exam 3

atomoxetine

A selective norepinephrine reuptake inhibitor used to treat attention deficit hyperactivity disorder (ADHD). It is non-stimulant medication that targets certain neurotransmitters in the brain.

risperdal

An antipsychotic medication used to treat schizophrenia, bipolar disorder, and irritability, aggression, temper tantrums, self-injurious behaviours associated with autism.

two neurotransmitters are most associated with ADHD

dopamine( affects motivation, reward, & attention) and norepinephrine (affects arousal & alerness. These neurotransmitters play crucial roles in regulating attention and behavior.

behavioral therapy is considered most effective for autism spectrum disorder & may require up to 40 hrs a week

early intensive behavioral intervention (EIBI) is a structured approach that focuses on teaching adaptive skills and reducing challenging behaviors through positive reinforcement and consistent schedules. it focuses on language, cognitive, & social skills its a form of applied behavior analysis (ABA) is also consider one of the most effective

A child with autism prefers to repeat lines from movies and avoid eye contact. These are examples of what core symptom domains?

These are examples of communication and social interaction deficits. as well as restritive, repetitivie patterns of behaviour. these two domains are requiered foe a diagnosis of autism spectrum disorder.

methylphenidate

is a central nervous system stimulant often prescribed to treat ADHD. It works by increasing dopamine and norepinephrine levels in the brain, improving attention and focus.

atomoxetine

is a non-stimulant medication used to treat ADHD. It works by selectively inhibiting the reuptake of norepinephrine, thereby enhancing attention and reducing impulsivity.

risperidone

is an atypical antipsychotic medication commonly used in the treatment of irritability associated with autism (ASD). It helps manage symptoms such as aggression, mood swings, and temper tantrums.

time window to for diagnosing acute stress disorder

is within three days to four weeks following a traumatic event. It allows for the assessment of symptoms that arise directly after the experience. after one month is shift yo PTSD

PTDS assosiated symptom

hypervigilance, flashbacks, avoidanceand emotional numbing.

PTSD(flashbacks or dissociation) 2 nursing interventions

include establishing a safe environment

using grounding techniques to help clients reconnect with the present.

and thought stopping to prevent negative thoughts from overwhelming the client. (teach the client to mentally say “stop" when intrusive thoughts occur)

factitious disorder

is a mental health condition where a person deliberately produces or feigns physical or psychological symptoms to assume a sick role. with no external obvious gain, often to obtain attention or sympathy.

malingering

is the deliberate fabrication or exaggeration of symptoms for an external incentive, such as financial gain or avoidance of duties.

somatic symptom disorder

is a mental health condition characterized by an excessive focus on physical symptoms, causing significant distress and impairment. Individuals experience real physical symptoms but often lack a medical explanation for them.

Is malingering a psychiatric disorder

It is not classified as a psychiatric disorder, as it involves the intentional production of symptoms for external rewards rather than underlying psychological conditions.

conversion disorder

is a mental health condition where individuals experience neurological symptoms, such as paralysis or seizures, that cannot be medically explained, typically linked to psychological stress.

illness anxiety disorder

is characterized by excessive worry about having a serious illness despite minimal or no physical symptoms. This condition can lead to significant anxiety and health-related behaviors.

anorexia nervosa

is a serious eating disorder characterized by self-starvation, an intense fear of gaining weight, and a distorted body image. Hallmark signs BMI <15 =extreme category, Lanugo (fine hair growth due to starvation), electrolyte imbalance from malnutrition/starvation

bulimia nervosa

is an eating disorder marked by recurrent episodes of binge eating followed by compensatory behaviors, such as vomiting or excessive exercise, to prevent weight gain. This condition often involves a preoccupation with body shape and weight. patients tent to be normal weight, and show signs like tooth erosion or Russell’s sign which is the callus formed on the knuckles from self-induced vomiting. parotid glad swelling due to overuse & irritation of salivary gland

binge eating disorder (BED)

is characterized by recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort, followed by feelings of guilt or shame. Unlike bulimia nervosa, BED does not involve regular compensatory behaviors such as vomiting, laxatives, fasting or excessive exercise. It can lead to obesity and various health complications.

