekly for a period of at least 3 months
· Not caused by a medical condition
Q: Enuresis
Concurrent Conditions
Answer:
· People with enuresis are at higher risk for ADHD
· More likely to have encopresis
Q: Enuresis
Treatment
Answer:
· Bed alarm
· Classic conditioning
· Treatment- bed alarms and Desmopressin
Q: Bulimia Nervosa
Diagnostic Criteria: Recurrent episodes of binge eating. An episode is char- acterized by both of
the following
Answer:
1.Eating, in a discrete period of time (within
2-hour period) an amount of food that is larger that what most individuals would eat in in a
similar period of time
2.A sense of lack of control over eating during the episode (feeling like they cannot stop eating)
· Recurrent inappropriate compensatory behaviors in order to prevent weight gain: such as selfinduced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive
exercise
· The binge eating and inappropriate compensatory behaviors both occur, on aver- age, at least
once per week for 3 months
· Self-evaluation is unduly influenced by body weight and shape
Q: Bulimia Nervosa
Severity
Answer:
· Mild 1-3 episodes per week
· Moderate 4-7 episodes per week
· Severe- 8-13 episodes per week
· Extreme 14 or more episodes per week
Q: Binge-Eating Disorder:
Diagnostic Criteria: Recurrent episodes of binge-eating is characterized by both of the following
Answer:
· Eating in a discrete period of time (2 hours) an amount of food that is larger than what most
people would eat
· A sense of lack of control over what and how much one is eating
· The binge-eating episodes are associated with 3 or more of the following
· Eating much more rapidly than normal
· Eating until feeling uncomfortably full
· Eating large amounts of food when not feeling physically hungry
· Feeling disgusted with oneself, depressed, or guilty afterwards
· The binge eating occurs, on average, at least once a week for 3 months
Q: Binge-Eating Disorder:
Severity
Answer:
· Mild- 1-3 binges per week
· Moderate 4-7
· Severe 8-13
· Extreme 14 or more
Q: Binge-Eating Disorder:
Prevalence
Answer:
1/6% females and males 0.8%
Q: Other Specified Eating Disorder
Answer:
· Applies to presentations in which symp- toms characteristic of a feeding and eating disorder
that impair functioning, but do not meet the full criteria for any of the disorders
Q: Unspecified Eating Disorders
Answer:
Ø Clinician chooses not to specify the reason the disorder is not met
Q: Elimination Disorders
Diagnostic Criteria
Answer:
· Repeated voiding of urine into bed or clothes, whether voluntary or involuntary
· The behavior is clinically significant as manifested by either a frequency of at least
2 times per week for at least 3 consecutive months
· At least 5 years of age
Q: Elimination Disorders
Prevalence
Answer:
· 5-10% among 5-year-olds
· 3-5% among 10-year-olds
· Bedwetting at night is more common in males
Q: Encopresis
Diagnostic Criteria
Answer:
· Repeated passage of feces into inappropriate places
(clothes, floor) whether involuntary or intentional
· At least one such event occurs each month or at least 3 months
· Child must be at least 4 years of age
Q: Encopresis
Prevalence
Answer:
· 1% of 5-year-olds
· More common in males
Exam 3: NURS663/ NURS 663 – Psychiatric
Mental Health Diagnosis and Management II
Exam Review | Questions and Verified
Answers| 100% Correct| Grade A (Latest
2023/ 2024 Update) – Maryville
Q: propanolol is good for
Answer:
panic attack with tremor; GAD with tremor
social anxiety and presentations
*monitor BP and HR
Q: agroaphobia therapy types
Answer:
insight oriented therapy
behavioral therapy
cognitive therapy
encourage good responses and minimize poor responses
Q: what is insight oriented therapy
Answer:
psychodynamic therapy; client’s self-awareness and understanding of the influence of the past on
present behavior
Q: symptoms in GAD
Answer:
3/6 present
restless, fatigue, irritability, muscle tension, poor concentration, sleep problems
Q: brain in GAD
Answer:
increased activity in amygdala
Q: OCD contaminiation
Answer:
hand washing
Q: OCD pathological doubt
Answer:
checking doors at night; also called harm concern
Q: OCD intruding thoughts
Answer:
thinking about something over and over
Q: OCD symmetry
Answer:
symmetry behaviors; clapping ends with even number, throw extra away to have even number
Q: what is an obsession
Answer:
recurrent and intrusive thought, feeling, idea, or sensation; mental event
Q: what is an compulsion
Answer:
conscious, standardized, recurrent behavior (counting, checking, avoiding); anxiety increases
when person does not do compulsion
Q: hoarding disorder treatment
Answer:
CBT recommended first line
medication not first line
Q: factitious dermatitis
Answer:
skin picking; person has attempted to stop/decrease
Q: cleptomania
Answer:
shoplifting
Q: insight oriented for agoraphobia