NR 222/ NR222 Exam 2 (2026/ 2027 updated) Health and Wellness Guide |Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Chamberlain.

NR 222/ NR222 Exam 2 (2026/ 2027 updated) Health and Wellness Guide |Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Chamberlain. Q. What does anorexia nervosa involve? ANSWER weight loss, fear of gaining weight and distored body image Q. What are the 2 types of anorexia nervosa? ANSWER Restricting Binge-eating/purging Q. What is the most serious complication in anorexia nervosa treatment? ANSWER Refeeding syndrome Q. What are the physical findings in anorexia? ANSWER Bradycardia, electrolyte disturbances and hormonal abnormalities Q. What does bulimia nervosa include? ANSWER Binge eating and compensatory behaviors (vomiting, laxative use) Q. What are signs of bulimia nervosa? ANSWER Russell's sign-callused knuckles dental erosion Q. What is FDA approved to treat bulimia nervosa? ANSWER fluoxetine (Prozac) Q. What does binge eating disorder lack? ANSWER Compensatory behaviors Q. What does binge eating disorder include? ANSWER Distress about bingeing Q. What is FDA approved to treat binge eating disorder? ANSWER Lisdexamfetamine (Vyvanse) Doesn't suppress appetite but controls impulses Q. What is avoidant restrictive food intake disorder driven by? ANSWER the fear of negative consequences (choking) instead of being driven by body image Q. What does rumination disorder invovle? ANSWER Regurgitation of food without nausea of disgust Q. What is pica? ANSWER the consumption of non food stubstances Q. What should you screen for with pica? ANSWER Nutritional deficiencies Q. What type of therapy might patients with pica need? ANSWER Behavioral therapy Q. What helps young people with disordered eating? ANSWER Early intervention with therapy and possible SSRI's Q. What type of therapy are frontline treatments for adolescents with eating disorders? ANSWER Family therapy and CBT Q. What does Alzheimer's disease look like? ANSWER gradual memory loss and disorientation Q. What does the diagnosis of Alzheimer's disease contain? ANSWER Rule out other causes Q. What does frontotemporal dementia involve? ANSWER personality changes, disinhibition and inappropriate behavior Q. What does Lewy body dementia include? ANSWER fluctuating attention, visual hallucinations, and Parkinsonian symptoms Q. What does vascular dementia result from? ANSWER cerebrovascular damage Q. How does vascular dementia often present? ANSWER with abrupt changes Q. What do mini mental state exam (MMSE) scores help categorize ANSWER cognitive impairment Q. MMSE score ANSWER Moderate is around 18 25–30 (Normal) 21–24 (Mild Cognitive Impairment) 10–20 (Moderate Impairment) below 10 (Severe Impairment). A score of 23 or lower is generally considered the threshold for clinically significant impairment Q. What does the Montreal Cognitive Assessment (MoCA) help distinguish ANSWER normal aging vs cognitive impairment Q. Cholinesterase inhibitors ANSWER improve symptoms but do not alter disease progression Q. What is memantine ANSWER and NMDA receptor antagonist used for moderate to severe Alzheimer's Q. What is essential in dementia care? ANSWER Safety planning, especially regarding wandering and driving Q. What FDA warning comes with antipsychotics in dementia related psychosis ANSWER increased mortality Q. What is essential for assessing neurocognitive disorders? ANSWER psychiatric evaluation with collateral (3rd party) information Q. What should be ruled out when suspecting dementia? ANSWER medical causes such as thyroid dysfunction Q. What has fewer antichholinergic effects than tricyclic antidepressants? ANSWER Trazodone Delerium vs depression delirium is acute Involves waxing/waning attention and may stem from medical causes or medications What is day/night confusion more characteristic of? neurocognitive disorder NOT depression What does depression usually involve? subjective complaints and preserved orientation What does narcolepsy include? daytime sleep attacks despite adequate night sleep What does Kleine-Levin syndrome involve? episodic hypersomnia with normal periods in between How doe circadian rhythm sleep disorders often affect? Night shift workers on off days What can treat middle of the night insomnia? zaleplon (sonata) What can be helpful to dx and prescribe sleep disorders? Sleep logs-1st step How does obstructive sleep apnea