Mental Health from Fitzgerald's 5th Ed

Which of the following is most consistent with the presentation of a patient with bipolar I disorder? A. increased need for sleep B. impulsive behavior C. fatigue D. anhedonia

B

Which of the following electrolyte disorders is commonly associated with delirium? A. hyponatremia B. hypernatremia C. hyperkalemia D. hypophosphatemia

A

According to DSM-5, a diagnosis of depression must include either depressed mood or which of the following? A. loss of interest or pleasure B. recurrent thoughts of death C. feelings of worthlessness D. weight change (either increase or decrease)

A

Anxiety in response to a challenging life event is a natural response by the body to: A. help a person focus on the issue at hand. B. diminish the fight-or-flight response. C. impair decision making under duress. D. provide transient improvement in physical capabilities.

A

Concomitant use of an SSRI with which of the following herbal products can potentially lead to serotonin syndrome? A. St. John's wort B. kava kava C. gingko biloba D. valerian root

A

DSM-5 criteria for substance use tolerance includes: A. diminished effect with the same amount of substance used. B. desiring to get an amplified effect with higher doses. C. ability to decrease the frequency of substance use. D. absence of withdrawal symptoms when substance is not used for a prolonged period.

A

Drug treatment options for a patient with bipolar disorder often include all of the following except: A. atomoxetine (Strattera®). B. lithium carbonate. C. risperidone (Risperdal®). D. valproic acid (Depakote®).

A

Indicate (yes or no) whether confusion is associated with the use of systemic anticholinergic agents in older adults A. Yes B. No

A

Is an acute onset of change in mental status most likely associated with delirium or dementia? A) Delirium B) Dementia

A

Is the use of medications with systemic anticholinergic effect most likely associated with delirium or dementia? A. Delirium B. Dementia

A

Potential noncognitive reasons for behavioral issues observed in older adults include all of the following except: A. ADHD. B. pain. C. infection. D. depression.

A

The drug buspirone (BuSpar®) has: A. low abuse potential. B. significant antidepressant action. C. a withdrawal syndrome when discontinued, similar to benzodiazepines. D. rapid onset of action.

A

The mechanism of action of benzodiazepines is as: A. a mediator of gamma-aminobutyric acid (GABA). B. an enhancer of serotonin. C. a dopamine antagonist. D. a serotonin agonist and dopamine antagonist.

A

The use of antipsychotic medications in older adults is associated with an increased risk for: A. stroke and cardiovascular events. B. hypoglycemia. C. delirium. D. hypertension.

A

The use of which of the following drugs often mimics generalized anxiety disorder? A. sympathomimetics B. antipsychotics C. anticholinergics D. alpha-beta antagonists

A

Use of laxatives and diuretics by persons with bulimia nervosa will most commonly result in: A. hypokalemia. B. hypercalcemia. C. proteinuria. D. hypernatremia.

A

When considering depression and thoughts about death, rank the following from most common (A) to the least common (C): A. Thinking it would be "OK to just die"; passive without a plan to cause self-harm B. Having suicidal thoughts C. Making a plan to commit suicide A) A, B, C B) A, C, B C) B, A, C D) B, C, A E) C, A, B F) C, B, A

A

When managing depression in older adults, all of the following should be considered except: A. starting at the highest dose possible of antidepressant and then titrating down once symptoms resolve. B. encouraging psychotherapy in addition to pharmacotherapy. C. utilizing electroconvulsive therapy for severe depression. D. conducting a medication review to minimize potential drug-drug interactions.

A

When stimulated, what is the activity associated with serotonin receptor site 5-HT2? A. agitation, anxiety, panic B. antimigraine effect C. antidepressant effect D. cerebral spinal fluid production

A

Which of the following agents has the longest T½? A. fluoxetine B. paroxetine C. citalopram D. sertraline

A

Conditions that commonly mimic or can worsen anxiety include all of the following except: A. opioid use. B. thyrotoxicosis. C. alcohol withdrawal. D. overuse of caffeine.

A- Opioid use does NOT mimic or worsen anxiety

Which of the following agents should be avoided in heavy alcohol users owing to a potential risk for hepatotoxicity? A. duloxetine B. desvenlafaxine C. escitalopram D. bupropion

A- duloxetine should be avoided

A general principle of drug absorption in an elderly adult is best described as: A. amount of absorption is decreased. B. rate of absorption is changed. C. drug absorption is altered but predictable. D. bioavailability is altered.

