Maryville NURS 623 Exam 3 with correct answers

Maryville NURS 623 Exam 3 What is the most common psychiatric disorder in the U.S? - correct answer Anxiety What are the DSM-5 symptom criteria for a diagnosis of general anxiety disorder? - correct answer excessive anxiety and worry of variety of things for at least 6 months What are the DSM-5 symptom criteria for a major depressive disorder? - correct answer Five or more symptoms including at least one depressed mood or loss of interest present in the same two weeks and present nearly every day differential diagnoses that would mimic the symptoms of depression? - correct answer *Anxiety *PTSD *Substance Abuse What are the risk factors for major depression? - correct answer *Age *Gender *Personal Hx (migrains, PUD, chronic pain) *Fx Hx (depression, suicide, alcholism, substance abuse) What are the common presenting symptoms of depression in the geriatric patient? - correct answer Somatic (general pain) Psychology (feeling of guilt/worry, suicidal, memory) Psychomotor (anxiety/agitation) Vegetative (poor appitite/sleep) What are the NON-pharmacologic treatments for management for major depressive disorder? - correct answer Interpersonal and cognitive behavior therapy What are the pharmacologic treatments for management for major depressive disorder? - correct answer SSRI, SNRI, TCA, MAO Names of common SSRIs - correct answer Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (paxil) Citalopram (celexa) Escitalopram (Lexapro) Names of common SNRIs - correct answer Duloxetine (Cymbalta) Venlafaxine (Effexor) Desvenlafaxine (Pristiq) What are concerns in elderly taking medication for major depression? - correct answer a slower metabolism requires lower dosing; greater risk of falls, osteoporosis, fractures What are the pharmacologic versus nonpharmacologic treatment for management for general anxiety disorder? - correct answer non-pharmacological interventions of cognitive behavioral therapy has proven equal results to SSRI pharmacologic therapy DIGFAST for bipolar because your digging yourself into hole - correct answer Distractibility Indiscretion/Insomnia Grandiosity Flight of ideas Activities ↑ Sleep Deficit Talkativeness What is the symptom criteria for BD I ? - correct answer identification of at least one-lifetime mania episode must have occurred What is the symptom criteria for BD II ? - correct answer identification of at least one hypomania episode and one major depressive episode must have occurred What is the symptom criteria for diagnosing unipolar (depression) - correct answer persistently depressed mood or loss of interest in activities, causing significant impairment in daily life (no mania/hypomania) How do you assess suicide risk (consider mnemonic SAD PERSONS) - correct answer S-ex A-ge D-epression P-revious attempt E-thanol abuse R-ational thinking loss S-ocial support loss O-rganized plan N-o spouse S-ickness How would you identify intimate partner violence? - correct answer *reluctant to speak in front of partner *gives evasive answers *Overly protective or controlling partner What are the stages of grieving? (DABDA) - correct answer Denial Anger Bargaining Depression Acceptance What are the phases of grief? (Aca) - correct answer Avoid Confront Accomadate Acknowledge the loss Reacting to the separation Recollecting and Re-experiencing the Relationship w/deceased How would you identify intimate partner violence? - correct answer 1) a patient who is reluctant to speak in front of her partner and gives evasive answers 2) Overly protective or controlling partner What is the clinical presentation of post-traumatic stress disorder (PTSD)? - correct answer A: INTRUSIVE thoughts, nightmares or flashbacks B: AVOIDANCE any situation of activity that brings memories C: HYPERAROUSAL: Hypersensitive or on edge, unprovoked anger, jumpiness, and on guard What are the DSM-5 criteria for a diagnosis of PTSD? - correct answer 1 SYMPTOM of intrusive, avoidance, or hyper-arousal MUST HAVE PERSISTED FOR MORE THAN 1 MONTH What is the management for PTSD? - correct answer PHARMACOLOGY: SSRI's paroxetine (paxil) or sertaline (Zoloft), anxiolytic buspirone (BuSpar) NON-PHARMACOLOGICAL: cognitive behavioral therapies, brief eclectic psychotherapy, narrative exposure therapy potential complications of over-prescription of opiate pain meds - correct answer Constipation Sedation Resp Depression Dizziness N/V Medications that can cause Constipation? - correct answer Antacids, anticholinergics, Anti convulsive, Antidepressants (TCAs), Antihypertensives, NSAIDs, Opioids What are the warning signs that the patient has Anorexia? - correct answer Substantial weight loss S/S of depression or mood swings cardio problems preoccupation with weight, calories, and food, wear baggy clothes history of excessive exercise What do labs look like in anorexia? - correct answer leukopenia elevated BUN anemic hypomagnesmia elevated TSH sinus bradycardia. What are the warning signs that the patient has Bulemia? - correct answer Significant weight gain tooth erosion calluses on back of hands esophageal erosion negative body image eats rapidly until uncomfortably full swollen salivary (parotid) glands irregular menses eat large amounts of food in isolation signs or symptoms of depression What do labs look like in bulemia? - correct answer Hyponatremia, hypochloremia, elevated amylase Discuss sleep hygiene strategies for a patient complaining