Download Georgette PMHNP Review Questions and Answers for Mental Health Nursing and more Exams Public Health in PDF only on Docsity! Georgette PMHNP Review Questions and Answers 100% Correct When many answers are remarkably similar, they are usually _____________ - ANSWER-wrong Interprofessional collaboration is encouraged. - ANSWER-Collaborate is usually right. Delegate is usually wrong. ADPIER - ANSWER-Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - ANSWER-Normal 0.6-1.2 Lithium toxicity occurs at levels - ANSWER-> 1.5 Signs of Lithium toxicity - ANSWER-severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - ANSWER-MANIA Lithium has evidence shown to - ANSWER-reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester - ANSWER-Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - ANSWER-rise Baseline labs before initiation of lithium - ANSWER-TSH creatinine (0.6-1.2) BUN (10-20) HCG (all psychotropics females 12-51) EKG 50+ Urinalysis (check for proteins, 4+ may indicate kidney disease) Side Effects of Lithium - ANSWER-hypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - ANSWER-staying hydrated avoiding NSAIDS compliance Depakote normal level - ANSWER-50-125 Depakote toxicity level - ANSWER-greater than 150 Teratogenic effects of Depakote - ANSWER-spina bifida Adverse effects of depakote - ANSWER-alopecia hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue Signs of Depakote toxicity - ANSWER-disorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity - ANSWER-DC med check level LFT ammonia MAOI + tyramine causes - ANSWER-hypertensive crisis Symptoms of hypertensive crisis - ANSWER-elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + - ANSWER-MEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds Treatment for hypertensive crisis - ANSWER-DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos - ANSWER-floppy baby, cleft palate Teratogenic effects of tegratol - ANSWER-neural tube defect Signs of anorexia nervosa - ANSWER-low BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - ANSWER-there is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands - ANSWER-Low BMI If a patient is depression, low energy, fatigued, you would prescribe - ANSWER- Wellbutrin Wellbutrin is contraindicated in patients with - ANSWER-seizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) - ANSWER-bupropion CLozaril is metabolized by - ANSWER-cytochrome P450 enzyme CYP1A2 INducers - ANSWER-induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - ANSWER-decrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage - ANSWER-Barbituates St. Johns Wart Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need ___________doses of their medication. - ANSWER-higher Inhibitors - ANSWER-inhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors - ANSWER-Sodium valproate Isoniazid Cimetidine Ketoconazole Alcohol Chloramphenicol Erythromycin Sulfonamine Cipro Omeprazole Metronidazole Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine a. 2D6 b. 1A2 c. 2C19 d. 2C9 - ANSWER-1A2 (want A 2 cigarette break) When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration - ANSWER-Decreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium D. Decreased renal clearance of lithium - ANSWER-A. decreased renal clearance of lithium Where is norepinephrine produced - ANSWER-locus coeruleus and medullary reticular formation Norepinephrine is associated with - ANSWER-mood disorders Serotonin is made where in the brain - ANSWER-raphe nuclei of the brainsteam Serotonin is associated with - ANSWER-sleep and mood disorder Dopamine is made in - ANSWER-substantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with - ANSWER-addiction and psychosis Acetylcholine is made - ANSWER-basal nucleus of Meynert Most abundant inhibitory neurotransmitter in the brain - ANSWER-GABA I don't have enough GABA, my anxiety is high Med used to increase GABA - ANSWER-benzos Fred flinstone needs a Zanny, Gabba dabba do. Most excitatory neutransmitter - ANSWER-glutamate Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus - ANSWER-increases symptoms of anxiety. Autism - ANSWER-deficits in social communication and social interaction across multiple settings Parents of kids with autism may report - ANSWER-No response when called by name Little or no eye contact Children with autism often like to line up, stack, or organize objects and