APEA EXAM zm
Exam Solution zm
Psychosocial/Psych 2026 A+ GRADE ASSURED COMPLE zm zm zm zm zm
TE SOLUTIONS AND VERIFIED ANSWERS (87A58)
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QUESTION 1 zm
A 76 year-
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old depressed patient is started on an SSRI. When should another antidepressant be t
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ried if there is no response?
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ANSWER
8-12 weeks Most learned authorities agree that if there is no response by 8-
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12 weeks at a maximal therapeutic dose, a different antidepressant should be tried. The 8-
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12 week period is the correct time frame because it will take this long to increase the dose and att
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empt to reach maximal dose for therapeutic response. 4-
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6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach
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and evaluate therapeutic dose.
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QUESTION 2 zm
Which patient is most likely to exhibit depression related to his illness? A patient wit
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h:
ANSWER
Parkinson's disease Diseases associated with the central nervous system are associated with high rat
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es of depression. These include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other il
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lnesses associated with high rates of depression are cancer and cardiovascular illnesses like myocard
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ial infarction. Depression worsens the outcome of any physical illness.
zm zm zm zm zm zm zm zm zm
QUESTION 3 zm
A patient with an eating disorder may concomitantly exhibit:
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ANSWER
Anxiety disorders Affective disorders, anxiety disorders, and substance abuse issues are common in
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patients who have eating disorders. Obsessive-
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compulsive disorder is also commonly observed. Patients with eating disorders are more likely to ha
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,ve a first or second degree relative with an eating disorder, affective disorder, or alcohol abuse. The
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re is no evidence that patients with eating disorders exhibit a higher incidence of sleep disorders or
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mliver disease. Thyroid disease should always be assessed in patients with eating disorders, but this
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
does not represent the reason for weight loss when eating disorder is present.
zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 4 zm
Which criterion below is a criterion for Alzheimer's Disease?
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ANSWER
Impairment of executive function The diagnostic criteria for Alzheimer's disease (AD) was establishe
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d by DSM V and other organizations. The criteria are similar. Criteria include a gradual onset of cog
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nitive decline. A rapid onset usually indicates another etiology, perhaps, delirium. Other criteria inclu
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de impairment of recent memory, difficulty with language or finding words, the inability to execute
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
skilled motor activities, disturbances of visual processing or disturbances in executive function that i
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ncludes abstract reasoning and concentration. Focal neurologic signs are consistent with a vascular d
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ementia. Radiologic evidence is not a criterion for diagnosis, though it may support the diagnosis of
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AD. There is no laboratory evidence of AD.
zm zm zm zm zm zm zm
QUESTION 5 zm
An 80 year old adult has begun to use over the counter diphenhydramine to help him
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fall asleep. What common side effect can occur in older adults with use of this medic
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ation?
ANSWER
Next day sleepiness Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits
zm zm zm zm zm zm zm zm zm zm zm zm
potent anti- zm
cholinergic effects in patients who take this, but especially in older adults. Urinary retention is com
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
mon (not incontinence) in older men with benign prostatic hyperplasia, but retention occurs in wom
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
en too. Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect i
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
s cognitive impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying si
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de effects like dry mouth and constipation.
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QUESTION 6 zm
A 69 year-
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old female patient reports feelings of anhedonia for the last month. What should be p
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art of the nurse practitioner's assessment?
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ANSWER
Depression Anhedonia is the loss of pleasure or interest in things that have always brought pleasure
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
or interest. If this is the case, this patient should be screened for depression. Anhedonia is a red fla
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g for depression.
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, QUESTION 7 zm
A 70 year-
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old male patient has an elevated MCV with an anemia. His triglycerides are 420. What
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should be suspected?
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ANSWER
Alcohol abuse This patient has an elevated mean corpuscular volume. This indicates a macrocytic an
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emia. Common macrocytic anemias are B12 deficiency and folate deficiency. These are common in ol
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
der patients, especially if they consume large quantities of alcohol. This patient also has elevated tri
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
glycerides. Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydr
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ates. This patient's history indicates two elements that indicate alcohol abuse. He should be question
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ed regarding alcohol abuse.
