Anxiety Disorders

Question 1

Anxiety Disorders

Answer 1

Most common group of mental disorders (1/3 of population affected)

Question 2

Anxiety Disorder Presentation

Answer 2

Complaint of worry, fear, anxiety, numerous physical complaints

Question 3

General Anxiety Disorder

Answer 3

characterized by excessive anxiety and worry about a number of events or activities.
The anxiety and worry are associated with three or more of the following six symptoms: (1) restlessness or feeling on edge, (2) easy fatigability, (3) difficulty concentrating, (4) irritability, (5) muscle tension, (6) sleep disturbance

Question 4

Panic Disorder

Answer 4

Recurrent unexpected panic attacks which are abrupt surges of intense fear or discomfort that peaks within minutes.

Must have 4 of the 13 symptoms and some persistent worry or change in behavior (avoidance)

Can’t also be due to a medication or other cause

Question 5

OCD

Answer 5

Obsessions - recurrent thoughts, urges, or images that are intrusive or unwanted

Compulsions - repetitive behaviors or acts that the individual feels complelled to complete to lessen the obsessions or anxiety

Question 6

GAD Age Differences

Answer 6

Children tend to have performance-focused anxiety and worry

Adults tend to have physical health or family well-being

Question 7

Anxiety Differentials

Answer 7

Always rule out / test for underlying cardiac, respiratory, endocrine, and medication side effects

Question 8

Anxiety Disorder Treatments

Answer 8

CBT is effective
Exercise is not specifically helpful, but good for overall health
Pharmacological treatment can be effective

Question 9

SSRI/SNRI

Answer 9

Effective in Anxiety Disorders
Meds may take up to 6 weeks for effect (family / friends notice improvements first)
Warn patients of withdrawal effects and the adverse effects which are most often worst in first two weeks

Question 10

Adjusting SSRI/SNRI

Answer 10

If not effective in 4-6 weeks, may try another agent or refer to specialist

Increasing the dose may be an option if there has been some therapeutic effect, but not as much as desired

Question 11

Benzodiazepines

Answer 11

Effective to acute management, especially for panic attacks

high risk of falls, etc. with elderly

Question 12

Serotonin Syndrome

Answer 12

mental status changes, autonomic instability, and neuromuscular changes, a potentially life-threatening side effect of SSRIs and SNRIs.

Question 13

Busiprone

Answer 13

Only for GAD.

Can worsen depression and since depression is often co-morbid with many anxiety disorders this is not recommended

Question 14

TCAs

Answer 14

Only used if other agents don’t work

Question 15

Phobia

Answer 15

Irrational fear that affects ability or daily routine / tasks / social life
Excessive worry or avoidance is the key to phobia v. normal fear
Usually divided broadly into fear of animals, environment, blood/needles. situation, or Other

Fear of a snake is normal, avoiding a friend’s house because they own a snake is phobia

Question 16

Social Phobia

Answer 16

Fear of being embarrassed, or judged by others

Question 17

A 65-year-old patient is being assessed by an advanced practice registered nurse (APRN) for complaints of redness and swelling in the joint of the left big toe. The patient indicates the condition is painful and seems to be getting worse. Lab results indicate a serum urate level of 7.5 mg/dL.

Which recommendation should the APRN make for this patient?

Acetaminophen

Calcium citrate

Tetracycline

Febuzostat

Answer 17

Febuxostat should be prescribed because it lowers serum urate. Acetaminophen would not be indicated due to the patients age

Question 18

A patient is being examined by an advanced practice registered nurse (APRN) for a follow-up appointment for lupus, a diagnosis that was received five years earlier.

Which routine lab test should the APRN order for this patient?

Sputum culture

Urinalysis

Blood sugar

Blood cultures

Answer 18

Correct! A urinalysis should always be obtained during follow-up visits because lupus nephritis can develop in patients without previous kidney involvement. A positive urinalysis would show proteinuria, cellular casts, and red blood cells in the urine sediment.

Question 19

A patient presents to a clinic for a three-month recheck for the diagnosis of Bell palsy. The advanced practice registered nurse (APRN) notes that paralysis remains on the affected side of the face, and the patient has tinnitus. The APRN determines the cranial nerve VII and internal auditory canal must be viewed before providing further treatment.

Which diagnostic test should the APRN order?
Electromyography (EMG)
Ultrasonography (US)
Magnetic resonance imaging (MRI)
Computed tomography (CT)

Answer 19

Correct! Magnetic resonance imaging (MRI) is the most optimal test to view the internal auditory canal and the cranial nerve VII. Paralysis lasting three months would warrant an MRI being ordered, with and without contrast, as there could be permanent damage to the auditory nerve.

