BEST REVIEW Pocket Prep PMHNP-BC QUESTIONS AND ANSWERS 2024/2025, Study Guides, Projects, Research of Health sciences

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BEST REVIEW Pocket Prep PMHNP-BC

QUESTIONS AND ANSWERS 2024/

Ethical Principal Terms (Justice, Veracity, Respect, Fidelity) •Justice: Doing what is fair •Veracity: Telling the truth •Respect: Treating everyone with equal dignity •Fidelity: Being true and loyal Inferential statistics numerical values that enable a researcher to draw conclusions that extend beyond the immediate data alone. Examples include t-test, analysis of variance, Pearson's r correlation, probability, and p-value. Descriptive statistics are used to describe the basic features of the data in a study. They are numerical values that summarize, organize and describe observations. Examples include mean, standard deviation, and variance. Three phases of a therapeutic relationship 1.Introduction 2.Working 3.Termination EPS Signs and Symptoms Affect motor function and muscle movement •Akathisia: motor restlessness, inability to remain still, rocking, pacing, or constant motion of a unilateral limb, subjective sense of restlessness, often mistaken for increasing anxiety •Akinesia: absence of movement, difficulty initiating motion, subjective feeling of lack of motivation to move, often mistaken for laziness or lack of interest •Dystonia: muscle spasticity usually in the back or neck, subjectively painful, often mistaken for agitation •Pseudo-Parkinson's: shuffling gait, motor slowing, mask-like facial expression, pill-rolling; tremors, muscle rigidity •Tardive dyskinesia: involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that may progress to limbs, can be irreversible, can occur as an acute process at the initiation of medications or as a chronic condition at any point during treatment Progression of Alzheimer's The onset of symptoms in Alzheimer's disease follows this progression: (1) mood changes, (2) cognitive impairment, (3) decline in functional independence, (4) behavioral and motor symptoms. Mood changes

are usually manifested as apathy rather than depression and are resistant to antidepressant medications but responsive to cholinesterase inhibitors Computer Competence vs. Literacy Computer competency is the ability to demonstrate proficiency in the use of software applications, such as Microsoft Word, Excel, and PowerPoint, and knowledge in computer terminology, hardware selection, and simple maintenance functions. Computer literacy is the level of expertise and familiarity someone has with computers. It generally refers to the ability to use an application rather than to write code. Individuals who are very computer literate are called power users. Information literacy involves recognizing when information is needed and being able to efficiently locate and use it. Information competency is often used as a synonym for information literacy. Counter-transference Countertransference represents the nurse practitioner's emotional reaction to the patient based on his or her past experiences. Signs that indicate the presence of countertransference include: •Intense emotional reactions during the first encounter with the patient •Recurrent anxiety or uneasiness while dealing with a patient •Uncharacteristic carelessness when following up with a patient •Difficulty empathizing •Resistance to others treating the patient •Preoccupation or dreaming about the patient •Frequently running overtime or cutting time short with patient •Depression during or after an interaction with a patient Sources of Knowledge Strongest to Weakest •Level 1 (strongest): Systematic review of randomized controlled trials or systematic review of nonrandomized trials •Level 2: Single randomized controlled trial or single nonrandomized trial •Level 3: Systematic review of correlational or observational studies •Level 4: Single correlational or observational study •Level 5: Systematic review of descriptive, qualitative, or physiologic studies •Level 6: Single descriptive, qualitative, or physiologic study •Level 7 (weakest): Opinions of authorities and expert committees Neuroleptic malignant syndrome is a rare, Neuroleptic malignant syndrome is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases.

