NR 547 midterm Exam Questions with Verified Answers (Correct
Update)
Question 1: ziprasidone (Geodon)
Answer: Indication: FDA approved for schizophrenia in ages 10 and older Special Comments: IM
dosing in acute agitation associated with schizophrenia Risk: Low metabolic risk Lowest risk for weight
gain Contraindicated in clients with QT, recent myocardial infarction, or uncompensated heart failure
High incidence of rash/urticaria related to Stevens-Johnson syndrome and Drug Reaction with
Eosinophilia and Systemic Syndrome (DRESS)
Question 2: Narcolepsy
Answer: -recurrent periods of napping or falling asleep without warning several times per day.
-clients with narcolepsy may also present with hypocretin (orexin) deficiency and abnormal REM sleep
latency.
Question 3: Six steps of the Differential Diagnosis
Answer: 1. Rule out malingering and factitious disorder 2. Rule out substance etiology 3. Rule out
medical etiology 4. Determine the specific primary disorder 5. Ditterentiating adjustment disorder from
the "other specified" and "unspecified" conditions 6. Establishing the boundary with no mental disorder
Question 4: Rule out the malingering and fictitious disorder
Answer: - ditterentiated based upon the motivation for the desception Malingering Disorder: motivation
is the achievement of a clearly recognizable goal (ex. insurance compensation, avoiding legal or military
responsibilities,obtaining drugs) Fictitious Disorder: deception is present even in the abscence of reward
Question 5: Rule out substance abuse
Answer: Determine use and types of substances: obtain labs
• If the onset of the psych symptoms occurs before the substance was used= Non-Substance Induced
Psychiatric Condition
• If the onset of psych symptoms occurs at the same time as substance use= Substance Induced
Psychiatric Condition
• If the substance is stopped for a significant period of time and symptoms persist= Non-Substance
Induced Psychiatric Condition
Question 6: Rule out disorder due to medical con- (screening/laboratory dition
Answer: one of the most important and diflcult distinctions in psychiatric diagnosis testing)
EXdepressive symptoms in response to a cancer diagnosis
-Important to determine the onset, severity, symptom pattern and course to establish if there isa
relationship
Page 1
,Question 7: Differentiate adjustment disorder from the "other specified" and "unspecified"
Answer: Adjustment Disorder: the clinical judgment is made that the symptoms have developed as a
maladaptive response to a psychosocial stressor. (If it is not caused by a stressor, the PMHNP has to
choose if the diagnosis falls in the "Other Specified" or "Unspecified" category) Other Specified: If the
PMHNP wants to indicate the specific reason for the diagnosis= Example: For a depressive episode with
insuflcient symptoms the PMHNP could use "Other Specified Depressive Disorder" Unspecified: If the
PMHNP does not want to indicate the specific reason the symptoms exist Why would you use
unspecified?
Question 8: Establish the boundary with no mental health disorder
Answer: Determine whether or not the symptoms are clinically significantenough to make a diagnosis o
Do they impair the patient's quality of life? o Most of the time, if the patient is seeking help, the answer
to that question is yes. o Psychiatric diagnosis can cause stress to patients, so use them appropriately Ex:
"a diagnosis of Male Hypoactive Sexual Desire Disorder, which includes therequirement that the low
sexual desire causes clinically significant distress in theindividual, would not be made in a man with low
sexual desire who is not currently ina relationship and who is not particularly bothered by the low
desire".
Question 9: Generalized Anxiety Disorder (GAD)
Answer: a disorder characterized by chronic excessive worry about everyday situations and tend to
focus on the "what ifs" accompanied by three or more of the following symptoms: restlessness, fatigue,
concentration problems, irritability, muscle tension, and sleep disturbance; symptoms are present on
most days for a period of at least six months
Question 10: PET scan in GAD
Answer: show increased activity in the amygdala (increased fear response) and reduced activation in the
prefrontal cortex (reduced reasoning)
Question 11: Social Anxiety Disorder
Answer: typical, everyday social interactions cause significant anxiety, self-consciousness, fear of
embarrassment, or a feeling of being judged negatively by others; anxiety can become so severe that
derealization, or a feeling of "spacing out," occurs. Persistent, lasting greater than six months.
