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MARYVILLE NURS 663 MEGADECK EXAM #2 QUESTIONS AND ANSWERS
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MARYVILLE NURS 663 MEGADECK EXAM #2 QUESTIONS AND ANSWERS
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MARYVILLE NURS 663 MEGADECKEXAM #2 QUESTIONS AND ANSWERS
Cyclothymic Disorder
Diagnostic Criteria: - Answer-· Diagnostic Criteria: For at least 2 years (1 year in
children and adolescents) there have been numerous periods with hypomanic
symptoms that do not meet the criteria for a hypomanic episode and numerous periods
with depressive symptoms that do not meet the criteria for a major depressive episode
· During the above 1- or 2-year period, the hypomanic and depressive periods have
been present for at least half of the time and the individual has not been without
symptoms for more than 2 months at a time
· Prevalence is 0.4% to 1%
· 15-50% risk for turning into Bipolar I or II
Lithium labs - Answer-level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH
bipolar meds: depression - Answer-lurasidone (13+), olanzapine + fluoxetine (10+)
(symbyax)
bipolar acute and mixed mania - Answer-aripiprazole, risperidone, olanzapine (13+),
quetiapine (acute only), asenapine (10+)
classic mood stabilizers - Answer-Lamotrigine (excellent medication to use), lithium,
Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal
(no evidence for true Bipolar disorder)
anti-depressants - Answer-class not used w/bipolar disorder
lithium - Answer-Anti-manic, antidepressant, anti-suicidal
Lithium side effects - Answer-Frequent urination, increased thirst, weight gain, sedation
lithium toxicity - Answer-sudden onset tremors, N/V/D, muscle weakness, slurred
speech, confusion, seizures (slowing down, feel really out of it)
Tourette's d/o - Answer-Multiple motor and at least one vocal tic (some tics come and
go, they don't have them all at the same time to receive the diagnosis)
HRT - Answer-habit reversal training can be used to manage tics
,Tics tx - Answer-Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt
Specific Learning Disorders - Answer-difficulties in the acquisition and use of listening,
speaking, reading, writing, reasoning, or mathematical abilities; dx by other
professionals w/specialized training; NP tx comorbid d/o
Anorexia nervosa - Answer-an eating disorder in which an irrational fear of weight gain
leads people to starve themselves; restrictive or binge/purge/exercise
Bulimia nervosa - Answer-an eating disorder characterized by episodes of overeating,
usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive
exercise
Binge-eating disorder - Answer-significant binge-eating episodes, followed by distress,
disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise
Avoidant/restrictive eating disorder - Answer-avoiding or restricting foods in childhood.
significantly low BMI; no distortion of body image or fear of gaining wt. r/o delusions
around food
Pica - Answer-an abnormal craving or appetite for nonfood substances, such as dirt,
paint, or clay that lasts for at least 1 month; decrs incidence with incr age
Feeding and Eating Disorders tx - Answer-Talk therapy (counseling is needed for the
distress) (intensive outpatient, partial inpatient or actual inpatient admission may be
needed); most have associated depression and/or anxiety
Feeding and Eating Disorders meds - Answer-fluoxetine help but not direct tx
Vyvanse approved for binge eating but not because of stimulant effects
Enuresis treatment - Answer-1. First line is behavioral interventions: bed alarms,
toileting at bedtime and during the night, bladder training
2. reassurance, resolves spontan, normal 4-5 yo
Enuresis meds - Answer-Desmopressin nasal spray; Infants 3 months of age to children
12 years of age:
Intranasal: 5 mcg/day as a single dose or in 2 divided doses. Dose range is 5 to 30
mcg/day. The morning and evening doses should be separately adjusted for an
adequate diurnal rhythm of water turnover.
Major Depressive Disorder Dx - Answer-5+ for at least a 2-week period; either #1 or 2
req
1. Depressed mood most of the day, nearly every day (can be irritability in children &
adolescents)
2. Diminished interest or pleasure in all, or almost all, activities
3. Change appetite/weight; kids not wt goals
,Insomnia or hypersomnia nearly every day
4. Up or down Psychomotor
5. Fatigue or loss of energy
6. Worthlessness/excessive or inappropriate guilt
7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with
ADHD, address mood first)
8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2
wk not req.
SLAP - Answer-Social supports; lethal; access to means; plan and previous attempt
Suicide risk: IS PATH WARM - Answer-Ideation, substance abuse, purpose to live
gone; anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage;
reckless, dramatic moods
SIGECAPS - Answer-Sleep, Interest, Guilt, Energy, Concentration, Appetite,
Psychomotor, Suicide
bipolar vs unipolar: look at bipolar if - Answer-1. family hx: 1st degree relatives
2. Substance use: chasing high or low
3. Response to SSRI: no resp to multiple tries or evidence of mania with use (not
diagnostic)
coprolalia - Answer-involuntary utterance of obscenities or inappropriate remarks
Bipolar I criteria - Answer-One manic episode required
Mania - Answer-elevated, expansive, energetic + 3, (unless irritable
mood then requires 4+)
1. SX Lastat least one week-any duration if hosp
2. Inflated self-esteem, grandiosity
3. Decreased need for sleep
4. More talkative, pressure to keep talking
5. Flight of ideas or racing thoughts
6. Distractibility: r/o ADHD (constant) intermit w/BD
7. Increase in goal-directed activity
8. Risky, impulsive behaviors (sex, money, pot for harm)
hypomania vs mania - Answer-a milder form of elevated mood that are less severe and
cause less impairment than ______ and (usually) don't require hospitalization
Mania impairment - Answer-severe in work, social activities, or relationships or to
necessitate hosp or there are psychotic features
Hypomania impairment - Answer-cause a change in functioning but not severe
, Mood disorder r/o - Answer-No symptoms can be due to a substance or general
medical condition
Most common anxiety disorder in children - Answer-separation anxiety disorder-per p
193 & 222 in DSM-V
Panic attack vs anxiety attack - Answer-thoughts of impending death distinctive for
panic
generalized anxiety disorder - Answer-an anxiety disorder in which a person is
continually tense, apprehensive, and in a state of autonomic nervous system arousal for
6 mo or more
social anxiety disorder - Answer-an anxiety disorder involving the extreme and irrational
fear of being embarrassed, judged, or scrutinized by others in social situations;
avoidance of soc situations
Phobias - Answer-A group of anxiety disorders involving a pathological fear of a specific
object or situation
Anxiety disorder tx - Answer-- First line tx: SSRIs: most effective, least s/e
- Anti-anxiety drugs: buspirone, hydroxyzine, benadryl
- Beta blockers: propranolol
- Psychotherapy
Avoid benzos
Anxiety disorder meds - Answer-Fluoxetine, sertraline, escitalopram, citalopram,
paroxetine, duloxetine, venlafaxine,
desvenlafaxine, vilazodone (Viibryd), vortioxetine (Trintellix) from most to least often
used/EBP
SSRI mechanism of action - Answer-Blocking reabsorption / reuptake, of serotonin,
leaves more serotonin available, which improves mood
SNRI mechanism of action - Answer-Inhibit reuptake of both serotonin and
norepinephrine
Anti-depressant education - Answer-Always teach the Black Box warning for incr SI risk
up to 24 y/o.
Schizophrenia - Answer-a psychological disorder characterized by 2 of the following for
at least 1 mo; must include at least one of first 3:
1. delusions,
2. hallucinations,
3. disorganized speech
4. Grossly disorganized/catatonic behavior
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