Wernicke's syndrome, Wernicke's syndrome, also known as Wernicke encephalopathy, is a neurological disease characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities. Her symptoms cannot be explained by Wernicke encephalopathy. Korsakoff syndrome Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B1). Korsakoff syndrome is most commonly caused by alcohol misuse and is often, but not always, preceded by an episode of Wernicke encephalopathy. Her symptoms cannot be explained by Korsakoff psychosis. Metasynthesis a scientific study that analyzes a collection of qualitative studies. These studies discover meaning by summarizing the results in a narrative format. Met analysis a scientific study that statistically analyzes a collection of quantitative studies. These studies use statistics to discover patterns that would be otherwise undetectable. Systematic Review A systematic review is a scientific study that gathers multiple studies and analyzes them to draw a larger conclusion. The term systematic refers to methodical order and planning. When conducting a systematic review, the researcher uses transparent and structured steps in order to avoid bias and increase confidence in the findings. There are two main types of systematic reviews; each differs by the type of research they analyze and how they analyze it. Primary Prevention Primary prevention is aimed at decreasing the number of new cases of mental disorders. An example of primary prevention is Drug Abuse Resistance Education (DARE) programs in elementary and middle schools. Secondary Prevention Secondary prevention is aimed at decreasing the number of existing cases of mental disorder. Examples of secondary prevention include telephone hotlines, crisis intervention, and disaster response. Tertiary Prevention Tertiary prevention is aimed at decreasing the disability and severity of a mental health disorder. Providing social skills education for a group of intellectually disabled teenagers is an example of tertiary prevention. FDA (Food and Drug Administration) Drug Responsibilities The Food and Drug Administration (FDA) is the federal agency that regulates the introduction of new drugs in the United States. The FDA protects consumers from the risks associated with drug purchases. They approve new drugs before they can be sold, and they determine which drugs should be assigned over-the-counter or prescription status.

*They do not approve or deny drug patents Somatic Nervous The somatic nervous system conveys information from the central nervous system to skeletal muscles and is responsible for voluntary movement. Dialectical Behavioral Therapy Dialectical behavioral therapy was originated by Marsha Linehan. It is most commonly used to treat borderline personality disorder. It focuses on emotional regulation, tolerance for distress, self- management skills, interpersonal effectiveness, and mindfulness. The treatment goals include: Decrease suicidal behaviors Decrease therapy-interfering behaviors Decrease emotional reactivity Decrease self-invalidation Decrease crisis-generating behaviors Decrease active passivity Increase realistic decision-making Increase accurate communication of emotions and competencies Nursing Science Nursing science emphasizes the concept of a human's response to sickness. Nursing science is the domain of knowledge concerned with: The adaptation of individuals and groups to actual or potential health problems The environments that influence health in humans The therapeutic interventions that promote health and affect the consequences of illness Medical Science Medical science emphasizes the concepts of diagnosis and treatment of disease. Licensure Agency or government grants permission to persons to engage in the practice of that profession Credentialing Process used to protect the public by ensuring a minimum level of professional competence Certification A process by which a professional organization or association certified that a person licensed to practice as a professional has met certain predetermined standards specified by that profession for specialty practice (ANCC only certifying body for advanced practice psychiatric nursing) Scope of practice

1. Define NP roles and actions
2. Identifies competencies assumed to be held by all NPs who function in a particular role
3. Varies broadly from state to state* Standards of Practice
4. Authoritative statements regarding the quality and type of practice that should be provided
5. Provide a way to judge the nature of care provided
6. Reflect the expectation for the care that should be provided to clients with various illnesses
7. Reflect professional agreement focused on the minimum levels of acceptable performance
8. Can be used to legally describe the standard of care that must be met by a provider
9. May be precise protocols that must be followed or more general guidelines that recommend actions Erik Erikson's stages of psychosocial development are matched with their associated virtue on opposite side of notecard Trust vs. Mistrust: Hope Autonomy vs. Shame and Doubt: Will Initiative vs. Guilt: Purpose Industry vs. Inferiority: Competence Identity vs. Role Confusion: Fidelity Intimacy vs. Isolation: Love Generativity vs. Stagnation: Care Ego-integrity vs. Dispair: Wisdom Solution Focused Therapy Aims to resolve problems through cognitive problem-solving and personal resources. Techniques include miracle questions, exception-finding questions, and scaling questions. Miracle question: If you awoke this morning to find that your problem no longer existed, what would be different? Exception-finding question: Was there a time when the problem did not occur? Scaling question: On a scale from 1 to 10, with 10 be very anxious, how would you rate your anxiety right now? Screening for Autism Spectrum Disorder Although this is an evidence-based and adequate tool, it is for toddlers only; this patient is too old for this assessment tool. Screening for developmental delays is a critical component of assessing for ASD. These checklists include the following: Modified Checklist for Autism in Toddlers (Age-Specific)

