Psychosocial/Psych questions and answeres latest 2022
A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if
there is no response? Correct Answer: 8-12 weeks
Most learned authorities agree that if there is no response by 8-12 weeks at a maximal therapeutic
dose, a different antidepressant should be tried. The 8-12 week period is the correct time frame because
it will take this long to increase the dose and attempt to reach maximal dose for therapeutic response.
4-6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach and
evaluate therapeutic dose.
Which patient is most likely to exhibit depression related to his illness? A patient with: Correct Answer:
Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of depression. These
include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other illnesses associated with
high rates of depression are cancer and cardiovascular illnesses like myocardial infarction. Depression
worsens the outcome of any physical illness.
A patient with an eating disorder may concomitantly exhibit: Correct Answer: Anxiety disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in patients who have
eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with eating
disorders are more likely to have a first or second degree relative with an eating disorder, affective
disorder, or alcohol abuse. There is no evidence that patients with eating disorders exhibit a higher
incidence of sleep disorders or liver disease. Thyroid disease should always be assessed in patients with
eating disorders, but this does not represent the reason for weight loss when eating disorder is present.
Which criterion below is a criterion for Alzheimer's Disease? Correct Answer: Impairment of executive
function
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other organizations.
The criteria are similar. Criteria include a gradual onset of cognitive decline. A rapid onset usually
indicates another etiology, perhaps, delirium. Other criteria include impairment of recent memory,
difficulty with language or finding words, the inability to execute skilled motor activities, disturbances of
visual processing or disturbances in executive function that includes abstract reasoning and
concentration. Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is not
a criterion for diagnosis, though it may support the diagnosis of AD. There is no laboratory evidence of
AD.
An 80 year old adult has begun to use over the counter diphenhydramine to help him fall asleep. What
common side effect can occur in older adults with use of this medication? Correct Answer: Next day
sleepiness
Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-cholinergic
effects in patients who take this, but especially in older adults. Urinary retention is common (not
incontinence) in older men with benign prostatic hyperplasia, but retention occurs in women too.
, Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect is cognitive
impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying side effects like
dry mouth and constipation.
A 69 year-old female patient reports feelings of anhedonia for the last month. What should be part of
the nurse practitioner's assessment? Correct Answer: Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or interest. If
this is the case, this patient should be screened for depression. Anhedonia is a red flag for depression.
A 70 year-old male patient has an elevated MCV with an anemia. His triglycerides are 420. What should
be suspected? Correct Answer: Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia. Common
macrocytic anemias are B12 deficiency and folate deficiency. These are common in older patients,
especially if they consume large quantities of alcohol. This patient also has elevated triglycerides.
Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydrates. This
patient's history indicates two elements that indicate alcohol abuse. He should be questioned regarding
alcohol abuse.
Which symptom listed below is typical of depression? Correct Answer: Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with difficulty falling
asleep are often anxious. Frequent waking and early morning wakening are often complaints by patients
with depression. There is no agreed on physiologic explanation, but, this is a common symptom.
Delirium differs from dementia because delirium: Correct Answer: often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a physical diagnosis like
urinary tract infection; or it may be due to consumption of a medication. Regardless, a change in
cognition or consciousness needs immediate evaluation. The evaluation should include a medication
review, physical exam and laboratory evaluation, and mental status exam.
Which screen for alcohol abuse has been validated in the elderly? Correct Answer: CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for "have you
ever felt you should CUT down" your alcohol consumption. The A stands for " does other's criticism of
your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinking". The E stands for
"have you ever had an EYE opener to steady your nerves or get rid of a hangover". A positive response
on any question constitutes a positive screen.
MMSE helps to identify patients with symptoms of: Correct Answer: dementia
The mini mental status exam (MMSE) is a very common and easily administered cognitive evaluation for
dementia. It tests orientation, recall, attention, calculation, language manipulation, and constructional
praxis. It is not sensitive for mild dementia and may be influenced by educational level and age. Even
with these limitations, the MMSE is the most widely used cognitive test for dementia in the US.
