Download ANCC PMHNP LATEST 2024/2025 TEST BANK WITH REAL QUESTIONS AND CORRECT ANSWERS RATED A+ and more Exams Medicine in PDF only on Docsity!
ANCC PMHNP LATEST 2024/2025 TEST
BANK WITH REAL QUESTIONS AND
CORRECT ANSWERS RATED A+
Behavioral management starts....? - ANSWER-Immediately upon admission If a child reports abuse.....? - ANSWER-Interview the child separately from parents Report to CPS Child shows to appointment w/o parents, plays with a toy in a sexual way, or if you suspect child abuse - ANSWER-Report to CPS, even on suspicion alone Where to interview a patient? - ANSWER-Private office with the door open Test taking strategies - ANSWER-Narrow it down to 2 possible choices When 2 choices are opposite, one is usually the answer When answer options are very similar to each other, they are usually not correct Absolutes are usually incorrect Test taking strategies 2 - ANSWER-Assessment before intervention Safety even before assessment Choose the most comprehensive option
Safety plan is correct, NOT no harm contract Tics are....? - ANSWER-Contraindication of a stimulant Before discharge....? - ANSWER-Can a patient stay safe and cope effectively Its important to build rapport with adolescents by.... - ANSWER-Ensuring confidentiality What you can keep confidential for an adolescent patient: - ANSWER-If the patient is attracted to the same gender If the patient is in a relationship with someone of the same age What can cause ethical dilemma with parent and child? - ANSWER-Separating child from parent for interview, but remember that the child is your primary patient and your patient has a right to confidentiality What to do for a patient with bipolar disorder who is not taking medications because they are forgetting? - ANSWER-Behavioral therapy Women may be at risk of suicide when....? - ANSWER-They are discharged home without an OB/GYN completing a risk assessment on them interprofessional collaboration - ANSWER-is encouraged.
Native Americans 3: - ANSWER-Use a healing stick; do not take the stick away. Make accommodations for patients. When serving a multicultural population: - ANSWER-Provide multicultural teaching; Use ethnospecific assessment parameters Patients want to use a traditional/spiritual healer - ANSWER-Obtain clearance for informed consent first but allow this. MAKE CULTURAL ACCOMMODATIONS! If a patient can't speak English... - ANSWER-Provide an interpreter for culturally sensitive care If a patient emails you about exacerbation of a symptom.....? - ANSWER-Call the patient and perform an assessment. You can't assess a patient over online chat. You can't perform interventions until you talk to the patient on the phone for real assessment. Before referral...? - ANSWER-See if there is something that you can do for the patient If culture is specified in a question..... - ANSWER-Choose a culturally sensitive answer. You do not necessarily need to refer a patient to a provider who shares the same culture. You can provide culturally sensitive care yourself. The patient feels funny because they inhaled acetone..... - ANSWER-Order a urine drug screen for other substances before you refer them out.
