NURS 547 REVISED FINAL EXAM 2026

NURS 547 REVISED FINAL EXAM 2026 What does a score of 0-7 on the Hamilton Depression Rating Scale (HAM-D) indicate? - -Normal (no depression) What does a score of 8-16 on the Hamilton Depression Rating Scale (HAM-D) indicate? - -Mild depression What does a score of 17-23 on the Hamilton Depression Rating Scale (HAM-D) indicate? - -Moderate depression What does a score of 24 or higher on the Hamilton Depression Rating Scale (HAM-D) indicate? - -Severe depression How are items on the Hamilton Depression Rating Scale (HAM-D) scored? - -Each item is scored 0-2 or 0-4, depending on severity. What type of tool is the Hamilton Depression Rating Scale (HAM-D)? - -A clinician administered tool used to assess the severity of depression symptoms. What aspects of depression does the Hamilton Depression Rating Scale (HAM-D) evaluate? - -Psychological and physical aspects of depression. HAM-D 17 Components - -Mood Guilt Feelings SI Insomnia Work and Activities Psychomotor Agitation or retardation Anxiety (psychological and somatic symptoms) Somatic symptoms Hypochondriasis Loss of weight Insight Limitation of HAM-D rating scale - -More focused on somatic symptoms which can over estimate depression in medically ill patients Alternative to HAM-D Scale - -Montgomery-Ashberg Depression Rating Scale (MADRS) which is better for tracking and treatment response Geriatric Depression Scale (GDS) - -Consists of yes/no questions that assess emotional, cognitive, and behavioral symptoms of depresion in older adults. It avoids somatic symptoms that may overlap with medical conditions NURS 547 Key Areas assessed in GDS - -Mood and Enjoyment Energy Levels Social Withdrawal Feelings of Hopelessness Memory Concerns Anxiety and Worry Suicidal Thoughts Scoring GDS - -1 point of each depressed response Yes to negative statements and no to positive statements Scoring Interpretation of GDS-30 - -0-30 0-9 Normal (no depression) 10-19 Mild Depression 20-30 Moderate to Severe Depression Scoring Interpretation GDS-15 - -0-15 Shorter version 0-4: Normal (No depression) 5-8: Mild Depression 9-11: Moderate Depression 12-15: Severe Depression Patient Health Questionnaire-9 (PHQ-9) - -self report tool for screening, diagnosing, and monitoring depression. Based on the DSM-5 criteria for MDD and evaluates symptom severity over the past two weeks Components of the PHQ-9 - -Nine Symptom Domains 1. Anhedonia 2. Depressed Mood 3. Sleep Problems 4. Fatigue 5. Appetite Changes 6. Low Self Worth 7. Concentration Issues 8. Psychomotor Changes 9. Suicidal Thoughts PHQ-9 Scoring Interpretation - -Each question is scored: 0=Not at all 1= Several Days 2= More than half the days NURS 547 NURS 547 NURS 547 3= Nearly Every Day Total Score: 0-27 PHQ-9 Depression Severity Levels - -0-4: Minimal or No depression 5-9: Mild Depression 10-14: Moderate Depression 15-19: Moderately Severe Depression 20-27: Severe Depression Clinica Use of the PHQ-9 - -Score >= 10: Possible clinical depression, further evaluation needed Score >=15: Likely MDD, consider therapy and/or medication Score >=20: Severe Depression, requires urgent intervention Mood Disorder Questionnaire - -screening tool used for Bipolar Disorder, and helps differentiate bipolar disorder from unipolar depression and other mood disorders Consists of three parts, assessing lifetime history of manic or hypomanic symptoms Part one of MDQ - -Symptom Checklist 13 yes/no questions Increased Energy and Activity Euphoric or irritable mood Decreased need for sleep Unusual talkativeness or pressured speech Racing Thoughts Easily Distracted Increase in goal-directed activities Involvement in Risky behaviors Unusual Confidence or grandiosity More outgoing/social than usual episodes lasting several days or longer other people noticing these changes symptoms occurring together in the same time period Part 2 MDQ - -Symptom Clustering 1 yes/no question "Have several of the above symptoms ever happened during the same period of time?" Part 3 MDQ - -Functional Impairment 1 questions, 3 point scale: No, Minor, or Serious problem NURS 547 "How much did these problems cause difficulty in work, social, or family life?" MDQ Scoring Interpretation - -7 or more "yes" responses in Part 1 "Yes" in Part 2 Moderate or serious impairment in part 3 is a positive screen. This is possible bipolar disorder, needs a clinical assessment Negative Screen: Fewer than 7 "yes" responses in Part 1 OR "No" in part 2 OR "No/Minor problems" in Part 3= unlikely bipolar disorder Limitations to MDQ - -More sensitive to Bipolar I Disorder than Bipolar II or Cyclothymia May produce false positives in BPD Anhedonia - -a diminished ability to experience pleasure TSH - -0.4-4 For patients on thyroid medications 0.5 -3 is often targeted Elevated TSH - -Hypothyroidism Low TSH - -hyperthyroidism hemoglobin - -Men 13.8-17.2 Women 12.1-15.1 Pregnant women 11-14 Children 11-16 Lithium Level - -Therapeutic range 0.6-1.2 Toxicity Risk >1.5 Severe toxicity >2 lithium toxicity symptoms - -confusion seizures tremors coma NURS 547 NURS 547 NURS 547 when should lithium trough levels be drawn - -12 hours after the last dose What other labs should be monitored when on lithium - -kid function and thyroid levels Depakote (Valproic Acid) Level - -Therapeutic range 50-125 Toxicity risk >150 Severe Toxicity >200 Symptoms of Depakote Toxicity - -Liver tox pancreatitis CNS depression When should trough levels be drawn for depakote level - -before the next dose what other labs should be monitored when on depakote - -liver enzymes platelets ammonia level What are specifiers for MDD - -describes its features, severity, and course. can help guide treatment planning and prognosis Severity specifiers for MDD - -Indicates how severe the episode is. Milk Moderate Severe With Psychotic Features Mild MDD - -few symptoms beyond diagnostic criteria, manageable distress Moderate MDD - -More symptoms, significant impairment but manageable Severe MDD - -Many symptoms, major impairment in functioning MDD with psychotic features - -Hallucinations or delusions present MDD with psychotic features, mood congruent - -Delusions/hallucinations consistent with depressive themes (guilt, worthlessness) MDD with psychotic features, mood- incongruent - -Psychotic features unrelated to mood (ex paranoia) MDD Episode features specifiers - -Adds details about the characteristics of the depressive episode NURS 547 NURS 547 With anxious distress With mixed features With melancholic Features With atypical features with psychotic features with catatonia with peripartum onset with seasonal pattern MDD with anxious distress - -feeling tense, restless, difficulty concentrating due to worry, fear of losing control **High risk of suicide and treatment resistance MDD with mixed features - -some manic/hypomanic symptoms present, but not enough for Bipolar Disorder (increased energy, elevated mood, talkativeness) **May indicate Bipolar Spectrum Disorder MDD with melancholic features - -Severe loss of pleasure (anhedonia) Lack of mood reactivity profound despair, guilt Early morning awakening, significant weight loss, psychmotor agitation/retardation **More biological in origin, better response to antidepressants or ECT MDD with atypical features - -Mood reactivity (can feel better with positive events) Increased appetitie or weight gain Hypersomnia (excessive sleeping) Heavy limb sensation (leaden paralysis