Exam (elaborations)
Maryville NURS 663 Exam 2 Megadeck – Q/A
Maryville NURS 663 Exam 2 Megadeck – Q/A
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Maryville NURS 663 Exam 2 Megadeck – Q/ACyclothymic Disorder
Diagnostic Criteria: ✔️Ans - · 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 ✔️Ans - level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC,
TSH
bipolar meds: depression ✔️Ans - lurasidone (13+), olanzapine +
fluoxetine (10+)(symbyax)
bipolar acute and mixed mania ✔️Ans - aripiprazole, risperidone,
olanzapine (13+), quetiapine (acute only), asenapine (10+)
classic mood stabilizers ✔️Ans - 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 ✔️Ans - class not used w/bipolar disorder
lithium ✔️Ans - Anti-manic, antidepressant, anti-suicidal
Lithium side effects ✔️Ans - Frequent urination, increased thirst,
weight gain, sedation
,lithium toxicity ✔️Ans - sudden onset tremors, N/V/D, muscle
weakness, slurred speech, confusion, seizures (slowing down, feel really
out of it)
Tourette's d/o ✔️Ans - 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 ✔️Ans - habit reversal training can be used to manage tics
Tics tx ✔️Ans - Alpha agonists (clonidine, guanfacine); Haldol is not the
first-line txt
Specific Learning Disorders ✔️Ans - 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 ✔️Ans - an eating disorder in which an irrational fear
of weight gain leads people to starve themselves; restrictive or
binge/purge/exercise
Bulimia nervosa ✔️Ans - 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 ✔️Ans - significant binge-eating episodes,
followed by distress, disgust, or guilt, but without the compensatory
purging, fasting, or excessive exercise
Avoidant/restrictive eating disorder ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - fluoxetine help but not
direct tx
Vyvanse approved for binge eating but not because of stimulant effects
Enuresis treatment ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - 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 ✔️Ans - Social supports; lethal; access to means; plan and
previous attempt
, Suicide risk: IS PATH WARM ✔️Ans - Ideation, substance abuse,
purpose to live gone; anxiety, trapped feeling; hopelessness, w/d from soc
supports, anger w/rage; reckless, dramatic moods
SIGECAPS ✔️Ans - Sleep, Interest, Guilt, Energy, Concentration,
Appetite, Psychomotor, Suicide
bipolar vs unipolar: look at bipolar if ✔️Ans - 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 ✔️Ans - involuntary utterance of obscenities or
inappropriate remarks
Bipolar I criteria ✔️Ans - One manic episode required
Mania ✔️Ans - 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 ✔️Ans - a milder form of elevated mood that are
less severe and cause less impairment than ______ and (usually) don't
require hospitalization
Mania impairment ✔️Ans - severe in work, social activities, or
relationships or to necessitate hosp or there are psychotic features
Hypomania impairment ✔️Ans - cause a change in functioning but not
severe
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