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NURS 6635 FINAL EXAM QUESTIONS WITH
100% ACCURATE ANSWERS
- Select the development time of symptoms in neuroleptic malignant syndrome. A. 12-24 hours B. 24-72 hours C. 4-7 days D.10-14 days - Accurate answers B. 24-72 hours If untreated syndrome lasts 10 to 14 days Treat with dantrolene or bromocriptine Select the brain region that shows the greatest anatomical abnormalities in schizophrenic patients. A. Hippocampus B. Amygdala C. Prefrontal cortex D. Basal ganglia - Accurate answers C. Prefrontal cortex has anatomical abnormalities hippocampus and amygdala have size decrease basal ganglia theoretical due to odd movements D. per some answers Select the mental function that is most affected in mild cognitive impairment. A. General cognition B. Activities of daily living C. Geographic orientation D. Recent memory - Accurate answers D. Recent memory Select the time frame for symptoms of schizophreniform disorder. A. 2 to 6 weeks B. 1 to 5 months C. 6 to 8 months D. 1 year - Accurate answers Symptoms are short term lasting at least 1 month but less than 6 months. p. 342 Select two comorbid factors common in schizophrenic patients - Accurate answers obesity, DM, substance use disorders, complex partial epilepsy, cardiovascular disease, HIV, COPD Select the medical condition that occurs less frequently in schizophrenic patients than in the general population - Accurate answers rheumatoid arthritis Select the percentage of remission that results from correct antipsychotic drug therapy of schizophrenic patients A. 15
B. 30
C. 45
D. 70 - Accurate answers p. 354 Approximately 60% will improve to the extent that they will achieve remission or only mild symptoms Select the most distinguishing feature in the course and prognosis of schizophrenia - Accurate answers worsening after each relapse Select the two behaviors of schizophrenic patients that occur more frequently than in the general population. - Accurate answers p.339 little impulse control, decreased social sensitivity, impulsive behavior, suicide, violent behavior Select the characteristic that is greater in childhood than adult onset schizophrenia - Accurate answers Social withdrawal p. 349 typically quiet introverted, no close friends, may have sudden onset of ocd Select the most reliable method to make a diagnosis of schizophrenia - Accurate answers a patient's history is essential for the diagnosis of schizophrenia; clinicians cannot diagnose schizophrenia simply by results of a mental status examination, which may vary. Select the dysfunction that is common to 50% to 85% of schizophrenic patients. - Accurate answers Various studies have reported abnormal eye movements in 50 to 85 percent of patients with schizophrenia compared with about 25 percent in psychiatric patients without schizophrenia and fewer than 10 percent in nonpsychiatrically ill control participant. p. 359 Select two of the "Four A's" symptoms of schizophrenia described by Bleuler A. autism B. ambivalence C. anhedonia D. abstract - Accurate answers the four As: associations, affect, autism, and ambivalence Select the age range for 90% of patients treated for schizophrenia - Accurate answers p. 358 90% of patients in treatment for schizophrenia are between 15 and 55 years old. (peak age of onset women - 25 to 35, men 10-25). Late onset refers to over 45. cannabis raises risk by 40% The most common type of hallucination in schizophrenia - Accurate answers Auditory Cognition of patient's with schizophrenia - Accurate answers Usually oriented to person, time, and place. they do have cognitive deficiencies in attention, executive function, working memory, and episodic memory leading cause of premature death in schizphrenia? - Accurate answers Suicide Positive and negative syndrome scale (PANNS) Brief psychiatric rating scale (BPRS)
Select the neurotransmitter that is most implicated in schizophrenia based on the effectiveness of antipsychotic drug therapy. A. Norepinephrine B. Dopamine C. GABA D. Glutamate - Accurate answers B. Dopamine Select two psychiatric disorders that are often misdiagnosed as childhood-onset or early onset schizophrenia A. Autism spectrum B. Obsessive-compulsive disorder C. Bipolar II D. Bipolar I - Accurate answers a and d Select the two factors that are not applicable to diagnosing schizoaffective disorder. A. Manic episodes B. Major depression C. Medical condition D. Substance abuse - Accurate answers c and d what are side effects of 1st generation antipsychotics? 2nd generation - Accurate answers 1st -EPS, sedation, postural hypotension (reduce dose, add antiparkinson med or change) can use propanolol 2nd - weight gain and metabolic derangements All antipsychotics elevate prolactin level (shrink gonads) Which antipsychotic is considered the most effective? - Accurate answers Clozapine - problems agranulocytosis, hypersalivation, sedation, tachy, weight gain, postural hypotension) Select the personality disorder in which patients are continually in crisis and exhibit unpredictable behavior - Accurate answers borderline personality disorder personality disorder with excessive suspiciousness and distrust? - Accurate answers paranoid personality disorder. use projection to give impulses and emotions to others that they cannot accept in themselves personality disorder with pervasive disrespect for rights of others - Accurate answers antisocial - has to be over 18 and demonstrated since 15
