Download Georgette Review PMHNP Questions and Answers latest Update 2023 2024 and more Exams Nursing in PDF only on Docsity! Georgette Review PMHNP Questions and Answers latest Update 2023/2024 When many answers are remarkably similar, they are usually _____________ - ✔w️rong Interprofessional collaboration is encouraged. - ✔C️ollaborate is usually right. Delegate is usually wrong. ADPIER - ✔A️ssessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - ✔N️ormal 0.6-1.2 Lithium toxicity occurs at levels - ✔>️ 1.5 Signs of Lithium toxicity - ✔s️evere nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - ✔M️ANIA Lithium has evidence shown to - ✔r️educe suicidal ideation What does lithium cause in neonate, especially 1st trimester - ✔E️bstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - ✔r️ise Baseline labs before initiation of lithium - ✔T️SH 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 - ✔h️ypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - ✔s️taying hydrated avoiding NSAIDS compliance Depakote normal level - ✔5️0-125 Depakote toxicity level - ✔g️reater than 150 Teratogenic effects of Depakote - ✔s️pina bifida Adverse effects of depakote - ✔a️lopecia 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 - ✔d️isorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity - ✔D️C med check level LFT ammonia MAOI + tyramine causes - ✔h️ypertensive crisis Symptoms of hypertensive crisis - ✔e️levated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + - ✔M️EPERIDINE STIMULANTS decongestants If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate - ✔A️. Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal - ✔A️. Carbamazepine Bulimia, weight is ___________ - ✔w️ithin the normal range. Pharm treatment for bulimia - ✔F️luoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa - ✔l️ow BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - ✔t️here 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 - ✔L️ow BMI If a patient is depression, low energy, fatigued, you would prescribe - ✔W️ellbutrin Wellbutrin is contraindicated in patients with - ✔s️eizure 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) - ✔b️upropion CLozaril is metabolized by - ✔c️ytochrome P450 enzyme CYP1A2 INducers - ✔i️nduce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - ✔d️ecrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage - ✔B️arbituates St. Johns Wart Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need ___________doses of their medication. - ✔h️igher Inhibitors - ✔i️nhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors - ✔S️odium 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 - ✔1️A2 (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 - ✔D️ecreased 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 - ✔A️. decreased renal clearance of lithium Where is norepinephrine produced - ✔l️ocus coeruleus and medullary reticular formation Norepinephrine is associated with - ✔m️ood disorders Serotonin is made where in the brain - ✔r️aphe nuclei of the brainsteam Serotonin is associated with - ✔s️leep and mood disorder Dopamine is made in - ✔s️ubstantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with - ✔a️ddiction and psychosis Acetylcholine is made - ✔b️asal nucleus of Meynert Most abundant inhibitory neurotransmitter in the brain - ✔G️ABA I don't have enough GABA, my anxiety is high ✔d️amage to the right parietal lobe What part of the brain is responsible for regulating emotions? A. Wernicke's area B. Occipital lobe C. Hippocampus D. Parietal lobe - ✔H️ippocampus Limbic system responsible for - ✔e️motions and memory Hypothalamus - ✔a️ppetite, hunger, water balance, circadian rhythms, libido, hormonal regulation thalamus - ✔s️ensory relay for smell emotions, memory, and regulated affective behaviors amygdala - ✔r️egulated emotion mediates mood emotional memories/meanings, fear, anxiety, stress emotion, aggression substantia nigra - ✔m️otor movements amygdala= - ✔e️motional memory Which of these brain structures puts emotional meaning on a stimulus, forms, emotional memories