APEA (Psych) 1 Certification Review Exam Questions And Answers Well Elaborated.
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Course
APEA PYSCHIATRY
Institution
APEA PYSCHIATRY
A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response? - correct answer A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response?
Parkinson's disease
Dis...
APEA (Psych) 1
A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if
there is no response? - correct answer A 76 year-old depressed patient is started on an SSRI. When
should another antidepressant be tried if there is no response?
Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of depression. These
include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other illnesses associated with
high rates of depression are cancer and cardiovascular illnesses like myocardial infarction. Depression
worsens the outcome of any physical illness. - correct answer Which patient is most likely to exhibit
depression related to his illness? A patient with:
Anxiety disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in patients who have
eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with eating
disorders are more likely to have a first or second degree relative with an eating disorder, affective
disorder, or alcohol abuse. There is no evidence that patients with eating disorders exhibit a higher
incidence of sleep disorders or liver disease. Thyroid disease should always be assessed in patients with
eating disorders, but this does not represent the reason for weight loss when eating disorder is present.
- correct answer A patient with an eating disorder may concomitantly exhibit:
Impairment of executive function
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other organizations.
The criteria are similar. Criteria include a gradual onset of cognitive decline. A rapid onset usually
indicates another etiology, perhaps, delirium. Other criteria include impairment of recent memory,
difficulty with language or finding words, the inability to execute skilled motor activities, disturbances of
visual processing or disturbances in executive function that includes abstract reasoning and
concentration. Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is not
a criterion for diagnosis, though it may support the diagnosis of AD. There is no laboratory evidence of
AD. - correct answer Which criterion below is a criterion for Alzheimer's Disease?
,Next day sleepiness
Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-cholinergic
effects in patients who take this, but especially in older adults. Urinary retention is common (not
incontinence) in older men with benign prostatic hyperplasia, but retention occurs in women too.
Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect is cognitive
impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying side effects like
dry mouth and constipation. - correct answer An 80 year old adult has begun to use over the counter
diphenhydramine to help him fall asleep. What common side effect can occur in older adults with use of
this medication?
Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or interest. If
this is the case, this patient should be screened for depression. Anhedonia is a red flag for depression. -
correct answer A 69 year-old female patient reports feelings of anhedonia for the last month. What
should be part of the nurse practitioner's assessment?
Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia. Common
macrocytic anemias are B12 deficiency and folate deficiency. These are common in older patients,
especially if they consume large quantities of alcohol. This patient also has elevated triglycerides.
Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydrates. This
patient's history indicates two elements that indicate alcohol abuse. He should be questioned regarding
alcohol abuse. - correct answer A 70 year-old male patient has an elevated MCV with an anemia. His
triglycerides are 420. What should be suspected?
Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with difficulty falling
asleep are often anxious. Frequent waking and early morning wakening are often complaints by patients
with depression. There is no agreed on physiologic explanation, but, this is a common symptom. -
correct answer Which symptom listed below is typical of depression?
, often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a physical diagnosis like
urinary tract infection; or it may be due to consumption of a medication. Regardless, a change in
cognition or consciousness needs immediate evaluation. The evaluation should include a medication
review, physical exam and laboratory evaluation, and mental status exam. - correct answer Delirium
differs from dementia because delirium:
CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for "have you
ever felt you should CUT down" your alcohol consumption. The A stands for " does other's criticism of
your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinking". The E stands for
"have you ever had an EYE opener to steady your nerves or get rid of a hangover". A positive response
on any question constitutes a positive screen. - correct answer Which screen for alcohol abuse has
been validated in the elderly?
dementia
The mini mental status exam (MMSE) is a very common and easily administered cognitive evaluation for
dementia. It tests orientation, recall, attention, calculation, language manipulation, and constructional
praxis. It is not sensitive for mild dementia and may be influenced by educational level and age. Even
with these limitations, the MMSE is the most widely used cognitive test for dementia in the US. - correct
answer MMSE helps to identify patients with symptoms of:
Weight below 90% of ideal body weight
Weight below 85% of ideal body weight is the correct criterion. This involves refusal to gain or maintain
weight within normal range. Occasionally weight below ideal body range does not involve losing weight,
but instead involves refusal to gain weight during a growth spurt. This is commonly observed during
pubertal growth spurts and is more common in adolescent females than males. The other three criteria
are correct as listed. - correct answer An adolescent female patient with anorexia nervosa must
exhibit 4 criteria for diagnosis. Which criterion listed below is NOT part of the diagnostic criteria?
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