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QUESTION 8 zm
Which symptom listed below is typical of depression?
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ANSWER
Early morning wakening Sleep difficulty is a common complaint among patients with depression. Pat
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ients with difficulty falling asleep are often anxious. Frequent waking and early morning wakening a
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re often complaints by patients with depression. There is no agreed on physiologic explanation, but,
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this is a common symptom.
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QUESTION 9 zm
Delirium differs from dementia because delirium:
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ANSWER
often develops acutely Delirium is a change in consciousness or cognition. It may be accompanied b
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y a physical diagnosis like urinary tract infection; or it may be due to consumption of a medication.
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Regardless, a change in cognition or consciousness needs immediate evaluation. The evaluation shoul
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d include a medication review, physical exam and laboratory evaluation, and mental status exam.
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QUESTION 10 zm
Which screen for alcohol abuse has been validated in the elderly?
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ANSWER
CAGE CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands f
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
or "have you ever felt you should CUT down" your alcohol consumption. The A stands for " does ot
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
her's criticism of your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinkin
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g". The E stands for "have you ever had an EYE opener to steady your nerves or get rid of a hango
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ver". A positive response on any question constitutes a positive screen.
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Exam Solution zm
Psychosocial/Psych 2026 A+ GRADE ASSURED COMPLE zm zm zm zm zm
TE SOLUTIONS AND VERIFIED ANSWERS (87A58)
zm zm zm zm zm
QUESTION 1 zm
A 76 year-
zm zm
old depressed patient is started on an SSRI. When should another antidepressant be t
zm zm zm zm zm zm zm zm zm zm zm zm zm
ried if there is no response?
zm zm zm zm zm
ANSWER
8-12 weeks Most learned authorities agree that if there is no response by 8-
zm zm zm zm zm zm zm zm zm zm zm zm zm
12 weeks at a maximal therapeutic dose, a different antidepressant should be tried. The 8-
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
12 week period is the correct time frame because it will take this long to increase the dose and att
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
empt to reach maximal dose for therapeutic response. 4-
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6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
and evaluate therapeutic dose.
zm zm zm
QUESTION 2 zm
Which patient is most likely to exhibit depression related to his illness? A patient wit
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
h:
ANSWER
Parkinson's disease Diseases associated with the central nervous system are associated with high rat
zm zm zm zm zm zm zm zm zm zm zm zm zm
es of depression. These include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other il
zm zm zm zm zm zm zm zm zm zm zm zm zm
lnesses associated with high rates of depression are cancer and cardiovascular illnesses like myocard
zm zm zm zm zm zm zm zm zm zm zm zm zm
ial infarction. Depression worsens the outcome of any physical illness.
zm zm zm zm zm zm zm zm zm
QUESTION 3 zm
A patient with an eating disorder may concomitantly exhibit:
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ANSWER
Anxiety disorders Affective disorders, anxiety disorders, and substance abuse issues are common in
zm zm zm zm zm zm zm zm zm zm zm zm zm
patients who have eating disorders. Obsessive-
zm zm zm zm zm
compulsive disorder is also commonly observed. Patients with eating disorders are more likely to ha
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
,ve a first or second degree relative with an eating disorder, affective disorder, or alcohol abuse. The
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
re is no evidence that patients with eating disorders exhibit a higher incidence of sleep disorders or
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm z
mliver disease. Thyroid disease should always be assessed in patients with eating disorders, but this
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
does not represent the reason for weight loss when eating disorder is present.
zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 4 zm
Which criterion below is a criterion for Alzheimer's Disease?