Autism Diagnostic Observation Schedule-Generic (ADOS-G) Ages and Stages Questionnaires Signs and Symptoms of Autism Spectrum Disorder No cooing by age one year, no single words by age 16 months, no two-word phrases by age 24 months Loss of language skills No imaginary play Little interest in playing with other children Extremely short attention span No response when called by name Little or no eye contact Intense tantrums Fixations on single objects Unusually strong resistance to changes in routines Oversensitivity to certain sounds, textures, or smells Appetite or sleep-rest disturbance, or both Self-injurious behavior O'Connor vs. Donaldson O'Connor vs. Donaldson ruled that harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization. Rennie vs. Klein Rennie vs. Klein determined that patients have the right to refuse any treatment and use an appeal process. Roger vs. oken Roger vs. Oken determined that patients have an absolute right to refuse treatment but that a guardian may authorize their treatment. Durham vs. United States Durham vs. United States determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. External Validity When the sample is representative of the population and the results can be generalized Internal Validity When the independent variable caused a change in the dependent variable Rett Syndrome X-linked dominant Most commonly found in females

Physical exam findings and associated features of Rett Syndrome are as follows: Seizures Irregular respirations Scoliosis Loss of purposeful hand skills Stereotypic hand movements Irregular HR is NOT associated with Rett Syndrome Highest rate of antisocial personality disorder, risk factors The highest prevalence (greater than 70%) of antisocial personality disorder is seen in adult men with alcohol use disorder in forensic settings. The 12-month prevalence across all demographics is 0.2% to 3.3%. It is more common among those with a first-degree relative with the same disorder. A person is more likely to develop antisocial personality disorder if they were diagnosed with conduct disorder and attention-deficit/hyperactivity disorder before the age of 10. Childhood abuse and erratic parenting can also contribute to the development of antisocial personality disorder. Cluster Personality Disorder Cluster A patients are characterized as withdrawn, cold, suspicious, and irrational. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster B patients are characterized as theatrical, emotional, and attention-seeking. They often experience intense interpersonal conflicts and exhibit an extremely labile mood. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C patients tend to be anxious, fearful, tense, and overcontrolled. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Suicide Meaning and Statistics There are over 35,000 suicides in the United States each year. This is in contrast to 20,000 deaths due to homicide each year. The ratio of suicide attempts to completed suicides is 25:1. Over the past few decades, the rate of suicide has increased in adolescents and decreased in the elderly. In the United States, suicide is the 10th leading cause of death. Freud's stages of psychosexual development Freud's stages of psychosexual development include: 1.Oral: Birth to 12-18 months 2.Anal: 12-18 months to 3 years 3.Phallic: 3 to 5-6 years 4.Latency: 5-6 years to adolescence 5.Genital: Adolescence to adulthood

