Georgette Review PMHNP. 100% VERIFIED ANSWERS 2024/2025 CORRECT, Exams of Business Administration

Download Georgette Review PMHNP. 100% VERIFIED ANSWERS 2024/2025 CORRECT and more Exams Business Administration in PDF only on Docsity! Georgette Review PMHNP. 100% VERIFIED ANSWERS 2024/2025 CORRECT When many answers are remarkably similar, they are usually _____________ wrong Interprofessional collaboration is encouraged. Collaborate is usually right. Delegate is usually wrong. ADPIER Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium Normal 0.5-1.2 Lithium toxicity occurs at levels > 1.5 Signs of Lithium toxicity severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for MANIA Lithium has evidence shown to reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to rise Baseline labs before initiation of lithium 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 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 staying hydrated avoiding NSAIDS compliance Dehydration can ________ lithium levels increase hyponatremia can ______ lithium levels Increase neural tube defects/spina bifida and long term developmental deficits Adverse reaction to Lamictal Steven Johnson's Syndrome Reactive attachment disorder is the product of a severely dysfunctional early relationship between the principal caregiver and the child. THIS DISORDER CAN BE CAUSED BY NEGLECT/ABUSE, then a history of the child being placed on foster home. When caregivers consistently disregard the child’s physical or emotional needs, the child fails to develop a secure and stable attachment with them. This failure causes a severe disturbance of the child’s ability to relate to others, manifested in a variety of behavioral and interpersonal problems. Some children are fearful, inhibited, withdrawn, apathetic, shows no emotion towards caregivers; others are aggressive, disruptive, and disorganized Steven Johnson Syndrome (SJS) Severe blistering of the skin, with mucous membrane involvement and fever Can be fatal Mood stabilizer that causes the least weight gain lamictal (lamotrigine) Antipsychotics that cause the least weight gain - ziprazidone - aripiprazole -lurasidone Least sedating antipsychotic aripiprazole Signs of SJS 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 sedation or weight gain Carbamazepine (tegretol) black box warning agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Medications that can cause delayed gastric emptying/ bloating after eating/ feeling full after eating a small quantity? Omeprazole, famotidine, ranitidine Child-bearing aged women 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 agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor ANC DC clozarli if ANC less than 1000 DC clozaril or carbamazepine if WBC 2000-3000, risk of agranulocytosis DC clozaril or carbamazepine if ANC less than 1000, whether pt is showing signs or not When on clozaril monitor for signs and symptoms of infection: sudden fever, chills, sore throat, weakness Only antipsychotic known to decrease risk of suicide in patients with schizophrenia. Clozapine 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? A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval Answer: Lithium can invert the t waves. Lithium can cause intracellular hypokalemia, which may contribute to lithium-induced electrocardiographic ST-T wave changes. B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) bupropion CLozaril is metabolized by cytochrome P450 enzyme CYP1A2 INducers induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels decrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage Barbituates St. Johns Wart Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need ___________doses of their medication. higher Inhibitors inhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors 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 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 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 HCTZ 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 D. decreased renal clearance of lithium Where is norepinephrine produced locus coeruleus and medullary reticular formation General functions of norepinephrine Alertness, focused attention, orientation, learning and memory Disorders associated with a decrease in norepinephrine depression symptoms and conditions Disorders associated with an increase in norepinephrine anxiety symptoms and conditions (PTSD) Serotonin is made where in the brain raphe nuclei of the brainsteam General functions of serotonin Regulations of sleep, pain perception, mood states, temperature, regulation of aggression, libido Dopamine is made in substantia nigra (regulates motor movements), ventral tegmental area, and nucleus accumbens Dopamine is associated with addiction and psychosis General functions of dopamine thinking, decision making, reward seeking behavior (addiction), fine muscle movement, cognition Disorders associated with low dopamine 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 ADOS M-CHAT ASQ Pharm management for autism antipsychotics are effective for symptoms such as tantrums, aggressive behaviors, self-injurious behaviors Neurotransmitters affected in autism Glutamate, GABA, and serotonin Broken Mirror Theory of Autism dysfunction of the mirror neuron system may be the cause of poor social interaction and cognitiion Imaging results on schizophrenia patients (MRI/PET) DECREASE in size of lobes, parts of limbic system, blood flow Ventricles will show ENLARGEMENT Abnormalities or changes/deficits in the prefrontal cortex, amygdala, basal ganglia, hippocampus, and