personality disorder with high degree of attention-seeking behavior - Accurate answers Histrionic Select the personality disorder in which patients are preoccupied with perfectionism and interpersonal control. A. Passive-aggressive B. Obsessive compulsive C. Narcissistic D. Avoidance - Accurate answers B Select the neurotransmitter for which the metabolite 5-HIAA in CSF is evident and predictive of suicide. A. Serotonin B. Dopamine C. Norepinephrine D. GABA - Accurate answers p. 575 A serotonin low metabolite In the diagnosis of schizophrenia, symptoms must persist for how long? A. 1-2 months B. 3-4 months C. 6-8 months D. 8-10 months - Accurate answers C. 6-8mos What substance is known to decrease blood concentrations of antipsychotics, yet improve cognitive impairments and parkinsonism in schizophrenia illnesses? A. Alcohol B. Benzodiazepines C. Marijuana D. Nicotine - Accurate answers D. Nicotine Select the drug that is most likely to cause parkinsonian movement symptoms. A. Lorazepam B. Propranolol C. Benztropine D. Haloperidol - Accurate answers D. Haloperidol Schizophrenia is equally prevalent in men and women. A. True B. False - Accurate answers B. True Bleuler identified "Four As" as fundamental symptoms of schizophrenia to frame his theory of internal mental schisms of patients that include all the following EXCEPT: A. Ambivalence B. Affective disturbances C. Arrogance
A. Dependent B. Paranoid C. Histrionic D. Schizoid - Accurate answers Cluster B - dramatic Antisocial Borderline Histrionic Narcissistic Select the main goal of psychosocial therapies for persons with schizophrenia. A. Reduce frequency of auditory hallucinations B. Develop coping skills for adverse effects of antipsychotic drugs C. Develop skills for independent living D. Reduce exacerbations and re- hospitalizations - Accurate answers C. Develop skills for independent living Select the type of neurochemical receptor that is blocked by caffeine. A. GABA B. Glutamate C. Adenosine D. Norepinephr ine - Accurate answers C. Adenosine Caffeine causes most of its biological effects via antagonizing all types of adenosine receptors. Select the personality disorder in which patients are most likely to tolerate spousal abuse to avoid losing sense of attachment. A. Dependent B. Narcissistic C. Passivea ggressive D. Depressive - Accurate answers A. Dependent Because persons with the disorder do not like to be alone, they seek out others on whom they can depend; their relationships, thus, are distorted by their need to be attached to another person. In a shared psychotic disorder (folie à deux), one member of the pair usually has dependent personality disorder; the submissive partner takes on the delusional system of the more aggressive, assertive partner on whom he or she depends. Pessimism, self-doubt, passivity, and fears of expressing sexual and aggressive feelings all typify the behavior of persons with a dependent personality disorder. An abusive, unfaithful, or alcoholic spouse may be tolerated for long periods to avoid disturbing the sense of attachment. What group is at highest risk for neuroleptic induced parkinsonism? - Accurate answers p. 594 elderly and female at highest risk. adverse effects typically occur within 5 to 90 days of treatment. Most notable Haldol. Treatment for parkinsonism? - Accurate answers benzotropine (cogentin), amantadine (Symmetrel), or benadryl. can use propanolol, clonidine, Most affected by Neuroleptic malignant syndrome? - Accurate answers Life-threatening. increased wbc, creatinine phosphokinase, liver enzymes, myoglobulin. Men more affected and young more affected medication for neuroleptic malignant syndrome - Accurate answers dantrolene, bromocriptine. Haldol poses greatest risk Who is most likely to get medication induced dystonias? - Accurate answers Men and young. treatment IM benadryl, valium Who is most at risk for acute akathisia? (restlessness,) - Accurate answers Middle aged women. Treat by changing drug
when does tardive dyskinesia arise Tx? - Accurate answers months to years after a typical antipsychotic med is initiated switch to an Atypical Antipsychotic. Clozaril does not cause tardive What are the four principles for treating medication induced postural tremor? - Accurate answers
- use lowest possible does of psych drug
- minimize caffeine consumption
- Take med at bedtime to reduce daytime tremor