The major characteristics of the oral stage include seeking oral gratification through sucking, eating, mouthing, and biting. The major characteristics of the anal stage include gratification from expelling and withholding feces and coming to terms with society's controls related to toilet training. The major characteristics of the phallic stage include seeking gratification through the genitals, coming to terms with the Oedipal conflict, and identifying with the same sex parent. The latency stage is characterized by a time in which sexual concerns are largely unimportant. During the genital phase, sexual interests reemerge and individuals begin to establish mature sexual relationships. stages of development to describe a child's feelings of desire for his or her opposite-sex parent and jealousy and anger toward his or her same-sex parent Piaget's stages of cognitive development Piaget's stages of cognitive development include: 1.Infancy (birth to 2 years): Sensorimotor 2.Early Childhood (2 to 5 years): Preoperational 3.Middle Childhood (6 to 11 years): Concrete operational 4.Adolescence (11 to 19 years): Formal operational During the formal operational stage, adolescents develop the following cognitive-spatial concepts: •Hypothetical-deductive reasoning: quick to think of excuses •Imaginary audience: feel as though everyone is looking at them •Personal fable: inflated opinion of themselves •Propositional thinking: can think of many possibilities Screening tools CDC for Autism The following tools are recommended by the CDC for the screening of Autism during well-child visits: •Autism Diagnostic Observation Schedule-Generic (ADOS-G) •Ages and Stages Questionnaires (ASQ) •Modified Checklist for Autism in Toddlers (M-CHAT) Schizoaffective disorder Schizoaffective disorder is characterized by patients experiencing symptoms of schizophrenia along with either depression or mania. Delusional Disorder Delusional disorder is a psychotic disorder characterized by the presence of delusions but no other symptoms of schizophrenia. Brief Psychotic Disorder

Brief psychotic disorder is characterized by at least one psychotic symptom present for less than one month. Schizophreniform Disorder Schizophreniform disorder is characterized by patients experiencing symptoms of schizophrenia but who have been ill for only one to six months. Oppositional Defiant Disorder Oppositional defiant disorder is characterized by multiple examples of negativistic behavior persistent for at least six months usually beginning when a child is three or four years old. Systems Thinking Systems thinking is the understanding of structures that undergird complex systems and uses this understanding to affect significant and enduring change. Systems thinking is an important skill for nurse practitioners who wish to enact effective quality improvement initiatives. Part A Medicare Coverage Part A: Coverage for hospitalizations (up to 90 days), skilled nursing facility (up to 100 days), hospice (up to six months for terminally ill), and some home health care. Part B Medicare Coverage Part B: Coverage for ambulatory practitioner service, physical, occupational, and speech therapy, medical equipment, diagnostic tests, and some preventative care. Part C Medicare Coverage Part C: Optional coverage for beneficiaries who can choose to receive all of their health care services through one of the provider organizations covered under the Medicare Advantage plan. Part D Medicare Coverage Part D: Optional coverage for outpatient pharmaceuticals. Personality Disorder Cluster and Symptoms Cluster A patients are characterized as withdrawn, cold, suspicious, and irrational. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster B patients are characterized as theatrical, emotional, and attention-seeking. They often experience intense interpersonal conflicts and exhibit an extremely labile mood. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C patients tend to be anxious, fearful, tense, and overcontrolled. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Indications for seclusion and restraint Indications for seclusion and restraint include: •Prevent clear, imminent harm to the patient or others •Prevent significant disruption to treatment program or physical surroundings

•Assist in treatment as part of ongoing behavior therapy •Decrease sensory overstimulation •Patient's voluntary reasonable request Contraindications suicide Contraindications for seclusion and restraint include: •Extremely unstable medical or psychiatric condition •Delirious or demented patients unable to tolerate decreased stimulation •Overtly suicidal patients •Patients with severe drug reactions or overdoses who require close monitoring of their drug dosages •For punishment or convenience of staff Establishing a malpractice suite The burden of proof in medical malpractice suits is by a preponderance of evidence (greater than 50%). Medical malpractice suits are civil cases. Proof beyond reasonable doubt applies to criminal cases. ** To establish a medical malpractice suit, the plaintiff must establish that a dereliction of duty directly caused damage (also known as the four Ds of medical malpractice). The plaintiff must establish that: •The nurse practitioner owed the plaintiff a duty •The nurse practitioner's conduct fell below the standard of care •The nurse practitioner's conduct caused the plaintiff injury Specifiers of Bipolar Mood Disorder Specifiers are special descriptions added to a patient's diagnosis to provide more information. Specifiers help characterize the condition and describe its overall course. Specifiers used to describe mood disorders include: •With atypical features: These patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection. •With melancholic features: These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions. •With anxious distress: These patients have high levels of tension, restlessness, worry, and fear. •With catatonic features: These patients exhibit either motor hyperactivity or inactivity. •With mixed features: These patients are experiencing a mixture of both manic and depressive symptoms. •With peripartum onset: These patients develop a mood episode during pregnancy or within a month of having their baby. •With psychotic features: These patients develop delusions or hallucinations along with their mood symptoms.