toys. Screenings for autism - ANSWER-ADOS M-CHAT ASQ Pharm management for autism - ANSWER-antipsychotics are effective for symptoms such as tantrums, aggressive behaviors, self-injurious behaviors Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons? A. raphe nuclei B. Nucleus acumbuns C. Locus coeruleus D. Amygdala - ANSWER-raphe nuclei Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality - ANSWER-frontal lobe Blockade of dopamine in this pathway can lead to increased prolactin levels - ANSWER-tuberoinfundibular pathway Muscle spasms ninth face, neck, tongue, back/neck muscles - ANSWER-acute dystonia Oculogyric crisis, which can lead to permanent injury. Patients have prolonged involuntary upwards deviation of the eyes bilaterally. - ANSWER-Rare presentation of acute dystonia. Pharm treatment for dystonia - ANSWER-cogentin (IM first then oral) Restlessness, inability to sit still. Pacing. Mistaken for anxiety. - ANSWER-Akathisia Commonly used rating scale for akathisia is - ANSWER-Barnes Akathisia rating scale and extrapyramidal symptom rating scale. Treatment for akathisis 1st line 2nd line 3rd line - ANSWER-1st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine Absence of movement or difficulty initiating movement - ANSWER-akinesia Treatment: cogentin Presence of symptoms of Parkinson's produced by D2 blockade in the nigrostriatal pathway - ANSWER-Pseudo-Parkinsonism Signs of Parkinsons - ANSWER-muscle rigidity shuffling gait mask like facial expression pill rolling tremors cogwheel rigidity Treatment for pseudo parkinsonism - ANSWER-cogentin Involuntary abnormal muscle movement of the mouth tongue face and jaw that may progress to limbs. Can take 1-2 years to occur. - ANSWER-Tardive dyskinesia Signs of tar dive dyskinesia - ANSWER-lip smacking protrusion of the tongue chewing motion facial dyskinesia involuntary movement. Treatment for TD - ANSWER-Stop offending antipsychotic, reduce the dose, or switch to clozapine. COGENTIN WORSENS IT Ingrezza or Austedo approved Non-psych med that can cause TD - ANSWER-Reglan A patient has been treated for the past several years with fluphenazine (Prolixin). You tonic that he is drooling and has a slight pill rolling movement of the fingers. These are EPS symptoms known as A. pseudo parkinsonism b. anticholinergic effects C. Tardive dyskinesia D. Acute dystonia - ANSWER-A. Pseudoparkinsonism A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway? A. Are you experiencing constipation? B. Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression? C. Are you experiencing increased thirst? D. Are you experiencing breast discharge? - ANSWER-Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression Fetal alcohol syndrome - ANSWER-Everything is low low weight, small features of the face. Which if the following antidepressants is associated with the most cardiovascular side effects? - ANSWER-Citalopram--causes QT prolongation What the body does to drugs? - ANSWER-Pharmacokinetics What the drug does to the body - ANSWER-pharmacodynamics The drug binds to the receptors and activates a biological response (opens the ion channel) - ANSWER-agonist effect drug causes the opposite effect of the agonist. Binds to the same receptor but closes the channel - ANSWER-inverse agonist drug does not fully activate the receptor - ANSWER-partial agonist drug binds to the receptor but foes not activate a biological response - ANSWER- antagonist The study of what the drug does to the body. - ANSWER-Pharmacodynamics When studying pharmacodynamics involving receptor, you know that an agonist produces the following effect? A. Does not fully activate the receptor B. Blocks the agonist from opening the channel C. Causes the opposite effect D. Activates a biological response and opens the ion channel. - ANSWER-Activates a biological response and opens the channel. Medications that can cause mania (very high yield) - ANSWER-Steroids Antabuse Isoniazid Antidepressants in persons with bipolar Flonase Medications causing depression - ANSWER-steroids beta blockers interferon accutate some retroviral drugs antineoplastic drugs benzos progesterone Fragile X syndrome - ANSWER-all their facial structures are larger. Severe adverse effect caused by antipsychotics - ANSWER-neuroleptic malignant syndrome Extreme muscle regidity Mutism elevated CPK Myoglobinura (cherry colored urine) Elevated WBCs