ANCC IQ domain 3 Diagnosis and Treatment| Questions and Answers with Rationale Graded A+| Latest 2022/2023

ANCC IQ domain 3: - Diagnosis and Treatment 1. You have a 16-year-old patient who suffers from Binge Eating Disorder. She is 5 foot 10 inches tall (70 inches) and has a BMI of 30. You consult the National Guideline Clearing house for the best information on treating the patient. Part of your treatment plan includes: - Implementing non-diet health at every size therapy in addition to psychotherapy to help with weight stabilization and binge eating. - Urine specific gravity, orthostatic vital signs, and oral temperatures taken on a regular basis. - Use of Sibutramine (Meridia) 10 mg PO QAM and a reduced calorie diet. It is associated with significant weight loss. - Treatment with Duloxetine (Cymbalta) long-term at low dose and a reduced calorie diet. It is associated with significant weight loss. - Implementing non-diet health at every size therapy in addition to psychotherapy to help with weight stabilization and binge eating. Rationale: Non-diet health refers to therapy that looks at eating a healthy diet at the weight yo are currently occupying. It does not use restriction dieting to reduce weight but rather seeks to teach good food habits and normal eating at the weight the patient occupies. Sibutramine was voluntarily removed from the US formulary due to cardiac problems in 2010. Checking urine specific gravity is a treatment of Bulimia Nervosa due to electrolyte problems with constant vomiting. SSRIs are used in high dosage for short timeframes in the treatment of binge eating disorder and are a level 2 guideline. 2. In distinguishing HIV-related depression from HIV dementia, which of the following findings would be indicative of HIV dementia? - Incoordination - Decreased motivation - Apathy and inertia - Diminished attention and concentration - Incoordination Rationale: Acquires abnormality in motor function verified by clinical examination (e.g. slowed rapid movements, abnormal gait, incoordination, hyperreflexia, hypertonia, or weakness) is indicative of HIV dementia but not HIV-related depression. Apathy, inertia, decreased motivation, and diminished attention and concentration are clinical symptoms that can be present in bot depression and dementia. 3. Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety. Sally's only other medical condition is exercise-induced asthma, and she is treated on Albuterol. Sally states she was in cognitive behavioral therapy (CBT), without relief, and would like to try a medication. Which is the most suitable initial treatment for Sally? - Risperidone (Risperdal) - Inderal (Propranolol) - Clonazepam (Klonopin) - Sertraline (Zoloft) - Sertraline (Zoloft) Rationale: Zoloft is used to treat social anxiety disorder and the patient is on Albuterol; therefore, the beta blocker Inderal is contraindicated with Albuterol due to the risk of increased CNS stimulation. 4. A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg PO QD for the past 16 months, presents to the PMHNP for an outpatient follow-up visit. During the visit, the patient states that she has not been feeling well, reporting the flu. She also states that she has not taken her medication in the last five days. Which of the following symptoms would she be describing if you suspect selective serotonin reuptake inhibitors (SSRIs) discontinuation syndrome? - Agitation, nausea, dysphoria, and disequilibrium - Restlessness, tremor, fever, and shivering - Restlessness, headache, increased heart rate, and diarrhea - Agitation, diaphoresis, tremor, and ataxia - Agitation, nausea, dysphoria, and disequilibrium Rationale: The patient has SSRI discontinuation syndrome and would be presenting with flu-like symptoms. If the patient had serotonin syndrome, she would present with symptoms of autonomic instability. 5. When evaluating a 5-year-old child with language deficits, which of the following is a key indicator in differentiating autistic disorder from a mixed receptive-expressive language disorder? - Family history of speech delay or language problems - Imaginative play is predominant form of expression. - Level of intelligence ranges from mild to severe impairment. - Language abnormalities such as echolalia are common. - Language abnormalities such as echolalia are common. Rationale: Language abnormalities sch as echolalia and stereotyped phrases out of context are more common in autistic disorders and are infrequent in mixed receptive-expressive language disorders. In both disorders 25% of cases have a family history of speech delays or language problems. Intelligence levels for both disorders can range from mild to severe, although in autistic disorders more severe impairment occurs more often. Imaginative play is usually present in the mixed receptive-expressive language disorder and either absent or rudimentary in autism spectrum disorders; it is not the predominant form of expression for either disorder. 6. Risk reduction for a 22-year-old patient with schizophrenia taking olanzapine includes patient education on daily exercise, balanced nutrition, and baseline and periodic monitoring of BP, weight, BMI, and: - Waist circumference, fasting glucose, fasting lipid panel - Waist circumference, fasting lipid panel, EKG, prolactin level - Fasting lipid panel, EKG, liver enzymes - Fasting glucose, fasting lipid panel, electrolytes - Waist circumference, fasting glucose, fasting lipid panel Rationale: All atypical antipsychotics pose risk for weight gain which requires baseline and periodic monitoring every month for 3 months, then quarterly for BP, weight, BMI, waist circumference, fasting glucose, and fasting lipid panel. In patients with diabetes or who have gained 5% of initial weight, measures are taken more frequently. Monitoring key indicators is intended to reduce the risk of medication-induced weight gain, metabolic syndrome, dyslipidemia, and diabetes mellitus. 7. In distinguishing between dementia and pseudodementia, which of the following findings would be expected in a patient with pseudodementia? - [Show less]