- B adrenergic receptor antagonist e.g. propanolol to reduce. Two rare medication induced movement disorders? - Accurate answers nocturnal myoclonus - contraction of specific leg muscles during sleep RLS - urge to move legs what newer generation antipsychotic causes severe akathisia - Accurate answers abilify rate of sexual dysfunction with fluoxetine? - Accurate answers 35 - 75% two antipsychotics with highest risk of increasing glucose levels - Accurate answers Clozapine and olanzapine which drug can cause hyponatremia in elderly? - Accurate answers oxcarbazepine (trileptal) severe perspiration as side effect from SSRIs, venlafaxine, and TCAs can be treated with what medications? - Accurate answers terazosin, oxybutynin What is the therapeutic index? - Accurate answers ratio of median toxic dose to median effective dose median toxic dose - dose at which 50% will experience a certain toxic effect median effective dose - dose at which 50% will experience therapeutic effect when high can use varying dose, when low requires monitoring (e.g. lithium) What is the definition of remission? - Accurate answers Disappearance of sx, but not necessary the presence of disease. Below syndromal threshold. What are responders? - Accurate answers Patients who improve but do not experience a full resolution. response is usually defined as a 50 percent or more decrease from baseline on a standard rating scale like HAM-D. which two disorders are more likely to be associated with residual manifestations of illness? - Accurate answers OCD and schizophrenia. (OCD less than 12% for full remission, partial is 47%) Treatment failure guidelines? - Accurate answers change meds reassess for correct dx are truly still not being helped and just seeing adverse effects check dosage investigate interactions patient compliance
What percent of patients with Substance abuse dependence meet criteria for antisocial personality disorder? - Accurate answers 35 to 60% Select the percentage of substance-addicted persons with a concurrent psychiatric disorder How many more times likely are people with substance abuse to commit suicide? - Accurate answers 20 times more likely than general population Select the psychoactive substance that is most frequently consumed worldwide - Accurate answers Caffeine Select the age range of the highest rate of substance dependence or abuse - Accurate answers 18- 25 Select the substance that is most commonly abused by adolescents - Accurate answers Alcohol Select the neurotransmitter system that is most associated with the addictive rewarding properties of opioids - Accurate answers p. 274 Dopamine Select the percentage of substance-addicted persons with a concurrent psychiatric disorder - Accurate answers p. 271 up to 50% Select the hepatic enzyme that performs the initial metabolism of alcohol - Accurate answers ADH (Alcohol Dehydrogenase) Select the preferred drug used to treat alcohol withdrawal - Accurate answers Benzodiazepines Select the brain region that is associated with substance addiction. A. Prefrontal cortex B. Caudate nucleus C. Basal ganglia D. Ventral tegmental - Accurate answers Basal ganglia Select the substance of abuse with the strongest evidence for genetic association - Accurate answers Alcohol p. Select the personality disorder in which patients seek social withdrawal - Accurate answers schizotypal Select the percentage of the U.S. population with a substance dependence problem as of year 2012 - Accurate answers 20% 2017 7% Select the two drugs used to treat alcohol dependence - Accurate answers Acamprosate, disulfiram, and naltrexone Select the most frequently abused illicit drug - Accurate answers Marijuana Select the percent blood alcohol level at which voluntary motor activity becomes impaired. - Accurate answers .2 -.3 slowed motor and decreased thinking ability
Select the factor that exerts the strongest influence on the initiation of substance use disorder in adolescents - Accurate answers Family, peers, leisure The enzyme ADH that catalyzes the conversion of alcohol into acetaldehyde is inhibited by which medication? A. Disulfiram B. Haloperidol C. Lorazepam D. Naloxone - Accurate answers Disulfiram Select the drug that is most likely to cause parkinsonian movement symptoms. A. Lorazepa m B. Propranol ol C. Benztropi ne D. Haloperidol - Accurate answers Haloperidol Select the time of onset for tolerance to develop from continuous use of hallucinogens such as LSD. A. 1-2 days B. 3-4 days C. 4-7 days D. 5-9 - Accurate answers A.1-2 days Select the brain region devoid of cannabinoid receptors. A. Brain stem B. Basal ganglia C. Cerebellu m D. Hippocam pus - Accurate answers A. Brain Stem Select the brain region that is associated with substance addiction. A. Prefrontal cortex B. Caudate nucleus C. Basal ganglia D. Ventral tegmental - Accurate answers D. The dopaminergic neurons in the ventral tegmental area (VTA) project to cortical and limbic regions causing reward pathway p. Select the neurotransmitter system that is most associated with the addictive rewarding properties of opioids. A. Dopaminergic B. Serotonergic C. Adrenergic D. Glutamatergic - Accurate answers A. Dopaminergic The opioid, catecholamine (dopamine), and gaba classic sign of etoh withdrawal - Accurate answers tremulousness What are the two broad categories of sexual disorders? - Accurate answers sexual dysfunction and paraphilias Essential features of sexual dysfunctions? - Accurate answers inability to respond to sexual stimulation or experience of pain during sexual activity SSRIs that inhibit female orgasm - Accurate answers fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram
