Anxiety, Bipolar Disorders, & Insomnia Flashcards

1
Q

The clinical features of geriatric bipolar disorder differ from those of bipolar disorder in younger (age <50 years) patients. Determine features of geriatric bipolar disorder that are specific to this population.

General medical illnesses are least common in older patients.

Excessive sexual interest and behavior during manic or hypomanic episodes appear to be less common in older patients.

There is inability to sit for periods longer than 10 minutes.

There is a high predisposition to fight or cause physical altercations during exam.

A

Excessive sexual interest and behavior during manic or hypomanic episodes appear to be less common in older patients.

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2
Q

The NP provides research to peers and NP students that support the identification of certain risk factors for generalized anxiety disorders (GADs). Establish a risk factor sensitive for GAD diagnosis in late life and in the geriatric patient.

Parental loss or separation

History of mental problems in parents

Transgender identity

Recent adverse life events

A

Recent adverse life events

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3
Q

The NP studying anxiety in the elderly should understand associated specified anxiety disorders. Predict what should be included in patient and family education regarding the possible signs and behaviors that they may expect at home.

The patient may become evasive and lie more.

The patient may avoid family.

The patient may develop Tourette-like symptoms.

The patient may have apprehensiveness and irritability.

A

The patient may have apprehensiveness and irritability.

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4
Q

The NP understands that treating bipolar disorder is often difficult. Bipolar diagnosis for a geriatric patient and family can be challenging. Recommend an accurate statement to share with the patient and family.

Most patients will overcome these experiences without the need for intervention.

Talking with family is the primary method of treating and approaching bipolar disorder.

Psychotherapy alone is the best treatment option for bipolar disorder.

Geriatric patients with bipolar disorder often have moments of repetitive mood control and inability to control their symptoms at various levels, regardless of treatment.

A

Geriatric patients with bipolar disorder often have moments of repetitive mood control and inability to control their symptoms at various levels, regardless of treatment.

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5
Q

Mrs. Wool arrives to the clinic today to discuss her inability to continue her job as a billing clerk. She often gets sweaty when she has a message to return a phone call because of an error in a bill. She states that “I just know the person on the phone will give me a hard time. I start to tear before I pick up the phone now.” She is often stressed in public places at least daily for the last several months. Recommend how to treat Mrs. Wool’s anxiety.

Send Mrs. Wool home with the task of monitoring her symptoms.

Mrs. Wool needs Flexeril 10 mg PO daily and return to the clinic in 4 weeks.

Prescribe fluoxetine 100 mg po daily with return in 2 weeks for follow-up.

Prescribe paroxetine 5 mg PO daily with referral for counseling.

A

Prescribe paroxetine 5 mg PO daily with referral for counseling.

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6
Q

To screen for insomnia, it is important to involve a therapeutic and holistic approach. Recommend a question type in the HPI to determine best treatment approach for a patient with insomnia.

Ask if they are able to sleep away from home.

Ask if they have many friends who stay up late with them.

Ask if they have a family history of sleep disorders.

Ask about napping and dozing during the day or evening, which should be avoided to maximize sleep drive at night.

A

Ask about napping and dozing during the day or evening, which should be avoided to maximize sleep drive at night.

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7
Q

The diagnosis of generalized anxiety disorder (GAD) is based on the presence of generalized, persistent, and excessive anxiety and a combination of various psychological and somatic complaints. DSM-5 diagnostic criteria for GAD require the presence of six symptoms (with at least some symptoms having been present for more days than not for the past 6 months). Determine a symptom specific for diagnosing GAD.

Mania

No existence of significant impact to daily life

Euphoria

Restlessness or feeling keyed up or on edge

A

Restlessness or feeling keyed up or on edge

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8
Q

The NP student is seeing a 68-year-old patient today who arrives to the clinic with a history of bipolar disorder. She would expect the patient to have difficulty with daily routine activities. Propose an activity that this geriatric bipolar patient might describe as particularly difficult.

Communicating daily with family

Getting dressed daily

Routine job functions that require concentration

Household chores

A

Household chores

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9
Q

A full history is the best and only initial evaluation to determine approach, severity, and effect of physical, mental, and functional impairments correlating with insomnia. The NP understands that there are many precipitating factors that can contribute to insomnia. Predict the best precipitating factor to listen and inquire about.

Psychiatric disorders do not contribute to insomnia

Sleeping in a room with pink tones

Childhood memories

Nocturia or shortness of breath

A

Nocturia or shortness of breath

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10
Q

The NP has continued to research appropriate treatment and management options for the bipolar patient who is diagnosed and treated in late life. Recommend the best treatment choice for the patient with bipolar disorder.

Lithium 600 mg PO daily with routine serum levels

Hydroxyzine 25 mg PO qhs

Sertraline 40 mg PO daily

Paxil 10 mg PO daily

A

Lithium 600 mg PO daily with routine serum levels

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11
Q

Choose a screening tool specific for bipolar disorder that can be administered easily for geriatric patients.

DSM-V Depression and Anxiety Scale

CAGE questionnaire

PHS-6

PHQ-9

A

PHQ-9

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12
Q

It is important to understand all treatment options that are available for insomnia for your patient. Propose the best therapeutic option for the geriatric patient struggling with insomnia.

