NURS 663 EXAM 1 MARYVILLE UNIVERSITY

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NURS 663 EXAM 1 MARYVILLE UNIVERSITY

LATEST -

QUESTIONS AND CORRECT ANSWERS/ NURS

663 EXAM 1 MVU

Case: 26 year old woman without a psychiatric history who presents for treatment of depression after her mother died. It has been over a year but she is still struggling with frequent bouts of sadness, has lost 15 lbs in the last four months, is unable to sleep past 4am, and is getting poor performance reviews at work due to impaired concentration and memory. She feels like nothing in life is enjoyable anymore.diagnosis and medications to consider? - ANSWER-MDD -Sertraline -Escitalopram -Fluoxetine -Mirtazapine

case: 35 year old woman with a history of major depressive disorder who presents complaining of persistent depression despite treatment with maximum dose sertraline and escitalopram in the past. She has been depressed for over eight months, and spends up to 16 hours per day lying in bed. She reports that she doesn't have the energy to get up in the morning, and that there is nothing that she enjoys doing, anyway. She has gained 35 lbs in the last eight months, reports feeling like she has failed everyone in her life, and states that she only leaves the house about once a week to shop for groceries. Recently, she has begun hearing vague voices when she feels especially badly, although she cannot make out specific words.

diagnosis and medications? - ANSWER-MDD

-Bupropion 1 / 4

pg. 2 -Venlafaxine -Duloxetine -Maybe fluoxetine

case: 39 year old man with a history of PTSD and depression who presents after

returning from a recent deployment to Afghanistan. He is having trouble sleeping because of nightmares about combat, is unable to tolerate being in crowded places, and visibly jumps at small noises during your interview. His unwillingness to leave the house is exacerbated by a lower spinal injury that has left him with chronic leg pain and a limp that he thinks makes him look "like an easy target." He also reports that he has difficulty sleeping through the night, is having trouble enjoying doing anything with his family, feels extremely guilty for the time that he was away from them while deployed, has low energy and concentration, but adamantly denies suicidal thoughts. He has tried maximum dose sertraline and venlafaxine, but neither were helpful. He also tried mirtazapine, but it was far too sedating and didn't work either.

diagnosis - ANSWER-PTSD, MDD, Chronic Pain

-Nortriptyline or another TCA -Duloxetine -Escitalopram -Prazosin

Patient comes in with symptoms of mania followed by periods of depression; what is it? - ANSWER-bipolar 1

patient comes in with hypomania/regular mood (euthymic) followed by periods of depression, what is it? - ANSWER-bipolar 2

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pg. 3 how many symptoms of mania must you have to have "full" mania? - ANSWER- seven of thirteen

what is the difference between mania and hypomania? - ANSWER-hypomania has less severe symptoms; 3 symptoms over shorter period of time (hypomania)

what is something you should watch out for if a patient is on multiple antidepressants? - ANSWER-SIADH

what medical problems mimic mood disorders? - ANSWER-hypothyroid- depression hyperthyroid- mania

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)

how is the severity of depression rated? - ANSWER-- Mild: no suicidal

thoughts/death wishes

- Moderate: some thoughts of death/self-harm

- Severe: plan/attempted

what are late side effects associated with lithium? - ANSWER-rare- renal failure thyroid failure 3 / 4

pg. 4 nephrogenic diabetes insipidus

how is lithium toxicity graded by blood trough level, and what symptoms would you see? - ANSWER-mild (1.5-2) - vomiting, diarrhea, ataxia, dizziness, slurred speech, nystagmus moderate (2.0-2.4) nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, delirium, syncope severe (>2.5) oliguria, renal failure, generalized convulsions

what medication decreases suicide rates? - ANSWER-lithium

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

DSM 5 for bipolar I disorder - ANSWER-depression + mania

DSM 5 for bipolar 2 disorder - ANSWER-depression + hypomania

what is the #1 predictor of suicide? - ANSWER-Hopelessness and loneliness

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