Question 20

A patient presents to the emergency department with a history of being discharged from the hospital one week earlier with a diagnosis of basilar fracture. Since yesterday, the patient has been sleeping more than usual and today has a severe headache with nausea and vomiting. The advanced practice registered nurse (APRN) assesses meningismus, positive Kernig and Brudzinski signs, and sluggish pupillary response. Other clinical findings include the following:
temperature: 101.3°F (38.5°C) orally
blood pressure: 168/92
apical: 52

Which should the APRN initially recommend to assist this patient?
Intravenous immune globulin
Broad-spectrum antibiotics
Lumbar puncture
Magnetic resonance imaging (MRI)

Answer 20

LP is contraindicated due to signs of increased ICP. Broad spectrum antibiotics is the best treatment.

Question 21

A female with a metabolic disorder is being evaluated by the advanced practice registered nurse (APRN) with symptoms of a chronic urinary tract infection. The urinalysis was positive for bacteria in the urine. The patient is reporting pain in the suprapubic region as well as pain upon urination.
Which treatment should the APRN recommend?

Phenazopyridine 100 to 200 mg TID for two to three days
Fosfomycin pwd 3 g mixed with 30cc saline and applied to the suprapubic region TID for five days
Xylocaine jelly two-inch strip applied to the suprapubic region up to five times per day
Ciprofloxacin 100 mg bid for two to three days

Answer 21

Phenazopyridine (Pyridium) 100 to 200 mg TID for two to three days is the recommended pharmacotherapy for pain associated with a urinary tract infection. The other three answers are not correct in either dose, application, or duration

Question 22

A patient presents to the emergency department with a sudden nosebleed. The advanced practice registered nurse (APRN) examination reveals bilateral ecchymosis, pallor of the skin and mucous membranes, and petechiae on the upper chest. A complete blood count reveals a platelet count of 18,000/µL and an absolute neutrophil count (ANC) of 400/µL.

Which form of anemia should the APRN diagnose for this patient?
Aplastic
Normocytic
Megaloblastic
Hemolytic

Answer 22

Aplastic anemia is a condition resulting from bone marrow stem cell failure. This patient has a low platelet count, a low neutrophil count, and evidence of a low white blood cell count representing pancytopenia, a key characteristic of aplastic anemia.

Question 23

A 46-year-old patient is being seen in the clinic by the advanced practice registered nurse (APRN). The patient presents with symptoms of malaise, weight loss, blood pressure 146/98, pulse 88 beats per minute, respiratory rate 24 breaths per minute, temperature of 101.6°F (38.7°C), flank pain, and urinary frequency. Urine dipstick tested positive for blood and leukocyte esterase. Symptoms have been present for the past three days. Ceftriaxone 1000 mg IM was given once. What should be the next-step medication therapy for this patient?

Fosfomycin (Monurol) pwd 3 g for three days
Cephalexin (Daxbia) 125 or 250 mg qd for six to 12 days
Ciprofloxacin (Cetraxal) 500 mg bid for five to seven days
Tamsulosin (Flomax) 0.4 mg qid for ten days

Answer 23

Correct! The symptoms point to acute pyelonephritis. An appropriate medication to follow the one-time ceftriaxone is ciprofloxacin 500 mg bid for five to seven days.

Question 24

A patient is being seen by an advanced practice registered nurse (APRN) for follow-up. The patient has chronic kidney disease, stage 3b, with eGFR 33 ml/min, creatinine 3.2 mg/dl, and Hgb 9.9. The patient complains of fatigue.

Which initial action should the APRN take?

Suggest the use of melatonin
Order physical therapy
Complete an iron study
Request a 24-hour urine collection

Answer 24

Stage 3 CKD need iron studies to determine if supplemental iron is needed.

Question 25

A 58-year-old patient was previously diagnosed with depression by an advanced practice registered nurse (APRN). During a routine visit, the APRN conducts a review of the patient’s medication and notes the patient is taking an antihistamine (Chlorpheniramine), tramadol (ConZip) for chronic pain, and venlafaxine (Effexor XR) to treat depression. During the assessment, the APRN notes that the patient is experiencing alterations in cognition and behavior, autonomic nervous system function, and neuromuscular activity. The patient also complains of a rigid feeling in both legs. The patient’s vital signs are within normal limits.

Which diagnosis should the APRN make for this patient?
Postural orthostatic tachycardia syndrome
Extrapyramidal syndrome
Serotonin syndrome
Klinefelter syndrome

Answer 25

Serotonin syndrome is a group of symptoms that may occur with the use of certain serotonergic medications, such as venlafaxine. These symptoms are associated with alterations in cognition and behavior, autonomic nervous system function, and neuromuscular activity.