NURS 660 EXAM QUESTIONS WITH ANSWERS LATEST UPDATED 2024 (ADHD)

NURS 660 EXAM QUESTIONS WITH ANSWERS LATEST UPDATED 2024 (ADHD) Peter, a 35-year-old stockbroker, has been advised by his supervisor to come and see you, the company mental health consultant. His supervisor is complaining that he often comes late to appointments, is inappropriately fidgety, interrupts people during meetings, has been offensive towards coworkers, and has been known to party excessively on weeknights. Peter asserts that he is just fine; he has a lot of projects on his mind and is simply standing up for himself when speaking with others. He likes to go out in the evenings to unwind. Recognizing probable ADHD, you interview both the patient and his work buddy, who is a longtime friend. How would you start your questions? Peer Answers Your Answer A. Compared to his parents, how often does the patient… 1% B. Compared to other people his age, how often does the patient… 82% C. Compared to his childhood, how often does the patient… 16% D. Compared to his children, how often does the patient… 0% B - Correct. When trying to diagnose this adult patient with ADHD, it is preferable to first ask him to compare his behavior to that of other adults his age, as this will give a better idea of the severity of his symptoms at this time. 2. According to DSM-5 criteria, what is the maximum age threshold for symptom onset when making a diagnosis of attention deficit hyperactivity disorder (ADHD)? Peer Answers Your Answer A. 5 3% B. 7 13% C. 12 77% D. 15 6% C - Correct. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the maximum age threshold for symptom onset for diagnosing ADHD changed from 7 to 12. Other revisions included the fact that, although symptoms must have been present prior to age 12, there does not have to have been impairment prior to age 12 when diagnosing someone who is older. The symptom count threshold also changed for adults (defined as age 17 and older), with 5 (instead of 6) symptoms required in the inattention and/or hyperactive/impulsive categories 3. A 15-year-old with inattentive-type attention deficit hyperactivity disorder has a hard time staying focused on the task at hand, has trouble organizing her work, and relies heavily on her mother to follow through with her homework. Problem solving is one of the hardest tasks for her. Her difficulty with sustained attention could be related to aberrant activation in the: Peer Answers Your Answer A. Dorsolateral prefrontal cortex 68% B. Prefrontal motor cortex 21% C. Orbital frontal cortex 8% D. Supplementary motor cortex 0% A - Correct. Sustained attention is hypothetically modulated by the cortico-striatal-thalamic-cortical loop involving the dorsolateral prefrontal cortex (DLPFC). Inefficient activation of the DLPFC can lead to problems following through or finishing tasks, disorganization and trouble sustaining mental effort; the patient exhibits all of these symptoms. The dorsal anterior cingulate cortex is important in regulating selective attention, and is associated with behaviors such as losing things, being distracted, and making careless mistakes. This area is certainly also inefficient in this patient. 4. Which of the following is true regarding cortical brain development in children with ADHD compared to healthy controls? Peer Answers Your Answer A. The pattern (i.e., order) of cortical maturation is different 7% B. The timing of cortical maturation is different 35% C. The pattern and timing of cortical maturation are different 51% D. Neither the pattern nor the timing of cortical maturation are different 5% B - Correct. There are differences in the timing of cortical maturation between children with and without ADHD that are apparent as early as age 7. That is, cortical maturation in children with ADHD seems to lag behind that of healthy children. In fact, the median age by which 50% of the cortical points achieve peak thickness is delayed by 3 years in children with ADHD. Delay is most prominent in the superior and dorsolateral prefrontal regions, which are particularly important for control of attention and planning. Delay is also seen in subcortical structures. A large cross-sectional mega-analysis demonstrated that the delay in brain maturation is not attributable to medication use. 5. A clinician is considering treatment options for a 26-year-old man with ADHD who has a history of alcohol and marijuana abuse. Which of the following accurately explains the effects of different stimulant formulations on neuronal firing? Peer