NURS663 2024 EXAM QUESTIONS
WITH CORRECT ANSWERS ||
GRADED A+
Examples of robust responses to psychotherapy - ANSWER ✔ Continue with skills
learned in therapy. Such as using deep breathing or thought replacement techniques
when anxiety symptoms appear
Booster sections for symptoms recurrence
Robust Response-- After a robust response to psychotherapy, patients and parents
should be encouraged to continue to implement skills learned during therapy,
particularly in response to reminders of the trauma, which can prompt symptom
recurrence. Booster sessions may be helpful in patients who experience symptom
recurrence.
Be familiar with responses to psychotherapy - ANSWER ✔ Robust response:
Continue with skills learned in therapy.
Booster sections for symptoms recurrence.
Changes in cortical and limbic areas of brain
Inadequate response; Consider and solve the following factors:
TREATMENT FIDELITY; (ie, the model is not provided as intended).
Can be corrected by ensuring that therapists receive appropriate training and
consultation in the selected model, receive ongoing, model-specific supervision, and
monitor their treatment fidelity over time.
TRAUMA REMINDERS; (ie exploration of potential trauma reminders or triggers)
- Further development of different coping strategies for triggers
-Helping the child to master the coping strategies identified.
ONGOING TRAUMA ;( symptoms may persist when trauma occurs during treatment).
This can be corrected by;
Increasing the focus on child safety early in treatment.
Helping children differentiate between real danger and trauma reminders.
-Helping nonoffending parents collaborate with children to develop effective strategies
for enhancing the child's safety.
,COMPLEX TRAUMA (response to early and prolonged interpersonal trauma occurring
during crucial developmental periods).
-Lengthier treatment with longer initial stabilization phase.
Cyclothymic Disorder (Cyclothymia) - ANSWER ✔ for at least two years for adults and
one year for children and adolescents there have been numerous periods with hypo
manic symptoms that do not meet criteria for hypo manic episode in numerous periods
of depressive symptoms that do not meet criteria for a major depressive episode during
the above two year or one year. The hypomanic and depressive periods have been
present for at least half the time and the individual has not been without the symptoms
for more than two months at a time. Criteria for major depression, mania, or hypo manic
episode have never been met. The symptoms Are not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia spectrum or other psychotic disorders.
The symptoms are not attributed to physiological effects of a substance or another
medical condition.
Dysthymic disorder or persistent depressive disorder (dysthymia) - ANSWER ✔ Full
criteria of major depressive episode have not been met. this disorder includes a
depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least two years. For children this may
only last one year and mood may be irritable. Two or more of the following symptoms
are present; poor appetite or over eating, insomnia or hypersomnia, low energy or
fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of
hopelessness. During the period of time of the disturbance the individual has never
been without symptoms for more than two months at a time. There has never been a
manic episode or a hypo manic episode and the symptoms do not meet cyclothymic
disorder. The symptoms cause clinically significant distress or impairment in social,
occupational or other important areas of functioning.
Major depressive disorder - ANSWER ✔ in this disorder five or more of the following
symptoms have been present during the same two week period and represent a change
from previous functioning at least one of the symptoms is either a depressed mood or
loss of interest or pleasure. The depressed mood is most of the day nearly every day. A
marked diminished interest or pleasure in almost all activities nearly every day.
Significant weight loss or gain insomnia or hypersomnia every day. Psycho mode
agitation/retardation. Fatigue or loss of energy. Feeling of worth less Ness or excessive
or inappropriate guilt. Diminished ability to think or concentrate or indecisiveness.
Recurrent thoughts of death. This can cause significant clinical distress or impairment in
social, occupational, or other important areas of functioning.
Depression Screening SIG-E-CAPS - ANSWER ✔ S- Sleep changes (usually
decreased)
I- Loss of interest
G- Guilty feelings/worthlessness
E- Energy low
,C- Concentration
A- Appetite changes (usually decreased)
P- Psychomotor changes (Lethargic, fatigue, hyper )
S- Suicidal ideation
Elderly and people with head injuries - ANSWER ✔ What population is most at risk for
syndrome of inappropriate diuretic hormone?
Carbamazepine (Tegretol) - ANSWER ✔ This medication may cause the syndrome of
inappropriate secretion of antidiuretic hormone. Due to hypo natremia.