of insomnia - correct answer Maintain a regular sleep and wake schedule Eat regular meals every day Develop a relaxing bedtime routine Limit amount of liquid consumed in evening Limit amount of caffeine consumed later in day Avoid tobacco and alcohol later in the day Avoid daytime naps Exercise regularly Limit exposure to bright lights or television in evening Bed should be used for sleeping and sex only Turn any clocks facing the bed away If not asleep after 20 mins get out of bed and engage in quiet activity before reattempting to fall asleep. What is the The most common long term effect of sexual assault - correct answer PTSD In an attempt to promote behavioral changes in a patient, what is the best approach to take as the provider? - correct answer Educate the patient on all of the options available to them and allow them to choose their plan what are the risk factors for substance abuse disorder - correct answer *Underlying mental health/emotional problems *low socioeconomic status *access to medications and substances patterns commonly seen in domestic violence among victims? - correct answer -Feels afraid of their partner -Avoids certain topics out of fear of angering partner -Feels they deserve to be hurt or mistreated -Feels emotionally numb or helpless patterns commonly seen in domestic violence among perpetrator? - correct answer -Humiliates/Criticizes partner -Blames the victim for their abusive behavior -Acts jealous and possessive -Limits partners access to money, phone, car What are different types of abuse? - correct answer *Physical *verbal *psychological *sexual populations that domestic violence typically affects? - correct answer -Can occur in ANY population higher prevalence in ethnic minorities & women Risk factors of suicide in the elderly? - correct answer *male gender *being single, divorced, or separated and without children *personal or family history of a suicide attempt *drug or alcohol abuse *severe anxiety or stress *physical illness *a specific suicide plan with access to firearms In a female patient who presents with abdominal pain, what is the first diagnostic test you would order? - correct answer HCG risk factors for development of a peptic ulcer/PUD - correct answer *H. Pylori infection *prolonged NSAID/ ASA use *smoking Differentiate among diverticulosis and diverticulitis - correct answer Diverticula are pockets that form in the lining of the colon. They can be present and simply an incidental finding (diverticulosis) or they can become infected or inflamed (diverticulitis) What are the risk factors of diverticulitis? - correct answer *Having diverticulosis in conjunction with untreated constipation *Smoking *lack of exercise *obesity *NSAID and Opioid use How would you differentiate between a diagnosis of gastroenteritis and irritable bowel syndrome? - correct answer IBS: is chronic LLQ pain diarrhea, constipation, passing mucous and occurs 1 or more times a week over 3 months. Gastroenteritis: (stomach bug) is caused by a bacteria, (no constipation) diarrhea, N/V symptom limited to several days How do you treat travelers diarrhea? - correct answer azithromycin 1000mg 1 one dose; or 500mg x 3 d Cipro 750 mg one dose Levofloxacin 500 mg 1-3 days differential diagnosis, for a patient presents with diarrhea - correct answer Acute: Gastritis, medication induced, lactose intolerant Chronic: CRhons, IBS, IBD, mode of transmission for Hepatitis A - correct answer fecal-oral mode of transmission for Hepatitis B - correct answer direct contact with infected blood or blood products or by sexual contact mode of transmission for Hepatitis C - correct answer blood, semen, maternal-neonate Describe the clinical presentation of appendicitis? (Subjective and objective findings) - correct answer Vague symptoms first 24 hours, worse when walking or jumping, N/V, low grade temp, +Rovsings, Psoas, obturator, mcburneys Describe the various maneuvers for diagnosing appendicitis? - correct answer ROVSING'S: Deep Papation LLQ do sudden unexpected release; Positive if causes Tenderness to RLQ. PSOAS: Pt on back and raise RT leg against pressure or on left side extend RT leg at hip; Positive if increased pain OBTURATOR: Pt on back with the right hip and knee flexed the examiner slowly rotates the right leg internally; Positive if pain over RLQ McBURNEY'S: pressure applied to McBurney's point (halfway between the umbilicus and the anterior spine of the ilium); Positive if pain with pressure applied Describe the clinical presentation for Gastroesophageal Reflux Disease (GERD)? - correct answer heartburn, regurgitation, water brash (reflex salivation), sour taste in morning, belching, coughing, and hoarseness. Objective: only sign may be occult blood in stool. How is GERD diagnosed (when to refer to GI)? - correct answer With symptoms, sometimes with upper endo; refer if failed treatment of step 2- after 6 weeks of treatment Discuss the patient education regarding lifestyle changes for management of GERD. - correct answer lifestyle changes including diet weight loss, raising the head of their bed 6-8 inches, avoid nicotine products avoid recumbency or sleeping for 3 to 4 hours after a meal, avoid bedtime snacks, avoid fatty and late meals, foods such as chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, and tomatoes, wearing loose comfortable clothing, and starting a routine exercise and weight loss program Describe medical management of GERD? - correct answer step-up: LIFESTYLE changes, PRN OTC H2ra and antacid; PPI; referral Step-down: starts with PPI then step down until Sx under control 46 year old male complains of dysphasia hoarseness and cough he states he wakes up with a sour taste in his mouth. What is the most likely cause of the patient symptoms? - correct answer GERD Managment of peptic/gastric ulcer - correct answer *relieve pain, heal the ulcer, and prevent complications/reoccurrence *PHARMACOLOGICAL therapy is the foundation of management (H2Ra, PPI, antacids, antibx w/H-pylori) Describe the diagnosis criteria IBS - correct answer 3 Criteria: 1. pain relieved by defacation or change in BMs for 3 months 2. BM with patterns of constipation/diarrhea 25% of the time 3. 