limbic regions of the brain can cause Aggression, impulsivity, and abstract thinking problems in schizophrenia It is not recommended for patients with schizophrenia to receive stimulants because they potentiate dopamine release 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 raphe nuclei Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality frontal lobe memory, understanding, language temporal lobe Both hemispheres of the brain are connected by the corpus callosum Area of sensorimotor information exchange between two hemispheres corpus callosum When there is disturbances in clock drawing test, which hemisphere is compromised right hemisphere/right parietal lobe Area for expressive speech frontal lobe Broca's Area Problems in the frontal lobe can lead to personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension Temporal lobe Wernicke's area If an elderly female patient is presenting with a DECREASED SEX DRIVE, it can be caused by TESTOSTERONE LEVELS and BLOOD FLOW TO THE PELVIC REGION Signs of lead poisoning developmental delay, learning difficulties, irritability, loss of appetite, weight loss, sluggishness and fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, pica Tip: If you have a patient that is living in a rural area especially in houses that were constructed in the 70s, it is important for you to know that there is a chance that they have had exposure to lead. Thus, if a parent brings in their child presenting with development delays (or any of the above S/S), test for lead poisoning Problems in the temporal lobe can lead to auditory hallucinations, aphasia, and amnesia Occipital lobe primary visual area problems in the occipital lobe can lead to Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain parietal lobe problems in the parietal lobe can lead to Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) meoslimbic pathway decreased dopamine in mesocortical projection to the dorsolateral prefrontal cortex leads to negative symptoms of schizophrenia mesocortical pathway Increased blockade of dopamine here leads to EPS nigrostriatal pathway Blockade of dopamine in this pathway can lead to increased prolactin levels tuberoinfundibular pathway Normal prolactin levels Men: < 20 ng/ml Women: < 25 ng/ml Muscle spasms ninth face, neck, tongue, back/neck muscles acute dystonia Oculogyric crisis, which can lead to permanent injury. Patients have prolonged involuntary upwards deviation of the eyes bilaterally. Rare presentation of acute dystonia. Pharm treatment for dystonia cogentin (IM first then oral) Restlessness, inability to sit still. Pacing. Mistaken for anxiety. Akathisia Commonly used rating scale for akathisia is Barnes Akathisia rating scale and extrapyramidal symptom rating scale. Treatment for akathisis 1st line 2nd line 3rd line 1st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine Absence of movement or difficulty initiating movement akinesia Treatment: cogentin Presence of symptoms of Parkinson's produced by D2 blockade in the nigrostriatal pathway Pseudo-Parkinsonism Signs of Parkinsons muscle rigidity shuffling gait mask like facial expression pill rolling tremors cogwheel rigidity Treatment for pseudo parkinsonism cogentin Involuntary abnormal muscle movement of the mouth tongue face and jaw that may progress to limbs. Can take 1-2 years to occur. Tardive dyskinesia Signs of tar dive dyskinesia lip smacking protrusion of the tongue chewing motion facial dyskinesia involuntary movement. Treatment for TD Stop offending antipsychotic, reduce the dose, or switch to clozapine. COGENTIN WORSENS IT Ingrezza or Austedo approved Non-psych med that can cause TD 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 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? Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression Fetal alcohol syndrome Everything is low low weight, small features of the face. Extreme muscle regidity Mutism elevated CPK Myoglobinura (cherry colored urine) Elevated WBCs Elevated LFts signs of NMS Treatment for NMS DC Offending agent Bromcriptine (parlodel) Dantrolene (muscle relaxant Serious effect of SSRIs serotonin syndrome serotonin syndrome Symptoms: hyperreflexia, myoclonic jerks, sweating, restlessness, elevated HR/BP, headache, fever, seizures, confusion, abnormal movements Treatment: ED and/or hospitalization. Discontinue offending agent. Treatment for serotonin syndrome DC offending agent Cyprophentadine Drugs/classes that can cause serotonin syndrome SSRI/TCA/MAOI/SNRI When switching to an SSRI to MAOI, wait 14 days When switching from Prozac to MAOI or TCA wait 5-6 weeks When switching from MAOI back to prozac wait 2 weeks. Non psych med that can cause serotonin syndrome triptans Serotonin discontinuation syndrome remember similar to alcohol withdrawal flu like symptoms False belief firmly maintained despite evidence to the contrary delusion Do you try to convince them the delusion is wrong or isn't real? No Patient believes that certain news bulletins have a direct reference to them referential thinking MSE: Though process organization of the patient's thoughts and ideas. Normal: logical, linear, coherent, and goal-oriented Abnormal: associations are not clear, organized, or coherent MSE: Thought content refers to themes that occupy the patient's thoughts and perceptual disturbances. E.g. Suicidal ideation/plan homicidal ideation/plan Concentration /attention/calculation (MSE) “I would like you to count backwards from 100 by sevens or do serial 7s” Orientation "What is the year? Season? Date? Day? Month?" / "Where are we (state) (country) (town) (hospital) (floor)?" Fund