SIADH - ANSWER ✔ excessive secretion of arginine vasopressin AVP also known as
antidiuretic hormone results in increase retention of fluid in the body. This condition is
called syndrome of inappropriate antidiuretic hormone. Water retention and SIADH
causes hypo natremia. SIADH may develop in response to injury to the brain or from
medication administration. The hyponatremia associated with this condition may cause
delirium.
SSRI withdrawal - ANSWER ✔ This stems from an abrupt withdrawal of this
medication, especially one with a shorter half-life such as peroxy teen or fluvoxamine,
has been associated with this. Symptoms may include dizziness, weakness, nausea,
headache, rebound depression, anxiety, insomnia, poor concentration, upper
respiratory symptoms, paresthesias, and migraine like symptoms. This usually does not
occur for at least a six week period of treatment and usually resolves spontaneously in
three weeks. People who experienced transient adverse effects in the first week of
taking an SSRI are more likely to experience this.
Fluoxetine/Prozac - ANSWER ✔ This is the SSRI lease likely to be associated with
withdraw because the half-life of its metabolite is more than one week and it effectively
tapers it self. It has been used in some cases to treat the discontinuation syndrome
caused by the termination of other SSRIs.
Medical causes for depression - ANSWER ✔ With symptoms of this clinicians should
have depressed adolescence tested for mononucleosis and we should test patients who
are marketally overweight or underweight for adrenal and thyroid dysfunction. We
should has patient with appropriate risk factors for HIV and older patients for viral
pneumonia among other conditions.
Pharmacological agents that can cause depression - ANSWER ✔ Steroid oral
contraceptives, reserpine methyl dopa, anti-cholinesterase insecticides, amphetamine
or cocaine withdrawal, alcohol or sedative hypnotic withdrawal, Madeleine
indomethacin, phenothiazine antipsychotic drugs, Valium, mercury, cycloserine,
vincristine, vinblastine, interferon.
, Endocrine/metabolic disorders that mimic depression - ANSWER ✔ Hypo thyroidism,
hyper thyroidism; mania, hypopituitarism, Addison disease, Cushing's syndrome,
diabetes mellitus
Infectious diseases that can mimic depression - ANSWER ✔ General paresis; tertiary
syphilis, toxoplasmosis, influenza, viral pneumonia, viral hepatitis, infectious
mononucleosis, acquired immune deficiency syndrome; aids
Collagen disorders that can mimic depression - ANSWER ✔ Rheumatoid arthritis,
lupus erythematosus
Nutritional disorders that can mimic depression - ANSWER ✔ Pellagra, pernicious
anemia
Neurological conditions that can mimic depression - ANSWER ✔ Multiple sclerosis,
Parkinson's disease, head trauma, complex partial seizures, sleep apnea, cerebral
tumors, cerebrovascular infarction or disease
Neoplastic conditions that can mimic depression - ANSWER ✔ Abdominal
malignancies, disseminated carcinomatosis
Modifiable Suicide Risk Factors - ANSWER ✔ this is a result of recurrent substance
use, exposure to violent and abuse, self destructive behaviors, maltreatment,
physical/sexual abuse, neglect.
Non-modifiable suicide risk factors - ANSWER ✔ sexual orientation, genetic factors,
monozygotic twins versus dizygotic twins.
Carbamazepine (Tegretol) - ANSWER ✔ In pregnancy in this medication used during
the first trimester may raise risk for neural tube defects example; spina bifida or other
congenital anomalies. If drug is continued start on folate 1 mg per day early in
pregnancy to reduce risk of neural tube defects. Atypical antipsychotics may be
preferable to lithium or anticonvulsants such as this if treatment of bipolar disorder is
required during pregnancy
Carbamazepine (Tegretol) - ANSWER ✔ This drug is metabolized through da CYP 450
3A4 System it is metabolized in the liver and excreted renally. Due to how the drug is
metabolized there are many drug interactions.
Carbamazepine (Tegretol) - ANSWER ✔ Thos drug decreases serum concentrations of
numerous drugs as a result of the prominent induction of hepatic CYP 3A4 system.
Monitoring for a decrease in clinical affects is frequently indicated it can decrease blood
concentration of Oral contraceptives which can result in breakthrough bleeding and
uncertain prophylaxis against pregnancy. It should not be administered with MAOI's.
Which must be stopped at least two weeks before initiating this treatment. With this drug
