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Georgette Review Exam Questions with Correct Answers, ANCC Review Manual PMHNP/ 2024-2025., Exams of Nursing

Georgette Review Exam Questions with Correct Answers, ANCC Review Manual PMHNP/ 2024-2025. 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

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Georgette Review Exam Questions with Correct

Answers, ANCC Review Manual PMHNP/ 2024-

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. Lithium toxicity occurs at levels - Answer: > 1. 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- 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 teratogenic effects of lithium - Answer: ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote - Answer: neural tube defects/spina bifida Adverse reaction to Lamictal - Answer: Steven Johnson's Syndrome Signs of SJS - Answer: FEVER --high yield sore throat facial swelling tongue swelling red rash skin sloughing body aches

prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause - Answer: sedation or weight gain Carbamazepine (tegretol) black box warning - Answer: agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians - Answer: Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women - Answer: check for pregnancy before starting mood stabilizer start on folic acid to support neural tube development during the first month that a woman is pregnant Clozaril/clozapine can cause - Answer: agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor - Answer: ANC DC clozarli if ANC - Answer: less than 1000 DC clozaril if WBC - Answer: 2000-3000, risk of agranulocytosis When on clozaril monitor for - Answer: signs and symptoms of infection: sudden fever, chills, sore throat, weakness

Clozaril only known antipsychotic to - Answer: decrease risk of suicide in patients with schizophrenia. Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond? - Answer: Answer: Lithium can invert the t waves. Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? - Answer: Answer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? - Answer: Answer: ANC less than 1000 If given during pregnancy, sodium valproate can cause which of the following medical problems in the baby? - Answer: Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population?

  • Answer: Carbamazepine Bulimia, weight is ___________ - Answer: within the normal range. Pharm treatment for bulimia - Answer: Fluoxetine SSRIs and TCAs effective in reducing binging and purging 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? - 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? - Answer: bupropion CLozaril is metabolized by - Answer: cytochrome P450 enzyme CYP1A 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 - Answer: 1A 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? - 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: - Answer: 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? - Answer: raphe nuclei Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality - Answer: frontal lobe memory, understanding, language - Answer: temporal lobe Both hemispheres of the brain are connected by the - Answer: corpus callosum Area of sensorimotor information exchange between two hemispheres - Answer: corpus callosum

When there is disturbances in clock drawing test, which hemisphere is compromised - Answer: right hemisphere/right parietal lobe Area for expressive speech - Answer: frontal lobe Broca's Area Problems in the frontal lobe can lead to - Answer: personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension - Answer: Temporal lobe Wernicke's area Problems in the temporal lobe can lead to - Answer: auditory hallucinations, aphasia, and amnesia Occipital lobe - Answer: primary visual area problems in the occipital lobe can lead to - Answer: Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain - Answer: parietal lobe problems in the parietal lobe can lead to - Answer: Sensory-perceptual disturbances and agnosia inability to perceive objects R-L confusion Difficulty writing agraphia Aphasia difficulty of language Cerebellum is responsible for - Answer: gross motor skills

fine motor skills balance A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the - Answer: frontal lobe Impairments in the clock drawing test can be associated with - Answer: damage to the right parietal lobe What part of the brain is responsible for regulating emotions? - Answer: Hippocampus Limbic system responsible for - Answer: emotions and memory Hypothalamus - Answer: appetite, hunger, water balance, circadian rhythms, libido, hormonal regulation thalamus - Answer: sensory relay for smell emotions, memory, and regulated affective behaviors amygdala - Answer: regulated emotion mediates mood emotional memories/meanings, fear, anxiety, stress emotion, aggression substantia nigra - Answer: motor movements amygdala= - Answer: emotional memory

Which of these brain structures puts emotional meaning on a stimulus, forms, emotional memories and is involved with rage and fear - Answer: amygdala A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep- rest cycle, and changes in libido. What is the neuroanatomical areas off the brain that is responsible for the regulation of these functions? - Answer: Hypothalamus Which serotonin receptor antagonism makes an antipsychotic "atypical" - Answer: 5HT2A Excess dopamine in this area causes positive schizophrenic symptoms - Answer: meoslimbic pathway decreased dopamine leads to negative symptoms of schizophrenia - Answer: mesocortical pathway Increased blockade of dopamine here leads to EPS - Answer: nigrostriatal pathway 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 - 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 - Answer: 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? - 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? - 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 signs of NMS - Answer: Extreme muscle rigidity Mutism elevated CPK Myoglobinura cherry colored urine Elevated WBCs Elevated LFts Treatment for NMS - Answer: DC Offending agent Bromcriptine parlodel Dantrolene A muscle relaxant Serious effect of SSRIs - Answer: serotonin syndrome hyperreflexia, myoclonic jerks, sweating - Answer: serotonin syndromeq Treatment for serotonin syndrome - Answer: DC offending agent Cyprophentadine Drugs/classes that can cause serotonin syndrome - Answer: SSRI/TCA/MAOI/SNRI When switching to an SSRI to MAOI, - Answer: wait 14 days When switching from Prozac to MAOI or TCA - Answer: wait 5-6 weeks

