NP3 Final Exam

Question 1

S&S of Depression

Answer 1

SIGECAPS
- Sleep; Interest; Guilt; Energy; Concentration; Appetite; Psychomotor; Suicide

Question 2

S&S of Anxiety

Answer 2

WATCHERS
- Worry; Anxiety; Tension in Body; Concentration; Hyperarousal; Energy Loss; Restlessness; Sleep Disturbance

Question 3

S&S of PTSD

Answer 3

• Flashbacks
• Hyperarousal

Question 4

OCD

Answer 4

• Obsessions: unwanted thoughts

vs

• Compulsions/ unwanted behaviors

Question 5

Depression & Anxiety Tx

Answer 5

• SSRIs
• Starting medication and weekly f/u

Question 6

Primary Care Tx Modalities

Answer 6

• Refer to Counseling
• 2w = rescreen d/t highest risk of suicide attempt
• Best Tx = psychotherapy & medication

Question 7

Purpose of DSM-V

Answer 7

• Provides descriptions, symptoms, and other criteria for diagnosing mental disorders

Question 8

SSRIs

Answer 8

• First line treatment = blocks reuptake
• Prozac, Zoloft, Celexa, Lexapro, Paxil
• Side effects = decrease libido, ED, anorexia, insomnia, fatigue, G.I. (G.I., bleed with Prozac)
  ** Wellbutrin = least likely to affect libido **

Question 9

TCAs

Answer 9

• Amitriptyline: hot flashes, sleep, pain QT elongation
• Imipramine, nortriptyline
• Other uses: PHN, stress incontinence
• Avoid high risk suicide
• OD will be fatal

Question 10

MAOIs

Answer 10

• Rarely used due to severe food and drug interactions (high tyramine)
• Phenelzine and tranylcypromine
• Do not use with SSRI or TCA
• Wait at least two weeks before initiation of either
• Avoid fermented foods

Question 11

ETOH Screening

Answer 11

CAGE
- Cut down?
- Annoyed with comments about your drinking?
- Guilty?
- Early drinking?

Question 12

Depression Screening

Answer 12

• GAD7
• PHQ2 & PHQ9
• Beck’s
• Geriatric depression scale

Question 13

Best Tx for SUD

Answer 13

• Benzodiazepines
• Refer to AA
• Decrease EtOH cravings = naltrexone

Question 14

Tx for Opioid OD

Answer 14

• Naloxone
• Inpatient treatment
• methadone; Suboxone

Question 15

Life-Threatening Delirium

Answer 15

WHHHIMPS
- Wernicke’s
- Hypoxia or hypercarbia
- Hypertensive encephalopathy
- Hyperthermia or Hypothermia
- Intracerebral hemorrhage
- Meningitis or encephalitis
- Poisoning
- Status epilepticus

Question 16

Hospice vs. Palliative

Answer 16

Hospice
- Last six months or less
- Includes palliative care

Palliative
- Comfort care
- Component of hospice care

Question 17

Roles of the Care Team

Answer 17

• MOLST & DNR = NP can initiate and sign
• Initiation of hospice = MD only
• NPs can be hospice attending
• NP cannot authorize certification for hospice

Question 18

Management Goals of Acute vs. Chronic Pain

Answer 18

Acute Pain
- Maintain alertness and function
- Minimize adverse effects
- Prevent chronic development

Chronic Pain
- Goal = increase quality of life
- Refer to pain management

Question 19

4 Pillars of Pain Therapy

Answer 19

1. Anti-inflammatories
2. Anticonvulsants
3. Mood modulators
4. Opiates

Question 20

First-Line Tx for Mild Pain

Answer 20

• Tylenol
• Topicals
• NSAIDs

Question 21

Over-Rx of Pain Medications

Answer 21

• Misuse
• Overuse
• Abuse
• OD

Question 22

Best Tx for Neuropathic Pain

Answer 22

• Gabapentin
• Non-opioids
• Calcium channel blockers
• TCAs
• Antiarrhythmics
• Local anesthetics

Question 23

Indication for Opioid Pain Therapy

Answer 23

• Moderate to severe pain
• Avoid extended release
• Avoid in the elderly

Question 24

Opioid Tx Time Frame

Answer 24

• No opioid Rx over timeframe greater than three months

Question 25

DEA Requirements

Answer 25

- Keep documents for six years at a minimum - Retake training every three years and must resign attestation

Question 26

S&S of Parkinson’s

Answer 26

TRAP - Asymmetric resting tremor - Rigidity - Akinesia or bradykinesia - Postural changes

Question 27

Headaches: Different Types

Answer 27

Tension - Nausea/vomiting, bilateral pressure or band like pain Cluster - Periorbital, unilateral, photophobia, tearing, nasal stuffiness

Question 28

Headaches: First-Line Tx

Answer 28

- Tylenol - NSAIDs - Triptans for migraines

Question 29

S&S of Shingles

Answer 29

- Unilateral, linear, erythematous, vesicular, painful, itchy, tingly, rash

Question 30

Tx for ADHD

Answer 30

Stimulants - Adderall, Vyvanse, Ritalin, Concerta, clonidine, Strattera, Intuniv

Question 31

Risk Factors for Alzheimer’s

Answer 31

- Age, family, history, genetics, head, injury, health and comorbidities

Question 32

Seizures: Different Types

Answer 32

Focal = unilateral - Complex partial and simple partial Generalized = bilateral - Absence and tonic clonic What is considered a cure? - Seizure free for 10 years without use of medications

Question 33

Factors to Determine the Type of Seizure

Answer 33

- Idiopathic, EtOH intoxication or withdrawal, metabolic, hypoxia, head, injury, meningitis, migraines

Question 34

Seizures: Medications & Contraindications

Answer 34

ALL ARE TERATOGENIC Focal = Carbamazepine & Lamictal Generalized = Depakene Absence = Zarontin & Depakene

Question 35

S&S of Bell Palsy

Answer 35

- Rapid onset = hours or days - Facial droop and difficulty making facial expressions - Pain around the jaw of the affected side Recovery time: if mild, one month

Question 36

TIA/CVA

Answer 36

ABCD2 Prognosis Score - Age - BP (<140/90) - Clinical features - Duration - Diabetes <4 = two day risk <1% >5 = two day risk 8.1%

Question 37

CVA

Answer 37

How do previous TIAs impact CVA prediction? - Short term = 3-10% @D2; 5% @D7; 9-17% @3m Criteria for administering thrombolytic therapy: - ER within three hours of symptom onset - CT brain to rule out, intracerebral hemorrhage

Question 38

Inflammatory Etiology

Answer 38

- Read, warmth, swelling, pain, loss of function

Question 39

Osteoporosis Dx Criteria

Answer 39

- T-scores less than or equal to -2.5.

Question 40

Urgent Care: Tetanus Considerations

Answer 40

- If none within the past five years, then recommended within 48 hours of the bite or injury - New = Adacel: includes whooping cough

Question 41

Risk Factors for Falls

Answer 41

- Polypharmacy - Weakness - Unbalanced gait

Question 42

S&S of Infection

Answer 42

- Memory: delirium and confusion

Question 43

Factors to Promote Change

Answer 43

- Age-appropriate screening - Provide education and resources - Address, treatment, barriers, and health disparities

Question 44

Resources & Tx Barriers

Answer 44

- Vision, hearing, language - Stigmas, financial or insurance coverage