BED diagnostic criteria

include recurrent binge eating episodes, marked distress during binge eating, and binge eating occurring at least once a week for three months. Patients must not engage in compensatory behaviors typical of bulimia nervosa. eating large amounts within 2hrs or so and feeling loss of control during these episodes

fluoxetine

is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression, anxiety disorders, and certain eating disorders, including bulimia nervosa and binge eating disorder. It works by increasing the level of serotonin in the brain, which can help improve mood and reduce binge-eating episodes.

Cognitive behavioral therapy (CBT)

is a type of psychotherapy that helps individuals identify and change negative thought patterns and behaviors. It is often used to treat a variety of mental health conditions, including bulimia, by promoting healthier coping strategies and emotional regulation.

maudsley approach

is a family-based treatment for anorexia nervosa that emphasizes parental involvement in the recovery process. It focuses on restoring the patient's weight and healthy eating behaviors while enhancing family support.

intermittent explosive disorder (IED)

is a mental health condition characterized by recurrent episodes of impulsive, aggressive, or violent behavior. Individuals with IED may experience intense anger and lose control, resulting in aggression towards people, property, or themselves also they may feel regret afterwards. Must occur twice weekly for 3 months for diagnosis.

3 categories of oppositional defiant disorder (ODD) symptoms

include angry/irritable argumentative behavior/defiance, and vindictiveness. These symptoms may lead to significant problems in social, educational, or work settings. symptoms must occur w/ at least one person who is not a sibling in a place like home, school, work or with peers.

pyromania

is a rare impulse control disorder characterized by an irresistible urge to set fires. Individuals with pyromania experience tension or arousal before starting a fire, and they feel pleasure or relief when witnessing the aftermath.

kleptomania

is a compulsion to steal items that are not needed for personal use or monetary value. People with kleptomania feel an increasing sense of tension before the theft and experience gratification or relief during and after the act.

What are two nursing interventions to reduce anxiety and encourage interaction with a child w/ ASD who avoids eye contact, uses scripted speak and insist on routine?

provide a low stimulus enviourment. use structure routines and familiar objects. positive reinforcement to encourage engagement and communication. Additionally, offer diversional activities when self-stimulatory or anxious behavior emerges. avoid sudden changes in schedule and environment to minimize anxiety.

Medications: Risperidone or AripiprazoleThese medications can help manage irritability and behavioral issues associated with autism spectrum disorder (ASD), particularly in children.

what brain structure is abnormally enlarged in children with autism?

The amygdala. (also overall brain volume may be large in early development.

The amygdala is a brain structure associated with processing emotions and social behaviors. In children with autism, it is often found to be abnormally enlarged.

Which class of medication is used to treat hyperactivity in ADHD, and what is a key side effect nurses must monitor?

Stimulants, such as methylphenidate (Ritalin) or amphetamines (adderal); nurses must monitor for increased heart rate and blood pressure also insomnia weight loss/anorexia.

Which class of medication is a non-stimulant(SNRI) used to treat ADHD, and what is a key side effect nurses must monitor?

Atomoxetine; nurses must monitor for increased risk of suicidal thoughts and liver function. as well as administer after meals to reduce anorexia, give dose early in the day to prevent insomnia monitor weight weekly

What is the purpose of a "drug holiday" in ADHD management?

A "drug holiday" in ADHD management allows patients to temporarily stop medication to assess functioning without it, minimize side effects (growth suppression or appetite loss), and prevent tolerance. Usually during weekends, or school breaks, as well as to prevent dependence and tolarance. most common with stimulants and should not be done abruptly w/out providers guidance risk for w/drawal symptoms( nausea, fative, headaches)

Which two psychological therapies have the strongest evidence for early intervention in autism?

Applied Behavior Analysis (ABA) and Early intensive behavioral intervention (EIBI) are the two psychological therapies with the strongest evidence for early intervention in autism, focusing on skill development and behavior modification.

another effective approach is Early start Denver Model (ESDM) focusing on 1on-1 interactions and play

A client diagnosed with ASD (Acute Stress Disorder) is showing signs of anxiety and hyperarousal. What are two techniques the nurse can implement during this acute stage?

Cognitive Behavioral Therapy (CBT) and grounding techniques such as deep breathing or mindfulness exercises. low stimulation environments can also help reduce anxiety. Additionally, the nurse can use distraction techniques and provide emotional support to foster a sense of safety.

Which trauma-related disorder is often diagnosed when an individual has emotional numbness and re-experiences traumatic events beyond one month after trauma?

