Psychosocial/Psych 70 QUESTIONS
WITH 100% CORRECT ANSWER S
A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be
tried if there is no response? - correct answer 8-12 weeks
Most learned authorities agree that if there is no response by 8-12 weeks at a maximal
therapeutic dose, a different antidepressant should be tried. The 8-12 week period is the
correct time frame because it will take this long to increase the dose and attempt to reach
maximal dose for therapeutic response. 4-6 weeks is nearing the appropriate time frame, but
this may be too short a period of time to reach and evaluate therapeutic dose.
Which patient is most likely to exhibit depression related to his illness? A patient with: - correct
answer Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of
depression. These include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other
illnesses associated with high rates of depression are cancer and cardiovascular illnesses like
myocardial infarction. Depression worsens the outcome of any physical illness.
A patient with an eating disorder may concomitantly exhibit: - correct answer Anxiety
disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in patients who
have eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with
eating disorders are more likely to have a first or second degree relative with an eating
disorder, affective disorder, or alcohol abuse. There is no evidence that patients with eating
disorders exhibit a higher incidence of sleep disorders or liver disease. Thyroid disease should
always be assessed in patients with eating disorders, but this does not represent the reason for
weight loss when eating disorder is present.
Which criterion below is a criterion for Alzheimer's Disease? - correct answer Impairment of
executive function
,Psychosocial/Psych 70 QUESTIONS
WITH 100% CORRECT ANSWER S
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other
organizations. The criteria are similar. Criteria include a gradual onset of cognitive decline. A
rapid onset usually indicates another etiology, perhaps, delirium. Other criteria include
impairment of recent memory, difficulty with language or finding words, the inability to execute
skilled motor activities, disturbances of visual processing or disturbances in executive function
that includes abstract reasoning and concentration. Focal neurologic signs are consistent with a
vascular dementia. Radiologic evidence is not a criterion for diagnosis, though it may support
the diagnosis of AD. There is no laboratory evidence of AD.
An 80 year old adult has begun to use over the counter diphenhydramine to help him fall
asleep. What common side effect can occur in older adults with use of this medication? -
correct answer Next day sleepiness
Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-
cholinergic effects in patients who take this, but especially in older adults. Urinary retention is
common (not incontinence) in older men with benign prostatic hyperplasia, but retention
occurs in women too. Diphenhydramine is contraindicated in patients with glaucoma. The most
serious side effect is cognitive impairment, like daytime sleepiness. Visual disturbances can
occur as well as annoying side effects like dry mouth and constipation.
A 69 year-old female patient reports feelings of anhedonia for the last month. What should be
part of the nurse practitioner's assessment? - correct answer Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or
interest. If this is the case, this patient should be screened for depression. Anhedonia is a red
flag for depression.
A 70 year-old male patient has an elevated MCV with an anemia. His triglycerides are 420. What
should be suspected? - correct answer Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia.
Common macrocytic anemias are B12 deficiency and folate deficiency. These are common in
, Psychosocial/Psych 70 QUESTIONS
WITH 100% CORRECT ANSWER S
older patients, especially if they consume large quantities of alcohol. This patient also has
elevated triglycerides. Triglycerides are commonly elevated when patients are exposed to
alcohol and carbohydrates. This patient's history indicates two elements that indicate alcohol
abuse. He should be questioned regarding alcohol abuse.
Which symptom listed below is typical of depression? - correct answer Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with difficulty
falling asleep are often anxious. Frequent waking and early morning wakening are often
complaints by patients with depression. There is no agreed on physiologic explanation, but, this
is a common symptom.
Delirium differs from dementia because delirium: - correct answer often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a physical
diagnosis like urinary tract infection; or it may be due to consumption of a medication.
Regardless, a change in cognition or consciousness needs immediate evaluation. The evaluation
should include a medication review, physical exam and laboratory evaluation, and mental
status exam.
Which screen for alcohol abuse has been validated in the elderly? - correct answer CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for
"have you ever felt you should CUT down" your alcohol consumption. The A stands for " does
other's criticism of your drinking ANNOY you". G stands for "have you ever felt GUILTY about
drinking". The E stands for "have you ever had an EYE opener to steady your nerves or get rid of
a hangover". A positive response on any question constitutes a positive screen.
