Neuropsychiatric Disorders: ADHD, Dementia, Substance Abuse, and Impulsive Compulsions, Exams of Nursing

Download Neuropsychiatric Disorders: ADHD, Dementia, Substance Abuse, and Impulsive Compulsions and more Exams Nursing in PDF only on Docsity! N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . NEI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders. (Test 4) 1. Peter, A 35 year old stockbroker, has been advised by his supervisor to come see you, the company mental health consultant. His supervisor is complaining that he often comes late to appointments, is inappropriately fidgety, interrupts people during meetings, has been offensive towards coworkers and has been known to party excessively on weeknights. Peter asserts that he is just fine; he has a lot of projects on him mind and is simply standing up for himself when speaking with others. He likes to go out in the evenings to unwind. Recognizing probable ADHD, you interview both the patient and his work buddy, who is a long-time friend. How would you start your questions? a) Compared to his parents, how often does the patient…. b) Compared to other people his age, how often does the patient…. c) Compared to his childhood how often does the patient…. d) Compared to his children, how often does the patient…. 2. According to the DSMV criteria, what is the maximum age threshold for symptom onset when making a diagnosis of attention deficit hyperactivity disorder? a) 5 b) 7 c) 12 d) 15 3. A 15-year-old with inattentive-type attention deficit hyperactivity disorder has a hard time staying focused on the task at hand, has trouble organizing her work, and relies heavily on her mother to follow through with her homework. Problem-Solving is one of the hardest tasks for her. Her difficulty with sustained attention could be related to aberrant activation in the: a) Dorsolateral prefrontal cortex b) Prefrontal motor cortex c) Orbital frontal cortex d) Supplementary motor cortex 4. Which of the following is true regarding cortical brain development in children with ADHD compared to healthy controls? A) The pattern (i.e. order) of cortical maturation is different B) The timing of cortical maturation is different C) The pattern and timing of cortical maturation are different N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . D) Neither the pattern nor the timing of the cortical maturation are different. N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 12. The cumulative data on the effects of physical exercise as an adjunctive treatment for children with ADHD have demonstrated potential beneficial effects of: a. Acute aerobic exercise b. Chronic aerobic exercise c. A and B d. Neither A or B 13. A patient with a history of alcohol use disorder has been sober for 6 weeks. He begins medication treatment for adult attention deficit hyperactivity disorder and expierences improvement, but 4 months later relapses with alcohol use disorder, engaging in three- binge-drinking episodes over a 2-week period. Does this patient need to discontinue medication treatment for ADHD? A) Yes he should be switched to non-medication treatment B) Only if he is currently on a long-acting stimulant; non-stimulant medication is acceptable in this scenario. C) No, both long-acting stimulants and non-stimulant medcations are acceptable in this scenario. 14. A 7 year-old boy has just been diagnosed with ADHD, combined type and his care provider feels that the best therapeutic choice is a stimulant. Family history is significant for diabetes and depression. The patient’s medical history is significant for asthma; physical exam reveals no abnormalities. According to current recommendations, what should be the providers next step? a) Prescribe a stimulant, as no additional tests are indicated for this patient b) Obtain an electrocardiogram (ECG), as the patient’s medical history and exam results warrant it c) Obtain an ECG, as this is mandatory prior to prescribing a stimulant to any child d) Prescribe a non-stimulant, as a stimulant would not be appropriate for this patient. N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 15. Mary, a 79-year-old patient, is brought to your office by her daughter, who reports that her mother has been exhibiting several concerning symptoms over the past year. Comprehensive questioning revelas that her symptoms are: trouble remembering familiar things, such as telephone numbers commonly dialed; not recognizing some close family members who visit often; and difficulty performing writing tasks. The patient’s motor function appears to be unaffected. Although not definitive, these symptoms are most likely indicative of which type of dementia? a) Alzheimer’s disease b) Dementia with Lewy bodies c) Hannington’s