Elevated LFts - ANSWER-signs of NMS Treatment for NMS - ANSWER-DC Offending agent Bromcriptine (parlodel) Dantrolene (muscle relaxant Serious effect of SSRIs - ANSWER-serotonin syndrome Score on CIWA that warrants PRN - ANSWER-greater than 8 Medication that will make patient physically ill if combined with alcohol - ANSWER- disulfiram (Antabuse) Antabuse shouldn't be taken for at leas ________________ after drinking - ANSWER- 12 hours. Signs and symptoms of alcohol withdrawal - ANSWER-N/V/D tremors sweats anxiety agitation tactile disturbances auditory disturbances visual disturbances headache altered sensorium agitation Rating scale of opiate withdrawal - ANSWER-COWS Signs and symptoms of opioid withdrawal - ANSWER-yawning, irritability, pupillary dilation piloerection muscle aches lacrimation rhinorrhea Treat COWS when score is greater than - ANSWER-7 Moderate withdrawal on COWS - ANSWER-13-24 Moderate withdrawal on CIWA - ANSWER-scoring 15 Treatment for COWS - ANSWER-Buprenorphine (Suboxone) Treatment for CIWA - ANSWER-scheduled meds plus diazepam SBIRT stands for - ANSWER-Screening, Brief Intervention, and Referral to Treatment SBIRT FRAMES - ANSWER-Feedback--tell them about their risk of their current alcohol use Responsibility--reinforce their responsibility for change Advice--based on facts about their drinking, offer simple and direct advice Menu--provide a menu of options for behavior change Empathetic interviewing--consider their perspective. Be non-judgemental Self-efficacy--encourage person to believe they can change. CAGE screening tool - ANSWER-cut down, annoyed, guilty, eye opener Acute onset altered level of consciousness inattenion poor prognosis--1 year mortality rate of is up to 40% - ANSWER-delirium Treatment of choice for delirium - ANSWER-haloperidol Avoid which class in delirium as it tends to prolong it - ANSWER-benzos impaired executive functioning, impaired problem solving, impaired organizational skills, altered memory. slow onset - ANSWER-dementia John is a 58 year old male patient with Bipolar 1 disorder and has been stable for 5 years on valproate and Seroquel. He was recently started on Flonase by his primary care. As the PMHNP, you are concerned that the addition of the Flonase may cause A. A hypertensive crisis B. SJS C. NMS D. a manic episode - ANSWER-a manic episode A 16-year off boy presents with a long head, large ears, and hyper extensible joints, is very shy, and starts rocking and flapping his hands when he is upset. Which of the following is your most likely diagnosis? A. Tourette disorder B. Autism C. Fragile X D. Rett disorder - ANSWER-Fragile X What muscle relaxant is recommended to be used in treatment of NMS? A. Bromocriptine B. Trihexyphenidyl C. Dantrolene D. Benztropine - ANSWER-Dantrolene A week after raising the dose of clomipramine, a patient treated for depression presents to the clinic with reports of change in mental status, fever, and hyperreflexxia. As the treating PMHNP, you know these symptoms are consistent with which of the following? A. NMS B. EPS C. Hypertensive crisis D. Serotonin syndrome - ANSWER-serotonin syndrome A 24 year olf female attempts suicide by overdose on an MAOI phenelzine. She is stabilized in the hospital. Ten days later she is started on venlafaxine and becomes tachycardia and diaphoretic, and develops myoclonic jerks. What condition is this? A. NMS B. Opisthotonos C. Akathisia D. Serotonin syndrome - ANSWER-serotonin syndrome a 17 year old arrives at the emergency department with nonspecific complaints The patient's temperature is 100.8, pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline for the treatment of depression. the patient has a history of substance use and smoked marijuana one week ago. The diagnosis is - ANSWER-serotonin syndrome Patient being treated for psychosis for 2 weeks develops symptoms of NMS. The following factors help the pMHNP to differentiate NMS from serotonin syndrome. A. autonomic instability, diaphoresis, tremors B. Hyperthermia, leukopenia, tachycardia C. Rigidity, hyperrefelexia, orthostatic hypotension D. Mutism, leukocytosis, myoglobinuria - ANSWER-mutism, leukocytosis, myoglobinuria Appraisal of the patient's SI plan, intent and access to implement plan would be documented in which part of standard psychiatric evaluation A Review of symptoms. B. Diagnosis C. Mental status exam D. History of