NSG 552 Exam 2: (Latest 2026/2027 Update) Somatic Disorders,
Dissociative Disorders, Anxiety, & Psychopharmacology | Q&A | Grade A |
100% Correct (Verified Answers) – Nursing Program
Subject: NSG 552 – Advanced Psychiatric-Mental Health Nursing
Source: NSG 552 Exam 2 Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. Which disorder has physical symptoms presenting for 6+ months where patients believe they are ill and
do not intentionally produce symptoms?
Correct Answer: Somatic symptom disorder
1. DSM-5 criteria: one or more somatic symptoms causing distress/disruption, excessive thoughts/behaviors, and
duration ≥6 months.
2. Symptoms are not feigned (unlike factitious disorder).
3. Treatment: regular PCP visits, CBT, gradual addressing of psychological issues.
2. How is factitious disorder treated?
Correct Answer: Confront in a non-threatening manner; collaborate with PCP
1. Factitious disorder = falsifying symptoms to assume sick role without external reward (unlike malingering).p>2.
Avoid direct accusation; confront gently (e.g., "The symptoms don't match expected patterns").
3. Coordinate care among providers to reduce unnecessary procedures.
3. What are the sedating antidepressants (mnemonic D.A.M.T.)?
Correct Answer: Doxepin, Amitriptyline, Mirtazapine, Trazodone
1. Sedating antidepressants are used when insomnia is prominent or when activating effects are undesirable.
2. Trazodone is commonly used off-label for insomnia at lower doses (50-100 mg).
3. Doxepin and amitriptyline are tricyclics with significant anticholinergic effects.
4. What are the activating antidepressants (mnemonic D.A.V.F.)?
Correct Answer: Duloxetine, Atomoxetine, Venlafaxine, Fluoxetine
1. Activating antidepressants are best given in the morning to avoid insomnia.
2. Fluoxetine has the longest half-life among SSRIs (2-4 days).
3. SNRIs (duloxetine, venlafaxine) can also be activating.
5. Which disorder involves falsifying physical or psychological signs/symptoms to assume a sick role, with
absence of external reward, often leading to long hospitalizations?
Correct Answer: Factitious disorder
1. Munchausen syndrome = factitious disorder (chronic, severe form).p>2. Differentiated from malingering (external
incentive like disability, litigation, opioids).p>3. Factitious disorder imposed on another (Munchausen by proxy) is child
abuse.
6. What is the treatment for illness anxiety disorder?
Correct Answer: SSRIs, see PCP regularly, CBT
1. Illness anxiety disorder = health anxiety/hypochondriasis (preoccupation with having serious illness despite mild/no
somatic symptoms).p>2. Avoid excessive testing (reinforces anxiety). Regular PCP visits (e.g., every 4-6 weeks) provide
reassurance without over-testing.
3. CBT addresses catastrophic misinterpretation of bodily sensations.
, 7. What is the treatment for somatic symptom disorder?
Correct Answer: See PCP regularly, address psychological issues gradually
1. Focus on symptom management, not cure. Validate distress while avoiding unnecessary procedures.
2. Schedule brief regular visits (e.g., monthly) to reduce urgent care/ED use.p3. CBT, mindfulness, and graded exposure
for severe cases.
8. What is "la belle indifférence"?
Correct Answer: Conversion disorder (neurological symptoms without explanation)
1. "Beautiful indifference" = lack of concern about seemingly severe neurological deficits (e.g., paralysis, blindness).
2. Not pathognomonic (some patients with organic lesions also show indifference).p>3. Treatment: physical therapy +
psychotherapy.
9. What are generic medical conditions that may precipitate anxiety?
Correct Answer: COPD, diabetes mellitus, thyroid disease, seizures
1. Medical causes of anxiety: hyperthyroidism, hypoglycemia, pheochromocytoma, asthma/COPD, cardiac arrhythmias,
seizure disorders.
2. Always rule out organic causes before diagnosing primary anxiety disorder.p>3. Medication-induced anxiety:
steroids, bronchodilators, stimulants (amphetamines, caffeine).
