Question

When assessing a patient who has a diagnosis of major depressive disorder, which would be considered cognitive symptoms of depression?

Answer 1

Correct Answers:

Hopelessness.
Inability to make decisions.

Rationale :

Hopelessness

🧠Hopelessness is a cognitive feature of major depressive disorder reflecting persistent negative expectations about the future and the belief that improvement is unlikely.

🧠It arises from maladaptive cognitions (e.g., Beck’s cognitive triad: negative views of self, world, and future) that bias interpretation toward loss and failure.

🧠This cognitive stance fuels rumination and attentional bias to negative information, reinforcing depressed mood and functional decline.

🧠Clinically, hopelessness is a powerful correlate of suicidal ideation and behavior, underscoring the need for direct safety assessment.

🧠Targeted interventions (e.g., cognitive restructuring, behavioral activation) specifically address these distorted beliefs, improving prognosis.

Inability to make decisions

🧠Indecisiveness (diminished ability to think/concentrate or decide) is a DSM-5 cognitive symptom of major depressive disorder.

🧠It reflects deficits in executive function, working memory, and processing speed, often linked to prefrontal cortical dysregulation and monoaminergic imbalance.

🧠Patients report being stuck, taking excessive time to choose, or avoiding choices, which impairs ADLs, work/school performance, and treatment adherence.

🧠Indecisiveness is distinct from anhedonia or low energy (somatic/affective domains), highlighting a cognitive target for therapy.

🧠While it often improves with remission, residual cognitive symptoms may persist and benefit from CBT, problem-solving therapy, and rehabilitative strategies.

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Answer 2

Correct Answers:

Childhood seizures

Rationale :

💠PTSD risk is tied to exposure to traumatic events (e.g., intimate partner violence, sudden death of a loved one, motor vehicle collisions), not primary neurologic conditions.

💠Childhood seizures are a neurologic disorder, not a psychological trauma, so they do not constitute a PTSD risk factor by themselves.

💠PTSD requires threat to life/physical integrity plus fear/helplessness with subsequent symptom clusters (re-experiencing, avoidance, negative mood/cognition, hyperarousal).

💠While seizures can be stressful, they lack the trauma exposure criterion central to PTSD diagnosis.

💠Therefore, childhood seizures are the non-risk choice among options grounded in actual trauma exposure.

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Answer 3

Correct Answers:

Increased heart rate and respiratory rate with diaphoresis.

Rationale :

🔷Anxiety activates the sympathetic nervous system, producing tachycardia, tachypnea, and diaphoresis (fight-or-flight response).

🔷In patients with acute pain, co-existing anxiety amplifies autonomic signs, so vitals often show ↑HR/↑RR with sweating.

🔷These physiologic markers are objective, helping differentiate anxiety from fatigue, infection, or mood-only changes.

🔷Catecholamine surge (epinephrine/norepinephrine) explains palpitations, shakiness, and hyperventilation.

🔷Recognizing this pattern directs care toward reassurance, analgesia optimization, and anxiolytic strategies as indicated.

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Answer 4

Correct Answers:

"Generalized anxiety disorder is diagnosed when a person spends at least six months worrying excessively."

Rationale :

🟩DSM-5 defines GAD by excessive, hard-to-control worry for ≥6 months about multiple events/activities.

🟩 Associated symptoms (≥3 in adults) include restlessness, fatigability, poor concentration, irritability, muscle tension, and sleep disturbance.

🟩The anxiety causes clinically significant distress or impairment in social/occupational functioning.

🟩The disturbance is not due to substances/another medical condition and is not better explained by another mental disorder.

🟩Shorter durations (e.g., 3 months) do not meet criteria, and 9–12 months exceed the minimum but are not required.

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Answer 5

Correct Answers:

Circadian rhythm sleep-wake disorders

Rationale :

🔶These disorders are defined by recurrent sleep disruption due to misalignment between the endogenous circadian system and sleep–wake schedule (e.g., shift-work disorder, jet lag, delayed sleep–phase).

🔶Core features are insomnia or excessive sleepiness recurring when the internal clock and external demands don’t match.

🔶Unlike primary insomnia, the key driver is timing misalignment, not sleep initiation/maintenance alone.

🔶They differ from REM sleep behavior disorder (enactment of dreams) and nightmare disorder (dysphoric dreams) which are parasomnias, not timing disorders.

🔶Management targets circadian realignment (e.g., light therapy, melatonin, schedule shifting, sleep hygiene).

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Answer 6

Correct Answers:

"Have you thought about or attempted suicide?"

Rationale :

⚠️In depression, suicide risk assessment is the top priority (safety first) and must be asked directly and non-judgmentally.

⚠️Suicide inquiry should include ideation, plan, intent, means, past attempts, and protective factors (e.g., C-SSRS framework).

⚠️Early identification enables immediate safety planning, level-of-care decisions (e.g., hospitalization), and means restriction.

⚠️While sleep, adherence, or psychotic symptoms matter, they are secondary to addressing imminent risk.

⚠️A clear, direct question is associated with better disclosure and reduced mortality through timely intervention.

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Answer 7

Correct Answers:

"Dementia is a chronic medical condition and delirium is an acute illness."

Rationale :

🧩 Delirium is acute, with fluctuating attention/awareness, often due to medical causes (infection, drugs, metabolic derangements) and is potentially reversible.

🧩 Dementia (major neurocognitive disorder) is chronic and progressive, with decline in memory, executive function, and language, typically over months–years.

🧩 Disturbance of attention is hallmark for delirium, not dementia; dementia shows relative attentional preservation until later stages.

🧩 Correct differentiation guides urgent work-up for reversible delirium vs. long-term neurocognitive care in dementia.

