Clinical PMHNP Exam 1 study questions and answers

Which theory of depression was developed based on observing that patients who were being treated for Hep C developed depressive symptoms? A. The monoamine theory B. The inflammation theory C. The HPA axis theory D. The stress-diathesis theory b. The inflammation theory Which of the following health conditions have a high co-morbidity with depression? A. Hypertension B. Asthma C. Diabetes mellitus D. Cardiovascular disease E. Celiac disease F. Cognitive impairment G. Obesity H. Cancer A. Hypertension C. Diabetes Mellitus D. Cardiovascular disease F. Cognitive impairment G. Obesity H. Cancer In the Cutler video on depression, he highlights that there are 200 different ways to meet the diagnostic criteria for depression. A. True B. False A. True You have diagnosed a 53-year-old male with moderate MDD and he has declined psychotherapy but has agreed to pharmacotherapy. He has diagnoses of Type 2 D.M. with a BMI of 32.1. Which of the following antidepressants would provide a dual benefit for this patient? A. Sertraline B. Fluoxetine C. Duloxetine D. Mirtazapine C. Duloxetine Your patient was started on fluoxetine and after ten weeks of treatment his PhQ 9 score is 9. What is your assessment of the efficacy of treatment based on this score? A. The patient is in remission B. The response is adequate but not in remission C. The response is possibly inadequate D. The response is inadequate B. The response is adequate but not in remission In the Star*D trial what percentage of patients treated for depression failed to respond to initial pharmacotherapy? A. 20% B. 30% C. 40% D. 50% D. 50% In the Star D trial for patients that achieved remission what percentage relapsed after 4.4 months? A. 25% B. 33% C. 42% D. 53% B. 33% When should adjunctive therapy be considered in treating MDD? (select all that apply) A. Already tried 3 or antidepressants B. Initial antidepressant well tolerated C. Partial response (50% improvement) D. Specific residual symptoms or side effects that can be targeted E. Severity of depression, more functional impairment F. Patient preference B. Initial antidepressant well tolerated D. Specific residual symptoms or side effects that can be targeted E. Severity of depression, more functional impairment F. Patient preference Rates of remission increased with each additional change in therapy, especially when switching. A. True B. False B. False You have diagnosed your patient with Major Depressive Disorder and after six weeks of being treated with fluoxetine 20 mg there is no treatment response. According to the VA/DoD Guidelines for treatment of MDD what is the next step? A. Switch to another monotherapy either an antidepressant or psychotherapy. B. Switch to a different antidepressant C. Augment with a second antidepressant D. Augment with a second medication or psychotherapy A. A, C B. B C. C D. A, D D. A,D Your patient has experienced her first episode of MDD and is in remission. How long should the antidepressant be continued after remission has been achieved to reduce the risk of relapse? A. 2 months B. 4 months C. 6 months D. One year C. 6 months For patients that respond to treatment with pharmacotherapy but are at high risk for recurrent depressive episodes, howe long should maintenance pharmacotherapy be continued? A. At least 6 months B. At least 12 months C. At least 24 months Indefinitely B. At least 12 months Having a patient sign a "no suicide contract" has demonstrated efficacy in reducing suicides among those who sign these "contracts". A. True B. False B. False When de-escalating a patient what is the recommended closest distance that you should stand from the patient? A. 1 arm length B. 2 arms length C. six feet D. 10 feet 2 arms length In order to assess agitation in a patient the practitioner should: A. Use past experiences with patients to compare to this patient B. Use an objective scale such as the Behavioral Activity Rating Scales C. Find the most experienced person with assessing agitation D. Avoid jumping to conclusions and monitor the patient over time B. Use an objective scale such as the Behavioral Activity Rating Scales You walk into the room of a patient in an acute care facility where you have been asked to consult with due to the patient's bizarre behavior. The patient is a 6'5" former body builder who is pacing the room, talking loudly and hurling verbal threats about wanting to hurt someone. You are fearful as the last time you encountered a patient such as this you were assaulted and ended up needing several stitches. Your decision would be to: A. Talk in a calm, reassuring manner to the patient B. Make eye contact so that the patient knows you are watching him C. Leave the room to secure someone else to work with the patient D. Leave the room to secure someone else to work with the patient C. Leave the room to secure someone else to work with the patient Select the key components of de-escalation: A. Hands should be visible and not clenched B. Directly face the patient but stand at arm's length C. Fold your arms D. Provide an in-depth explanation of the problem as you see it E. If the patient is delusional point out that this is faulty thinking F. Introduce yourself and ask the patient his/her name and how they would like to be addressed G. Have your back to the exit so the patient must go around you to leave the room. H. Use clarifying sentences A. Hands should be visible and not clenched F. Introduce yourself and ask the patient his/her name and how they would like to be addressed H. Use clarifying sentences Your patient is extremely agitated and it is evident that the patient needs medication to calm him down. Which of the following would be the least effective way to approach to this subject? A. "When you were this worked up before we gave you a shot and it really helped so I have ordered the same medicine for you" B. "I need to protect you from hurting someone so I would like for you to take some medication to help you stay in control." C. "I am going to need to give you some medication to help you maintain control. Would you prefer something by mouth or by a shot?" D. "In order to protect yourself from injury I am going to need to give you some medication. What has worked for you in the past or do you have a preference? " A. "When you were this worked up before we gave you a shot and it really helped so I have ordered the same medicine for you" Which of the following statements are correct related to suicidality in the elderly? A. Suicides increase with age and therefore are the highest risk for suicide B. Attempts at suicide are more serious C. More lethal than the younger population D. Depression is easier to treat with lower