NURS 663 EXAM 1 MARYVILLE UNIVERSITY
LATEST 2024-2025 WITH 200 ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS/ NURS
663 EXAM 1 MVU
Case: 26 year old woman without a psychiatric history who presents for treatment
of depression after her mother died. It has been over a year but she is still
struggling with frequent bouts of sadness, has lost 15 lbs in the last four months, is
unable to sleep past 4am, and is getting poor performance reviews at work due to
impaired concentration and memory. She feels like nothing in life is enjoyable
anymore.
diagnosis and medications to consider? - ANSWER-MDD
-Sertraline
-Escitalopram
-Fluoxetine
-Mirtazapine
case: 35 year old woman with a history of major depressive disorder who presents
complaining of persistent depression despite treatment with maximum dose
sertraline and escitalopram in the past. She has been depressed for over eight
months, and spends up to 16 hours per day lying in bed. She reports that she
doesn't have the energy to get up in the morning, and that there is nothing that she
enjoys doing, anyway. She has gained 35 lbs in the last eight months, reports
feeling like she has failed everyone in her life, and states that she only leaves the
house about once a week to shop for groceries. Recently, she has begun hearing
vague voices when she feels especially badly, although she cannot make out
specific words.
diagnosis and medications? - ANSWER-MDD
-Bupropion
pg. 1
,-Venlafaxine
-Duloxetine
-Maybe fluoxetine
case: 39 year old man with a history of PTSD and depression who presents after
returning from a recent deployment to Afghanistan. He is having trouble sleeping
because of nightmares about combat, is unable to tolerate being in crowded places,
and visibly jumps at small noises during your interview. His unwillingness to leave
the house is exacerbated by a lower spinal injury that has left him with chronic leg
pain and a limp that he thinks makes him look "like an easy target." He also reports
that he has difficulty sleeping through the night, is having trouble enjoying doing
anything with his family, feels extremely guilty for the time that he was away from
them while deployed, has low energy and concentration, but adamantly denies
suicidal thoughts. He has tried maximum dose sertraline and venlafaxine, but
neither were helpful. He also tried mirtazapine, but it was far too sedating and
didn't work either.
diagnosis - ANSWER-PTSD, MDD, Chronic Pain
-Nortriptyline or another TCA
-Duloxetine
-Escitalopram
-Prazosin
Patient comes in with symptoms of mania followed by periods of depression; what
is it? - ANSWER-bipolar 1
patient comes in with hypomania/regular mood (euthymic) followed by periods of
depression, what is it? - ANSWER-bipolar 2
pg. 2
,how many symptoms of mania must you have to have "full" mania? - ANSWER-
seven of thirteen
what is the difference between mania and hypomania? - ANSWER-hypomania has
less severe symptoms; 3 symptoms over shorter period of time (hypomania)
what is something you should watch out for if a patient is on multiple
antidepressants? - ANSWER-SIADH
what medical problems mimic mood disorders? - ANSWER-hypothyroid-
depression
hyperthyroid- mania
What are the "frequency" modifiers for MDD? - ANSWER-episodic: symptoms
dissipate over time
recurrent: likely to reappear in future
subclinical: sadness + 3 symptoms > 10 days (full criteria not met)
how is the severity of depression rated? - ANSWER-- Mild: no suicidal
thoughts/death wishes
- Moderate: some thoughts of death/self-harm
- Severe: plan/attempted
what are late side effects associated with lithium? - ANSWER-rare- renal failure
thyroid failure
pg. 3
, nephrogenic diabetes insipidus
how is lithium toxicity graded by blood trough level, and what symptoms would
you see? - ANSWER-mild (1.5-2) - vomiting, diarrhea, ataxia, dizziness, slurred
speech, nystagmus
moderate (2.0-2.4) nausea, vomiting, anorexia, blurred vision, clonic limb
movements, convulsions, delirium, syncope
severe (>2.5) oliguria, renal failure, generalized convulsions
what medication decreases suicide rates? - ANSWER-lithium
what other modifiers might be present with diagnosis of MDD? - ANSWER-- With
psychotic features: hallucinations, paranoia
- In partial remission: some symptoms still present, but full criteria not met; period
without any significant
symptoms lasting less than 2 months
- In full remission: no signs/symptoms >2 months
- Unspecified: symptoms vague, hard to tell
DSM 5 for bipolar I disorder - ANSWER-depression + mania
DSM 5 for bipolar 2 disorder - ANSWER-depression + hypomania
what is the #1 predictor of suicide? - ANSWER-Hopelessness and loneliness
pg. 4
