NUR7375900 PMHNP Acute and chronic management of adult with Psych
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Free NUR7375900 PMHNP Acute and chronic management of adult with Psych Questions
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Each episode of mania is triggered only by a major life stressor
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With repeated episodes, the brain becomes more resistant to mood changes
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Over time, manic episodes may occur more easily and with stressors or poor sleep
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Mania occurs only in response to substance use or sleep deprivation
Explanation
Correct Answer Is:
(C) Over time, manic episodes may occur more easily and with stressors or poor sleep
The kindling hypothesis proposes that repeated mood episodes in bipolar disorder sensitize the brain over time, making subsequent episodes easier to trigger with increasingly minor stressors or disruptions such as poor sleep. Early episodes may require significant psychosocial stressors to ignite, but over time the threshold lowers and episodes can be sparked by minimal triggers, emphasizing the importance of early and consistent treatment.
Why Other Options are Incorrect:
A. Each episode of mania is triggered only by a major life stressor — The kindling hypothesis actually suggests the opposite: that over time, episodes require less significant triggers, not always major life stressors.
B. With repeated episodes, the brain becomes more resistant to mood changes — This contradicts the kindling hypothesis, which states the brain becomes more sensitized, not resistant, with repeated episodes.
D. Mania occurs only in response to substance use or sleep deprivation — While these are known triggers, the kindling hypothesis encompasses a broader range of decreasing threshold triggers and is not limited to substance use or sleep deprivation alone.
________ disorders coexist with major depressive disorders.
- Thought
- Anxiety
- Bipolar
Explanation
Correct Answer: B) Anxiety
Anxiety disorders are among the most commonly comorbid conditions with major depressive disorder (MDD). Research consistently shows that approximately 50–60% of patients with MDD also meet criteria for an anxiety disorder, such as generalized anxiety disorder, panic disorder, or social anxiety disorder. This comorbidity is associated with greater symptom severity, functional impairment, and poorer treatment outcomes, requiring careful assessment and integrated management. While thought disorders and bipolar disorder can co-occur with depression in some presentations, they are not documented as the most prevalent and well-established comorbidity with MDD the way anxiety disorders are.
What is the primary purpose of the AIMS (Abnormal Involuntary Movement Scale) test in clinical practice?
- To assess cognitive function in patients with schizophrenia
- To evaluate the severity of depressive symptoms
- To screen for and monitor tardive dyskinesia and other involuntary movements
- To diagnose bipolar disorder based on mood symptoms
Explanation
Explanation:
Correct Answer: (C) To screen for and monitor tardive dyskinesia and other involuntary movements
The AIMS is a standardized clinical tool used to detect, quantify, and monitor abnormal involuntary movements, particularly tardive dyskinesia, in patients receiving antipsychotic medications. It evaluates movements across multiple body regions including the face, lips, tongue, extremities, and trunk, providing a structured and consistent way for clinicians to track changes over time.
Why Other Options are Incorrect:
A. To assess cognitive function in patients with schizophrenia — Cognitive assessment tools such as the MoCA or MMSE are used for this purpose; the AIMS is specifically a movement scale.
B. To evaluate the severity of depressive symptoms — Depression severity is measured by tools such as the PHQ-9 or Hamilton Depression Rating Scale, not the AIMS.
D. To diagnose bipolar disorder based on mood symptoms — Bipolar disorder diagnosis relies on clinical interviews and mood assessment tools, not movement scales like the AIMS.
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Sudden mood swings and periods of intense euphoria
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Recurrent panic attacks and avoidance of social situations
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Presence of delusions, hallucinations, or disorganized speech lasting 6 months
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Long-term memory loss and inability to recognize familiar people
Explanation
Correct Answer Is:
(C) Presence of delusions, hallucinations, or disorganized speech lasting 6 months
According to the DSM-5, a diagnosis of schizophrenia requires the presence of at least two of five characteristic symptoms — delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms — with at least one being delusions, hallucinations, or disorganized speech, persisting for a significant portion of a 6-month period. These are the core positive symptoms that define the disorder.