MMSE helps to identify patients with symptoms of: - correct answer dementia
WITH 100% CORRECT ANSWER S
A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be
tried if there is no response? - correct answer 8-12 weeks
Most learned authorities agree that if there is no response by 8-12 weeks at a maximal
therapeutic dose, a different antidepressant should be tried. The 8-12 week period is the
correct time frame because it will take this long to increase the dose and attempt to reach
maximal dose for therapeutic response. 4-6 weeks is nearing the appropriate time frame, but
this may be too short a period of time to reach and evaluate therapeutic dose.
Which patient is most likely to exhibit depression related to his illness? A patient with: - correct
answer Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of
depression. These include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other
illnesses associated with high rates of depression are cancer and cardiovascular illnesses like
myocardial infarction. Depression worsens the outcome of any physical illness.
A patient with an eating disorder may concomitantly exhibit: - correct answer Anxiety
disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in patients who
have eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with
eating disorders are more likely to have a first or second degree relative with an eating
disorder, affective disorder, or alcohol abuse. There is no evidence that patients with eating
disorders exhibit a higher incidence of sleep disorders or liver disease. Thyroid disease should
always be assessed in patients with eating disorders, but this does not represent the reason for
weight loss when eating disorder is present.
Which criterion below is a criterion for Alzheimer's Disease? - correct answer Impairment of
executive function
,Psychosocial/Psych 70 QUESTIONS
WITH 100% CORRECT ANSWER S
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other
organizations. The criteria are similar. Criteria include a gradual onset of cognitive decline. A
rapid onset usually indicates another etiology, perhaps, delirium. Other criteria include
impairment of recent memory, difficulty with language or finding words, the inability to execute
skilled motor activities, disturbances of visual processing or disturbances in executive function
that includes abstract reasoning and concentration. Focal neurologic signs are consistent with a
vascular dementia. Radiologic evidence is not a criterion for diagnosis, though it may support
the diagnosis of AD. There is no laboratory evidence of AD.
An 80 year old adult has begun to use over the counter diphenhydramine to help him fall
asleep. What common side effect can occur in older adults with use of this medication? -
correct answer Next day sleepiness
Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-
cholinergic effects in patients who take this, but especially in older adults. Urinary retention is
common (not incontinence) in older men with benign prostatic hyperplasia, but retention
occurs in women too. Diphenhydramine is contraindicated in patients with glaucoma. The most
serious side effect is cognitive impairment, like daytime sleepiness. Visual disturbances can
occur as well as annoying side effects like dry mouth and constipation.
A 69 year-old female patient reports feelings of anhedonia for the last month. What should be
part of the nurse practitioner's assessment? - correct answer Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or
interest. If this is the case, this patient should be screened for depression. Anhedonia is a red
flag for depression.
A 70 year-old male patient has an elevated MCV with an anemia. His triglycerides are 420. What
should be suspected? - correct answer Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia.
Common macrocytic anemias are B12 deficiency and folate deficiency. These are common in
, Psychosocial/Psych 70 QUESTIONS
WITH 100% CORRECT ANSWER S
older patients, especially if they consume large quantities of alcohol. This patient also has
elevated triglycerides. Triglycerides are commonly elevated when patients are exposed to
alcohol and carbohydrates. This patient's history indicates two elements that indicate alcohol
abuse. He should be questioned regarding alcohol abuse.
Which symptom listed below is typical of depression? - correct answer Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with difficulty
falling asleep are often anxious. Frequent waking and early morning wakening are often
complaints by patients with depression. There is no agreed on physiologic explanation, but, this
is a common symptom.
Delirium differs from dementia because delirium: - correct answer often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a physical
diagnosis like urinary tract infection; or it may be due to consumption of a medication.
Regardless, a change in cognition or consciousness needs immediate evaluation. The evaluation
should include a medication review, physical exam and laboratory evaluation, and mental
status exam.
Which screen for alcohol abuse has been validated in the elderly? - correct answer CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for
"have you ever felt you should CUT down" your alcohol consumption. The A stands for " does
other's criticism of your drinking ANNOY you". G stands for "have you ever felt GUILTY about
drinking". The E stands for "have you ever had an EYE opener to steady your nerves or get rid of
a hangover". A positive response on any question constitutes a positive screen.
MMSE helps to identify patients with symptoms of: - correct answer dementia