Post-Traumatic Stress Disorder (PTSD) is the trauma-related disorder characterized by symptoms such as emotional numbness and intrusive memories or flashbacks of traumatic events, avoidance of trauma reminders, negative alterations in mood/thinking, ghyperarousal that persist for more than one month.

Which neurotransmitters are associated with hyperarousal in PTSD?

• Norepinephrine is especially tied to hypervigilance, anxiety, and arousal in PTSD.

• Serotonin helps regulate mood and is often low in trauma-related disorders.

• Dopamine may be disrupted, affecting motivation and emotional regulation.

• Glutamate is involved in the formation of fear memories.

What type of therapy helps trauma patients reframe negative thought patterns related to the trauma?

Cognitive Behavioral Therapy (CBT) — specifically the cognitive restructuring or reframing component. CBT is a first-line treatment for PTSD and trauma-related disorders.

What is the key distinguishing feature of factitious disorder vs. malingering?

The key distinguishing feature of factitious disorder is that individuals intentionally produce or feign symptoms for the sake of assuming the sick role, without any obvious external incentives, while malingering involves fabricating or exaggerating symptoms for obvious external benefits, such as financial gain or avoidance of responsibility.

A patient is convinced they have a brain tumor despite normal imaging. What disorder does this likely represent?

This likely represents Illness Anxiety Disorder, previously known as hypochondriasis, where a person is preoccupied with having a serious illness despite medical reassurance.

What nursing response is best when caring for a patient with conversion disorder who suddenly becomes unable to walk?

“I understand this symptom feels very real to you, even if tests haven’t shown a physical cause.”

Why it's correct:

• Acknowledges the patient's real distress

• Avoids confrontation or reinforcing the idea that they're "faking"

• Maintains therapeutic communication

• Focuses on supportive care, not on challenging the legitimacy of symptoms

What are two nursing priorities for managing somatic symptom disorder?

• Ensure safety

  • Especially if the patient has pain, dizziness, or other symptoms that increase fall risk or lead to excessive medication use.

• Promote consistent care & reduce unnecessary medical interventions

  • Use one primary provider or nurse to reduce "doctor shopping"

  • Avoid reinforcing the focus on physical symptoms

  • Instead, encourage attention to emotional distress or coping strategies

  • also set limits on excessive testing or requests

True or False: Patients with somatic symptom disorder intentionally fabricate their symptoms.

False; they are not intentionally faking symptoms but are genuinely experiencing distress.

What lab abnormalities are commonly seen in anorexia nervosa due to starvation?

Common abnormalities include electrolyte imbalances, such as low potassium, sodium, and hypomagnesemia. anemia or pancytopenia deficiency in all three blood cells lines due to bone marrow supression

A patient with binge eating disorder (BED) reports shame and eats in isolation. What intervention could help the patient identify emotional eating triggers?

Encourage the patient to keep a food and emotion diarythat records food intake along with emotions and situations that trigger binge eating episodes.

Why is refeeding syndrome a concern in anorexia treatment, and what should the nurse monitor?

Refeeding syndrome is a potentially fatal condition that occurs when feeding is restarted too quickly in malnourished patients, leading to severe electrolyte imbalances and fluid shifts. Nurses should monitor electrolyte levels, particularly phosphorus, potassium, and magnesium, along with vital signs and fluid balance.

A nurse is working with a client using the Maudsley Approach. What is the main goal of Phase 1?

The Maudsley Approach is a family-based treatment for adolescents with anorexia nervosa. It includes 3 phases:

1. Weight restoration – family takes control of meals to restore the child’s weight

2. Returning control to the adolescent – gradual return of responsibility for eating

3. Establishing autonomy & identity – focus on self-esteem, personal development

This method empowers families without shaming the child and has strong outcomes, especially when started early.

A teen has no remorse for harming animals, breaks into cars, and forces peers into activities. What diagnosis does this fit?

This behavior is characteristic of Conduct Disorder, which is marked by a repetitive pattern of behavior that violates the rights of others or major societal norms.

These behaviors align with Conduct Disorder, which involves:

• Aggression to people and animals

• Destruction of property

• Deceitfulness or theft

• Serious rule violations

What is a distinguishing feature between conduct disorder and oppositional defiant disorder?

A key distinguishing feature is that conduct disorder involves more severe behaviors that violate societal norms or the rights of others, while oppositional defiant disorder primarily includes a pattern of angry, irritable behavior and defiance toward authority figures without the same level of aggression or serious infractions to others/property

What lab abnormality is commonly seen in anorexia nervosa and contributes to cardiac complications?