and is involved with rage and fear - ✔a️mygdala 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? - ✔H️ypothalamus Which serotonin receptor antagonism makes an antipsychotic "atypical" - ✔5️HT2A Excess dopamine in this area causes positive schizophrenic symptoms - ✔m️eoslimbic pathway decreased dopamine leads to negative symptoms of schizophrenia - ✔m️esocortical pathway Increased blockade of dopamine here leads to EPS - ✔n️igrostriatal pathway Blockade of dopamine in this pathway can lead to increased prolactin levels - ✔t️uberoinfundibular pathway Muscle spasms ninth face, neck, tongue, back/neck muscles - ✔a️cute dystonia Oculogyric crisis, which can lead to permanent injury. Patients have prolonged involuntary upwards deviation of the eyes bilaterally. - ✔R️are presentation of acute dystonia. Pharm treatment for dystonia - ✔c️ogentin (IM first then oral) Restlessness, inability to sit still. Pacing. Mistaken for anxiety. - ✔A️kathisia Commonly used rating scale for akathisia is - ✔B️arnes Akathisia rating scale and extrapyramidal symptom rating scale. Treatment for akathisis 1st line 2nd line 3rd line - ✔1️st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine Absence of movement or difficulty initiating movement - ✔a️kinesia Treatment: cogentin Presence of symptoms of Parkinson's produced by D2 blockade in the nigrostriatal pathway - ✔P️seudo-Parkinsonism Signs of Parkinsons - ✔m️uscle rigidity shuffling gait mask like facial expression pill rolling tremors cogwheel rigidity Treatment for pseudo parkinsonism - ✔c️ogentin Involuntary abnormal muscle movement of the mouth tongue face and jaw that may progress to limbs. Can take 1-2 years to occur. - ✔T️ardive dyskinesia Signs of tar dive dyskinesia - ✔l️ip smacking protrusion of the tongue chewing motion facial dyskinesia involuntary movement. Treatment for TD - ✔S️top offending antipsychotic, reduce the dose, or switch to clozapine. COGENTIN WORSENS IT Ingrezza or Austedo approved Non-psych med that can cause TD - ✔R️eglan 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 - ✔A️. 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? - ✔A️re you experiencing pill rolling tremors, shuffling gait, and mask like facial expression Fetal alcohol syndrome - ✔E️verything is low low weight, small features of the face. Which if the following antidepressants is associated with the most cardiovascular side effects? - ✔C️italopram--causes QT prolongation What the body does to drugs? - ✔P️harmacokinetics What the drug does to the body - MSE: Though process - ✔o️rganization of the patient's thoughts and ideas. MSE: Thought content - ✔r️efers to themes that occupy the patient's thoughts and perceptual disturbances. Suicidal ideation/plan homicidal ideation/plan Exam ised to quantify cognitive status in adults - ✔m️ini mental status exam or may say Folstein Component of Folstein/mini mental status - ✔I️ would like you to could backwards from 100 by 7s or do serial 7s Folstein/mini mental status registration/ability to learn new material - ✔r️epeat after me, bed, bat, ball Suiciidal risk factors - ✔p️revious 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 - ✔G️enuineness Acceptance Nonjudgment Authenticity Empathy Respect Professional boundaries displacement of feelings for significant people int he client's past onto the PMHNP - ✔t️ransference Nurses's emotional reaction to the client based on past experiences. - ✔C️ountertransference Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? A. Omeprazole B. Propranolol C. Levothyroxine D. Clarithromycin - ✔P️ropranolol A patient with a known diagnosis of bipolar I disorder presents to your clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months To determine if a medication change or increase is warranted, it is important to gather more information. You suspect a possible medication-induced manic episode when the patient endorses what? A. She was recently placed on a beta blocker for anxiety. B. She was recently prescribed a benzo C. She recently had a flare up of her rheumatoid arthritis