ANCC PMHNP BOARD EXAM review 2023, Exams of Nursing

Download ANCC PMHNP BOARD EXAM review 2023 and more Exams Nursing in PDF only on Docsity! ANCC PMHNP BOARD EXAM review 2023 MOOD D/ MDD CRITERIA A - A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1. Depressed mood daily… 2. Loss of pleasure of joy in activities/inerests 3. Significant weight loss/gain. 4. insomnia/hypersomnia. 5. fatigue or loss of energy daily 6. psychomotor retardationagitation 7. feelings of worthlessness or guilt 8. diminished ability to think/concentrate, indecisiveness 9. recurrent thoughts of death, SI, or SI attempt MOOD D/O: MDD CRITERIA B-E - B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. ANCC PMHNP BOARD EXAM review 2023 C. The episode is not attributable to the physiological effects of a substance or to another medical condition. D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition. MOOD D/O: MDD PREVALENCE - Twelve-month prevalence of major depressive disorder in the United States is approximately 7%, with marked differences by age group such that the prevalence in 18- to 29-year-old individuals is threefold higher than the prevalence in individuals age 60 years or older. Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence. ANCC PMHNP BOARD EXAM review 2023 E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted. MOOD D/O: DYSTHYMIA PREVALENCE - The 12-month prevalence in the United States is approximately ANCC PMHNP BOARD EXAM review 2023 0.5% for persistent depressive disorder and 1.5% for chronic major depressive disorder. MOOD D/O: DYSTHYMIA DEVELOPMENT COURSE - Persistent depressive disorder often has an early and insidious onset (i.e., in childhood, adolescence, or early adult life) and, by definition, a chronic course. Among individuals with both persistent depressive disorder and borderline personality disorder, the covariance of the corresponding features over time suggests the operation of a common mechanism. Early onset (i.e., before age 21 years) is associated with a higher likelihood of comorbid personality disorders and substance use disorders. MOOD D/O: DYSTHYMIA RISK FACTORS - -Factors predictive of poorer long-term outcome include higher levels of neuroticism (negative affectivity), greater symptom severity, poorer global functioning, and presence of anxiety disorders or conduct disorder. -It is thus likely that individuals with persistent depressive disorder will have a higher proportion of first-degree relatives with persistent depressive disorder than do individuals with major depressive disorder, and more depressive disorders ANCC PMHNP BOARD EXAM review 2023 in general. -A number of brain regions (e.g., prefrontal cortex, anterior cingulate, amygdala, hippocampus) have been implicated in persistent depressive disorder. Possible polysomnographic abnormalities exist as well. CN I - olfactory-smell sensory CN II - Optic - vision sensory CN III - Oculomotor Nerve- Motor Controls eye movement, pupil constriction, & eyelid movement CN IV - trochlear nerve-down and inward eye movement motor CN V - trigeminal nerve-muscles of mastication; sensation of face, scalp cornea, mucus membranes and nose ANCC PMHNP BOARD EXAM review 2023 UDS cannabis - 3 days to 4 wks: depends on use UDS cocaine - 6-8 hrs; metabolites 2 to 4 days UDS heroin - 36-72 hrs UDS methadone - 3 days UDS Methaqualone m*f* quaaludes!!!!! - 7 days UDS Morphine - 46-72 HRS UDS - PCP - 8 days **CPK & AST often elevated** UDS Propoxyphene - 6-48 hrs CHILDREN: routine checkups - Start: 1 to 2 weeks How often: every month x 4, 6, 9, 12, 15, 18, 24 mo, annually after 3 yrs CHILDREN: anemia - 9-12 mo, as needed ANCC PMHNP BOARD EXAM review 2023 CHILDREN: blood test for lead - 9 to 12 mo, annually after if in high risk area CHILDREN: UA - age 5, as needed CHILDREN: BP - age 3, annually CHILDREN: hearing and vision - start:prior to discharge or 1 mo, prior to discharge and by 6 mo how often: annually at age 4/3, screen for strabismus btwn 3 and 5 Tanner Stage 1 (boys and girls) - Boys: preadolescent testes, scrotum, penis Girls: preadolescent breasts Pubic hair: Preadolescent Tanner Stage 2 (boys and girls) - Boys: Enlargement of scrotum, testes; scrotum roughens and reddens Girls: Breast buds w/ areolar enlargement Pubic hair: Sparse, pale, fine ANCC PMHNP BOARD EXAM review 2023 Tanner Stage 3 (boys and girls) - Boys: Penis elongates Girls: Breast enlargement without separate nipple contour Pubic hair: Darker, increased amount, curlier Tanner Stage 4 (boys and girls) - Boys: Penis enlarges in breadth and development of glans; rugae appear Girls: Areola and nipple project as secondary mound Pubic hair: Adult in character but not as voluminous Tanner Stage 5 (Boys and girls) - Boys: Adult shape and appearance Girls: Adult breast; areola recedes, nipple retracts Pubic hair: Adult pattern Trust vs. Mistrust - Erikson: 0-18 mo: If needs are dependably met, infants develop a sense of basic trust Failure: Difficult receiving and giving Autonomy vs. Shame and Doubt - Erikson: 18 mo-3 yrs: Erikson's stage in which a toddler learns to exercise will and to do things independently; Goal: self-control, will power, control of body ANCC PMHNP BOARD EXAM review 2023 Concrete Operational stage (Piaget) - 7-12 years Understanding of concrete relationships (math and quantity); development of conservation (knowing changes in shape are not changes in volume), spacial relationships, think about past and present, begins to value others Formal Operational stage (Piaget) - 