A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if
there is no response? Correct Answer: 8-12 weeks
Most learned authorities agree that if there is no response by 8-12 weeks at a maximal therapeutic
dose, a different antidepressant should be tried. The 8-12 week period is the correct time frame because
it will take this long to increase the dose and attempt to reach maximal dose for therapeutic response.
4-6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach and
evaluate therapeutic dose.
Which patient is most likely to exhibit depression related to his illness? A patient with: Correct Answer:
Parkinson's disease
Diseases associated with the central nervous system are associated with high rates of depression. These
include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other illnesses associated with
high rates of depression are cancer and cardiovascular illnesses like myocardial infarction. Depression
worsens the outcome of any physical illness.
A patient with an eating disorder may concomitantly exhibit: Correct Answer: Anxiety disorders
Affective disorders, anxiety disorders, and substance abuse issues are common in patients who have
eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with eating
disorders are more likely to have a first or second degree relative with an eating disorder, affective
disorder, or alcohol abuse. There is no evidence that patients with eating disorders exhibit a higher
incidence of sleep disorders or liver disease. Thyroid disease should always be assessed in patients with
eating disorders, but this does not represent the reason for weight loss when eating disorder is present.
Which criterion below is a criterion for Alzheimer's Disease? Correct Answer: Impairment of executive
function
The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other organizations.
The criteria are similar. Criteria include a gradual onset of cognitive decline. A rapid onset usually
indicates another etiology, perhaps, delirium. Other criteria include impairment of recent memory,
difficulty with language or finding words, the inability to execute skilled motor activities, disturbances of
visual processing or disturbances in executive function that includes abstract reasoning and
concentration. Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is not
a criterion for diagnosis, though it may support the diagnosis of AD. There is no laboratory evidence of
AD.
An 80 year old adult has begun to use over the counter diphenhydramine to help him fall asleep. What
common side effect can occur in older adults with use of this medication? Correct Answer: Next day
sleepiness
Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-cholinergic
effects in patients who take this, but especially in older adults. Urinary retention is common (not
incontinence) in older men with benign prostatic hyperplasia, but retention occurs in women too.
, Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect is cognitive
impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying side effects like
dry mouth and constipation.
A 69 year-old female patient reports feelings of anhedonia for the last month. What should be part of
the nurse practitioner's assessment? Correct Answer: Depression
Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or interest. If
this is the case, this patient should be screened for depression. Anhedonia is a red flag for depression.
A 70 year-old male patient has an elevated MCV with an anemia. His triglycerides are 420. What should
be suspected? Correct Answer: Alcohol abuse
This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia. Common
macrocytic anemias are B12 deficiency and folate deficiency. These are common in older patients,
especially if they consume large quantities of alcohol. This patient also has elevated triglycerides.
Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydrates. This
patient's history indicates two elements that indicate alcohol abuse. He should be questioned regarding
alcohol abuse.
Which symptom listed below is typical of depression? Correct Answer: Early morning wakening
Sleep difficulty is a common complaint among patients with depression. Patients with difficulty falling
asleep are often anxious. Frequent waking and early morning wakening are often complaints by patients
with depression. There is no agreed on physiologic explanation, but, this is a common symptom.
Delirium differs from dementia because delirium: Correct Answer: often develops acutely
Delirium is a change in consciousness or cognition. It may be accompanied by a physical diagnosis like
urinary tract infection; or it may be due to consumption of a medication. Regardless, a change in
cognition or consciousness needs immediate evaluation. The evaluation should include a medication
review, physical exam and laboratory evaluation, and mental status exam.
Which screen for alcohol abuse has been validated in the elderly? Correct Answer: CAGE
CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for "have you
ever felt you should CUT down" your alcohol consumption. The A stands for " does other's criticism of
your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinking". The E stands for
"have you ever had an EYE opener to steady your nerves or get rid of a hangover". A positive response
on any question constitutes a positive screen.
MMSE helps to identify patients with symptoms of: Correct Answer: dementia
The mini mental status exam (MMSE) is a very common and easily administered cognitive evaluation for
dementia. It tests orientation, recall, attention, calculation, language manipulation, and constructional
praxis. It is not sensitive for mild dementia and may be influenced by educational level and age. Even
with these limitations, the MMSE is the most widely used cognitive test for dementia in the US.