and received treatment for one week (aka a steroid) D. She recently began a new retroviral agent for hepatitis - ✔r️ecently treated for RA Scale to test for alcohol withdrawal - ✔C️IWA Score on CIWA that warrants PRN - ✔g️reater than 8 Medication that will make patient physically ill if combined with alcohol - ✔d️isulfiram (Antabuse) Antabuse shouldn't be taken for at leas ________________ after drinking - ✔1️2 hours. Signs and symptoms of alcohol withdrawal - ✔N️/V/D tremors sweats anxiety agitation tactile disturbances auditory disturbances visual disturbances headache altered sensorium agitation Rating scale of opiate withdrawal - ✔C️OWS Signs and symptoms of opioid withdrawal - ✔y️awning, irritability, pupillary dilation piloerection muscle aches lacrimation rhinorrhea Treat COWS when score is greater than - ✔7️ Moderate withdrawal on COWS - ✔1️3-24 Moderate withdrawal on CIWA - ✔s️coring 15 Treatment for COWS - ✔B️uprenorphine (Suboxone) Treatment for CIWA - ✔s️cheduled meds plus diazepam SBIRT stands for - ✔S️creening, Brief Intervention, and Referral to Treatment SBIRT FRAMES - ✔F️eedback--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 - ✔c️ut down, annoyed, guilty, eye opener Acute onset altered level of consciousness inattenion poor prognosis--1 year mortality rate of is up to 40% - ✔d️elirium Treatment of choice for delirium - ✔h️aloperidol Avoid which class in delirium as it tends to prolong it - ✔b️enzos impaired executive functioning, impaired problem solving, impaired organizational skills, altered memory. slow onset - ✔d️ementia 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 - ✔A️rrange 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. - ✔B️. 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 - ✔D️ Countertransferance Moderate level on the MMSE - ✔1️0-20 Moderate level on the HAM-D - ✔1️4-18 Moderate level on the PHQ-9 - ✔1️0-14 Moderate level on the Beck - ✔1️0-29 Moderate on GAD 7 - ✔1️0-14 Moderate on COWS - ✔1️3-24 Moderate on CIWA - ✔1️5 Dementia is characterized by _____________ onset. - ✔g️radual Alzheimers is cortical or subcortical dementia - ✔c️ortical Cortical dementia causes - ✔l️anguage and memory problems. Examples of subcortical dementia - ✔H️untington's disease Parkinson's disease AIDS dementia complex Which type of dementia can cause depression, motor symptoms, and apathy - ✔s️ubcortical Cognitive decline (concentration, attention), motor abnormalities(lack of coordination, ataxia, tremors, dystonia, muscle rigidity) and behavioral abnormalities (HIGH YIELD) - ✔d️ementia r/t HIV Recurrent visual hallucinations Parkinson features Adversely reacts to antipsychotics - ✔L️ewy body dementia---recurrent visual hallucinations. caused by cardiovascular disease. Common in hypertension and CVD - ✔v️ascular dementia Hallmark signs of vascular dementia - ✔c️arotid bruits, fundoscopic abnormalities, and enlarged cardiac chambers Personality, language (slurred) and behavioral changes - ✔P️icks disease --frontal lobe changes Huntington's disease - ✔s️ubcortical, think motor symptoms High incidence of depression nd psychosis First line agent for psychotic symptoms of dementia - ✔a️ntipsychotics avoid benzos A 69 year old man with diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms? A. Haloperidol B. Quetiapine C. Valium D. Olanzapine - ✔h️aloperidol. 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 - ✔a️ltered 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 - ✔A️ntiretroviral therapy. Aimed at deceasing the number of new cases - ✔p️rimary prevention Any form of screening is what Level of prevention - ✔s️econdary Aimed at decaying disability and severity - ✔t️ertiary decreased effects of the same dose over time - ✔t️olerance 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) - ✔k️indling Where in the brain are abnormalities found causing ADHD - ✔f️rontal cortex --high yield basal ganglia abnormalities in the reticular activating system Neurotransmitters involved in ADHD - ✔D️NS dopamine norepineph serotonin ADHD causes DNS - ✔d️opamine noreip