11-15+ y.o. 1. Future thinking 2. Abstract thinking 3. Complex problem solving Reflex: rooting and sucking - Appears: Newborn Disappears: 3-4 mo Reflex: Moro (startle) - Appears: Newborn Disappears: 3-4 mo Elicit by striking a flat surface while infant is lying or allow head and trunk to fall backward to an angle of 30. Reaction: infants arms and legs symmetrically extend and then abduct while her fingers spread to form a C shape. ANCC PMHNP BOARD EXAM review 2023 Grasp (palmar, plantar) reflex - Appears: Newborn Disappears: 3-6 mo; 4 mo Pacing/stepping reflex - appears: Newborn disappears 1-2mo Hold baby upright w/hand across chest - baby steps Tonic neck reflex (fencer position) - BIRTH TO 3 or 4 MONTHS Turn newborn head turned to the right: Right arm/leg EXTEND Left arm/leg flex Turn newborn head to the left: Left arm/leg EXTEND Right arm/leg flex Babinski reflex - Appears: Newborn Disappears: 12 mo or when walking Reflex in which a newborn fans out the toes when the sole of the foot is touched ANCC PMHNP BOARD EXAM review 2023 cerebral cortex (cerebrum) - -grey, wrinkled surface that is densely packed with neurons -located in upper forebrain -connections between neurons grow as we learn and develop -surface is wrinkled to increase surface area (convolutions) -2 hemispheres right hemisphere functions - -Receives somatic sensory signals from and controls muscles on left side of body. -Musical and artistic awareness -Space and pattern perception -Recognition of faces and emotional content of facial expressions -Generating emotional (negative) content of language -Generating mental images to compare spatial relationships -processes interacting w/ the environment -attention capacity -intuition -Identifying and discriminating among odors left hemisphere functions - -sequential processing, analytic thought, logic, language, science and math -positive emotions ANCC PMHNP BOARD EXAM review 2023 examples: mean, standard deviation, variance Aaron Beck - pioneer in Cognitive Therapy. Suggested negative beliefs cause depression. Gerald Klerman and Myrna Weissman - interpersonal therapy Sigmund Freud - founder of psychoanalysis Carl Rogers - person-centered therapy Humanistic; self-concept and unconditional positive regard drive personality Viktor Frankl - existential therapy-encourages reflection on life and self- concentrafion durable power of attorney - -a legal agreement that allows an agent or representative of the patient to act on behalf of the patient -can cover physical, mental and terminal illnesses EMDR (eye movement desensitization and reprocessing) - - created by Francine Shapiro ANCC PMHNP BOARD EXAM review 2023 having people imagine traumatic scents and using a finger to trigger eye movements Freud: Oral stage (birth to 1 year) - Pleasure is focused on oral activities: feeding and sucking. Chewing, crying Failure=envy, excessive dependence on others, schizophrenia, substance abuse, paranoia Freud: Anal - 1.5-3 yrs Sphincter control, expulsion and retention success=achieve autonomy and independence Failure=shame from loss of control depressive disorders Freud:Phallic Stage - (3 to 6 yrs) Identification with parent of same sex; development of sexual identity; focus is on genital organs success=curiosity without embarrassment, mastery over impulses, sense of sexual identity Failure=sexual identity disorders Freud: Latency - 6-puberty Peer relationships, learning, motor skills, socialization Failure=inability to socialize or form relationships, failure of interest to learn or work ANCC PMHNP BOARD EXAM review 2023 Freud: Genital - Puberty on Integration and synthesis of behaviors from early stages (primarily general based sexuality) Failure=sexual perversion disorders neurological soft signs - -dysdiadochokinesia (posterior lobe of cerebellum lesion) *can't complete rapid alternating movements -astereognosis (lesion of parietal lobe) -choreiform movements -tics -agraphesthesia (can't recognize letters/numbers drawn on hand) - facial grimacing - impaired fine motor skills -abnormal blinking -abnormal motor tone -EPS MDD risk factors - - genetic loading - prior episode of MDD - female - postpartum period ANCC PMHNP BOARD EXAM review 2023 Serotonin syndrome symptoms - Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity Agitation Restlessness Rapid heart rate and elevated body Headache Diaphoresis, shivering, goosebumps Confusion, fever, seizures, unconscious discontinuation syndrome - a condition that can occur following the interruption, dose reduction, or discontinuation of antidepressant drugs, including selective serotonin re-uptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Flu like symptoms Fatigue and lethargy Myalgia Decreased concentration N/V Impaired memory Paresthesias Irritability, anxiety, insomnia Crying ANCC PMHNP BOARD EXAM review 2023 Dizziness and vertigo kindling - -The process of neuronal membrane threshold sensitivity dysfunction -brain is overly sensitive to electrical stimuli neuronal firing occurs even w/o stimuli bipolar disorder incidence and demographics - 0.7% of general population affects 2.3 million American adults mean onset is early 20s Ataques de nervios (Culture-bound syndromes) - Latino cultural bound syndrome-Usually provoked by disruptions in family bonds and may have s/s of trembling,crying,and screaming Khyal attacks - Wind attacks are a common manifestation among Cambodian and other Asian cultures, commonly manifest in neck soreness and tinnitus Anxiety incidence and