•With rapid cycling: These patients have experienced at least four mood episodes in the past year. •With seasonal pattern: These patients regularly become ill at a certain time of the year. Sexual Identity Sexual identity refers to whom someone is sexually or affectionately attracted. Gender identity refers to a person's identity along a continuum between normative constructs of masculinity and femininity. Gender identity disorder is a formal diagnosis to describe persons who experience significant gender dysphoria. Transgender is an umbrella term describing people whose gender identity does not conform to gender norms associated with the sex they were assigned at birth. Gender Identity Sexual identity refers to whom someone is sexually or affectionately attracted. Sexual orientation also refers to the direction of sexual attraction; however, most people prefer the term sexual identity because it allows people to determine their own identities. Sexual orientation or identity does not always relate to gender identity. Gender identity refers to a person's identity along a continuum between normative constructs of masculinity and femininity. Gender identity disorder is a formal diagnosis to describe persons who experience significant gender dysphoria. Transgender Transgender is an umbrella term describing people whose gender identity does not conform to gender norms associated with the sex they were assigned at birth. Bipolar Features •With atypical features: These patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection. •With melancholic features: These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions. •With anxious distress: These patients have high levels of tension, restlessness, worry, and fear. •With catatonic features: These patients exhibit either motor hyperactivity or inactivity. •With mixed features: These patients are experiencing a mixture of both manic and depressive symptoms. •With peripartum onset: These patients develop a mood episode during pregnancy or within a month of having their baby. •With psychotic features: These patients develop delusions or hallucinations along with their mood symptoms. •With rapid cycling: These patients have experienced at least four mood episodes in the past year. Shingles

Herpes zoster, is an inflammatory condition where a virus produces painful vesicular eruptions along the nerves from one or more dorsal root ganglia. The shingles vaccine is recommended for anyone older than 60 years who has had the chickenpox. The shingles vaccine should not be given to: •People with a weakened immune system •People with HIV, AIDS, or a T-cell count below 200 •Patients being treated with high-dose steroids EPS Signs and Symptoms •Akathisia: motor restlessness, inability to remain still, rocking, pacing, or constant motion of a unilateral limb, subjective sense of restlessness, often mistaken for increasing anxiety •Akinesia: absence of movement, difficulty initiating motion, subjective feeling of lack of motivation to move, often mistaken for laziness or lack of interest

• Dystonia: muscle spasticity usually in the back or neck, subjectively painful, often mistaken for agitation •Pseudo-Parkinson's: shuffling gait, motor slowing, mask-like facial expression, pill-rolling; tremors, muscle rigidity •Tardive dyskinesia: involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that may progress to limbs, can be irreversible, can occur as an acute process at the initiation of medications or as a chronic condition at any point during treatment Tanner stages of breast development Tanner Stages of a girl's breast development are as follows: Stage 1: Prepubertal Stage 2: Breast bud stage with elevation of breast and papilla Stage 3: Further enlargement of breast and areola Stage 4: Areola and papilla form a secondary mound above the level of the breast Stage 5: Projection of papilla related to recession of areola Level 1 (strongest): Systematic review of randomized controlled trials or systematic review of nonrandomized trials Level 2: Single randomized controlled trial or single nonrandomized trial Level 3: Systematic review of correlational or observational studies Level 4: Single correlational or observational study Level 5: Systematic review of descriptive, qualitative, or physiologic studies Level 6: Single descriptive, qualitative, or physiologic study Level 7 (weakest): Opinions of authorities and expert committees