serotonin Hallmarks of ADHD - 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 - ✔d️epression During patient education on sertraline, the PMHNP focuses upon the potential side effect of A. agranulocytosis B. hypernatremia C sexual dysfunction D weight loss - ✔s️exual dysfunction A 23 year old woman is Brought in to to the ER after attempting to commit suicide by cutting her wrists. Which action by the PMHNP would be of highest priority initially? A. Assess her coping behaviors B. Assess her current level of suicidality C. Take her vital signs D. Asess her health history - ✔t️ake her vital signs Bipolar Mnemonic (DIG FAST) - ✔D️istractibility impulsivity grandiosity flight of ideas agitation, psychomotor sleep need decreased talkativeness, pressured speech What is the gold standard treatment for mania - ✔l️ithium What is neuroprotective treatment for bipolar I - ✔l️ithium Normal Free T4 - ✔0️.8-2.8 Normal TSH - ✔0️.5-5.0 When T4 and T3 are high, and TSH is low - ✔h️yperthyroidism When T4 and T3 are low, and TSH is high - ✔h️ypothyroidism Hypothyroidism mimics - ✔d️epression hyperthyroidism mimics - ✔m️ania sensitive to cold, cold intolerant - ✔h️ypothyroid heat intolerant - ✔h️yperthyroid Normal AST and ALT - ✔A️ST 5-40 ALT 5-35 with liver damage ALT - ✔r️ises to 50x normal Argues with authority - ✔o️ppositional defiant disorder defiant but not aggressive - ✔o️ppositional defiant disorder treatment for ODD - ✔t️herapy Person is aggressive, lack of remorse, destruction of property, deceit or theft - ✔c️onduct disorder treatment for conduct disorder - ✔t️arget mood and aggression. person has sudden: blindness, mutism, paralysis, paresthesia, neurological symptoms - ✔c️onversion disorder emotional or behavioral reaction to a stressful event or change in person's life within 3 months of it happening. - ✔a️djustment disorder A male patient informs as adult PMHNP that he has not slept in three days, has poor concentration, and denies fatigue. The patient's diagnosis is: A. ADHD B. Bipolar disorder C. Panic disorder D. Primary insomnia - ✔b️ipolar disorder The neuroprotective treatment of choice for bipolar disorder is - ✔l️ithium According to the current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes: A.) Lithium B. Citalopram C. Lamotrigine D. Quetiapine - ✔q️uetiapine intrusive reexperiencing of a traumatic event - ✔P️TSD symptoms of PTSD - ✔h️yperarousal, avoidance of stimuli associated with trauma, intrusive symptoms Pharm treatment for pTSD - ✔S️SRI (Zoloft) TCA Prazosin AVOID BENZOS Risk factors for OCD - ✔f️irst degree relative and PANDAS--associated with strep infection, Tourette's - ✔A️t least 2 motor tics and at least one vocal tic have been present. Cause of tourettes - ✔d️opamine --hyperactivity of the dopamine system. use of external agents that mimic disease (patient ingests foreign body) - ✔f️actitious disease excessive worry more than 6 months - ✔G️AD Age of onset of schizophrenia in males - ✔1️8-25 Age of onset of schizophrenia in females - ✔2️5-35 Cause of schizophrenia - Freud Oral Stage - ✔0️-1 Erogenous zone: mough Freud Anal Stage - ✔1️-3 years Erogenous zone: anus Freud Phallic Stage - ✔3️-6 years Erogenous zone is genitals Freud latent stage - ✔6️ to puberty Representation of sexual feelings Freud Genital stage - ✔•️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 - ✔e️go boundaries way of coping with anxiety in which an object or person of ambivalence is viewed as perfect or has having exaggerated positive qualities - ✔i️dealization person attributes themselves, an object or another person as completely flawed, worthless, or having exaggerated negative qualities - ✔d️evaluation motivational interviewing - ✔b️ased 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 - ✔P️recontemplation Contemplation Preparation Action Maintenance Relapse person has no intention of change and lack of insight - ✔p️recontemplation action in precontemplation - ✔g️ive information to raise awareness of the problem, but do not try to tell the person what to do. person is thinking about