Watch the clock or a scary movie at bedtime.

Take medication (e.g., medical marijuana or other).

Set realistic allotted time and attempts to avoid lying in bed awake for longer time frames.

Undergo physical therapy.

A

Set realistic allotted time and attempts to avoid lying in bed awake for longer time frames.

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13
Q

The NP is working in the geriatric unit today to establish care for new patients. She meets an 80-year-old male who has been working with a psychologist for depression. The patient reports that he is being treated for depression but unsure if the medication he is taking will work for anxiety. He is anxious most times that there are events or new people around. Recommend the best medication to treat anxiety and depression.

Mirtazapine 45 mg PO qhs

Duloxetine 60 mg PO qd

Flexeril 10 mg po qhs

Buspirone 7.5 mg po BID

A

Duloxetine 60 mg PO qd

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14
Q

Anxiety in the elderly should not be ignored. Oftentimes, NPs treat patients daily without recognizing anxiety caused by depressive symptoms. Determine the most accurate statement surrounding anxiety behavior.

Worry is common for all, and excess worrying means caring more.

Worry about the uncontrollability and presumed dangerous consequences of worrying.

Worrying excessively about depression is not associated with anxiety.

The ability to calm oneself would eliminate the diagnosis of anxiety.

A

Worry about the uncontrollability and presumed dangerous consequences of worrying.

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15
Q

The NP understands the importance of selecting the correct class of medications for the patient suffering from insomnia. Propose the indicated class of medications for the patient with insomnia.

SSRIs

Melatonin

Stimulants

Muscle relaxers

A

Melatonin

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16
Q

A full history is the best and only initial evaluation to determine approach, severity, and effect of physical, mental, and functional impairments correlating with insomnia. The NP understands that there are many precipitating factors that can contribute to insomnia. Predict the best precipitating factor to listen and inquire about.

Eating sweets before bedtime

PTSD, which is often accompanied by intrusive thoughts and nightmares

Psychiatric disorders do not contribute to insomnia

Sleeping in a room with pink tones

A

PTSD, which is often accompanied by intrusive thoughts and nightmares

17
Q

The NP provides research to peers and NP students that support the identification of certain risk factors for generalized anxiety disorders (GADs). Establish a risk factor sensitive for GAD diagnosis in late life and in the geriatric patient.

Parental loss or separation

Chronic physical illness (e.g., respiratory, cardiovascular, metabolic, cognitive)

History of mental problems in parents

Transgender identity

A

Chronic physical illness (e.g., respiratory, cardiovascular, metabolic, cognitive)

18
Q

There are specific anxiety disorders that the NP should be familiar with. Determine which is a potential anxiety disorder.

Phobia manic disorder

Agoraphobia

Geriatric anxiety disorder (GAD)

Psychotic anxiety

A

Agoraphobia

19
Q

Choose a screening tool specific for bipolar disorder that can be administered easily for geriatric patients.

PHS-6

Two-Question Screen

CAGE questionnaire

DSM-V Depression and Anxiety Scale

A

Two-Question Screen

20
Q

The clinical features of geriatric bipolar disorder differ from those of bipolar disorder in younger (age <50 years) patients. Determine features of geriatric bipolar disorder that are specific to this population.

There is a high predisposition to fight or cause physical altercations during exam.

There is inability to process thought or recite dates and times.

There is inability to sit for periods longer than 10 minutes.

Comorbid anxiety and substance use disorders are less common in geriatric patients.

A

Comorbid anxiety and substance use disorders are less common in geriatric patients.

21
Q

It is important to understand all treatment options that are available for insomnia for your patient. Propose the best therapeutic option for the geriatric patient struggling with insomnia.

Have a sleep diary.

Undergo physical therapy.

Have a nightcap or a glass of wine at bedtime.

Take medication (e.g., medical marijuana or other).

A

Have a sleep diary.

22
Q

The NP has continued to research appropriate treatment and management options for the bipolar patient who is diagnosed and treated in late life. Recommend the best treatment choice for the patient with bipolar disorder.

Hydroxyzine 25 mg PO qhs

Lithium 100 mg PO once per week with routine serum levels

Paxil 10 mg PO daily

Quetiapine 50 mg PO daily for 1 week then 100 mg PO BID

A

Quetiapine 50 mg PO daily for 1 week then 100 mg PO BID

23
Q

The NP student is seeing a 68-year-old patient today who arrives to the clinic with a history of bipolar disorder. She would expect the patient to have difficulty with daily routine activities. Propose an activity that this geriatric bipolar patient might describe as particularly difficult.

Routine job functions that require concentration

Communicating daily with family

Keeping a checkbook

Getting dressed daily

A

Keeping a checkbook

24
Q

A 69-year-old male presents to the clinic with complaints of difficulty sleeping every night for several weeks. He states that he has tried melatonin, but it makes him tired the next day. He would like a treatment that is not “another pill thrown at me.” Recommend a therapeutic option that the NP can share for the treatment of insomnia for this patient.

Establish a stable bedtime and wake time 7 days per week.

Try to sleep through the day when sleepy.

Stimulant medications taken at night will help reduce the issue of day challenges.

Do not lay in bed if not sleepy; get up and walk around.

A

Establish a stable bedtime and wake time 7 days per week.