Clinical PMHNP Exam 1 study questions with complete solutions

Which theory of depression was developed based on observing that patients who were being treated for Hep C developed depressive symptoms? A. The monoamine theory B. The inflammation theory C. The HPA axis theory D. The stress-diathesis theory b. The inflammation theory Which of the following health conditions have a high co-morbidity with depression? A. Hypertension B. Asthma C. Diabetes mellitus D. Cardiovascular disease E. Celiac disease F. Cognitive impairment G. Obesity H. Cancer A. Hypertension C. Diabetes Mellitus D. Cardiovascular disease F. Cognitive impairment G. Obesity H. Cancer In the Cutler video on depression, he highlights that there are 200 different ways to meet the diagnostic criteria for depression. A. True B. False A. True You have diagnosed a 53-year-old male with moderate MDD and he has declined psychotherapy but has agreed to pharmacotherapy. He has diagnoses of Type 2 D.M. with a BMI of 32.1. Which of the following antidepressants would provide a dual benefit for this patient? A. Sertraline B. Fluoxetine C. Duloxetine D. Mirtazapine C. Duloxetine Your patient was started on fluoxetine and after ten weeks of treatment his PhQ 9 score is 9. What is your assessment of the efficacy of treatment based on this score? A. The patient is in remission B. The response is adequate but not in remission C. The response is possibly inadequate D. The response is inadequate B. The response is adequate but not in remission In the Star*D trial what percentage of patients treated for depression failed to respond to initial pharmacotherapy? A. 20% B. 30% C. 40% D. 50% D. 50% In the Star D trial for patients that achieved remission what percentage relapsed after 4.4 months? A. 25% B. 33% C. 42% D. 53% B. 33% When should adjunctive therapy be considered in treating MDD? (select all that apply) A. Already tried 3 or > antidepressants B. Initial antidepressant well tolerated C. Partial response (>50% improvement) D. Specific residual symptoms or side effects that can be targeted E. Severity of depression, more functional impairment F. Patient preference B. Initial antidepressant well tolerated D. Specific residual symptoms or side effects that can be targeted E. Severity of depression, more functional impairment F. Patient preference Rates of remission increased with each additional change in therapy, especially when switching. A. True B. False B. False You have diagnosed your patient with Major Depressive Disorder and after six weeks of being treated with fluoxetine 20 mg there is no treatment response. According to the VA/DoD Guidelines for treatment of MDD what is the next step? A. Switch to another monotherapy either an antidepressant or psychotherapy. B. Switch to a different antidepressant C. Augment with a second antidepressant D. Augment with a second medication or psychotherapy A. A, C B. B C. C D. A, D D. A,D Your patient has experienced her first episode of MDD and is in remission. How long should the antidepressant be continued after remission has been achieved to reduce the risk of relapse? A. 2 months B. 4 months C. 6 months D. One year C. 6 months For patients that respond to treatment with pharmacotherapy but are at high risk for recurrent depressive episodes, howe long should maintenance pharmacotherapy be continued? A. At least 6 months B. At least 12 months C. At least 24 months Indefinitely B. At least 12 months Having a patient sign a "no suicide contract" has demonstrated efficacy in reducing suicides among those who sign these "contracts". A. True B. False B. False When de-escalating a patient what is the recommended closest distance that you should stand from the patient? A. 1 arm length B. 2 arms length C. six feet D. 10 feet 2 arms length In order to assess agitation in a patient the practitioner should: A. Use past experiences with patients to compare to this patient B. Use an objective scale such as the Behavioral Activity Rating Scales C. Find the most experienced person with assessing agitation D. Avoid jumping to conclusions and monitor the patient over time B. Use an objective scale such as the Behavioral Activity Rating Scales You walk into the room of a patient in an acute care facility where you have been asked to consult with due to the patient's bizarre behavior. The patient is a 6'5" former body builder who is pacing the room, talking loudly and hurling verbal threats about wanting to hurt someone. You are fearful as the last time you encountered a patient such as this you were assaulted and ended up needing several stitches. Your decision would be to: A. Talk in a calm, reassuring manner to the patient B. Make eye contact so that the patient knows you are watching him C. Leave the room to secure someone else to work with the patient D. Leave the room to secure someone else to work with the patient C. Leave the room to secure someone else to work with the patient Select the key components of de-escalation: A. Hands should be visible and not clenched B. Directly face the patient but stand at arm's length C. Fold your arms D. Provide an in-depth explanation of the problem as you see it E. If the patient is delusional point out that this is faulty thinking F. Introduce yourself and ask the patient his/her name and how they would like to be addressed G. Have your back to the exit so the patient must go around you to leave the room. H. Use clarifying sentences A. Hands should be visible and not clenched