Anxiety Disorders Flashcards
Anxiety Disorders
Most common group of mental disorders (1/3 of population affected)
Anxiety Disorder Presentation
Complaint of worry, fear, anxiety, numerous physical complaints
General Anxiety Disorder
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
Panic Disorder
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
OCD
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
GAD Age Differences
Children tend to have performance-focused anxiety and worry
Adults tend to have physical health or family well-being
Anxiety Differentials
Always rule out / test for underlying cardiac, respiratory, endocrine, and medication side effects
Anxiety Disorder Treatments
CBT is effective
Exercise is not specifically helpful, but good for overall health
Pharmacological treatment can be effective
SSRI/SNRI
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
Adjusting SSRI/SNRI
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
Benzodiazepines
Effective to acute management, especially for panic attacks
high risk of falls, etc. with elderly
Serotonin Syndrome
mental status changes, autonomic instability, and neuromuscular changes, a potentially life-threatening side effect of SSRIs and SNRIs.
Busiprone
Only for GAD.
Can worsen depression and since depression is often co-morbid with many anxiety disorders this is not recommended
TCAs
Only used if other agents don’t work
Phobia
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
Social Phobia
Fear of being embarrassed, or judged by others
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
Febuxostat should be prescribed because it lowers serum urate. Acetaminophen would not be indicated due to the patients age
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
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.
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)
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.
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)
LP is contraindicated due to signs of increased ICP. Broad spectrum antibiotics is the best treatment.
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
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
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
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.
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
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.
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
Stage 3 CKD need iron studies to determine if supplemental iron is needed.
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
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.