present? snoring, daytime fatigue and disrupted sleep What is an example of a Dual Orexin Receptor Antagonist (DORA) Lemborexant (Dayvigo) What drug class is doxepin Tricyclic antidepressant (TCA) What is Ramelteon (Rozerem) melatonin receptor agonist How should z drugs like zaleplon (Sonata) be taken? on an empty stomach for faster onset Is Amitriptyline a good choice? Can address sleep but has anticholinergic side effects What is a first line intervention for insomnia Cognitive Behavioral Therapy for Insomnia (CBT-I) How is sleep promoted? Enhance GABA and Galanin Inhibit DA, NE, 5HT, Hcrt, ACh, HA What is the FDA risk of benzodiazepine use for insomnia in adults? risk for abuse/addiction Risks if stopped What are the FDA warning with Z Drugs? Sleep behaviors (sleep walking, driving, eating, shopping) What agents are good for falling asleep? Melatonergic Agents Do people have the right to discontinue treatment? If they have capacity Family objections do not override this What is important to remember about children and death They may misinterpret euphemisms for death Clear explanations are developmentally appropriate What are key in palliative conversations? validation and acknowledgement of emotional expression Death Cessation of vital bodily functions Dying Gradual loss of these functions beginning at birth and ending at death. Bereavement The objective state of loss Grief Subjective emotional response Mourning Cultural and public expressions of grief Good death Free of avoidable suffering, respects patient's and family's wishes Bad death suffering, neglect of values, poor communication Stages of death Shock and Denial Anger Bargaining Depression Acceptance Erickson's older adult stage Integrity vs despair Normal grief natural, diminishes with time Prolonged Grief Disorder (PGD) diagnosable after 12 months in adults When is PGD more likely? After sudden or violent loss Associated with higher suicide risk and comorbidities What is gold standard for PGD Prolonged Grief Disorder Therapy (PGDT) grief monitoring, exposure, memory integration Pharmacotherapy may be adjunctive but is not primary What are the 6 domains of end of life care? Diagnosis Comfort Capacity Clarity Controversy Collaboration What is common in terminally ill patients depression, anxiety and delirium Phases of Grief · Shock and denial (days-weeks) acute anguish, lost patterns of conduct, resolution (months-year) · Denial, bargaining, depression, anger, acceptance · No real timeline, comes in waves Grief vs. MDD · Grief- Sx may meet syndromal criteria for MDD episode, but survivor rarely has morbid feelings of guilt, worthlessness, SI, or psychomotor retardation o Considers self bereaved o Dysphoria often triggered by thoughts or reminders of the deceased o Onset within 2 months of bereavement o Duration of depressive episode is less than 2 months o Functional impairment is transient and mild o No family or personal hx of depression o Predominant affect is emptiness and loss o Pain of grief accompanied with positive emotions and humor, self-esteem generally preserved MDD vs. Grief MDD o May consider self weak, defective, or bad o Dysphoria is often autonomous and independent of thoughts or reminders of the deceased o Onset at any time o Depression often becomes chronic, episodic, or intermittent o Clinically significant distress or impairment o Family or personal hx of depression o Persistent depressed mood and inability to anticipate happiness or pleasure o Pervasive unhappiness and misery, self-critical and pessimistic ruminations, feelings of worthlessness and self-loathing Persistent Complex Bereavement Disorder o Unshakeable grief that does not follow the general pattern of improvement over time, individuals continue to experience persistent and intense emotions or moods and unusual, severe symptoms that impair major areas of functioning, or that cause extreme distress o Persists for greater than 6 months after bereavement o Patients report loss of self-worth and sense of self, feel emotionally disconnected from others and do not wish to move on from bereavement, sometimes feeling that to do so would represent a betrayal of the deceased o At least one of the following: Intense and persistent yearning for the deceased -Frequent preoccupation with the deceased -Intense feelings of emptiness or loneliness -Recurrent thoughts that life is meaningless or unfair