Why Other Options are Incorrect:
A. Sudden mood swings and periods of intense euphoria — These features are more characteristic of bipolar disorder, not schizophrenia.
B. Recurrent panic attacks and avoidance of social situations — These are hallmark features of panic disorder and social anxiety disorder, not schizophrenia.
D. Long-term memory loss and inability to recognize familiar people — These symptoms are more consistent with neurocognitive disorders such as dementia, not schizophrenia.
Jane is a 25-year-old female who presents to the clinic for the treatment of major depressive disorder (unipolar depression), recurrent. The patient health questionnaire 9 (PHQ-9) score is 5. The specifier would indicate to the PMHNP the next intervention is ______. (Choose the best answer)
- To prescribe fluoxetine
- Watchful waiting
- Watchful waiting and psychotherapy
- To prescribe fluoxetine and psychotherapy
Explanation
Explanation:
Correct Answer: (B) Watchful waiting
A PHQ-9 score of 5 indicates mild depression at the lower boundary of the mild range. For a patient with recurrent MDD but currently minimal-to-mild symptom severity, the most appropriate and conservative intervention is watchful waiting — closely monitoring the patient without immediately initiating pharmacotherapy or formal psychotherapy. This approach avoids overtreatment while ensuring timely follow-up if symptoms worsen.
Why Other Options are Incorrect:
A. To prescribe fluoxetine — Pharmacotherapy is not indicated for a PHQ-9 score of 5, which reflects minimal depressive symptoms not yet warranting medication initiation.
C. Watchful waiting and psychotherapy — While psychotherapy is beneficial, a PHQ-9 of 5 does not yet necessitate formal structured psychotherapy as an immediate intervention. Watchful waiting alone is the most appropriate first step at this severity level.
D. To prescribe fluoxetine and psychotherapy — This combination is reserved for moderate to severe depression (PHQ-9 scores of 10 and above) and would represent overtreatment at Jane's current symptom level.
Which of the following is a common legal criterion for involuntary psychiatric admission in adults?
- The individual has a history of psychiatric hospitalization.
- The individual poses a danger to themselves or others due to mental illness.
- The individual refuses outpatient therapy.
- The individual has a family history of mental illness.
Explanation
Correct Answer: B) The individual poses a danger to themselves or others due to mental illness.
The most widely recognized legal standard for involuntary psychiatric admission across U.S. states is that the individual must present a clear and imminent danger to themselves or others as a result of a mental illness, and they must lack the capacity or willingness to seek voluntary treatment. This criterion balances individual civil liberties with the duty to protect both the patient and the public. The legal process typically involves a formal evaluation and may require judicial oversight.
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Anorexia nervosa
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Bulimia nervosa
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Avoidant restrictive food intake disorder
Explanation
Correct Answer: (A) Anorexia nervosa Caloric restriction combined with an intense fear of gaining weight are the two defining and pathognomonic features of anorexia nervosa according to DSM-5 criteria. Anorexia nervosa is characterized by persistent restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight or becoming fat even when underweight, and a disturbance in the way body weight or shape is experienced.
Why Other Options are Incorrect:
B. Bulimia nervosa — Bulimia nervosa is characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, laxative use, or excessive exercise to prevent weight gain. The defining feature of restricting calories without binge-purge cycles is not the hallmark of bulimia nervosa.
C. Avoidant restrictive food intake disorder (ARFID) — ARFID involves avoidance or restriction of food intake based on sensory characteristics, fear of aversive consequences such as choking or vomiting, or lack of interest in eating. Critically, ARFID does not involve a fear of weight gain or disturbance in body image, which clearly distinguishes it from anorexia nervosa.
Serotonin syndrome and neuroleptic malignant syndrome are medical emergencies. How will the PMHNP know the differences of SS and NMS and how to treat serotonin syndrome and neuroleptic malignant syndrome? Write in all 3 answers.