change, is aware there is a problem, but is not committed to changing - ✔c️ontemplation action in contemplation - ✔h️elp the person find a change strategy that is realistic, acceptable, accessible, and effective. Person has made the decision to change and is ready for action - ✔p️reparation action step in preparation - ✔h️elp the person find the change strategy that is realistic, acceptable, appropriate, and effective. person is engaging in specific, overt actions to change - ✔a️ction action step in action - ✔s️upport and advocate help accomplish steps for change. person is engaging in behaviors to prevent relapse - ✔m️aintenance action step in maintenance - ✔h️elp the person identify the possibility of a relapse identify strategies to prevent relapse. therapy that changes the clients irrational beliefs and negative cognitive disortions - ✔c️ognitive therapy. method that uses journaling, cognitive restructuring - ✔c️ognitive therapy. Who invented DBT - ✔M️arsha Linehan used for borderline personality disorder Goal of DBT - ✔r️educe suicidal behaviors Emphasizes accepting freedom and making responsible choices - ✔e️xistential therapy well suited to those facing issues of existence, for example those with terminal illness, those contemplating suicide, or going through transition in life Goal: focus on present and personal responsibility focus on a. patient's subjective world - ✔E️xistential therapy therapy that is person centered self-directed growth self-actualization - ✔H️umanistic therapy therapy that focuses on interpersonal issues causing distress to understand manage relationship problems - ✔i️nterpersonal therapy therapy used for PTSD Goal: achieve adaptive resolution relate trauma from a negative thought to a positive thought - ✔E️MDR process providing a personal with visual or auditory information about the autonomic physiologic functions of his or her body. - ✔b️iofeedback Family systems therapy (VERY HIGH YIELD) - ✔t️riangles, triangulation, self-differentiation triangles are not good for the family Structural family therapy - ✔b️oundaries, hierarchies Strategic therapy - ✔p️aradoxical intervention--tell the family member that they can worry for one hour of the day. Solution focused therapy - ✔m️iracle question patient attributes their own unacceptable thoughts feelings, and motives onto another person - ✔p️rojection redirection of an impulse (usually aggression) onto a powerless substitute target - ✔d️isplacement displace our unacceptable emotions onto behaviors which are constructive and socially acceptable, rather than destructive healthy defense mechanism - promise keeping, integrity, honesty being respectful, competent and professional - ✔f️idelity telling the truth - ✔v️eracity doing for self - ✔a️utonomy Rennie v Klein Court Case - ✔i️nvoluntary patient not found incompetent, has a right to refuse psychotropic medications, goal of case management - ✔p️romote quality and cost-effective outcomes. Stark Law - ✔y️ou can't refer to family members for treatment of your patients. PICOT - ✔P️atient or problem intervention comparison outcome time evidence from systematic review or meta analysis of many RCTs - ✔l️evel 1 evidence evidence from at least one RCT - ✔l️evel 2 evidence Before implementing/creating change of policy - ✔a️ssess/address/identify potential organizational barriers and facilitators meet with stakeholders patient advocacy - ✔r️educe 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 - ✔j️ust culture of safety Process for quality improvement - ✔p️lan, do, study, act reflective practice - ✔d️ebriefing strategies goal: to improve practice Highest rate of suicide in US - ✔n️ative Americans True or false A culturally expected response to a stressor does not always mean a mental illness - ✔t️rue grasp palmar reflex disappear by - ✔5️-6 months moro startle reflex disappear by - ✔5️-6 months babinski reflex normal until - ✔a️ge 2 shrill cry in baby - ✔i️ntracranial pressure playing with genitals normal in ages 3-6 - ✔t️rue treatment for cultural syndrome - ✔b️rief supportive therapy