🧩 Screening tools (e.g., CAM for delirium; MoCA/MMSE for dementia) help operationalize this distinction.

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Answer 8

Correct Answers:

Endorphins

Rationale :

💊 Endorphins (notably β-endorphin) are synthesized in the hypothalamus and pituitary from POMC and act as potent µ-opioid receptor agonists.

💊 They mediate analgesia and euphoria, released during stress, exercise, and pain modulation.

💊 High µ-receptor affinity underlies strong antinociceptive effects via descending inhibitory pathways.

💊 By contrast, enkephalins (δ-predominant) and dynorphins (κ-predominant) have different receptor targets and distributions.

💊 Clinically, endogenous opioids help explain phenomena like the runner’s high and contribute to stress-induced hypoalgesia.

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Answer 9

Correct Answers:

Severe, chronic, and disabling disorder following exposure to a traumatic event.

Rationale :

🎖️PTSD follows exposure to actual/threatened death, serious injury, or sexual violence, with symptoms persisting >1 month (often chronic).

🎖️Symptom clusters include intrusion (flashbacks, nightmares), avoidance, negative alterations in mood/cognition, and hyperarousal.

🎖️ The disorder is frequently disabling, impairing social, occupational, and interpersonal functioning.

🎖️ It is distinct from acute stress disorder, which lasts 3 days–1 month and may resolve.

🎖️ Accurate definition guides early trauma-focused therapies (e.g., TF-CBT, EMDR) and pharmacologic support as needed.

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Answer 10

Correct Answers:

Auditory hallucinations

Rationale :

👂Auditory hallucinations are a core positive symptom in schizophrenia and meet psychosis criterion (with delusions or disorganized speech).

👂They often present as voices commenting, conversing, or giving commands, even with normal sensorium.

👂Diagnosis also requires functional decline and duration criteria (≥1 month active symptoms; 6-month continuous disturbance).

👂Negative symptoms (e.g., blunted affect, alogia, avolition) are important for prognosis but do not alone establish diagnosis.

👂Recognizing hallucinations prompts risk assessment (e.g., command content) and antipsychotic initiation per guidelines.

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Week 4 Quiz- Midterm Exam

No.

1 :
When assessing a patient who has a diagnosis of major depressive disorder, which would be considered cognitive symptoms of depression?

2 :
Which of the following is NOT a risk factor for post-traumatic stress disorder?

3 :
A nurse practitioner is caring for a person who has experienced pain for three days. What signs would the practitioner note if the patient has anxiety in addition to the pain?

4 :
A nurse practitioner preceptor and learner are discussing criterion for a diagnosis of generalized anxiety disorder. Which statement by the nurse practitioner learner indicates understanding?

5 :
What class of disorders describes a group of conditions characterized by recurrent sleep disruption patterns?

6 :
A nurse practitioner preceptor and learner are preparing to interview a patient with a history of depression. Which of the following is a priority for the providers to ask the patient understanding?

7 :
A nurse practitioner preceptor and learner are discussing alterations of memory. Which statement by the nurse practitioner learner indicates understanding?

8 :
Which endogenous opioid is located in the hypothalamus and pituitary and is a strong g-receptor agonist?

9 :
Which of the following best defines post-traumatic stress disorder (PTSD)?

10 :
Which would be considered a diagnostic symptom of schizophrenia?

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Week 4 Quiz- Midterm Exam

No.

1 : When assessing a patient who has a diagnosis of major depressive disorder, which would be considered cognitive symptoms of depression?

2 : Which of the following is NOT a risk factor for post-traumatic stress disorder?

3 : A nurse practitioner is caring for a person who has experienced pain for three days. What signs would the practitioner note if the patient has anxiety in addition to the pain?

4 : A nurse practitioner preceptor and learner are discussing criterion for a diagnosis of generalized anxiety disorder. Which statement by the nurse practitioner learner indicates understanding?

5 : What class of disorders describes a group of conditions characterized by recurrent sleep disruption patterns?

6 : A nurse practitioner preceptor and learner are preparing to interview a patient with a history of depression. Which of the following is a priority for the providers to ask the patient understanding?

7 : A nurse practitioner preceptor and learner are discussing alterations of memory. Which statement by the nurse practitioner learner indicates understanding?

8 : Which endogenous opioid is located in the hypothalamus and pituitary and is a strong g-receptor agonist?

9 : Which of the following best defines post-traumatic stress disorder (PTSD)?

10 : Which would be considered a diagnostic symptom of schizophrenia?

1 :
When assessing a patient who has a diagnosis of major depressive disorder, which would be considered cognitive symptoms of depression?

2 :
Which of the following is NOT a risk factor for post-traumatic stress disorder?

3 :
A nurse practitioner is caring for a person who has experienced pain for three days. What signs would the practitioner note if the patient has anxiety in addition to the pain?

4 :
A nurse practitioner preceptor and learner are discussing criterion for a diagnosis of generalized anxiety disorder. Which statement by the nurse practitioner learner indicates understanding?

5 :
What class of disorders describes a group of conditions characterized by recurrent sleep disruption patterns?

6 :
A nurse practitioner preceptor and learner are preparing to interview a patient with a history of depression. Which of the following is a priority for the providers to ask the patient understanding?

7 :
A nurse practitioner preceptor and learner are discussing alterations of memory. Which statement by the nurse practitioner learner indicates understanding?

8 :
Which endogenous opioid is located in the hypothalamus and pituitary and is a strong g-receptor agonist?

9 :
Which of the following best defines post-traumatic stress disorder (PTSD)?

10 :
Which would be considered a diagnostic symptom of schizophrenia?