Answers Your Answer A. Pulsatile stimulation amplifies undesirable phasic dopamine (DA) and norepinephrine (NE) firing, which can lead to euphoria and abuse 46% B. Immediate release stimulants lead to tonic firing, which can lead to euphoria and abuse 22% C. Tonic firing is the result of rapid receptor occupancy and fast onset of action as seen with extended release formulations 1% D. Extended release stimulants result in phasic stimulation of NE and DA signals, but this does not lead to euphoria and abuse 29% A - Correct. Pulsatile delivery of stimulants can cause a frequent and rapid increase in NE and DA, and this amplifies phasic firing. Phasic firing is hypothetically associated with reward, feelings of euphoria, and abuse potential. 6. Scarlet, a 25-year-old bartender, was diagnosed with ADHD at age 10. She has been on and off medication since then; first on immediate-release methylphenidate, then on the methylphenidate patch. She has experimented with illicit drugs during her late adolescence and is still a heavy drinker. After a few years of self-medication with alcohol and cigarettes, she is seeking medical attention again. You decide to put her on 80 mg/day of atomoxetine, one of the non-stimulant medications effective in ADHD. Why does atomoxetine lack abuse potential? Peer Answers Your Answer A. It decreases norepinephrine levels in the nucleus accumbens, but not in the prefrontal cortex 15% B. It increases dopamine levels in the 71% prefrontal cortex but not in the nucleus accumbens C. It modulates serotonin levels in the raphe nucleus 10% D. It increases dopamine in the striatum and anterior cingulate cortex 3% B - Correct. The prefrontal cortex lacks high concentrations of DAT, so in this brain region, DA gets inactivated by NET. Therefore, inhibiting NET in the prefrontal cortex increases both DA and NE. As only a few NET exist in the nucleus accumbens, atomoxetine does not induce an increase in DA and NE in the nucleus accumbens, the reward center of the brain, thus atomoxetine does not have abuse potential. 7. A 15-year-old patient with ADHD has a rare mutation in the gene for the dopamine transporter (DAT). In deciding which treatment to initiate for this patient's ADHD, you know it will be important to avoid treatments that depend on normally functioning DAT. Which of the following drugs are transported into neurons via the dopamine transporter? Peer Answers Your Answer A. Amphetamine 53% B. Atomoxetine 10% C. Methylphenidate 11% D. A and B 14% E. None of the above 9% A - Correct. Amphetamine blocks DAT and the norepinephrine transporter (NET) by binding at the same site that the monoamines bind. Thus, amphetamine is a competitive inhibitor and pseudosubstrate for DAT and NET, such that (at least at high doses) amphetamine is actually transported into the presynaptic DA terminal. 8. A patient with attention deficit hyperactivity disorder (ADHD) has not yet had successful treatment: he has experienced either loss of efficacy toward the end of the day or efficacy but insomnia at night. He is frustrated and wants to know what other treatment options exist. The most recently available new treatments for attention deficit hyperactivity (ADHD) represent: Peer Answers Your Answer A. Novel neurotransmitter targets 3% B. New formulations of existing active ingredients 55% C. A and B 40% B - Correct. The majority of approved treatments for ADHD, and specifically new agents approved recently, are formulation variations of either amphetamine or methylphenidate: Their differences lie not in the active ingredient but rather in how that active ingredient is delivered—i.e., release mechanism. Modified-release formulations are designed to release drug in a controlled and predictable manner that allows for a particular efficacy and safety profile. Modifying the release of drug can improve tolerability by eliminating peaks and troughs in plasma concentration, and can improve efficacy by increasing duration of action as well as by eliminating peaks and troughs. 9. Rita is a 28-year-old patient with untreated ADHD. You are currently deciding between guanfacine and clonidine as potential treatments for this patient. The selective alpha 2A agonist guanfacine appears to be: Peer Answers Your Answer A. Less tolerated than the alpha 2 agonist clonidine 3% B. Better tolerated than the alpha 2 agonist clonidine 78% C. Less efficacious than the alpha 2 agonist clonidine 5% D. More efficacious than the alpha 2 agonist clonidine 12% B - Correct. Guanfacine is better tolerated than clonidine