B

A middle-aged woman who has taken a therapeutic dose of lorazepam for the past 6 years wishes to stop taking the medication. You advise her that: A. she can discontinue the drug immediately if she believes it no longer helps with her symptoms. B. rapid withdrawal in this situation can lead to tremors and hallucinations. C. she should taper down the dose of the medication over the next week. D. gastrointestinal upset is typically reported during the first week of benzodiazepine withdrawal.

B

An 81-year-old man who was recently diagnosed with Alzheimer's-type dementia is accompanied by his granddaughter for an office visit. The granddaughter reports that her grandfather often acts erratically with angry outbursts that can soon be followed by a more "normal" demeanor. She reports that the grandfather recently moved in with her, and she would like for this arrangement to continue as long as possible. In counseling the granddaughter, you consider all of the following except that: A. behavioral difficulties often arise in patients with AD if their usual routine is disrupted. B. treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline. C. a home safety evaluation should be conducted and appropriate modification performed. D. any sudden change in mental status should be reported to the healthcare provider as soon as possible.

B

An alternative to methadone that can be used to curb opioid withdrawal symptoms is the use of: A. gabapentin. B. buprenorphine plus naloxone. C. methylnaltrexone. D. topiramate.

B

Cheilosis in a patient with bulimia nervosa is best described as: A. ruptured capillaries in the cornea. B. deep cracks or splits in the corners of the mouth. C. inflammatory lesions in the pharynx. D. hair that is easily plucked.

B

Dementia syndrome or cognitive impairment that is associated with severe depression is called: A. delirium. B. pseudodementia. C. Alzheimer's disease. D. bipolar disorder.

B

Diagnostic criteria for generalized anxiety disorder include all of the following except: A. difficulty concentrating. B. consistent early morning wakening. C. apprehension. D. irritability.

B

During an office visit, a 38-year-old woman states, "I drink way too much but do not know what to do to stop." According to Prochaska's change framework, her statement is most consistent with a person at the stage of: A. precontemplation. B. contemplation. C. preparation. D. action.

B

In general, pharmacologic intervention for patients with depression should: A. be given for about 4 months on average. B. continue for a minimum of 6 months after remission is achieved. C. be continued indefinitely with a first episode of depression. D. be titrated to a lower dose after symptom relief is achieved.

B

Initial treatment for anorexia nervosa usually includes: A. referral for parenteral nutrition evaluation. B. antidepressant therapy. C. use of psychostimulants. D. psychoanalysis.

B

Interpersonal violence is uncommon in same-sex relationships. A. True B. False

B

Is an insidious onset over months to years most likely associated with delirium or dementia A) Delirium B) Dementia

B

Medications that commonly contribute to delirium include all of the following except: A. first generation antihistamines. B. cardioselective beta-adrenergic antagonists. C. opioids. D. benzodiazepines.

B

Patient presentation possibly common to anxiety and depression includes: A. a feeling of worthlessness. B. psychomotor agitation. C. dry mouth. D. appetite disturbance.

B

Physical examination findings in patients with bulimia nervosa often include: A. body mass index (BMI) less than 75% of anticipated. B. dental surface erosion. C. tachycardia. D. hair that is easily plucked.

B

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for a substance use disorder include all of the following except: A. substance use in larger amounts or over longer period than intended. B. substance overuse resulting in hospitalization. C. craving or strong desire to use. D. substance use in potentially hazardous positions.

B

Use of St. John's wort is known to impact the effectiveness of all of the following medications except: A. oral contraceptives. B. fluoroquinolones. C. cyclosporine. D. select antiretrovirals.

B

When considering characteristics of the domestic violence perpetrator, one of the best predictors of a subsequent homicide of victims of domestic violence is which of the following? A. history of perpetrator striking victim on the face with an open hand B. history of perpetrator attempting to strangle the victim C. perpetrator's access to kitchen knives. D. history of victim alcohol abuse

B

When considering pharmacologic options to treat neuropathic pain in a 72-year-old man, which of the following is the least appropriate option because of its systemic anticholinergic effect? A. nortriptyline B. amitriptyline C. duloxetine D. venlafaxine

B

When initiating SSRI therapy for a patient with panic disorder, the NP should consider all of the following except: A. starting with a low dose and slowly escalating doses as necessary. B. it is preferable to use agents that are more energizing than those that are less energizing. C. selecting agents with a low rate of insomnia and akathisia. D. SSRI therapy can precipitate panic attacks with early use.

B

When stimulated, what is the activity associated with serotonin receptor site 5-HT1D? A. agitation, anxiety, panic B. antimigraine effect C. antidepressant effect D. cerebral spinal fluid production

B

Which of the following agents offers an intervention for the control of tremor and tachycardia associated with alcohol withdrawal? A. phenobarbital B. clonidine C. verapamil D. naltrexone

B

Which of the following describes prescriptions for antidepressant medications written by primary care providers? A. dose too high B. dose too low C. excessive length of therapy D. appropriate length of therapy

B

Which of the following drugs is likely to be the most dangerous when taken in an intentional overdose equivalent to a standard adult therapeutic dose? A. a 4-week supply of paroxetine B. a 2-week supply of amitriptyline C. a 3-week supply of duloxetine D. a 5-day supply of alprazolam

B

Which of the following is most consistent with the diagnosis of bulimia nervosa? A. Patients with bulimia nervosa usually present asking for treatment. B. Periods of anorexia often occur. C. Hyperkalemia often results from laxative abuse. D. Most patients with bulimia nervosa are significantly obese.

B

Which of the following is often reported by individuals with anxiety? A. constipation B. muscle tension C. hive-form skin lesions D. somnolence

B

Which of the following is the most helpful first-line approach in the care of a patient with alcoholism? A. Advise the patient in a straightforward manner to stop drinking. B. Counsel the patient that alcohol abuse is a treatable disease. C. Inform the patient of the long-term health consequences of alcohol abuse. D. Refer the patient to Alcoholics Anonymous.

B

Which of the following medications is most likely to cause sexual dysfunction? A. vilazodone (Viibryd®) B. paroxetine (Paxil®) C. nortriptyline (Pamelor®) D. bupropion (Wellbutrin®)

B

With the use of a benzodiazepine in an older adult, the risk of fall is most likely to occur ___________ of the medication. A. at the onset of action B. at the peak of action C. at the middle point of duration of action D. toward the end of anticipated duration of action

B

Women's violence against male partners is as likely to result in serious injury as men's violence toward women. A. True B. False

B

A 42-year-old man who has a long-standing history of alcohol abuse presents for primary care. He admits to drinking 12 to 16 beers daily for 10 years. He states, "I really do not feel like the booze is a problem. I get to work every day." Your most appropriate response is: A. "Work is usually the last thing to go in alcohol abuse." B. "Your family has suffered by your drinking." C. "I am concerned about your health and safety." D. "Participating in a support group can help you understand why you drink."

C

A 44-year-old man has been taking an SSRI for the past 4 months and complains of new onset of sexual dysfunction and difficulty achieving orgasm. You advise him that: A. this is a transient side effect often seen in the first weeks of therapy. B. switching to another SSRI would likely be helpful. C. this is a common adverse effect of SSRI therapy that is unlikely to resolve without adjustment in his therapy. D. he should see a urologist for further evaluation.

C

A 64-year-old man undergoing chemotherapy for lung cancer asks about the use of medical marijuana to help relieve symptoms of pain and nausea. The NP considers: A. there is no evidence supporting the use of medical marijuana in cancer. B. smoking would be preferred to edible forms to maximize effect for this patient. C. the state laws should be consulted to check the legal status of medical marijuana prior to prescribing. D. the patient should be evaluated for substance abuse

C

As you develop the initial treatment plan for a woman with panic disorder, you consider prescribing: A. carbamazepine (Tegretol®). B. risperidone (Risperdal®). C. citalopram (Celexa®). D. bupropion (Wellbutrin®).

C

Depression often manifests with all of the following except: A. psychomotor retardation B. irritability. C. palpitations. D. increased feelings of guilt.

C

In caring for elderly patients, the NP considers that all of the following is true except: A. many older patients with dementia have a component of depression. B. dementia signs and symptoms usually evolve over months, but depression usually has a more rapid onset. C. with dementia, a patient is aware of difficulties with cognitive ability. D. treating concurrent depression can help improve symptoms of dementia.

C

In treating a person with panic disorder using an SSRI, the NP should consider that there is: A. considerable abuse potential with these medications. B. no significant therapeutic advantage over TCAs. C. a reduction in number and severity of panic attacks. D. significant toxicity in overdose.

C

Peak symptoms of alcohol withdrawal are usually observed how long after alcohol intake is discontinued? A. less than 12 hours B. 12 to 24 hours C. 24 to 36 hours D. more than 36 hours

C

When discontinuing benzodiazepine treatment after prolonged use, you recommend: A. terminating treatment immediately. B. decreasing the dose 20% per day. C. decreasing the dose 25% per week. D. decreasing the dose 50% per week.

C

When prescribing a benzodiazepine, the NP should consider that: A. the ingestion of 3 to 4 days of therapeutic dose can be life-threatening. B. the medication must be taken at the same hour every day. C. concomitant use of alcohol should be avoided. D. onset of therapeutic effect takes many days.

C

When providing care for a middle-aged man with acute cocaine intoxication, you inquire about: A. feelings of anxiety. B. difficulty maintaining sleep. C. chest pain. D. abdominal pain.

C

When stimulated, what is the activity associated with serotonin receptor site 55-HT1A? A. agitation, anxiety, panic B. antimigraine effect C. antidepressant effect D. cerebral spinal fluid production

C

Which of the following statements is true regarding depression and relapse? A. Without maintenance therapy, the relapse rate is typically less than 50% in the first year. B. The risk of relapse is less for those who have experienced multiple episodes of major depressive disorder. C. The risk of relapse is greatest in the first 2 months after discontinuation of therapy. D. Relapse rarely occurs if there is an absence of symptoms after 9 months of treatment discontinuation.

C

A patient has been taking citalopram for 1 week and complains of mild nausea and diarrhea. You advise that: A. this is a common, long-lasting side effect of SSRI therapy. B. he should discontinue the medication. C. another antidepressant should be substituted. D. he should be taking the medication with food.

D

All of the following are risk factors for relapse except: A. a current episode lasting more than 2 years. B. onset of depression occurring at younger than 20 years of age. C. poor recovery between episodes. D. absence of persistent depressive disorder preceding the episode.

D

Among the preferred first-line pharmacologic treatment options for patients with PTSD include the use of: A. methylphenidate (Ritalin®). B. oxazepam (Serax®). C. lithium carbonate. D. sertraline.

D

Characteristics of binge eating disorder include all of the following except: A. lack of control over the amount and type of food eaten. B. behavior present for at least 6 months. C. marked distress, self-anger, shame, and frustration as a result of binging. D. purging activity after an eating binge.

D

DSM-5 criteria for anorexia nervosa include all of the following except: A. refusal to maintain body weight at or above the minimum normal weight for age and height. B. intense fear of gaining weight or becoming fat despite being underweight. C. distorted experience and significance of body weight and shape. D. absence of at least three consecutive menstrual cycles.

D

In providing primary care for a patient with post-traumatic stress disorder (PTSD), you consider that all of the following are likely to be reported except: A. agoraphobia. B. feeling of detachment C. hyperarousal. D. poor recall of the precipitating event.

D

Lorazepam or oxazepam is the preferred benzodiazepine for treating alcohol withdrawal symptoms when there is a concomitant history of: A. seizure disorder. B. folate deficiency anemia. C. multiple substance abuse. D. hepatic dysfunction.

D

Persistent depressive disorder (formerly known as dysthymia) is characterized by: A. suicidal thoughts. B. multiple incidents of harming oneself. C. social isolation. D. low level depression.

D

Risk of benzodiazepine misuse is minimized by use of: A. agents with a shorter T½. B. the drug as an as-needed rescue medication for acute anxiety. C. more lipophilic products. D. products with long duration of action.

D

The most common trigger for delirium is: A. alcohol withdrawal. B. fecal impaction. C. head trauma. D. acute infection.

D

Treatment with venlafaxine (Effexor®) can lead to dose-dependent increases in: A. heart rate. B. serum glucose. C. AST/ALT. D. blood pressure.

D

When stimulated, what is the activity associated with serotonin receptor site 5-HT3? A. agitation, anxiety, panic B. antimigraine effect C. antidepressant effect D. nausea, diarrhea

D

Which of the following SSRIs is associated with the greatest anticholinergic effect? A. fluvoxamine B. sertraline C. fluoxetine D. paroxetine

D

Which of the following contains the greatest amount of alcohol? A. 12 oz (360 mL) beer (9 proof) B. 4 oz (120 mL) wine (22 proof) C. 3.5 oz (105 mL) mixed drink (30 proof) D. 3 oz (90 mL) liquor (80 proof)

D

Which of the following is an over-the-counter herbal preparation used to relieve symptoms of depression? A. valerian root B. melatonin C. kava kava D. St. John's wort

D

Which of the following is not a component of the CAGE questionnaire? A. Have you ever felt you should cut down on your drinking? B. Have you been annoyed by people criticizing your drinking? C. Have you ever felt guilty about your drinking? D. Have you ever engaged in a violent act while drinking?

D

Which of the following medications has little systemic anticholinergic effect? A. diphenhydramine B. amitriptyline C. chlorpheniramine D. loratadine

D

Indicate (yes or no) whether constipation is associated with the use of systemic anticholinergic agents in older adults A) Yes B) No

Yes