disease d) Frontotemporal dementia 16. A young man who is pre-med and has a family history of Alzheimer’s disease is interested in learning more about the brain regions that are involved in memory and the development of Alzheimer’s disease. You describe the pathways of acetylcholine, an important neurotransmitter involved in dementia. As part of your explanation, you tell him that major cholinergic projections stem from the to the , which are believed to be involved in memory. a. Basal forebrain; nucleus accumbens b. Basal forebrain; hippocampus c. Striatum; hypothalamus d. Striatum; prefrontal cortex 17. A young woman brings her 72- year-old mother in for an appointment because she is concerned that her mother may have Alzheimer’s disease. The mother does not feel that anything is wrong, but her daughter states that she has seemed somewhat depressed and forgetful lately. Data have shown that: a) Depression is often co-morbid with Alzheimer’s disease b) Depression may increase the risk of developing Alzheimer’s disease c) Depression may be a prodromal symptom of Alzheimer’s disease. d) All of the above e) None of the above N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 18. Thomas is a 54-year-old man with a family history of Alzheimer’s disease. As a voluntary participant in research studies on Alzheimer’s disease, Thomas, recently had amyloid positron emission tomography (amyloid PET) neuroimaging done. Although he currently exhibits no behavioral symptoms of Alzheimer’s disease, Thomas’s amyloid PET scans revealed accumulation of beta amyloid protein throughout cortical and limbic areas of his brain. Although much research is yet to be done, data indicate that the normal physiological role of amyloid beta protein may include: a) Blood vessel repair functions b) Antimicrobial functions c) Both of the above 19. A 68-year-old patient with an early diagnosis of Alzheimer’s disease is put on a cholinesterase inhibitor in hopes of improving his cognitive function. This patient has been a chain smoker for over 40 years and refuses to give up the habit. Which of the following medications would not be appropriate for this patient giving his smoking habit? a) Donepezil b) Galantamine c) Rivastigmine d) None of these medications should be prescribed to a patient who smokes e) There are no contraindications due to smoking for these medications 20. John, a 73-year-old mid-stage Alzheimer’s patient, has been on donepezil 10 mg/day for approximately 8 months to aid in improving his cognitive functioning. His wife has begun to notice a loss of effectiveness over the past month, and they present today to determine a new course of action. You decide to augment John’s donepezil with 5 mg/day of memantine. Which of the following properties of memantine may be useful in treating Alzheimer’s disease? a) Serotonin 3 (5HT3) antagonism b) Sigma antagonism c) N-Methyl-D-Asparte (NMDA) antagonism d) NMDA antagonism at the magnesium site 21. Mildred is a 66-year-old patient. She is currently showing no signs of Alzheimer’s disease but is considering enrolling in one of the ongoing Alzheimer’s disease immunotherapy- based clinical trials (the DIAN-TU and A4 studies). You explain to Mildred that such immunotherapy involves: a) Antibodies that bind to NMDA receptors in the brain N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 29. Impulsivity is hypothesized to be related to the , while compulsivity is hypothesized to be related to the . a) Amygdala, ventral striatum b) Ventral striatum, amygdala c) Dorsal Striatum, Ventral striatum d) Ventral striatum, dorsal striatum 30. 73-year-old Laura has had a history of alcohol abuse. When people age, their sensitivity to alcohol increases, as their tolerance decreases, and alcohol takes longer to be metabolized. Many prescribed medications increase the negative effects of alcohol. Laura was recently prescribed desipramine, a tricyclic antidepressant. What are the adverse effects that Laura should be aware of in combining the prescription medication with alcohol, particularly in the first week of treatment? a) Severe hepatotoxicity with therapeutic doses b) Increased anticoagulant effects c) Combined CNS depression decreases psychomotor performance d) Masked signs of delirium tremens 31. Lisa, who is 13, has been staying up later than usual, complaining that she cannot sleep. Sometimes during the day, she locks herself in her room for hours, only coming out to use the bathroom. Recently, her mother discovered boxes of hidden cereal, chips and cookies in her closet. Her mother suspects that Lisa has an eating disorder, but she is not sure if Lisa is vomiting or not, and her weight appears to be normal. Upon psychiatric evaluation, Lisa has a negative affect, functional impairment, elevated thin- ideal internalization, and body dissatisfaction. She says she is dieting, but that she is not fasting. Which eating disorder is she at high risk for? a) Anorexia nervosa b) Bulimia nervosa c) Binge-eating disorder N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . 32. A 28-year-old painter presents with a severe drinking problem and you affirm the need for pharmacotherapy. When you suggest naltrexone, the curious artist would like to know how this well help. Which might you use as part of your explanation? a) Naltrexone blocks mu-opioid receptors to reduce the euphoria you might normally experience with heavy drinking b) Naltrexone blocks metabotropic glutamate receptors (mGluR) to reduce the euphoria you might normally experience with heavy drinking c) Naltrexone stimulates mu-opioid receptors to the euphoria you might normally experience with heavy drinking d) Naltrexone stimulates the mGLuR receptors to the euphoria you might normally experience with heavy drinking. 33. After seeing a 39-year-old accountant for several years, she has recently disclosed her 10-year prescription opiate addiction to you. She is quite functional addict, but continues seeking opiates to avoid withdrawal effects. Which of the following might you tell her about potential recovery? a) Opioid receptors can readapt to normal but need a reduction in the amount of opiate exposure over time in order to do so. b) Opioid receptors cannot readapt to normal after severe addiction but can reorganize to nearly full functionality with the aid of permanent pharmacotherapy. 34. A 24-year-old woman with a 6-year history of smoking has decided she is ready to quit. She is considering nicotine replacement therapy but is concerned that she may just end up dependent of that instead. Which of the available nicotine replacement therapies carries the highest risk of dependence? a) Gum b) Lozenge c) Nasal spray d) Oral inhaler e) Transdermal patch 35. Mary is a 33-year-old woman with alcohol use disorder. She consumes several drinks a day nearly every day of the week and has recently had her two children removed from her care. She is motivated to attempt to stop drinking in order to get her children back. She previously attempted to quit cold turkey and on her own and ended up in the emergency room with severe withdrawal symptoms. Considering these factors, would she be a good candidate for reduced-risk drinking as a goal? a) Yes N EI questions on ADHD, Dementia, Substance Abuse & impulsive Compulsive Disorders . b) No 36. Clara is at a party with some friends and decides to try “Molly”. She was told that “Molly” is the pure form of Ecstasy (3,4, methlenedi-oxymethamphetamine), lacking many of the harmful additives that can be found in Ecstasy. Upon taking the pill, Clara notices that while she is in a state of excited delirium, she has a nosebleed, she is sweating profusely, and she feels nauseous. She is disoriented and wonders why she is feeling so horrible after taking the pure form of the drug. Her symptoms are most likely attributed to: a) A synthetic cathinone such as methylone b) Caffeine c) Methamphetamine 37. Peter is a 17-year-old student who has been using spice (synthetic cannabinoid) over the past year. Synthetic cannabinoids such as spice may be associated with increased risk of psychosis compared to natural marijuana because they: a) Do not contain cannabidiol b) Are full rather than partial agonists c) A and B d) Neither A or B 38. Eddie is a 43-year-old who has a 22-year-old daughter with a history of cocaine addiction. He recently heard about a novel cocaine vaccine that is being studied and would like to know more about it. In describing the cocaine vaccine, you explain that a cocaine-induced “high” is experienced when: a) At least 47% of the dopamine transporters are occupied by cocaine b) At least 97% of the norepinephrine transporters are occupied by cocaine c) Both of the above 39. A 26-year-old woman develops a dependence on opioids after taking them during her recovery from knee surgery. She attempts to stop using them on her own, but when she does stop or decreases her dose, she experiences nausea, muscle aches, sweating, diarrhea, insomnia, and depression. She and her practitioner decide that buprenorphine would be an appropriate treatment strategy. Which of the following statements is true? a) The patients should have the buprenorphine implant, probuphine, inserted immediately. b) The patient should initiate oral buprenorphine while downtitrating her current opioid. c) The patient should be in a mild withdrawal scale prior to initiating buprenorphine d) The patient should complete withdrawal before beginning buprenorphine treatment.