2 features of either: altered frequency, form, sensory act of defecation or varied bloating and pain What are the risk factors are associated with Cholelithiasis? - correct answer female gender obesity pregnancy increased age drug induced (oral contraceptives, clofibrates) cystic fibrosis rapid weight loss, spinal cord injury ileal disease with extensive resection diabetes mellitus sickle cell anemia Cirrhosis Biliary issues What is the clinical presentation of cholecystitis? - correct answer colicky type pain Indigestion N/V (after high-fat meals) Pain localized to RUQ referred pain to back & RT shoulder What laboratory findings would you expect to see with acute cholecystitis? - correct answer Elevated Alkaline Phosphatase & Bilirubin 45 year old obese woman with severe pain in tenderness in the right upper quadrant accompanied by nausea and vomiting and fever there is a positive Murphy sign what is the most likely diagnosis? - correct answer Cholecystitis What elevated laboratory test is considered the gold standard for diagnosis of non-alcoholic pancreatitis? - correct answer Serum amylase, concurrent with Lipase What is the clinical presentation of chronic pancreatitis? - correct answer LUQ can radiate to lumbar area weight loss diarrhea N/V dyspepsia PE findings with pancreatitis? - correct answer epigastric tenderness with no rebounding tenderness, may feel pseudeocyst/mass mild jaundice. What are the recommendations/guidelines for colon cancer screenings for average risk? - correct answer Average Risk: 50-75 or African American 45+ fecal occult blood every 1 yr flex sig every 5 yrs Colonoscopy every 10 years What are the recommendations/guidelines for colon cancer screenings for high risk? - correct answer fecal occult blood every 1 yr At 40 y/o Barium enema or colonoscopy every 3-5 yrs What is the clinical presentation of diverticular disease? - correct answer *LLQ pain (worse after eating) relieved with passing stool or gas *colonic distention *W/itis: anorexia, vomiting, chills, tachycardic more common in elderly How would you manage a patient with an incidental finding of uncomplicated diverticular disease? - correct answer Requires no further intervention and can be managed with a high-fiber diet or a daily fiber supplementation with psyllium if antibx are needed with diverticulitis what would be used? - correct answer Flagyl & Cipro or Bactrim Which of the following best describes the dietary recommendations to reduce the incidence of diverticular disease? - correct answer Increase the amount of fiber in the diet True/False A patient experiencing exacerbation of symptoms of ulcerative colitis should be encouraged to eat high fiber foods such as raw fruits and vegetables - correct answer FALSE; True/False A patient with Crohn's disease should be encouraged to eat high fiber foods such as whole grain bread, pumpkin seeds, and nuts. - correct answer TRUE True/False A person with Irritable Bowel Syndrome (IBS) should slowly increase their fiber intake to 20-30 gm/day. - correct answer TRUE What type of hernia has The tissue herniates through the internal inguinal ring, which in men extends the length of the spermatic cord. - correct answer Indirect Inguinal s/s of an ingunal hernia - correct answer LLQ or RLQ pain and bulging, especially when straining, coughing, or bending over; burning or aching sensation at the bulge S/S of EPIDIDYMITIS - correct answer --Pain in lower abdomen Swollen, red, warm scrotum. -Testicle pain and tenderness, usually only on one side that comes on gradually s/s of prostatitis - correct answer Painful or difficult/frequency of urination -Fever/chills -Blood in urine S/S of endometriosis - correct answer -Abdominal and/or pelvic pain -Painful periods -Pain with intercourse -Pain with BM or urination S/S of colon cancer - correct answer -Hypogastrum or LLQ pain -Blood in stool -Pencil-thin stools -Feeling of incomplete BM What type of hernia has The transversus abdominis and internal oblique muscles are attached, forming a high arch on the inferior border that results in a faulty shutter mechanism - correct answer Direct inguinal What type of hernia occurs at the fossa ovalis where the femoral artery exits from the abdomen - correct answer Femoral When you put someone on antidepressant what do you worry about? - correct answer Developing suicidal ideations The DMS V criteria for major depressive disorder requires? - correct answer Five or more symptoms including at least one depressed mood or loss of interest present in the same two weeks an present nearly every day Physical examination of a patient diagnosed with anorexia nervosa includes - correct answer Emaciation/cachexia