A culture expected response to a stressor... - ANSWER-Does not necessarily indicate a mental health disorder. Try to understand the context before diagnosing a disorder. Susto - ANSWER-Latino Folk illness- a shocking, unpleasant or frightening experience that is believed to cause the soul to leave the body Apoptosis - ANSWER-Cell death Thyroid problems can cause mood abnormalities - ANSWER-Depressed? Check thyroid. Manic? Check thyroid. Check TSH first and then T3 and T4. Values are: - ANSWER-0.5-5. Hyperthyroidism is a lower score Hypothyroidism is a higher score Hyperthyroidism symptoms - ANSWER-Heat intolerance, agitation, anxiety, irritability, tachycardia, mood swings, weight loss Hypothyroidism symptoms - ANSWER-Cold intolerance, lethargy, weight gain, decreased libido
Fluoxetine, Paroxetine, bupropion due to hypotension and bradycardia Antipsychotics that cause QT prolongation.... - ANSWER-Ziprasidone, quetiapine, haloperidol, citalopram Antipsychotics less likely to cause QT prolongation - ANSWER-aripiprazole, lurasidone, olanzapine Least sedating SSRI - ANSWER-escitalopram and fluoxetine Safest SSRI for patients with heart issues - ANSWER-sertraline and escitalopram lamotrigine - ANSWER-can cause stevens johnson syndrome (severe rash) mood stabilizer that causes the least weight gain Antipsychotics that cause the least weight gain - ANSWER-ZAL (ziprasidone, aripirazole, lurasidone) Antipsychotics and weight gain - ANSWER-Check BMI, hip-to-waist ratio, glucose, and lipid panel Nonpharmacologic management- exercise and diet pharmacologic- switch to antipsychotic that causes less weight gain. ZAL
New patient labs - ANSWER-CMP, lipid panel, A1C Carbamazepine (tegretol) facts - ANSWER-Black box warning for agranulocytosis (decreased WBCs) and aplastic anemia. Can cause stevens johnson syndrome. Screening for asian patients on carbamazepine? - ANSWER-HLA B 1502, increases risk of stevens johnson syndrome in asian patients antiepileptics carbamazepine, topiramate, and phenytoin (dilantin) can make.. - ANSWER-oral birth control less effective carbamazepine and closaril can cause agranulocytosis so you should... - ANSWER- monitor for signs of infection: fever, chills, sore throat, weakness DC carbamazepine/clozaril at ANC of - ANSWER-ANC less than 1, DC carbamazepine/clozaril at WBC of - ANSWER-2,000-3,000 whether patient shows signs of infection or not closapine/clozaril can cause ---------- and it is the only antipsychotic that can...? - ANSWER-myocarditis and cardiomyopathy It is the only antipsychotic that can reduce risk of suicide in patients with schizophrenia
DC lithium and check serum Lithium levels! Things that may increase lithium concentration and lead to toxicity - ANSWER- NSAIDS, ACE inhibitors (lisinopril) Dehydration Hyponatremia (low sodium, under 135) can reduce lithium clearance Addiction neurotrasmitters - ANSWER-Dopamine and GABA Nightmare neurotrasmitters - ANSWER-Norepinephrine primarily Alcohol affects which neurotransmitter primarily? - ANSWER-GABA Neuroleptic Malignant Syndrom (NMS) - ANSWER-POTENTIALLY FATAL Caused by antipsychotics Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) from muscle destruction Myogoblinuria (breakdown of muscle, rhabdomyolysis) Elevated WBC and Elevated LFT Fever
NMS treatment - ANSWER-Bromocriptine (parlodel) D2 agonist Dantrolene (dantrium) muscle relaxant DC the offending agent Serotonin Syndrome - ANSWER-Caused by antidepressants Hyperreflexia Myoclonic jerks Fever Tachycardia Agitation Confusion/disorientation GI upset When switching from MAOI to fluoxetine....? - ANSWER-Wait 2 weeks St. John's Wort: - ANSWER-Increases serotonin Can impair glucose tolerance/ reduce insulin response How long to wait after stopping old drug before starting a new drug? - ANSWER-A wash out period of 5 half lives
Wellbutrin (bupropion) is contraindicated in patients with - ANSWER-A seizure disorder or a history of seizures. Anorexia or bulimia It reduces the seizure threshold Triptans contraindications: - ANSWER-Triptans increase serotonin. Do not give SSRI/SNRI/MAOI if patient is on a triptan. Could cause serotonin syndrome Alcohol and antidepressants - ANSWER-can make mental health symptoms worse can increase drug side effects Do not mix with maoi due to increase of blood pressure Schizophrenia facts: - ANSWER-Starts in 20s-30s A hallmark symptom is impaired proverb interpretation Associated with a lipid disorder- reduced HDL and high triglycerides Schizophrenic patients have a lower tolerability to: - ANSWER-alpha 2 receptor agonists like guanfacine and clonidine __________ are contraindicated in patients with schizophrenia - ANSWER- Stimulants- they increase dopamine levels
Schizophrenia neurobiological defects: - ANSWER-Enlarged venetricles Atrophy of cerebral cortex. Smaller frontal and temporal lobes Reduced symmetry in temporal, frontal, occipital lobes Decreased cerebral blood flow. Hippocampal and amygdala reduction Due to abnormalities in various brain structures, schizophrenic patients can display: - ANSWER-Aggression, impulsivity, abstract thinking problems Patients with schizophrenia need __________ training? - ANSWER-Social skills training. This is a tertiary prevention strategy. Also they made need referral to an exercise program to improve quality of life. Calculating Haldol IM dose - ANSWER-Start with 20x oral dose for first month. Do not exceed 100mg IM dose at one time. Break up shots for later in the month if needed. Nonpharmacologic treatment for schizophrenia - ANSWER-Group Therapy Assertive Community Treatment (ACT) - ANSWER-Mental health services are provided in a community health setting, rather than a more restrictive residential or hospital setting for those experiencing severe mental illness.