presenting illness - ANSWER-C mental status exam a 48 year off Caucasian male presents for his therapy appointment. He is sad about losing his wife recently to covid 19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk of suicide? A. Previous attempt B. Age C. Gender D. Marital Status - ANSWER-A previous attempt Which of the following patients is at higher risk of suicidie? A. 30 year old married African American female with previous attempt B. A 35 year old single Asian male with previous suicide attempt C. A 38 year old single African American male who is manager of a bank D. A 68 year off single Caucasian male with depression - ANSWER-D. 68 year old single, caucasian male, depression C. Valium D. Olanzapine - ANSWER-haloperidol. An 81 year old female with a history of vascular dementia is brought to the hospital for increased agitation and UTI. Which of the following features most distinguishes the effects of delirium from dementia? A. Altered level of consciousness B. Behavioral disturbances C. Cognitive deficits D. Language difficulties - ANSWER-altered level of consciousness What is the best treatment for AIDS dementia complex A. Acetylcholinesterase inhibitors B. Symptom targeted pharmacologic treatments C. Nonpharmacologic supportive care D. Antiretroviral therapy - ANSWER-Antiretroviral therapy. Aimed at deceasing the number of new cases - ANSWER-primary prevention Any form of screening is what Level of prevention - ANSWER-secondary Aimed at decaying disability and severity - ANSWER-tertiary decreased effects of the same dose over time - ANSWER-tolerance tendency of some regions of the brine to react to repeated low-level bioelectrical stimulation, by progressively boosting synaptic discharges, thereby lowering seizure threshold (alcohol and benzos) - ANSWER-kindling Where in the brain are abnormalities found causing ADHD - ANSWER-frontal cortex -- high yield basal ganglia abnormalities in the reticular activating system Neurotransmitters involved in ADHD - ANSWER-DNS dopamine norepineph serotonin ADHD causes DNS - ANSWER-dopamine noreip serotonin Hallmarks of ADHD - ANSWER-persistent pattern of inattention or hyperactivity, impulsivity, or both. What to check prior to prescribing a stimulant? - ANSWER-cardiac history, family history of CVD and get an EKG prior to starting Amphetamines are approved in children as young as - ANSWER-3 Signs of stimulant abuse - ANSWER-insomnia tremors heart palpiations increased BP and HR Rating scale for ADHD - ANSWER-Connors and Vanderbilt Must monitor in two settings Hallmarks of borderline personality disorder - ANSWER-impulsivity with self-damaging behavior Recurrent suicidal behavior Treatment for Borderline - ANSWER-DBT Hallmarks of antisocial personality - ANSWER-reckless disregard for welfare of others lack of remorse indifference to the feelings of others INCREASED HOMICIDAL IDEATION --HIGH YIELD Primarily in girls normal development then decline loss of purposeful hand movements stereotypic hand movements --flapping of hands deceleration of head growth - ANSWER-Rett syndrome Chronically moody, sad irritable for no reason - ANSWER-Disruptive mood dysregulation disorder patient reacts grossly out of proportion to situation sudden rage/anger outbursts - ANSWER-Intermittent explosive disorder Mnemonic for depression SIGECAPS - ANSWER-Sleep disturbance interest reduced guilt and self-blame energy loss and fatigue concentration problems appetite changes psychomotor changes suicidial thoughts Neurotransmitters involved in depression - ANSWER-DNS dopamine, norepinephrine, serotonin cognition and memory symptoms of MDD in older adults is often confused with dementia related symptoms and is called - ANSWER-pseudo dementia = depression Clients with pseudodementia/depression, have a __________________ of symptoms. - ANSWER-acute onset. Dementia patients will have Pseudodementia/depression will have - ANSWER-dementia: lack of answers or confabulate answers pseudodementia: general responses "I Don't know" First line pharm treatment for depression due to safety - ANSWER-SSRIs/SNRIs Second line for depression - ANSWER-TCAs Reason TCAa are second line - ANSWER-Can cause EKG changes More lethal if taken in overdose attempt. Reason to use ECT - ANSWER-depression with psychotic features treatment resistant depression Which characteristic of fluoxetine provides the greatest