relapse rates A. Suicides increase with age and therefore are the highest risk for suicide B. Attempts at suicide are more serious C. More lethal than the younger population You are seeing a 75-year-old patient who has been brought to an emergency room for agitation and reported hallucinations. His spouse states that he had been going about his usual routine when he began saying things that did not make sense, he was unsure where he was and thought that she was her sister. When she tried to get him into the car to take to the ED, he was argumentative and threatened to jump out of the car which was completely opposite of his usual behavior. You try in to interview the patient but he is unable to provide you with any meaningful information. He is threatening to leave the ED and had to be held down for a blood draw. What is your next step? A. Order a CBC with diff, CMP, UA, urine toxicology B. Consult with the ED provider for obtaining an LP and EEG with possible neuroimaging C. Order risperidone orally disintegrating tablet and assess for efficacy D. Correct the cause of the delirium rather than giving any psychotropics A. Order a CBC with diff, CMP, UA, urine toxicology B. Consult with the ED provider for obtaining an LP and EEG with possible neuroimaging C. Order risperidone orally disintegrating tablet and assess for efficacy In the patient described above you have assessed his capacity. Select the components for assessing capacity. A. Ability to communicate a choice B. Ability to understand relevant information C. Ability to appreciate risks and benefits D. Ability to rationally manipulate the information at hand A. A, C B. B, D C. C D. A, B, C, D D. A, B, C, D When assessing a patient for bipolar disorder who is not manic (which is very easy to identify), it is important to consider differentials. What are differentials to consider for bipolar disorder? A. Substance use B. Medication withdrawal C. Medication side effects D. Hyperarousal state with PTSD E. A panic attack A. A, B, C B. D, E C. A, C D. All of the above D. All of the above According to the Thase presentation on the top 10 drug combinations for MDD what should be considered when a Level I strategy is ineffective? A. Was the patient taking the medication as prescribed? B. Is there an occult medical illness? C. Could the patient be using a substance that was not reported during visits? D. Do I have the correct diagnosis? E. Could the patient be malingering? A. Was the patient taking the medication as prescribed? B. Is there an occult medical illness? C. Could the patient be using a substance that was not reported during visits? D. Do I have the correct diagnosis? Social anxiety disorder (SAD) is one of the most common anxiety disorders. Select the true statements related to SAD. (select all that apply) A. More common in women with onset in adolescence B. Chronic and unremitting C. Low SES, single and low educational achievement are risk factors D. High comorbidity with MDD A. More common in women with onset in adolescence B. Chronic and unremitting C. Low SES, single and low educational achievement are risk factors D. High comorbidity with MDD Select the gold standard nonpharmacological treatment for social anxiety disorder: A. CBT B. IPT C. Exposure and Response Therapy D. Acceptance and Commitment Therapy A. CBT Select the true statement regarding anxiety disorders: (select all that apply) A. GAD co-occurs with other anxiety disorders B. Differentials for anxiety disorders are CAD and pulmonary disorders C. Anxiety disorders should be treated at any severity due to anticipated progression in severity over time D. Hypothyroidism is a differential for anxiety A. GAD co-occurs with other anxiety disorders B. Differentials for anxiety disorders are CAD and pulmonary disorders The following medications have FDA approval to treat panic disorder and agoraphobia. Which of the following would you use with caution in an elderly patient or a patient with cardiovascular disease? (check all that apply A. Citalopram B. Fluoxetine C. Paroxetine D. Venlafaxine A. Citalopram D. Venlafaxine In the Natural Medicines database when looking for complementary treatments for anxiety which of the following was found to be "possibly ineffective"? A. Probiotics B. Gingko C. Lavender D. Melatonin A. Probiotics Your patient is a 41-year-old female without any history of chronic illnesses. She is seeing you in your office after reporting she has been to the emergency room three times in the past month for what she thought was a heart attack. After the third episode she was told that her symptoms are related to a panic attack and she should see a PMHNP. After conducting a thorough history and an MSE along with reviewing screening questionnaires you diagnose her with generalized anxiety disorder (F41.1) and panic disorder (F41.0). Which of the following options would be the best treatment plan for this initial visit? A. CBT B. Sertraline 50 mg p.o. Q.D. (#30, 1 refill) C. Sertraline 50 mg p.o. Q.D. (#30, 0 RF) CBT and alprazolam 0.5 mg p.o. up to t.i.d. prn anxiety (#15) D. Sertraline 50 mg p.o. Q.D. (#30, 0 RF & CBT) C. Sertraline 50 mg p.o. Q.D. (#30, 0 RF) CBT and alprazolam 0.5 mg p.o. up to t.i.d. prn anxiety (#15) The risk of developing anxiety disorders is enhanced by: A. Depression B. Substance abuse C. Eating disorders D. All of the above D. All of the above Which of the following statements regarding anxiety and gender differences is true? A. Women have greater rates of almost all anxiety disorders B. Gender ratios are nearly equal with OCD C. No significant difference exists in average age of anxiety onset D. Women have a twofold greater lifetime rate of agoraphobia than men E. All of the above E. All of the above Which of the following epidemiological statements is true regarding anxiety disorders? A. Panic disorder has the lowest heritability B. The mean age of onset is higher in girls C. The age of onset is earlier than that of mood disorders D. Rates in males peak the fourth and fifth decades of life E. All of the above C. The age of onset is earlier than that of mood disorders Anxiety disorders A. Are greater among people at lower socioeconomic levels B. Are highest among those with higher levels of education C. Are lowest among homemakers D. Have shown different prevalence with regard to social class but not ethnicity A. Are greater among people at lower socioeconomic levels Generalized anxiety disorder A. Is least likely to coexist with another mental disorder B. Has a female to male ratio of 1:2 C. Is a mild condition D. Has about a 50% chance of recurrence after recovery E. Has a low prevalence in primary care settings D. Has about a 50% chance of recurrence after recovery