ANCC PMHNP CERT EXAM REVIEW 2023, Exams of Nursing

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How do you assess cranial nerve V trigeminal? - ✔Tell patient to close eyes, take piece of cotton or other soft item and lightly touch either one of both sides of each of the three divisions of the trigeminal.

How do you assess for cranial nerve VII facial? - ✔Observe the patient for nystagmus or twitching of the eye. This nerve controls facial movements and expression, check for symmetry. Have the patient wrinkle forehead, close eyes, smile, pucker lips, show teeth, and puff out cheeks.

primitive reflexes - ✔reflexes, controlled by "primitive" parts of the brain, that disappear during the first year of life

Mororeflex - ✔Extending of limbs when they hear a loud noise (defend themselves)

rooting reflex - ✔a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple

palmer grasp - ✔grasping with the whole hand

scope of practice - ✔The range of clinical procedures and activities that are allowed by law for a profession

Quality Improvement (QI) - ✔an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy

PDSA model - ✔Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI)

Trendelenburg sign - ✔Occurs with severe subluxation of one hip When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side

CYP450 inhibitors - ✔Fluvoxamine Fluoxetine Paroxetine Duloxetine Sertraline

CYP450 inducers - ✔Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin St John's Wort

What is the adverse effect of Depakote on the liver? - ✔can cause liver damage, and the risk is more likely to occur during the first 6 months of taking the medication. Signs might include nausea or vomiting, loss of appetite, abdominal pain, dark-colored urine, facial swelling, and yellowing of the skin or white of eyes

What would you do for a patient on Depakote with +4 protein in the urine? - ✔Rule out UTI, no adjustment for medication is needed

What happens when you take carbamazepine (tegertal) and erythromycin together? - ✔ It will decrease the effect of the antibiotic by inhibition

What happens when you take zyprexa and smoke? - ✔nicotine will increase the excretion of the drug thereby inhibiting it's effect

ICP in Infants S/S - ✔Bulging fontanels, high-pitch cry, irritability, restlessness

ICP

CHILDREN signs and symptoms - ✔• Headache

• Vomiting (usually projectile)
• Seizures
• Diplopia (Dbl vision), blurred vision

Neuro cry - ✔high-pitched and very grating on the ears due to their neurological sxs being overwhelmed

Neuroleptic Malignant Syndrome - ✔Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes. FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles

NMS treatment - ✔Dantrolene D2 agonists (e.g., bromocriptine).

lead poisoning - ✔A medical condition caused by toxic levels of the metal lead in the blood

Lead poisoning treatment - ✔chelation therapy

Amygdala's role in emotion - ✔- Aggression center

• Role in storing implicit emotional memories
• Stimulation (+) anger/violence or fear/anxiety
• Damage (-) mellow; hyperorality; hypersexuality; dis-inhibited behavior

Amygdala role in aggression - ✔Small volume increase aggression.

Frontal Lobe Atrophy - ✔As neurons die in the frontal and temporal regions, these lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally controlled by these parts of the brain. ... Scientists think that FTLD (frontal temporal lobe dementia) is the most common cause of dementia in people younger than age 60

Four dopaminergic pathways - ✔mesocortical mesolimbic nigrostriatal tuberoinfundibular

mesocortical pathway - ✔a path through which dopaminergic projections travel to reach the neocortex

mescolimbic pathway - ✔The mesolimbic pathway, sometimes referred to as the reward pathway, is a dopaminergic pathway in the brain. The pathway connects the ventral tegmental area in the midbrain, to the ventral striatum of the basal ganglia in the forebrain. The ventral striatum includes the nucleus accumbens and the olfactory tubercle.

Nigrostriatal pathway - ✔the dopaminergic tract from the substantia nigra to the striatum

Tuberoinfundibular pathway - ✔from hypothalamus to anterior pituitary -> DA released from these neurons inhibit prolactin secretion -> when DA receptors here are blocked prolactin levels rise cause galactorrhea)

primary prevention - ✔Efforts to prevent an injury or illness from ever occurring.

secondary prevention - ✔Efforts to limit the effects of an injury or illness that you cannot completely prevent, screening exams.

tertiary prevention - ✔actions taken to contain damage once a disease or disability has progressed beyond its early stages

menopause hormone therapy - ✔most effective therapy for moderate -severe vasomotor symptoms - use quality of life scales to identify degree of vasomotor symptom severity

*should not be used for protection against CVD or dementia

congestive heart failure and depression - ✔MDD is highly prevalent in these patients

Thyroid levels while on lithium - ✔Because of the high incidence of thyroid dysfunction that occurs during lithium treatment, patients should have a careful thyroid physical examination and determination of serum thyroid-stimulating hormone (TSH) and antithyroid peroxidase antibody titers before lithium treatment is begun. Patients with normal thyroid function initially should be reevaluated every 6 to 12 months for several years, and thyroid dysfunction should be treated if diagnosed. The development of thyroid dysfunction does not typically require discontinuation of lithium. If thyroid function is abnormal at the initial evaluation, lithium can still be given if necessary, but the thyroid dysfunction should be treated.

SSRIs MOA - ✔block reuptake of serotonin by inhibiting the presynaptic reuptake

SNRIs mechanism - ✔Inhibit 5-HT and norepinephrine reuptake.

Lithium mechanism of action - ✔Not established, possibly related to inhibition of phosphoinosital cascade It inhibits excitatory neurotransmitters such as dopamine and glutamate, and promotes GABA-mediated neurotransmission.