zm zm zm zm zm zm zm zm
ANSWER
Impairment of executive function The diagnostic criteria for Alzheimer's disease (AD) was establishe
zm zm zm zm zm zm zm zm zm zm zm zm
d by DSM V and other organizations. The criteria are similar. Criteria include a gradual onset of cog
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
nitive decline. A rapid onset usually indicates another etiology, perhaps, delirium. Other criteria inclu
zm zm zm zm zm zm zm zm zm zm zm zm zm
de impairment of recent memory, difficulty with language or finding words, the inability to execute
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
skilled motor activities, disturbances of visual processing or disturbances in executive function that i
zm zm zm zm zm zm zm zm zm zm zm zm zm
ncludes abstract reasoning and concentration. Focal neurologic signs are consistent with a vascular d
zm zm zm zm zm zm zm zm zm zm zm zm zm
ementia. Radiologic evidence is not a criterion for diagnosis, though it may support the diagnosis of
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AD. There is no laboratory evidence of AD.
zm zm zm zm zm zm zm
QUESTION 5 zm
An 80 year old adult has begun to use over the counter diphenhydramine to help him
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm z
fall asleep. What common side effect can occur in older adults with use of this medic
m zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
ation?
ANSWER
Next day sleepiness Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits
zm zm zm zm zm zm zm zm zm zm zm zm
potent anti- zm
cholinergic effects in patients who take this, but especially in older adults. Urinary retention is com
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
mon (not incontinence) in older men with benign prostatic hyperplasia, but retention occurs in wom
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
en too. Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect i
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
s cognitive impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying si
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
de effects like dry mouth and constipation.
zm zm zm zm zm zm
QUESTION 6 zm
A 69 year-
zm zm
old female patient reports feelings of anhedonia for the last month. What should be p
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
art of the nurse practitioner's assessment?
zm zm zm zm zm
ANSWER
Depression Anhedonia is the loss of pleasure or interest in things that have always brought pleasure
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
or interest. If this is the case, this patient should be screened for depression. Anhedonia is a red fla
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g for depression.
zm zm
, QUESTION 7 zm
A 70 year-
zm zm
old male patient has an elevated MCV with an anemia. His triglycerides are 420. What
zm zm zm zm zm zm zm zm zm zm zm zm zm zm z
should be suspected?
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ANSWER
Alcohol abuse This patient has an elevated mean corpuscular volume. This indicates a macrocytic an
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
emia. Common macrocytic anemias are B12 deficiency and folate deficiency. These are common in ol
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
der patients, especially if they consume large quantities of alcohol. This patient also has elevated tri
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
glycerides. Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydr
zm zm zm zm zm zm zm zm zm zm zm zm
ates. This patient's history indicates two elements that indicate alcohol abuse. He should be question
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
ed regarding alcohol abuse.
zm zm zm
QUESTION 8 zm
Which symptom listed below is typical of depression?
zm zm zm zm zm zm zm
ANSWER
Early morning wakening Sleep difficulty is a common complaint among patients with depression. Pat
zm zm zm zm zm zm zm zm zm zm zm zm zm
ients with difficulty falling asleep are often anxious. Frequent waking and early morning wakening a
zm zm zm zm zm zm zm zm zm zm zm zm zm zm
re often complaints by patients with depression. There is no agreed on physiologic explanation, but,
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this is a common symptom.
zm zm zm zm
QUESTION 9 zm
Delirium differs from dementia because delirium:
zm zm zm zm zm
ANSWER
often develops acutely Delirium is a change in consciousness or cognition. It may be accompanied b
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
y a physical diagnosis like urinary tract infection; or it may be due to consumption of a medication.
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
Regardless, a change in cognition or consciousness needs immediate evaluation. The evaluation shoul
zm zm zm zm zm zm zm zm zm zm zm zm
d include a medication review, physical exam and laboratory evaluation, and mental status exam.
zm zm zm zm zm zm zm zm zm zm zm zm zm
QUESTION 10 zm
Which screen for alcohol abuse has been validated in the elderly?
zm zm zm zm zm zm zm zm zm zm
ANSWER
CAGE CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands f
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
or "have you ever felt you should CUT down" your alcohol consumption. The A stands for " does ot
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
her's criticism of your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinkin
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
g". The E stands for "have you ever had an EYE opener to steady your nerves or get rid of a hango
zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm zm
ver". A positive response on any question constitutes a positive screen.
zm zm zm zm zm zm zm zm zm zm