demographics - Lifetime prevalence of 29% in u.s. More common in women and girls ANCC PMHNP BOARD EXAM review 2023 Median age of onset=11 CIWAA SCORING - 0-9=absent or very mild withdrawal 10-15=mild withdrawal 16-20=moderate withdrawal 21-67=severe withdrawal and possible DTs SLUMS exam; What is it and scoring - 11 items measures cognition, including orientation, short term memory, calculations, naming of animals, clock drawing, geometric figures 27-30=normal in person w/ h.s. diploma 21-26=mild neurocognitive disorder 0-20=dementia mood disorder questionnaire; what is it and scoring - screens for bipolar d/o positive screen if: 7/13 yes responses in part I, yes to #2, and moderate or serious response to part 3 Hamilton Depression Rating Scale - measures depression 0 to 76 ANCC PMHNP BOARD EXAM review 2023 Structural family therapy - Minuchin most preventable cause of intellectual disability - fetal alcohol syndrome Disruptive Mood Dysregulation Disorder - -a childhood disorder, >6 and <18, marked by severe recurrent temper outbursts along with a persistent irritable or angry mood -boys and school age screen for family and personal hx of bd check what level for restless leg syndrome - ferritin Piaget's stages of cognitive development: some people can't focus - sensorimotor, preoperational, concrete operational, formal operational Thalamus - the brain's sensory control center in limbic syetem, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla (except sense of smell) Amygdala - A limbic system structure involved in memory and emotion, particularly fear, anxiety and aggression. ANCC PMHNP BOARD EXAM review 2023 Hypothalamus - A limbic system structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), regulates autonomic nervous system (fight or flight)- helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward. Hippocampus - a neural center located in the limbic system; helps convert short term memory to long term memory, puts memories into storage quasi-experimental research - involves manipulation of variables but lacks a comparison group or randomization cross-sectional study - study of population that are similar but differ by one specific variable (like age), to find relationships btwn variables at a specific point in time cohort study - a research study that compares a particular outcome (lung cancer) in groups of individuals who differ by certain characteristics (smokers vs non-smokers) standard deviation - a computed measure of how much scores vary around the mean score ANCC PMHNP BOARD EXAM review 2023 95% of sample falls within 2 SDs of mean=bell curve longitudinal study - a study that observes the same participants on many occasions over a long period of time to find relationships between variables correlation coefficient - A measure of interdependence of two random variables that ranges from -1 to +1 t-test - a statistical test used to evaluate the the differences in means between 2 groups qualitative study - seek to understand how individuals and communities perceive and make sense of the world and their experiences Includes case studies, open ended inquiry, field studies, participant observation and ethnographic studies Confidence Interval (CI) - A range of values that predicts the probability of including a specific parameter being assessed level of significance (p value) - the probability of a particular result occurring by chance alone. ANCC PMHNP BOARD EXAM review 2023 Ford vs. Wainwright (1986) - competency to be executed must be aware of punishment and in best position to make whatever peace with religion O'Connor v. Donaldson - Established that mental illness alone is not enough for involuntary hospitalization -- mentally ill cannot be confined against their will if they can survive on their own Rennie vs Klein - patients have the right to refuse any treatment Durham vs. United States - insanity defense signs of atypical depression - -interpersonal rejection sensitivity, increased appetite, marked mood reactivity, leaden paralysis, and weight gain -more common in women - occur early in age -common in BD I and II nursing scope of practice - Tasks or procedures that the nurse can perform within the state the nurse is working in. defines roles and actions ANCC PMHNP BOARD EXAM review 2023 identifies competencies broad variations from state to state Standards of Practice - Authoritative statements addressing the quality and practice offers way to judge nature of care reflects expectation for care thar should be provided to patients reflects minimum levels of acceptable performance can be used legally reflects 1 guideline applicable to all psych nps regardless of location Global Developmental Delay - This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing. This category requires reassessment after a period of time. Borderline Intellectual Functioning - IQ 71-84 without adaptive functioning trouble ANCC PMHNP BOARD EXAM review 2023 Unspecified Intellectual Disability - child is 5 years or older and cannot reliably be assessed due to physical or mental impairment 4 major dimensions of recovery - health, home, purpose, community creator of nurse client relationship - Hildegard peplau Theory of self care - Dorothy 0rem Caring Theory - Jean Watson LACE model, what did it do - Licensure Accreditation Certification Education identified 4 APRN roles state legislative statutes: - grant legal authority, the nurse practice act, may require collaborative agreement Nurse Practice Act: - provides title protection