Carbamazepine mechanism - ✔Block voltage-dependent sodium channels

Structural Therapy - ✔A therapeutic approach directed at changing or realigning the organization of a family to modify dysfunctional patterns and clarify boundaries. Developed by Salvador Minuchin.

crisis intervention - ✔five-step problem-solving technique to promote adaptation and improve future coping

Irvin Yalom - ✔A leading figure in contemporary group therapy, especially the interpersonal approach

group therapy - ✔therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction

boderline personality disorder - ✔impulsive actions, often with the potential for self- harm as well as mood instability and chaotic relationships

DBT (dialectical behavior therapy) - ✔a form of therapy used to treat borderline personality disorder that combines elements of the behavioral and cognitive treatments with a mindfulness approach based on Eastern meditative practices

eating disorder treatment - ✔-correct dangerous eating patterns

-address psychological and situational factors that have led to / are maintaining the disorder -often requires family and friend participation

When to admit for eating disorder? - ✔75% below ideal body weight and/or electrolyte imbalances

just culture - ✔culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action

GERIATRIC ANEMIA - ✔lower than normal RBC that is common in seniors

PHQ-9 scores - ✔1-4 min depression 5-9 Mild depression 10-14 moderate depression 15-19 Moderately severe depression 20-17 Severe depression

Beck Depression Inventory (BDI) - ✔1-10 normal 11-16 Mild 17-20 Borderline depression 21-30 Moderate 31-40 Severe Over 40 Extreme

HAM-D - ✔0-7 normal 8-16 Mild 17-23 Moderate 24 (+) Severe

HAM-A - ✔17 or less indicates mild anxiety 18-24 mild to moderate anxiety

GAD-7 - ✔1-4 minimal anxiety 5-9 Mild anxiety 10-14 Moderate anxiety 15-21 Severe anxiety

Zung Self-Rating Depression Scale - ✔50-69 indicates depression 70 (+) severe depression

MoCA - ✔26-30 normal 22.1 mild impairment 16.2 Alzheimer's Disease

MMSE - ✔24-30 normal 23-20 mild 19-10 middle-moderate Alzheimer's 9-0 Late stage-severe Alzheimer's

Dementia - ✔a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes

delirium - ✔an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech.

Pediatric SSRIs - ✔fluoxetine (ages 8 and up) escitalopram (ages 12 and up)

Pediatric OCD FDA medications - ✔clomipramine (anafranil) 10 years and up fluoxetine (prozac) 8 years and up fluvoxamine (luvox) 8 years and up sertraline (zoloft) 6 years and up

galactorrhea - ✔abnormal flow of milk from the breasts

Dopamine - ✔a neurotransmitter that regulates motor behavior, motivation, pleasure, and emotional arousal

Serotonin - ✔A neurotransmitter that affects hunger,sleep, arousal, and mood.

GABA - ✔An inhibitory neurotransmitter in the brain.

Glutamate - ✔A major excitatory neurotransmitter; involved in memory

Acetylcholine - ✔A neurotransmitter that enables learning and memory and also triggers muscle contraction

Crisis training is proven to be effective in helping to deescalate situations to prevent the officer from using what? - ✔Lethal force

Signs of child abuse - ✔Head injuries;bruises and welts in the shapes of objects;Burns;human bites;rope burn;fractures in different stages of healing

AIDS dementia complex (ADC) - ✔Encephalitis, behavioral changes, decline in cognitive function Progressive slowing of motor functions

Apoptosis - ✔process of programmed cell death

Recovery (training principle) - ✔Holistic, person-centered approach to mental health care. Two premises: 1) It is possible to recover from a mental health condition; 2) The most effective recovery is patient-directed

neuron death - ✔the stage of early nervous system development during which large numbers of neurons die, typically those that have not established effective synaptic contacts

Mini-Cog Test - ✔■ Quick method for assessing dementia. If abnormal, screen further with MMSE. ■ Use these two methods: the clock drawing test with word recall test (three unrelated words). ■ Instruct patient to draw a clock and mark it with the hands showing a certain time. ■ Example: Instruct patient to "Draw a clock that shows 20 minutes past 4."

• Scoring clock test: Hands point to the correct time and numbers on clock are in correct sequence.

meta-analysis - ✔a statistical technique that averages the results of two or more studies to see if the effect of an independent variable is reliable

PTSD diagnostic criteria - ✔Three or more of the following should be present for more than 1 month:

1. Inability to recall an important aspect of the event
2. avoidance of activities, people, places that remind the patient of the event
3. attempts to avoid thinking or talking about the event
4. Feelings of detachment or estrangement from others
5. markedly decreased interest or anhedonia (inability to experience pleasure)
6. Restricted Range of Affect
7. Belief ones future has been foreshortened because of the event
8. Increased state of arousal characterized by insomnia, irritability, angry outbursts, poor concentration, hypervigilance, exaggerated startle response

PTSD treatment - ✔MEDICATIONS:

• Antidepressants (Zoloft, Paxil).
• Anxiolytics.
• If manifestations include nightmares or insomnia, Minipress has been prescribed. (Normally used to treat HTN, Minipress blocks the brain's response to NE and has been effective in suppressing nightmares.)

THERAPY:

• Cognitive Therapy
• Exposure Therapy

Zyprexa (olanzapine) - ✔monitor for metabolic syndrome

Risperidone (Risperdal) - ✔monitor for prolactin level increases

gastric emptying drugs - ✔Metoclopramide, Erythromycin, Domperidone, Cisapride

oversupply linked to schizophrenia. undersupply linked to tremors and decreased mobility in Parkinson's disease - ✔Dopamine

With Alzheimer's disease, ACh-producing neurons deteriorate. - ✔Acetylcholine

undersupply of serotonin - ✔linked to depression

Undersupply of norepinephrine. - ✔can depress mood

undersupply of GABA - ✔linked to seizures, tremors, and insomnia