10. What are the signs of serotonin syndrome?
Correct Answer: Muscle spasm (rigidity), fever, increased heart rate (tachycardia), confusion
1. Serotonin syndrome triad: altered mental status, autonomic instability, neuromuscular excitation.
2. Common triggers: combining multiple serotonergic drugs (SSRI + MAOI, SSRI + tramadol, SSRI + linezolid).
3. Treatment: discontinue causative agents, supportive care, cyproheptadine for severe cases.
11. What is a contraindication for clonazepam?
Correct Answer: Renal dysfunction (clonazepam is renally cleared; caution/avoid)
1. Clonazepam metabolized in liver but significant renal excretion; accumulation in renal impairment.
2. Benzodiazepines not metabolized in liver (LOT = Lorazepam, Oxazepam, Temazepam) are safer in liver disease.p>3.
Avoid in myasthenia gravis, severe respiratory insufficiency, narrow-angle glaucoma.
12. What are the risks of barbiturates?
Correct Answer: Lethal in overdose, withdrawal, and abuse. Bind to GABA-A receptors, increasing duration of
chloride channel opening (reducing neuronal excitability).
1. Barbiturates have low therapeutic index; respiratory depression in overdose (can be fatal).
2. Withdrawal can cause seizures, delirium, death (unlike benzodiazepines but still serious).p>3. Rarely used now except
for seizure disorders, anesthesia, and assisted dying.
13. What are examples of short, intermediate, and long-acting benzodiazepines?
Correct Answer: Short (TOMA): Temazepam, Oxazepam, Midazolam, Alprazolam. Intermediate (CETL): Clonazepam,
Estazolam, Temazepam?, Lorazepam. Long (DC²F): Diazepam, Chlordiazepoxide, Clorazepate, Flurazepam.
1. Short-acting (10-20 hr half-life): Alprazolam, midazolam, oxazepam.
2. Intermediate (20-40 hr): Lorazepam, clonazepam, estazolam.
3. Long-acting (>40 hr): Diazepam, chlordiazepoxide, clorazepate (active metabolites → accumulation).
14. What are the neurotransmitter profiles in anxiety disorders?
Correct Answer: Norepinephrine – Increased; Serotonin – Decreased; GABA – Decreased
1. Anxiety associated with increased noradrenergic activity (locus ceruleus).
2. Serotonin dysfunction (both decreased and increased depending on region).
3. GABAergic deficit → decreased inhibitory tone (GABA facilitates chloride influx → hyperpolarization).
Dissociative Disorders, Anxiety, & Psychopharmacology | Q&A | Grade A |
100% Correct (Verified Answers) – Nursing Program
Subject: NSG 552 – Advanced Psychiatric-Mental Health Nursing
Source: NSG 552 Exam 2 Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. Which disorder has physical symptoms presenting for 6+ months where patients believe they are ill and
do not intentionally produce symptoms?
Correct Answer: Somatic symptom disorder
1. DSM-5 criteria: one or more somatic symptoms causing distress/disruption, excessive thoughts/behaviors, and
duration ≥6 months.
2. Symptoms are not feigned (unlike factitious disorder).
3. Treatment: regular PCP visits, CBT, gradual addressing of psychological issues.
2. How is factitious disorder treated?
Correct Answer: Confront in a non-threatening manner; collaborate with PCP
1. Factitious disorder = falsifying symptoms to assume sick role without external reward (unlike malingering).p>2.
Avoid direct accusation; confront gently (e.g., "The symptoms don't match expected patterns").
3. Coordinate care among providers to reduce unnecessary procedures.
3. What are the sedating antidepressants (mnemonic D.A.M.T.)?
Correct Answer: Doxepin, Amitriptyline, Mirtazapine, Trazodone
1. Sedating antidepressants are used when insomnia is prominent or when activating effects are undesirable.
2. Trazodone is commonly used off-label for insomnia at lower doses (50-100 mg).
3. Doxepin and amitriptyline are tricyclics with significant anticholinergic effects.
4. What are the activating antidepressants (mnemonic D.A.V.F.)?
Correct Answer: Duloxetine, Atomoxetine, Venlafaxine, Fluoxetine
1. Activating antidepressants are best given in the morning to avoid insomnia.
2. Fluoxetine has the longest half-life among SSRIs (2-4 days).
3. SNRIs (duloxetine, venlafaxine) can also be activating.
5. Which disorder involves falsifying physical or psychological signs/symptoms to assume a sick role, with
absence of external reward, often leading to long hospitalizations?