of knowledge “Who is the president/governor?” Clock Drawing Test (CDT) Clock Drawing Test (CDT) = is a simple tool that is used to screen people for signs of neurological problems such as Alzheimer’s and other dementias. It is a very quick way to screen a person for possible dementia. It often requires only a minute or two for completion. Impairments on the CDT can be associated with damage to the right parietal lobe (right hemisphere). Registration/Ability to learn new material Name 3 objects: one second to say each. Then ask the patient all 3 objects Exam ised to quantify cognitive status in adults mini mental status exam or may say Folstein Component of Folstein/mini mental status 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 repeat after me, bed, bat, ball Suiciidal risk factors Signs and symptoms of alcohol withdrawal N/V/D tremors sweats anxiety agitation tactile disturbances auditory disturbances visual disturbances headache altered sensorium agitation Rating scale of opiate withdrawal COWS Signs and symptoms of opioid withdrawal yawning irritability/anxiety pupillary dilation (pinpoint pupils can indicate opioid intoxication) piloerection muscle aches lacrimation rhinorrhea sweating insomnia n/v/d Treat COWS when score is greater than 7 Moderate withdrawal on COWS 13-24 Moderate withdrawal on CIWA scoring 15 Treatment for COWS Buprenorphine (Suboxone) Treatment for CIWA scheduled meds plus diazepam SBIRT stands for Screening, Brief Intervention, and Referral to Treatment SBIRT FRAMES 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 cut down, annoyed, guilty, eye opener Acute onset altered level of consciousness inattenion poor prognosis--1 year mortality rate of is up to 40% delirium Treatment of choice for delirium low-dose haloperidol Avoid which class in delirium as it tends to prolong it benzos impaired executive functioning, impaired problem solving, impaired organizational skills, altered memory. slow onset 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 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 Fragile X What muscle relaxant is recommended to be used in treatment of NMS? A. Bromocriptine B. Trihexyphenidyl C. Dantrolene D. Benztropine 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, 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 A. To arrange for an emergency psychiatric intervention B. Arrange for the woman's safety C. Request a restraining order D. Request to speak to the husband 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: A. Do you mean yo are thinking about leaving your wife to moving out?" B. Tell me what you mean by "it would be simpler if you weren't there anymore." C. So you are thinking suicide might be an option for you? D. Remain silent. B. 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? A. Empathy B. Modeling C. Transference D. Countertransference D Countertransferance Moderate level on the MMSE 10-20 Moderate level on the HAM-D 14-18 Moderate level on the PHQ-9 10-14 Moderate level on the Beck 10-29 Moderate on GAD 7 10-14 Moderate on COWS 13-24 Moderate on CIWA 15 Normal moCA score 26 -30 Moderate on Hamilton Anxiety Rating Scale (HAM-A) 18-24 Moderate Anxiety Dementia is characterized by _____________ onset. gradual Alzheimers is cortical or subcortical dementia cortical Cortical dementia causes language (aphasia) and memory problems (amnesia). Subcortical dementia Motor symptoms (lack of coordination, tremors, dystonia), depression, apathy Examples of subcortical dementia Huntington's disease Parkinson's disease AIDS dementia complex Which type of dementia can cause depression, motor symptoms, and apathy subcortical Cognitive decline (concentration, attention), motor abnormalities(lack of coordination, ataxia, tremors, dystonia, muscle rigidity) and behavioral abnormalities (HIGH YIELD) dementia r/t HIV HIV-related dementia If a patient comes to your office with history of IV drug use and upon assessment, presents with early signs of HIV-related dementia, ORDER AN HIV TEST. The best pharmacological treatment for HIV- related dementia is ANTIRETROVIRALS because if you treat the HIV, it will help with the memory problems. Therefore, refer the patient to their PCP to start their HIV treatment Recurrent visual hallucinations Parkinson features Adversely reacts to antipsychotics Lewy body dementia---recurrent visual hallucinations. Frontotemporal Dementia / Frontal Lobe Dementia / Pick's Disease in its early stages, it will present with CHANGES IN PERSONALITY, BEHAVIORAL, & LANGUAGE (such as slurred speech or unable to speech expression and comprehension) Tip: If someone has Pick’s Disease or Frontal Lobe Tumor, it can also affect their social skills, which leads to inappropriate social behavior caused by cardiovascular disease. Common in hypertension and CVD -executive function -cognitive processes (planning and working memory) - problem solving - attention Neurotransmitters involved in ADHD DNS dopamine norepineph serotonin ADHD causes DNS dopamine noreip serotonin Hallmarks of ADHD persistent pattern of inattention or hyperactivity, impulsivity, or both. What to check prior to prescribing a stimulant? cardiac history, family history of CVD and get an EKG prior to starting Amphetamines are approved in children as young as 3 Signs of stimulant abuse insomnia tremors heart palpiations increased BP and HR Rating scale for ADHD Connors and Vanderbilt Must monitor in two settings Hallmarks of borderline personality disorder impulsivity with self-damaging behavior Recurrent suicidal behavior Treatment for Borderline DBT