NR547 Midterm Exam ACTUAL EXAM TEST BANK 200 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)|AGRADE Terri is a 79 -year old who presents with confusion. She has positive urine leukocyte esterase. - ANSWER -Refer Rational e: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract infection (UTI) , which may cause confusion. Refer this client for treatment of the UTI. Treat or Refer: Julio is a 66 -year-old who presents with depression. His vitamin D level 11 ng/mL. - ANSWER -Refer Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP may refer or treat vitamin D deficiency depending on the level of comfort o f the provider. Treat or Refer: Beth is a 24 -year-old who presents with anxiety. Her T3 is 260 ng/dL. - ANSWER -Refer Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated with anxiety symptoms. Client can be reeva luated for anxiety once hyperthyroid treatment has been initiated and T3 levels are within normal limits. Treat or Refer: Fred is a 19 -year-old who presents with psychosis. His vitamin B12 level is 900 picograms/mL. - ANSWER -Begin treatment Rationale: Th e B12 level is within normal limits. Treatment for symptoms of psychosis should be initiated . Treat or Refer: Ted is a 64 -year-old who presents with confusion. His serum creatinine is 7.0 mg/dL and BUN is 32. - ANSWER -Refer Rationale: Elevated serum crea tinine and BUN indicate a problem with kidney function, which could contribute to confusion. Symptom -Directed Treatment - ANSWER -Psychiatric medication is generally prescribed in a transdiagnostic manner in which symptoms rather than diagnoses guide clini cal practice Social Determinants of Health (SDOH) - ANSWER -the conditions in which individuals are "born, grow, live, work, and age" that contribute to the development of both physical and psychiatric pathology over the course of one's life" SDOH: social and structural factors that impact mental health - ANSWER -• Discrimination, racism, social exclusion • Adverse early life experiences • Poor education • Unemployment, underemployment, job insecurity • Poverty • Neighborhood deprivation • Food insecurity • Poor housing quality and housing instability Legal and Ethical Considerations - ANSWER -Protecting the privacy and confidentiality of client records is a legal obligation and may help reassure the client The SNAPPS Method - ANSWER -Summarize the history and findings Narrow the differential dx to 2 -3 possibilities Analyze the differential by comparing & contrasting the possibilities Probe the preceptor by asking questions about alternative approaches or uncertainties Plan the management of the client's health issues Select an issue from the case for self -directed learning Prioritizing Client Complaints and Questions - ANSWER -Use client -centered communication techniques -Strategies • Acknowledge the client's list of questions and concerns and review th e list with the client with a statement such as, "I see you have a list of concerns; let's look at it together." • Mutually negotiate what to cover during the visit, use of positive language • Be honest about the time allotted for the visit while planning jointly how to use that time • Plan for follow -up, Set a mutual agenda and time frame for the next visit, Review which issues have been addressed, and which ones will be addressed at the next visit. Document this plan as a reminder for the next visit Parts of the Initial Psychiatric Interview - ANSWER -Identifying data Source and reliability Chief complaint Present illness Past psychiatric history Substance use/abuse Past medical history Family history Developmental and social history Review of systems Mental status examination Physical examination Formulation DSM -5 diagnoses Treatment plan Psychiatric Review of Systems - ANSWER -Mood -Depression: Sadness, tearfulness, sleep, appetite, energy, concentration, sexual function, guilt, psychomotor agitation or slowing, interest. A common pneumonic used to remember the symptoms of major depression is SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation or slowing, Suicidality). -Mania: Impulsivity, grandiosity, recklessness, excessive energy, decreased need for sleep, increased spending beyond means, talkativeness, racing thoughts, hypersexuality. -Mixed/Other: Irritability, liability. Anxiety -Generalized anxiety symptoms: Where, when, who, how long, how frequent. -Panic di sorder symptoms: How long until peak, somatic symptoms including racing heart, sweating, shortness of breath, trouble swallowing, sense of doom, fear of recurrence, agoraphobia. -Obsessive -compulsive symptoms: Checking, cleaning, organizing, rituals, hang -ups, obsessive thinking, counting, rational vs. irrational beliefs. -Posttraumatic stress disorder: Nightmares, flashbacks, startle response, avoidance. -Social anxiety symptoms -Simple phobias, for example, heights, planes, spiders, etc. Psychosis -Hallu cinations: Auditory, visual, olfactory, tactile. -Paranoia. -Delusions: TV, radio, thought broadcasting, mind control, referential thinking. -Patient's perception: Spiritual or cultural context of symptoms, reality testing. Other -Attention -deficit/hyperactivity disorder symptoms. -Eating disorder symptoms: Binging, purging, excessive exercising process of DSM -5 differential diagnosis - ANSWER -1) ruling out Malingering and Factitious Disorder 2) ruling out a substance etiology 3) ruling out an etiological medical condition 4) determining the specific primary disorder(s) 5) differentiating Adjustment Disorder from the residual Other Specified and Unspecified conditions 6) establishing the boundary with no mental disorder most commo n mental illness in the United States - ANSWER -Anxiety disorders differential diagnosis - ANSWER -The provider's initial hypothesis -a working list of potential problems that can be associated with the initial or chief complaint -Diagnostic and Statistical Manual of Mental Disorders (DSM -5-TR) • provides guidance for identifying psychiatric diagnoses Psychiatric assessment: History taking - ANSWER --History of Present Illness -How long have you been feeling this way? -Did something happen in your life that may have triggered these emotions? -How is this current situation impacting your life? The Psychiatric History -Have you ever been hospitalized for any mental health issues? -Have you ever had counseling or psychotherapy? -Have you ever taken medications for your mental health in the past? -Are you currently on any medications for mental health or sleep? Medical History/Screening for General Medical Conditions -Do you have a primary care provider? -Do you have any medical illnesses? -Are you currently taking any medications or herbal supplemen ts? -Do you have any allergies to medications? -Have you ever been hospitalized for any reason? -Have you ever had surgery? Family Psychiatric History -Has any relative of yours ever been hospitalized for a mental health issue? -Has any blood relative of yours ever been diagnosed with a mental health issue? -Has any blood relative of yours had a history of seizures or dementia/Alzheimer's? Social and Developmental History -Tell me a little bit about your childhood and how you grew up. -How was your experience in school when you were younger? Did you enjoy school? -How do you support yourself with your finances?