Correct Answer: Factitious disorder
1. Munchausen syndrome = factitious disorder (chronic, severe form).p>2. Differentiated from malingering (external
incentive like disability, litigation, opioids).p>3. Factitious disorder imposed on another (Munchausen by proxy) is child
abuse.
6. What is the treatment for illness anxiety disorder?
Correct Answer: SSRIs, see PCP regularly, CBT
1. Illness anxiety disorder = health anxiety/hypochondriasis (preoccupation with having serious illness despite mild/no
somatic symptoms).p>2. Avoid excessive testing (reinforces anxiety). Regular PCP visits (e.g., every 4-6 weeks) provide
reassurance without over-testing.
3. CBT addresses catastrophic misinterpretation of bodily sensations.
, 7. What is the treatment for somatic symptom disorder?
Correct Answer: See PCP regularly, address psychological issues gradually
1. Focus on symptom management, not cure. Validate distress while avoiding unnecessary procedures.
2. Schedule brief regular visits (e.g., monthly) to reduce urgent care/ED use.p3. CBT, mindfulness, and graded exposure
for severe cases.
8. What is "la belle indifférence"?
Correct Answer: Conversion disorder (neurological symptoms without explanation)
1. "Beautiful indifference" = lack of concern about seemingly severe neurological deficits (e.g., paralysis, blindness).
2. Not pathognomonic (some patients with organic lesions also show indifference).p>3. Treatment: physical therapy +
psychotherapy.
9. What are generic medical conditions that may precipitate anxiety?
Correct Answer: COPD, diabetes mellitus, thyroid disease, seizures
1. Medical causes of anxiety: hyperthyroidism, hypoglycemia, pheochromocytoma, asthma/COPD, cardiac arrhythmias,
seizure disorders.
2. Always rule out organic causes before diagnosing primary anxiety disorder.p>3. Medication-induced anxiety:
steroids, bronchodilators, stimulants (amphetamines, caffeine).
10. What are the signs of serotonin syndrome?
Correct Answer: Muscle spasm (rigidity), fever, increased heart rate (tachycardia), confusion
1. Serotonin syndrome triad: altered mental status, autonomic instability, neuromuscular excitation.
2. Common triggers: combining multiple serotonergic drugs (SSRI + MAOI, SSRI + tramadol, SSRI + linezolid).
3. Treatment: discontinue causative agents, supportive care, cyproheptadine for severe cases.
11. What is a contraindication for clonazepam?
Correct Answer: Renal dysfunction (clonazepam is renally cleared; caution/avoid)
1. Clonazepam metabolized in liver but significant renal excretion; accumulation in renal impairment.
2. Benzodiazepines not metabolized in liver (LOT = Lorazepam, Oxazepam, Temazepam) are safer in liver disease.p>3.
Avoid in myasthenia gravis, severe respiratory insufficiency, narrow-angle glaucoma.
12. What are the risks of barbiturates?
Correct Answer: Lethal in overdose, withdrawal, and abuse. Bind to GABA-A receptors, increasing duration of
chloride channel opening (reducing neuronal excitability).
1. Barbiturates have low therapeutic index; respiratory depression in overdose (can be fatal).
2. Withdrawal can cause seizures, delirium, death (unlike benzodiazepines but still serious).p>3. Rarely used now except
for seizure disorders, anesthesia, and assisted dying.
13. What are examples of short, intermediate, and long-acting benzodiazepines?
Correct Answer: Short (TOMA): Temazepam, Oxazepam, Midazolam, Alprazolam. Intermediate (CETL): Clonazepam,
Estazolam, Temazepam?, Lorazepam. Long (DC²F): Diazepam, Chlordiazepoxide, Clorazepate, Flurazepam.
1. Short-acting (10-20 hr half-life): Alprazolam, midazolam, oxazepam.
2. Intermediate (20-40 hr): Lorazepam, clonazepam, estazolam.
3. Long-acting (>40 hr): Diazepam, chlordiazepoxide, clorazepate (active metabolites → accumulation).
14. What are the neurotransmitter profiles in anxiety disorders?
Correct Answer: Norepinephrine – Increased; Serotonin – Decreased; GABA – Decreased
1. Anxiety associated with increased noradrenergic activity (locus ceruleus).
2. Serotonin dysfunction (both decreased and increased depending on region).
3. GABAergic deficit → decreased inhibitory tone (GABA facilitates chloride influx → hyperpolarization).