without the deceased -A frequent urge to join the deceased in death Delirium Vs. Dementia Delirium o 4A & 3C: disturbance in attention and awareness. o Abrupt/acute onset with altering severity throughout the day. o Cognitive disturbance, consequence of another medical condition or substance related. o Can’t be explained by neuro-cognitive dx or coma o More short-term memory than long term memory impaired o Orientation grossly disorganized o Prominent hallucinations o Poor attention o Judgment, social skills, and behavior are grossly impaired o Associated with acute illness, vital signs often abnormal, neuro exam may be abnormal Dementia vs. Delirium Dementia o More long-term memory impaired than short term o Attention less impaired o Orientation varies o Rare hallucinations o Judgment, social kills, and behavior are initially relatively intact o Onset usually insidious o Short term course varies, but stable o Chronic and progressive Normal signs of aging and memory performance o Everything tends to slow down as we age o Erikson: integrity vs despair. Central conflict is coping, maintaining self-esteem, reconciliation. o Complains about memory loss, but can provide detailed examples of forgetfulness o Occasionally searches for words o May have to pause for directions, but doesn't get lost in familiar places o Remembers recent important events, conversations not impaired o Interpersonal social skills not impaired Screening tools for neurocognitive disorders in the geriatric population Mini-mental status exam (MMSE) - Most widely used, cutoff 24 SLUMS exam -Effective at screening for executive function domain -HS education: score 27-30 normal. Scores 21-26 mild neurocognitive disorder, scores between 0-20 indicate dementia Mini-Cog -3 minute screening for cognitive impairment -Cut-off 3 for dementia screening Alzheimer's Disease o Cause: Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain. o Short-term memory loss o Impaired executive function o Difficulty with ADLs o Time and spatial disorientation o Language impairment, personality changes o Memory deficit, aphasia, apraxia, agnosia o Severe: cannot communicate o Onset: mid 60s and above Vascular Dementia o Cause: conditions such as blood clots disrupt blood flow in the brain o Forgetting current or past events, Misplacing items o Impaired abstraction, mental flexibility, processing speed, and working memory o Verbal memory is better preserved o Slower cognitive decline o Dementia occurs months within a stroke o Hallucinations or delusions o Trouble following instructions or learning new information o Onset: 65+ Lewy Body Dementia o Cause: abnormal deposits of protein called lewy bodies affect the brain's chemical messengers o Visual hallucinations o Spontaneous parkinsonisms- muscle rigidity, loss of coordination, reduced facial expression o Cognitive fluctuations o Visuospatial, attention, and executive function deficits are worse o Memory impairment not as severe o Earlier presentation of personality changes and psychosis o REM sleep disturbances, insomnia, increased daytime sleepiness o Onset: 50+ Frontal Lobe Dementia o Cause: Abnormal amounts of Tau and TDP-43 accumulate in in the neurons of the frontal and temporal lobes o Progressive behavioral or personality changes that impair social conduct o Impulsive behaviors, emotional extremes (flatness or excessive) o Language impairment- difficulty making or understanding speech o Possible preserved episodic memory o Shaky hands, problems with balance and walking o Onset: between 45 & 64 Donezepil (Aricept) o Cholinesterase inhibitor o GI side effects: nausea/vomiting, diarrhea, (resolve within 3 weeks of use) o Bradycardia found usually in those with underlying heart disease o CYP-450 metabolism o Indicated for mild to severe cognitive impairment o Slows the progression of memory loss o Diminishes apathy, depression, hallucinations, anxiety, euphoria, purposeless motor behaviors o Helps retain cognitive and adaptive faculties at a stable level for several months o May be beneficial for Lewy body dementia and vascular dementia o Warning: may cause catastrophic reaction with signs of grief and agitation- DC use. Galantamine o Cholinesterase inhibitor o GI side effects: dizziness, headache, nausea/vomiting, diarrhea, and anorexia (mild and transient) o CYP450 metabolism o Indicated for mild to moderate memory impairment o Rarely prescribed Memantine (Namenda) o NMDA receptor antagonist o May protect cells from excess glutamate by partially blocking NMDA receptors o Indicated for moderate to severe memory impairment o Fewer side effects than cholinergics, titrate over 4 weeks to target dose o Safe and well tolerated o Side effects: dizziness, headache, constipation, and confusion Do not use in severe renal impairment The risks of prescribing antipsychotics for patients with dementia · Black Box warning for all anti-psychotics · Increased risk of mortality of elderly patients with dementia-related psychosis · Primarily due to increased risk of cardiovascular events · Weigh risks vs benefits. · Know for education for families and patients Depression vs. Dementia · Depression o Onset can be dated with some precision o Rapid progression of sx after onset o Patients usually complain of some cognitive loss o Patients emphasize disability o Patients usually communicate strong sense of distress o Dysfunction at night uncommon Dementia vs. Depression Dementia o Onset is slow and insidious o Slow progression of sx throughout course o Patients usually complain little of cognitive loss (they don’t notice it, family does) o Patients conceal disability o Patients often appear unconcerned o Dysfunction at night (sun downing) common Insomnia Disorder o Symptoms must occur at least 3 nights/week for 3 months o Difficulty falling asleep, difficulty staying asleep, early morning awakenings o Exclusion of medical disorder, medications, substances, another sleep wake disorder, insufficient opportunity for sleep Hypersomnia o Symptoms must occur for at least 3 nights/week for 3 months o Multiple episodes of sleeping within the same day o Main sleep lasts 9hrs, but is nonrestorative o Difficulty to be fully aroused when woken o Excessive daytime sleepiness Klein/ Levin Syndrome o Most common in adolescent boys o Type of hypersomnolence o At least two episodes of excessive sleepiness and sleep duration, each persisting from two days to 5 weeks o Episodes occur multiple times a year, but at least once every 18 months o Patient has normal alertness, cognitive function, behavior, and mood in between episodes. o At least one of the following during an episode: cognitive dysfunction, altered perception, eating disorder (Anorexia or hyperphagia), or disinhibited behavior (hypersexuality, impulsive behaviors) Medications to treat insomnia -Benzodiazepine hypnotics -Non-benzo hypnotics (Z-drugs) -Antidepressants -Hypocretin/Orexin antagonist -Melatonin receptor angonists -Antihistamine -Antipsychotics (not reviewed) -Anticonvulsants (not reviewed) Benzodiazepine Hypnotics for insomnia o Benzodiazepine hypnotics o Estazolam, flurazepam, quazepam, temazepam, triazolam o Enhance GABA and galanin o Do not consume with alcohol or opiates- very dangerous Non-benzo hypnotics (Z-drugs) o Eszopiclone, zaleplon, zolpidem o Black box warning: unsafe sleep behaviors o Enhance GABA and galanin o Taking with high fat meal will impact absorption and effect Antidepressants for insomnia o Trazadone -Mainly through antihistamine effects. -Dosing for sleep is lower: 25-150mg Doxepin Hypocretin/Orexin antagonist o Block orexin, decreases arousal and helps sleep o Suvorexant, Lemborexant Melatonin receptor angonists o Melatonin -acts on M1, M2, and M3. Helps with phase delayed sleep problems. Non-addictive, OTC. Not regulated o ramelteon, tasimelteon - Acts on M1 and M2 o Good for falling asleep, not for staying asleep o No risk of complex sleep behaviors, no addiction issues, doesn't suppress respiratory drive Antihistamine for insomnia o Diphenhydramine -Blocks histamine receptor, makes less arousal -Affects muscarinic receptors- anticholinergic effects (dry mouth, constipation, etc) Antipsychotics for Insomnia o Quetiapine, olanzapine o (not reviewed) Anticonvulsants for Insomnia o Clonazepam, gabapentin, tiagabine o (not reviewed) Medications to promote wakefulness Modafinil o Used for narcolepsy, hypersomnolence, shift-work disorder o Works through action of blocking dopamine transporter o Leads to downstream action on other wake promoting neurotransmitters o Doesn’t have risk of causing addiction or abuse of stimulants o Tonic firing, not phasic firing: slow, consistent, steady Solriamfetol o Blocks norepinephrine and dopamine in the prefrontal cortex Low risk for abuse and misuse Anorexia Nervosa o ED o RID- Restriction of intake, Intense fear of weight gain, Disturbance in perception of one’s wt or body image o 2 Sub-types: o Restricting type- typical anorexia, extreme diet, fasting, excessive exercise o Binge/purge type- self-induced vomiting, laxative abuse, diuretic abuse, enema abuse. NOT BULIMIA- difference is extremely low body weight. o Severity based on BMI. o Extremely high mortality rate- 6x more likely to die. Mainly due to physiological complications, but 20% die by suicide o Physiological findings: lanugo, carotenemia (orange discoloration of skin, palms, does NOT affect sclera) Binge Eating Disorder o ED o BO- “binge eaters overeat” - Recurrent Binge episodes (1x week for 3 months) - Out of control overeating o Plus 3+ more of the following: - Fast past full- eat faster than usual, uncomfortably full -Feast when not famished, tend to eat when not hungry - Flushed and flustered and feeling disgusted, can feel embarrassed or disgusted of behavior o Severity based on episodes per week -Mild- 1-3x week - Moderate- 4-7x week - Severe- 8-13x week - Extreme- 14x week o No regular compensatory behaviors, behavioral indicators for over eating are required for diagnosis, marked distress about binge eating. o Over concern about body weight/shape not required for dx, but often present Bulimia Nervosa o ED o BOCP - Recurrent Binge episodes (1x week for 3months) - Out of control overeating - Excessive Concern with body weight/shape - Purging or other compensatory behaviors o Severity based on episodes per week - Mild- 1-3x week - Moderate- 4-7x week - Severe- 8-13x week - Extreme- 14x week o Physiological findings: Russell’s sign (callousing, scarring of dorsal side of hand from gagging self with hand to induce vomiting), hypertrophy of salivation glands (chipmunk cheeks) · Avoidant/restrictive food intake disorder o FD o Hallmark: avoiding or restricting what they're eating. -Can be result of bad experience with certain food. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: -Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). -Significant nutritional deficiency. -Dependence on enteral feeding or oral nutritional supplements. -Marked interference with psychosocial functioning. The disturbance is not from lack of available food or by an associated culturally sanctioned practice. -The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. ARFID treatment No medications to treat, no clinical guidelines. Involve nutritionist. CBT, exposure therapy Pica o FD o Repeated eating of non-food substances that are not nutritional for at least one month. o Eating behavior is not developmentally, culturally, or socially normal o If the eating behavior occurs in the context of another mental or medical disorder, the severity of the eating behavior can warrant additional clinical attention. o Must be greater than 2 years old to be diagnosed o Will usually go away by adolescence on it's own. o No lab test will confirm or rule out. May see low levels of iron/zinc, higher levels of lead. Anemia can be cause o Differential Dxs: Autism and anemia Pica Treatment Treatments: physical and test for mineral imbalances, lead poisoning, etc. Control for behavior and environmental factors. CBT, daily logs to examine if there's a trigger or association of eating nonfood items. Seek to reduce impulse to eat abnormally Rumination Disorder o FD o Repeated regurgitation of food (to be rechewed, reswallowed, or spit out) for at least one month o Regurgitation is not due to medical condition o Regurgitation dues not occur solely during course of other feeding/eating disorder o If it occurs with another mental or medical condition, the severity o the eating behavior can warrant additional clinical attention o High rate of spontaneous remission o No FDA approved treatment. More of behavioral training Anorexia Nervosa Treatment o No FDA approved medications specifically for Anorexia. o May require medical treatment, hospitalization for dehydration/ electrolyte abnormalities o Treat other psychiatric issues such as anxiety, depression. o Psychotherapy (Usually CBT) Binge Eating Disorder Treatment o Vyvanse (Lisdexamfetamine) o Psychotherapy (Usually CBT) Bulimia Nervosa Treatment o Fluoxetine (SSRI) o Psychotherapy (Usually CBT) Wellbutrin in Eating Disorders · Contraindicated in ANY eating disorder- Black box warning. Can increase risk of seizures.