degree of safety for patients who have severe depression A. Greater efficacy than an TCA B. Less potential drug interaction C. Less potential for injury with intentional overdose. D. Less potential for suicidal thinking. - ANSWER-less potential for injury with intentional overdose. Do no harm contracts reduce the risk of suicide - ANSWER-NO A 72 year old is brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is being treated with lisinopril. The exam is normal and the mini mental status exam provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis? A. Alzheimers disease B. Vascular dementia C. Depression D. Delirium - ANSWER-depression Risk factors for OCD - ANSWER-first degree relative and PANDAS--associated with strep infection, Tourette's - ANSWER-At least 2 motor tics and at least one vocal tic have been present. Cause of tourettes - ANSWER-dopamine --hyperactivity of the dopamine system. use of external agents that mimic disease (patient ingests foreign body) - ANSWER- factitious disease excessive worry more than 6 months - ANSWER-GAD Age of onset of schizophrenia in males - ANSWER-18-25 Age of onset of schizophrenia in females - ANSWER-25-35 Cause of schizophrenia - ANSWER-intrauterine insults prenatal exposure to toxins, including viral agents Problem in the brain in schizophrenia - ANSWER-enlarged ventricles, everything else decreases Things to monitor and labs while on antispychotic - ANSWER-serum glucose, serum lipid panel, weight, BMI, waist to hip ratio. liver and kidney function CBC non-harm treatment for schizophrenia - ANSWER-ACT (assertive community treatment) Person has psychotic symptoms similar to schizophrenia as well as mood symptoms seen in depression and bipolar - ANSWER-schizoaffective trust vs mistrust - ANSWER-birth to one year virtue in trust vs mistrust - ANSWER-hope autonomy vs shame and doubt - ANSWER-early childhood 1-3 years virtue for autonomy vs shame and doubt - ANSWER-will (they seek will power, independence) Inititiative vs. guilt - ANSWER-late childhood 3-6 years virtue of initiative vs guilt - ANSWER-purpose Ability to be a self-starter, to initiate one's own activities. Industry vs inferiority (VERY HIGH YIELD) - ANSWER-school age 6-12 years Industry vs inferiority virtue - ANSWER-competence Identity vs role confusion - ANSWER-Adolescence 12-20 identity vs role confusion virtue - ANSWER-fidelity personal identity unfavorable: they're confused over who they are. Initimacy vs isolation - ANSWER-Early adulthood 20-35 Intimacy vs isolation virtue - ANSWER-love Generativity vs stagnation - ANSWER-middle adultgood 35-65 years generatively vs stagnation virtue - ANSWER-care key event: parenting integrity vs despair (VERY HIGH YIELD) - ANSWER-late adulthood greater than 65 years integrity vs despair virtue - ANSWER-wisdom fulfillment and comfort with life willing to face death, sense of integrity Piaget focuses on - ANSWER-behavior Piaget Sensorimotor 0-2 - ANSWER-object permanence and object constancy Piaget Preoperational (VERY HIGH YIELD) 2-7 years - ANSWER-magical thinking egocentric pretend play Piaget Concrete operational 7-11 years - ANSWER-Thinks logically about concrete objects Understands conservation and reversibility Piaget Formal Operational (VERY HIGH YIELD) 12+ years - ANSWER-Reason abstractly Freud Oral Stage - ANSWER-0-1 Erogenous zone: mough Freud Anal Stage - ANSWER-1-3 years Erogenous zone: anus Freud Phallic Stage - ANSWER-3-6 years Erogenous zone is genitals Freud latent stage - ANSWER-6 to puberty Representation of sexual feelings Freud Genital stage - ANSWER-•puberty-adulthood •sexual urges reawaken & are directed to an individual outside the family circle •unresolved conflicts from previous stages arise •if conflict is resolved, capable of having a mature adult sexual relationship individuals are able to distinguish between self and non self - ANSWER-ego boundaries way of coping with anxiety in which an object or person of ambivalence is viewed as perfect or has having exaggerated positive qualities - ANSWER-idealization person attributes themselves, an object or another person as completely flawed, worthless, or having exaggerated negative qualities - ANSWER-devaluation motivational interviewing - ANSWER-based on trans theoretical model of change nonconfrontational ask open ended questions empatheic patient centered affirmations of the positive traits