PSYCH Flashcards
A 45-year-old female on fluoxetine (Prozac), an SSRI, presents to the emergency department with confusion, tremors, and a fever of 39°C after her medication dose was doubled two days ago. The nurse practitioner suspects serotonin syndrome. What is the most likely cause of her symptoms?
Answer Choices:
A. Bacterial infection
B. Dehydration
C. Increased serotonergic activity
D. Electrolyte imbalance
C. Increased serotonergic activity - Serotonin syndrome is often triggered by increased serotonin levels due to a recent change in dose or introduction of new medication with serotonergic properties.
Which of the following is NOT typically a symptom of serotonin syndrome?
Answer Choices:
A. Mental status changes
B. Bradycardia
C. Neuromuscular hyperactivity
D. Autonomic instability
B. Bradycardia - Serotonin syndrome usually presents with symptoms like hyperthermia, mental status changes, neuromuscular hyperactivity, and autonomic instability, which may include tachycardia, not bradycardia.
A patient presents with inducible clonus, agitation, and diaphoresis. They are on an SSRI. According to the Hunter Toxicity Criteria Decision Rules, how should serotonin syndrome be diagnosed?
Answer Choices:
A. Spontaneous clonus without agitation
B. Inducible clonus with associated symptoms (agitation)
C. Hyperreflexia without clonus
D. Seizures and muscle rigidity
B. Inducible clonus with associated symptoms (agitation) - The Hunter Criteria include inducible clonus with agitation or diaphoresis as a means of diagnosing serotonin syndrome.
A patient taking both an SSRI and an MAOI begins experiencing severe muscle rigidity and fever. How should the FNP proceed in treating possible serotonin syndrome in this patient?
Answer Choices:
A. Prescribe anti-pyretics and observe
B. Refer for immediate hospitalization and provide supportive care
C. Treat with antibiotics to prevent sepsis
D. Increase the dose of the offending agent
B. Refer for immediate hospitalization and provide supportive care - Severe cases of serotonin syndrome require hospitalization for close monitoring and administration of treatments like benzodiazepines for agitation and serotonin antagonists when needed.
Which medication could be used to mitigate agitation in a case of serotonin syndrome?
Answer Choices:
A. Acetaminophen
B. Benzodiazepines
C. Beta-blockers
D. Antidepressants
B. Benzodiazepines - Benzodiazepines can effectively manage agitation and prevent seizures in patients with serotonin syndrome.
Several days after starting a new migraine medication, a patient presents with symptoms of serotonin syndrome. On review, the medication is found to interact with their current SSRI. What is the best action plan regarding their serotonergic medications?
Answer Choices:
A. Discontinue the new medication immediately and monitor closely
B. Discontinue all serotonergic medications indefinitely
C. Reduce the dose of the SSRI only
D. Continue both medications but counsel on symptom monitoring
A. Discontinue the new medication immediately and monitor closely - Ceasing the new serotonergic medication reduces further risk of serotonin syndrome, and close monitoring should continue to ensure resolution of symptoms.
What ongoing care consideration should be addressed for a patient who has experienced serotonin syndrome?
Answer Choices:
A. Immediate restarting of the previously discontinued serotonin agent
B. Nitrate adjustments for managing blood pressure
C. Slow titration of serotonergic medications if needed in the future
D. Avoidance of benzodiazepines
C. Slow titration of serotonergic medications if needed in the future - Patients who have experienced serotonin syndrome should have any future serotonergic medications carefully titrated with close follow-up to prevent recurrence.
A 32-year-old woman presents to your clinic with complaints of feeling anxious, experiencing palpitations, and having difficulty sleeping for the past three months. Her symptoms started after starting a new job. What psychiatric disorder should be high on your differential diagnosis list?
Answer Choices:
A. Major Depressive Disorder
B. Generalized Anxiety Disorder
C. Post-Traumatic Stress Disorder
D. Bipolar Disorder
B. Generalized Anxiety Disorder - The symptoms of excessive anxiety and worry for at least six months align with generalized anxiety disorder, especially given the new life stressor (new job).
A patient with a long-standing history of depression comes to see you after the unexpected death of their partner. They report feeling profound sadness, lack of appetite, and difficulty sleeping. Given this context, what should be your initial consideration?
Answer Choices:
A. Major Depressive Disorder
B. Normal Grief
C. Complicated Grief
D. Persistent Depressive Disorder
B. Normal Grief - It’s important to differentiate between depressive episodes and normal grieving processes, especially given the recent loss. Careful monitoring is required to determine if it transitions to complicated grief or depression.
During a routine pediatric visit, a 7-year-old child is noted to have difficulty paying attention and often interrupts others. What condition should be included in your differential diagnosis?
Answer Choices:
A. Autism Spectrum Disorder
B. Generalized Anxiety Disorder
C. Attention-Deficit/Hyperactivity Disorder (ADHD)
D. Major Depressive Disorder
C. Attention-Deficit/Hyperactivity Disorder (ADHD) - The child’s symptoms align with ADHD, which typically includes inattention, impulsivity, and sometimes hyperactivity.
A 50-year-old male patient presents to the clinic because family members are concerned about his persistent forgetfulness and disorientation over the past few months. Which condition is most likely?
Answer Choices:
A. Major Depressive Disorder with Cognitive Features
B. Mild Cognitive Impairment
C. Alzheimer’s Disease
D. Schizophrenia
C. Alzheimer’s Disease - The progressive cognitive decline and disorientation in an adult over the age of 50 are suggestive of a neurocognitive disorder such as Alzheimer’s disease.
During an examination, a 22-year-old college student describes experiencing persistent disturbing thoughts and subsequent repetitive behaviors since their teens. What is the most likely diagnosis?
Answer Choices:
A. Generalized Anxiety Disorder
B. Major Depressive Disorder
C. Obsessive-Compulsive Disorder (OCD)
D. Post-Traumatic Stress Disorder
C. Obsessive-Compulsive Disorder (OCD) - The hallmark symptoms of OCD are intrusive thoughts (obsessions) and repetitive behaviors (compulsions).
A 17-year-old visits your clinic with a history of weight fluctuation and fear of gaining weight despite being underweight. Which condition needs consideration?
Answer Choices:
A. Anorexia Nervosa
B. Bulimia Nervosa
C. Generalized Anxiety Disorder
D. Bipolar Disorder
A. Anorexia Nervosa - The patient’s fear of weight gain and significant underweight status are characteristic of anorexia nervosa.
A Vietnam war veteran who hasn’t been the same since their return reports nightmares, flashbacks of combat, and hyperarousal. What condition are you considering?
Answer Choices:
A. Major Depressive Disorder
B. Post-Traumatic Stress Disorder (PTSD)
C. Panic Disorder
D. Schizophrenia
B. Post-Traumatic Stress Disorder (PTSD) - The symptoms including nightmares, flashbacks, and hyperarousal correlate with PTSD, commonly seen in veterans and those who have experienced trauma.