Explanation
Correct Answer:
Differences between Serotonin Syndrome (SS) and Neuroleptic Malignant Syndrome (NMS):
Serotonin Syndrome is caused by excess serotonergic activity from serotonergic drugs (SSRIs, MAOIs, SNRIs). It presents rapidly — within 24 hours — with the classic triad of neuromuscular changes (clonus, hyperreflexia, tremor), autonomic instability (hyperthermia, tachycardia, diaphoresis), and altered mental status.
Neuroleptic Malignant Syndrome is caused by dopamine blockade from antipsychotic medications. It develops gradually over days to weeks and presents with "lead pipe" muscle rigidity, severe hyperthermia, autonomic instability, and altered mental status.
The key distinguishing feature is that SS presents with hyperreflexia and clonus, while NMS presents with severe lead-pipe rigidity. SS onset is rapid; NMS onset is gradual.
Treatment of Serotonin Syndrome: Immediately discontinue all serotonergic agents. Provide supportive care with IV fluids, cooling measures, and cardiac monitoring. Administer benzodiazepines for agitation. In severe cases, cyproheptadine (serotonin antagonist) is given to block excess serotonin activity.
Treatment of Neuroleptic Malignant Syndrome: Immediately discontinue the offending antipsychotic. Provide aggressive supportive care including hydration and cooling. Administer dantrolene to reduce muscle rigidity and hyperthermia. Bromocriptine or amantadine (dopamine agonists) may be used to restore dopaminergic function. ICU-level care is often required given the potentially fatal course.
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A fixed, false belief not based in reality
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A sudden loss of memory or identity
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A sensory perception without an external stimulus
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An exaggerated fear of a specific object or situation
Explanation
Correct Answer Is:
(C) A sensory perception without an external stimulus
A hallucination is defined as a sensory experience — such as hearing, seeing, smelling, tasting, or feeling something — that occurs in the absence of an actual external stimulus. It is a perception that feels real to the individual but has no basis in the external environment. Hallucinations are a key positive symptom of schizophrenia and other psychotic disorders.
Why Other Options are Incorrect:
A. A fixed, false belief not based in reality — This defines a delusion, not a hallucination. Delusions involve distorted thinking rather than false sensory experiences.
B. A sudden loss of memory or identity — This describes dissociative amnesia or dissociative identity disorder, which are entirely separate conditions unrelated to hallucinations.
D. An exaggerated fear of a specific object or situation — This describes a phobia, which falls under anxiety disorders and is distinct from psychotic perceptual disturbances.
Explanation
Correct Answer: (Full explanation of all 3 key differences and treatments)
Serotonin Syndrome (SS) is caused by excess serotonergic activity, most commonly due to the use or overdose of serotonergic medications such as SSRIs, SNRIs, MAOIs, or combinations thereof. It presents rapidly — often within hours — with the classic triad of neuromuscular abnormalities (clonus, hyperreflexia, tremor), autonomic instability (tachycardia, hyperthermia, diaphoresis), and altered mental status (agitation, confusion). Treatment involves discontinuing the offending agent, supportive care, and administering cyproheptadine, a serotonin antagonist, in addition to benzodiazepines for agitation and muscle rigidity.
Neuroleptic Malignant Syndrome (NMS) is caused by dopamine blockade, typically from antipsychotic medications or abrupt withdrawal of dopaminergic agents. It develops more slowly — over days to weeks — and is characterized by the tetrad of severe muscle rigidity (lead-pipe rigidity), hyperthermia, autonomic instability, and altered mental status. A key distinguishing lab finding is a significantly elevated creatine kinase (CK) due to muscle breakdown. Treatment involves immediately discontinuing the antipsychotic, providing aggressive supportive care, and administering dantrolene (a muscle relaxant) and bromocriptine (a dopamine agonist).
Key Differentiating Features between the two are onset speed (SS is rapid; NMS is gradual), causative agent (serotonergic drugs vs. dopamine-blocking drugs), neuromuscular findings (hyperreflexia and clonus in SS vs. lead-pipe rigidity in NMS), and laboratory findings (markedly elevated CK is hallmark of NMS but not SS). Recognizing these distinctions is critical as both are life-threatening emergencies requiring prompt and distinct management approaches.
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