When switching from MAOI back to prozac - Answer: wait 2 weeks. Non psych med that can cause serotonin syndrome - Answer: triptans Serotonin discontinuation syndrome - Answer: remember similar to alcohol withdrawal flu like symptoms False belief firmly maintained despite evidence to the contrary - Answer: delusion Do you try to convince them the delusion is wrong or isn't real? - Answer: No Patient believes that certain news bulletins have a direct reference to them - Answer: referential thinking MSE: Though process - Answer: organization of the patient's thoughts and ideas. MSE: Thought content - Answer: refers to themes that occupy the patient's thoughts and perceptual disturbances. Suicidal ideation/plan homicidal ideation/plan Exam is Used to quantify cognitive status in adults - Answer: mini mental status exam or may say Folstein Component of Folstein/mini mental status - Answer: I would like you to could backwards from 100 by 7s or do serial 7s

Folstein/mini mental status registration/ability to learn new material - Answer: repeat after me, bed, bat, ball Suiciidal risk factors - Answer: previous attempt Male 45+ Female 55+ Divorced, single, separated white living alone psychiatric disorder physical illness substance abuse family history recent loss male gender Characteristics of therapeutic relationship - Answer: Genuineness Acceptance Nonjudgment Authenticity Empathy Respect Professional boundaries displacement of feelings for significant people int he client's past onto the PMHNP - Answer: transference Nurses's emotional reaction to the client based on past experiences. - Answer: Countertransference

Which of the following medications is known to exacerbate or cause depression? - Answer: Propranolol She recently had a flare up of her rheumatoid arthritis and received treatment for one week a steroid - Answer: recently treated for RA Scale to test for alcohol withdrawal - Answer: CIWA 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 - 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? - Answer: Fragile X What muscle relaxant is recommended to be used in treatment of NMS? - 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? - 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? - 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. - Answer: mutism, leukocytosis, myoglobinuria Appraisal of the patient's Suicide intent plan, intent and access to implement plan would be documented in which part of standard psychiatric evaluation - Answer: 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? - Answer: previous attempt Which of the following patients is at higher risk of suicidie? - Answer: 68 year old single, caucasian male, depression A 64 year old caucasian male referred for treatment of refractory depression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority? - Answer: thoughts of self-harm, plan, intent, access

A married female patient has been in therapy with an adult psychiatric and mental health nurse practitioner for 3 months. The patient's husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the clinical nurse specialist stating that her husband is drunk, violent, and threatening to kill her. The PMHNPs priority intervention is - Answer: Arrange for the woman's safety. A client says to the PMHNP, Some days life is just not worth it. All my wife and I do is fight and scream. Things at home were be calmer and simpler if I just wasn't there anymore." The most therapeutic response is: - Answer: Tell me what you mean by "it would be simpler if you weren't there anymore" While working with an older male client, the nurse begins to think that the client reminds her of her grandfather and responds as if she is the granddaughter. The nurse is developing which of the following? - Answer: Countertransferance Moderate level on the MMSE - Answer: 10-20 Moderate level on the HAM-D - Answer: 14-18 Moderate level on the PHQ-9 - Answer: 10-14 Moderate level on the Beck - Answer: 10-29 Moderate on GAD 7 - Answer: 10-14 Moderate on COWS - Answer: 13-24 Moderate on CIWA - Answer: 15

Dementia is characterized by _____________ onset. - Answer: gradual Alzheimers is cortical or subcortical dementia - Answer: cortical Cortical dementia causes - Answer: language and memory problems. Examples of subcortical dementia - Answer: Huntington's disease Parkinson's disease AIDS dementia complex Which type of dementia can cause depression, motor symptoms, and apathy - Answer: subcortical Cognitive decline (concentration, attention), motor abnormalities(lack of coordination, ataxia, tremors, dystonia, muscle rigidity) and behavioral abnormalities (HIGH YIELD) - Answer: dementia r/t HIV Recurrent visual hallucinations Parkinson features Adversely reacts to antipsychotics - Answer: Lewy body dementia---recurrent visual hallucinations. caused by cardiovascular disease. Common in hypertension and CVD - Answer: vascular dementia Hallmark signs of vascular dementia - Answer: carotid bruits, fundoscopic abnormalities, and enlarged cardiac chambers