Question 12: panic attack
Answer: acute anxiety during which an individual develops an intense fear of negative outcomes
accompanied by a feeling of imminent danger and often occur in familiar places; accompanied by
physiological symptoms such as palpitations, SOB, numbness and tingling, nausea and vomiting, chest
pain, trembling, dizziness
Page 2
, Question 13: phobia
Answer: an intense fear of a specific situation or object that is not in proportion to the actual danger
associated with the situation or object.
Question 14: Agoraphobia
Answer: intense fear, anxiety, or panic out of proportion to the situation that occurs in two or more of
the following specific scenarios: public transportation (bus) open spaces (parking lot or bridge) enclosed
spaces (store, theater) standing in a crowd or line (crowd) being outside of their home Requires
Question 15: mnemonic SSRI
Answer: Ettective - Escitalopram For - Fluoxetine, Fluvoxamine Sadness - Sertraline Panic - Paroxetine
Compulsions - Citalopram
Question 16: Side Effects of SSRI's
Answer: 7 S's: Stomach upset (GI upset) Sexual dysfunction Serotonin syndrome - with other
serotonergic agents (i.e. MAOs) - hyperthermia, muscle rigidity, flushing, diarrhea Sleep diflculties
(insomnia) Suicidal thoughts ( esp. in patients age 24 and under) Stress (agitation, anxiety)Size increase
/ Weight gain
Question 17: mnemonic SNRIs
Answer: Vexed - Venlafaxine Depressed - Duloxetine & Desvenlafaxine (active metabolite of
venlafaxine) - Duloxetine
Question 18: Side effects of SNRIs
Answer: SHAT: Same adverse ettects as SSRI's, plus Hypertension Adrenergic ettects (awake
[insomnia], anxious, agitated) Tachycardia
Question 19: obsessive-compulsive disorder
Answer: most often diagnosed by age 35; experience obsessions, compulsions, or both and often
recognize that the thoughts and behaviors are excessive or irrational.
Question 20: Treatment for OCD Selective
Answer: serotonin reuptake inhibitors (SSRIs) are well tolerated. Typically, treatment for OCD requires
high doses; a common dose of fluoxetine for OCD is 80 mg.
Page 3
Update)
Question 1: ziprasidone (Geodon)
Answer: Indication: FDA approved for schizophrenia in ages 10 and older Special Comments: IM
dosing in acute agitation associated with schizophrenia Risk: Low metabolic risk Lowest risk for weight
gain Contraindicated in clients with QT, recent myocardial infarction, or uncompensated heart failure
High incidence of rash/urticaria related to Stevens-Johnson syndrome and Drug Reaction with
Eosinophilia and Systemic Syndrome (DRESS)
Question 2: Narcolepsy
Answer: -recurrent periods of napping or falling asleep without warning several times per day.
-clients with narcolepsy may also present with hypocretin (orexin) deficiency and abnormal REM sleep
latency.
Question 3: Six steps of the Differential Diagnosis
Answer: 1. Rule out malingering and factitious disorder 2. Rule out substance etiology 3. Rule out
medical etiology 4. Determine the specific primary disorder 5. Ditterentiating adjustment disorder from
the "other specified" and "unspecified" conditions 6. Establishing the boundary with no mental disorder
Question 4: Rule out the malingering and fictitious disorder
Answer: - ditterentiated based upon the motivation for the desception Malingering Disorder: motivation
is the achievement of a clearly recognizable goal (ex. insurance compensation, avoiding legal or military
responsibilities,obtaining drugs) Fictitious Disorder: deception is present even in the abscence of reward
Question 5: Rule out substance abuse
Answer: Determine use and types of substances: obtain labs
• If the onset of the psych symptoms occurs before the substance was used= Non-Substance Induced
Psychiatric Condition
• If the onset of psych symptoms occurs at the same time as substance use= Substance Induced
Psychiatric Condition
• If the substance is stopped for a significant period of time and symptoms persist= Non-Substance
Induced Psychiatric Condition
Question 6: Rule out disorder due to medical con- (screening/laboratory dition
Answer: one of the most important and diflcult distinctions in psychiatric diagnosis testing)
EXdepressive symptoms in response to a cancer diagnosis
-Important to determine the onset, severity, symptom pattern and course to establish if there isa
relationship
Page 1
,Question 7: Differentiate adjustment disorder from the "other specified" and "unspecified"
Answer: Adjustment Disorder: the clinical judgment is made that the symptoms have developed as a
maladaptive response to a psychosocial stressor. (If it is not caused by a stressor, the PMHNP has to
choose if the diagnosis falls in the "Other Specified" or "Unspecified" category) Other Specified: If the
PMHNP wants to indicate the specific reason for the diagnosis= Example: For a depressive episode with
insuflcient symptoms the PMHNP could use "Other Specified Depressive Disorder" Unspecified: If the
PMHNP does not want to indicate the specific reason the symptoms exist Why would you use
unspecified?