Hypokalemia (low potassium)

What sign may indicate self-induced vomiting in bulimia nervosa, often visible on the hands?

Russell's sign, which is the presence of calluses or scars on the knuckles due to frequent contact with teeth during vomiting.

What electrolyte imbalance is common during refeeding syndrome and must be monitored?

Hypophosphatemia (low phosphate levels)

• When nutrition (especially carbs) is reintroduced, insulin increases → drives phosphorus into cells → blood levels drop

• This can lead to:

  • Respiratory failure

  • Muscle weakness

  • Cardiac arrhythmias

Which two SSRIs are commonly used to treat mood symptoms in impulse control disorders?

Fluoxetine and escitalopram

What are two key nursing interventions when managing a patient with conduct disorder who becomes aggressive?

Ensure a safe environment and maintain clear boundaries with backup staff. redirect violent behavior

What is the name of the structured family-based approach used to treat anorexia in adolescents?

Maudsley approach

What screening tool uses 4 questions to identify alcohol use disorder in adults?

CAGE Questionnaire

• C – Have you ever felt you should Cut down on your drinking?

• A – Have people Annoyed you by criticizing your drinking?

• G – Have you ever felt Guilty about your drinking?

• E – Have you ever had a drink first thing in the morning (an Eye-opener)?

What is the term for the phenomenon where a patient appears strangely indifferent to serious physical symptoms, commonly seen in conversion disorder?

La belle indifférence

Which neurotransmitters are implicated in substance use disorders, particularly with alcohol?

• Dopamine → pleasure, reward pathway

• Norepinephrine → arousal, stress response

• GABA → alcohol enhances GABA = calming effect

• Glutamate → alcohol suppresses it (involved in memory, learning)

For alcohol specifically:

• Increases dopamine = reinforcement (addiction)

• Enhances GABA = sedation

• Inhibits glutamate = memory loss, blackouts

What medication is used to support alcohol abstinence by producing severe reactions when alcohol is consumed?

Disulfiram is used for alcohol abstinence and works by:

• Blocking the breakdown of alcohol → causes severe unpleasant reaction if alcohol is consumed

• Reactions: N/V, flushing, palpitations, hypotension, chest pain

• Avoid alcohol-containing products (mouthwash, cough syrup, colognes)

• Can stay in the system for 2 weeks after stopping

Name one physical sign associated with binge eating disorder that differs from bulimia nervosa.

Binge eating disorder is characterized by physical signs such as significant weight gain or obesity, whereas bulimia nervosa typically shows normal weight or fluctuating weight due to compensatory behaviors.

What withdrawal symptoms might you expect 12–24 hours after alcohol cessation?

Withdrawal symptoms may include anxiety, tremors, sweating, nausea, vomiting, insomnia, headaches and, in severe cases, seizures or delirium tremens.

These are part of Stage 2 alcohol withdrawal — progressing toward more severe symptoms if untreated

Which screening tool is most appropriate to assess alcohol use in an older adult?

MAST-G is the most appropriate screening tool for assessing alcohol use in older adults, focusing on the unique aspects of this demographic.

A nurse is teaching about Wernicke encephalopathy. Which statement shows the client needs more education?

“I can avoid it by staying hydrated when I drink.”

Wernicke encephalopathy

is a neurological disorder caused by thiamine deficiency, often associated with alcohol misuse. It can lead to confusion, ataxia, and ophthalmoplegia.

A hospitalized client with a history of alcohol use disorder becomes confused and has ataxia. Which treatment is most important to administer first?

Thiamine IV injection supplementation

During Phase 1 of the Maudsley approach for anorexia nervosa, what is the primary goal?

Parents take control of meals and weight restoration

A client with tics and vocal outbursts wants to know what treatment might help. Which is the best option to discuss?

Haloperidol and behavioral therapy

A client screens positive on the MAST-G. What does this tool specifically assess?

The Michigan Alcoholism Screening Test Geriatric Version assesses alcohol use and dependency in elderly patients.

During family therapy, the nurse explains Phase 2 of the Maudsley Approach. Which statement reflects correct understanding?

We begin returning control of food choices to the adolescent.This phase aims to support the adolescent in making independent food choices while maintaining family support.