1. A 76 year-old depressed patient is started on an SSRI. When should another
antidepressant be tried if there is no response?
- 8-12 weeks
Most
... [Show More] 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.
2. Which patient is most likely to exhibit depression related to his illness? A
patient with:
- 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.
3. A patient with an eating disorder may concomitantly exhibit:
- 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.
4. Which criterion below is a criterion for Alzheimer's Disease?
- 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.
5. 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?
- 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.
6. A 69 year-old female patient reports feelings of anhedonia for the last
month. What should be part of the nurse practitioner's assessment?
- 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.
7. A 70 year-old male patient has an elevated MCV with an anemia. His
triglycerides are 420. What should be suspected?
- 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.
8. Which symptom listed below is typical of depression?
- 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.
9. Delirium differs from dementia because delirium:
- 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.
10.Which screen for alcohol abuse has been validated in the elderly?
- 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. [Show Less]