Question 8: Establish the boundary with no mental health disorder
Answer: Determine whether or not the symptoms are clinically significantenough to make a diagnosis o
Do they impair the patient's quality of life? o Most of the time, if the patient is seeking help, the answer
to that question is yes. o Psychiatric diagnosis can cause stress to patients, so use them appropriately Ex:
"a diagnosis of Male Hypoactive Sexual Desire Disorder, which includes therequirement that the low
sexual desire causes clinically significant distress in theindividual, would not be made in a man with low
sexual desire who is not currently ina relationship and who is not particularly bothered by the low
desire".
Question 9: Generalized Anxiety Disorder (GAD)
Answer: a disorder characterized by chronic excessive worry about everyday situations and tend to
focus on the "what ifs" accompanied by three or more of the following symptoms: restlessness, fatigue,
concentration problems, irritability, muscle tension, and sleep disturbance; symptoms are present on
most days for a period of at least six months
Question 10: PET scan in GAD
Answer: show increased activity in the amygdala (increased fear response) and reduced activation in the
prefrontal cortex (reduced reasoning)
Question 11: Social Anxiety Disorder
Answer: typical, everyday social interactions cause significant anxiety, self-consciousness, fear of
embarrassment, or a feeling of being judged negatively by others; anxiety can become so severe that
derealization, or a feeling of "spacing out," occurs. Persistent, lasting greater than six months.
Question 12: panic attack
Answer: acute anxiety during which an individual develops an intense fear of negative outcomes
accompanied by a feeling of imminent danger and often occur in familiar places; accompanied by
physiological symptoms such as palpitations, SOB, numbness and tingling, nausea and vomiting, chest
pain, trembling, dizziness
Page 2
, Question 13: phobia
Answer: an intense fear of a specific situation or object that is not in proportion to the actual danger
associated with the situation or object.
Question 14: Agoraphobia
Answer: intense fear, anxiety, or panic out of proportion to the situation that occurs in two or more of
the following specific scenarios: public transportation (bus) open spaces (parking lot or bridge) enclosed
spaces (store, theater) standing in a crowd or line (crowd) being outside of their home Requires
Question 15: mnemonic SSRI
Answer: Ettective - Escitalopram For - Fluoxetine, Fluvoxamine Sadness - Sertraline Panic - Paroxetine
Compulsions - Citalopram
Question 16: Side Effects of SSRI's
Answer: 7 S's: Stomach upset (GI upset) Sexual dysfunction Serotonin syndrome - with other
serotonergic agents (i.e. MAOs) - hyperthermia, muscle rigidity, flushing, diarrhea Sleep diflculties
(insomnia) Suicidal thoughts ( esp. in patients age 24 and under) Stress (agitation, anxiety)Size increase
/ Weight gain
Question 17: mnemonic SNRIs
Answer: Vexed - Venlafaxine Depressed - Duloxetine & Desvenlafaxine (active metabolite of
venlafaxine) - Duloxetine
Question 18: Side effects of SNRIs
Answer: SHAT: Same adverse ettects as SSRI's, plus Hypertension Adrenergic ettects (awake
[insomnia], anxious, agitated) Tachycardia
Question 19: obsessive-compulsive disorder
Answer: most often diagnosed by age 35; experience obsessions, compulsions, or both and often
recognize that the thoughts and behaviors are excessive or irrational.
Question 20: Treatment for OCD Selective
Answer: serotonin reuptake inhibitors (SSRIs) are well tolerated. Typically, treatment for OCD requires
high doses; a common dose of fluoxetine for OCD is 80 mg.
Page 3
