NURS 6501 ADVANCED PATHOPHYSIOLOGY ACTUAL EXAM
LATEST 2024/2025 QUESTIONS AND VERIFIED CORRECT
ANSWERS/ ALREADY GRADED A++
What is the role of the primary care provider in mental health? - ANSWER -
Screen for mental health issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable
severe mental disorders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - ANSWER -
Screens for MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days,
more than half the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due
the PHQ9
If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - ANSWER Used for screening,
diagnosing, and treating
- It asks about functioning impairments which is needed for the DSM-based
diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
,5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric
adults? - ANSWER 20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a
geriatric patient? - ANSWER Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs,
previous hx of antidepressant-induced hyponatremia, low body weight,
concomitant use of thiazides or other hyponatremia-inducing agents)
- monitor regularly in the elderly
What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - ANSWER
Common SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
L = decreased libido and sleep
E = Neutral effect on energy
A = neural effect on addiction
P = celexa may stop working after awhile (increase or switch)
Zoloft AE:
Insomnia, somnolence, fatigue, abnormal ejaculation, suicidal thoughts
What are characteristics of major depressive disorder or MDD? 9 -
ANSWER Diagnostics need 5 or more of the following:
- SS occur more days than not in a 2 week period
- SS cause significant impairment in any realm of functioning
- Depressed mood
,- Loss of interest
- Significant unintended ▲ in weight or appetite
- Significant ▲ sleep
- ▲ psychomotor activity (restlessness)
- Fatigue, loss of energy
- Worthlessness, guilt
What is serotonin syndrome? - ANSWER - Increased serotonergic activity
in the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-
OD
Serotonin in the Body:
CNS: Modulates attention, behavior, and thermoregulation
PNS: Regulates GI motility, vasoconstriction, uterine contraction, and
bronchoconstriction, promotes PLT aggregation
PE of serotonin syndrome 11 - ANSWER - Hyperthermia, flushed skin,
diaphoresis
- Agitation
- Slow, continuous, horizontal eye movements (ocular clonus)
- Dilated pupils
- Tremor, akathisia
- Deep tendon hyperreflexia (common)
- Inducible or spontaneous muscle clonus (common)
- Muscle rigidity
- Bilateral babinski
- Dry mucus membranes
- Increased bowel sounds
What is discontinuation syndrome (from SSRIs)?
"FINISH" - ANSWER 2-3 days after stopping SSRIs abruptly
F: flu-like SS
I: insomnia
N: nausea
I: imbalance
S: sensory disturbances
H: hyperarousal
, Bupropion
- MOA
- BENFITS
AE
CONTRA - ANSWER MOA
- act to inhibit reuptake of NE, dopamine, and serotonin
BENFIT
- Depression
- Smoking cessation
- Seasonal affective disorder
- Treat sexual dysfunction relative to SSRI therapy
AE
- weight loss
- increases libido ⇒ combine with SSRI
- can cause seizures by lowering the seizure threshold
CONTRA
- History of seizures
- Do not prescribe to pts with psych disorders ⇒ ↑ risk for delusions or
hallucinations
RF for ETOH abuse 4 - ANSWER Younger adults (18-29 yrs)
Men > women
Native americans
Genetics (low response to ETOH), environment (peer influences), specific
personality traits (impulsivity, extroversion), cognitive fxn
What are predisposing factors impacting the likelihood of someone
developing a SA issue? - ANSWER Predisposing Factors:
- Unhealthy use of one substance increases the likelihood of unhealthy use
of other substances
- Family history
- Social history
- Partner or friends with SA, living in a community with poverty, violence,
and/or high ETOH/drug use
Use of:
- Caffeine, tobacco, ETOH, prescription meds, marijuana, illicit drugs
LATEST 2024/2025 QUESTIONS AND VERIFIED CORRECT
ANSWERS/ ALREADY GRADED A++
What is the role of the primary care provider in mental health? - ANSWER -
Screen for mental health issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable
severe mental disorders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - ANSWER -
Screens for MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days,
more than half the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due
the PHQ9
If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - ANSWER Used for screening,
diagnosing, and treating
- It asks about functioning impairments which is needed for the DSM-based
diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
,5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric
adults? - ANSWER 20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a
geriatric patient? - ANSWER Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs,
previous hx of antidepressant-induced hyponatremia, low body weight,
concomitant use of thiazides or other hyponatremia-inducing agents)
- monitor regularly in the elderly
What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - ANSWER
Common SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
L = decreased libido and sleep
E = Neutral effect on energy
A = neural effect on addiction
P = celexa may stop working after awhile (increase or switch)
Zoloft AE:
Insomnia, somnolence, fatigue, abnormal ejaculation, suicidal thoughts
What are characteristics of major depressive disorder or MDD? 9 -
ANSWER Diagnostics need 5 or more of the following:
- SS occur more days than not in a 2 week period
- SS cause significant impairment in any realm of functioning
- Depressed mood
,- Loss of interest
- Significant unintended ▲ in weight or appetite
- Significant ▲ sleep
- ▲ psychomotor activity (restlessness)
- Fatigue, loss of energy
- Worthlessness, guilt
What is serotonin syndrome? - ANSWER - Increased serotonergic activity
in the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-
OD
Serotonin in the Body:
CNS: Modulates attention, behavior, and thermoregulation
PNS: Regulates GI motility, vasoconstriction, uterine contraction, and
bronchoconstriction, promotes PLT aggregation
PE of serotonin syndrome 11 - ANSWER - Hyperthermia, flushed skin,
diaphoresis
- Agitation
- Slow, continuous, horizontal eye movements (ocular clonus)
- Dilated pupils
- Tremor, akathisia
- Deep tendon hyperreflexia (common)
- Inducible or spontaneous muscle clonus (common)
- Muscle rigidity
- Bilateral babinski
- Dry mucus membranes
- Increased bowel sounds
What is discontinuation syndrome (from SSRIs)?
"FINISH" - ANSWER 2-3 days after stopping SSRIs abruptly
F: flu-like SS
I: insomnia
N: nausea
I: imbalance
S: sensory disturbances
H: hyperarousal
, Bupropion
- MOA
- BENFITS
AE
CONTRA - ANSWER MOA
- act to inhibit reuptake of NE, dopamine, and serotonin
BENFIT
- Depression
- Smoking cessation
- Seasonal affective disorder
- Treat sexual dysfunction relative to SSRI therapy
AE
- weight loss
- increases libido ⇒ combine with SSRI
- can cause seizures by lowering the seizure threshold
CONTRA
- History of seizures
- Do not prescribe to pts with psych disorders ⇒ ↑ risk for delusions or
hallucinations
RF for ETOH abuse 4 - ANSWER Younger adults (18-29 yrs)
Men > women
Native americans
Genetics (low response to ETOH), environment (peer influences), specific
personality traits (impulsivity, extroversion), cognitive fxn
What are predisposing factors impacting the likelihood of someone
developing a SA issue? - ANSWER Predisposing Factors:
- Unhealthy use of one substance increases the likelihood of unhealthy use
of other substances
- Family history
- Social history
- Partner or friends with SA, living in a community with poverty, violence,
and/or high ETOH/drug use
Use of:
- Caffeine, tobacco, ETOH, prescription meds, marijuana, illicit drugs