reflective listening Transtheoretical Model of Change - ANSWER-Precontemplation Contemplation Preparation Action Maintenance Relapse person has no intention of change and lack of insight - ANSWER-precontemplation action in precontemplation - ANSWER-give information to raise awareness of the problem, but do not try to tell the person what to do. - Instillation of hope: experiencing optimism through observing improvement of other members - Interpersonal learning: occurs when receiving feedback from grp members re: one's bx (input), learning successful ways of relating to group members (output) study of long term sequel of adverse childhood events found - ANSWER-positive relationship between heart disease, obesity, DM, unintended pregnancy, depression, anxiety, cancer, COPD, sleep disorders, dissociative disorders, and substance use disorder. Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral therapy in DBT include which of the following? A. Skills training and exposure B. Examination of feelings and relating feelings to visceral sensations C. Working through the transference with the therapist D. Cognitive interpretation of past traumatic events. - ANSWER-A skills training and exposure treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life. Recovery isn't about getting rid of the problem, but recognizing and fostering their abilities, interests, and dreams. - ANSWER-Recovery Model Goals of Assertive COMMUNITY Treatment - ANSWER-help people become more independent and integrate into the community reduce reliance on hospitals providing around the clock care. NP Core Competencies - ANSWER-Scientific Foundations Leadership Quality Practice Inquiry Technology and Information Literacy Policy Health Delivery System Ethics Independent Practice who identifies our scope of practice - ANSWER-state board of nursing if board of nursing is an answer, to verify information.......... - ANSWER-it is usually the correct answer. Reporting your coworker to the board of nursing........ - ANSWER-is usually the incorrect answer. standard or quality of practice is determined by - ANSWER-American Nurses Association How many releases of information are required to release information on patients chemical and psychiatric care to a third party - ANSWER-2 Exceptions to confidentiality - ANSWER-patient revels an intent to harm self or others. answering court orders, subpoenas, or summonses Tarasoff principal - ANSWER-duty to warn competency - ANSWER-legal term, we can not determine competency. we can determine their capacity care is provided on a fair and equal basis - ANSWER-justice do no harm imminent danger - ANSWER-nonmaleficience promoting well being and doing good - ANSWER-beneficence promise keeping, integrity, honesty being respectful, competent and professional - ANSWER-fidelity telling the truth - ANSWER-veracity doing for self - ANSWER-autonomy Rennie v Klein Court Case - ANSWER-involuntary patient not found incompetent, has a right to refuse psychotropic medications, goal of case management - ANSWER-promote quality and cost-effective outcomes. Stark Law - ANSWER-you can't refer to family members for treatment of your patients. PICOT - ANSWER-Patient or problem intervention comparison outcome time evidence from systematic review or meta analysis of many RCTs - ANSWER-level 1 evidence evidence from at least one RCT - ANSWER-level 2 evidence Before implementing/creating change of policy - ANSWER-assess/address/identify potential organizational barriers and facilitators meet with stakeholders patient advocacy - ANSWER-reduce stigma of mental illness through education help patients receive available services Seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix system issues - ANSWER-just culture of safety Process for quality improvement - ANSWER-plan, do, study, act reflective practice - ANSWER-debriefing strategies goal: to improve practice Highest rate of suicide in US - ANSWER-native Americans True or false A culturally expected response to a stressor does not always mean a mental illness - ANSWER-true grasp palmar reflex disappear by - ANSWER-5-6 months moro startle reflex disappear by - ANSWER-5-6 months babinski reflex normal until - ANSWER-age 2 shrill cry in baby - ANSWER-intracranial pressure playing with genitals normal in ages 3-6 - ANSWER-true treatment for cultural syndrome - ANSWER-brief supportive therapy