MTHFR gene mutation - ANSWER-Can cause low homocysteine, b9 (folate) and b Atypical antipsychotics do what that 1st gen antipsychotics don't? - ANSWER- 5HT2A antagonism Dopamine pathways: Mesolimbic - ANSWER-Overactivation leads to positive symptoms Regulates emotional behaviors Associated with reward, motivation, pleasure Dopamine pathways: Mesocortical - ANSWER-Hypoactivation leads to negative, cognitive, and affective symptoms Dopamine pathways: Nigrostriatal - ANSWER-Mediates motor movements. Blockade of D2 receptors in this pathway can cause EPS Acute dystonia, parkinsonism, akathisia. Chronic blockade can lead to tardive dyskinesia Hyperactivation can led to tics, dyskinesias Dopamine pathways: Tuberoinfundibular - ANSWER-Disruption of this pathway can cause prolactin levels to rise which may result in galactorrhea and gynecomastia. Females may also experience amenorrhea.
EPS symptoms are a result of - ANSWER-an imbalance between (too little)dopamine and (too much) acetycholine Treatment for EPS - ANSWER-Cogentin (benztropine) Metoclopramide (reglan) can cause - ANSWER-EPS like symptoms Tardive dyskinesia treatment - ANSWER-Lower the dose of antipsychotic or change the drug Ingrezza (valbenazine) or Austedo (deuterbenzene) Steroids can cause - ANSWER-Mania, Depression, Psychosis Bipolar disorder facts: - ANSWER-High degree of heritability There is no single bipolar gene If developing over the age of 45, it is most likely due to a medical condition. Anorexia symptoms - ANSWER-pain after eating/ fullness delayed gastric emptying, can be cause by famotidine or omeprazole
A patient with borderline personality disorder presents with anger, irritability, and self-harming behavior. Treat with : - ANSWER-Lithium A patient with borderline personality disorder presents with a depressed mood, emotional lability, and interpersonal problems, rejection sensitivity, aggression, hostility. Treat with : - ANSWER-Depakote Schizoid personality disorder - ANSWER-Appears cold and detached Voluntary social isolation Does not care what other people think of them Avoidant personality disorder - ANSWER-Avoidance of activities involving significant interpersonal contact. Avoids social interaction due to fear of criticism or not being liked. Schizotypal personality disorder - ANSWER-Interpersonal difficulties and social anxiety Ideas of reference Magical thinking Paranoid ideation Unusual perceptual experiences Behavior overtly odd
Conversion disorder - ANSWER-Person has blindness, mutism, paralysis, or paresthesia, or other nervous system symptoms that cannot be explained by medical evaluation. Symptoms usually begin after a stressful experience. Behavioral therapy - ANSWER-Focuses on changing maladaptive behaviors by participating in active behavioral techniques: Exposure, relaxation, skills training, problem-solving, role-playing, modeling. Cognitive behavioral therapy - ANSWER-Focuses on changing unhelpful or unhealthy thoughts or behaviors. Journaling - ANSWER-is a CBT tool that helps individuals understand and manage their thoughts. Interpersonal Therapy - ANSWER-The goal is to identify and modify interpersonal problems, to understand and manage relationship problems. (marital conflict) Psychodynamic therapy - ANSWER-Focuses on unconscious processes and how they might influence past and present behavior. Humanistic therapy - ANSWER-Focuses on self directed growth and self actualization. Each person has the potential to find meaning. Originated by Carl Rogers.
