GEORGETTE REVIEW PMHNP WITH COMPLETE SOLUTIONS GUARANTEED PASS, Exams of Nursing

Download GEORGETTE REVIEW PMHNP WITH COMPLETE SOLUTIONS GUARANTEED PASS and more Exams Nursing in PDF only on Docsity! GEORGETTE REVIEW PMHNP WITH COMPLETE SOLUTIONS GUARANTEED PASS 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 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? 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 ->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? A. Morphine B. NSAIDS C. Methylphenidate D. Acetaminophen - ANSWER ->Answer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1,000 C. WBC less than 5,000 D. ANC less than 2000 - ANSWER ->Answer: ANC less than 1000 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 - ANSWER ->A. 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 - ANSWER ->A. 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? 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 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 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 A. frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe - ANSWER ->frontal lobe Impairments in the clock drawing test can be associated with - ANSWER ->damage to the right parietal lobe 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 Exam ised 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 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 - ANSWER ->Propranolol 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 - 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 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 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? A. Prior and current meds, dose, clinical response, side effects. B. Thoughts of self-harm, plan, intent, access C. Extent of alcohol use, and motivation to reduce to safe levels D. Sleep patterns and hygiene - 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 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 - 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: 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. - ANSWER ->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 - ANSWER ->D 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 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 When T4 and T3 are high, and TSH is low - ANSWER ->hyperthyroidism When T4 and T3 are low, and TSH is high - ANSWER ->hypothyroidism Hypothyroidism mimics - ANSWER ->depression hyperthyroidism mimics - ANSWER ->mania sensitive to cold, cold intolerant - ANSWER ->hypothyroid heat intolerant - ANSWER ->hyperthyroid Normal AST and ALT - ANSWER ->AST 5-40 ALT 5-35 with liver damage ALT - ANSWER ->rises to 50x normal Argues with authority - ANSWER ->oppositional defiant disorder defiant but not aggressive - ANSWER ->oppositional defiant disorder treatment for ODD - ANSWER ->therapy Person is aggressive, lack of remorse, destruction of property, deceit or theft - ANSWER ->conduct disorder treatment for conduct disorder - ANSWER ->target mood and aggression. person has sudden: blindness, mutism, paralysis, paresthesia, neurological symptoms - ANSWER ->conversion disorder emotional or behavioral reaction to a stressful event or change in person's life within 3 months of it happening. - ANSWER ->adjustment 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 - ANSWER ->bipolar disorder The neuroprotective treatment of choice for bipolar disorder is - ANSWER ->lithium 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 - ANSWER ->quetiapine intrusive reexperiencing of a traumatic event - ANSWER ->PTSD symptoms of PTSD - ANSWER ->hyperarousal, avoidance of stimuli associated with trauma, intrusive symptoms Pharm treatment for pTSD - ANSWER ->SSRI (Zoloft) TCA Prazosin AVOID BENZOS 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) 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. person is thinking about change, is aware there is a problem, but is not committed to changing - ANSWER ->contemplation action in contemplation - ANSWER ->help 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 - ANSWER ->preparation action step in preparation - ANSWER ->help the person find the change strategy that is realistic, acceptable, appropriate, and effective. person is engaging in specific, overt actions to change - ANSWER - >action action step in action - ANSWER ->support and advocate help accomplish steps for change. person is engaging in behaviors to prevent relapse - ANSWER - >maintenance action step in maintenance - ANSWER ->help the person identify the possibility of a relapse identify strategies to prevent relapse. therapy that changes the clients irrational beliefs and negative cognitive disortions - ANSWER ->cognitive therapy. method that uses journaling, cognitive restructuring - ANSWER - >cognitive therapy. Who invented DBT - ANSWER ->Marsha Linehan used for borderline personality disorder Goal of DBT - ANSWER ->reduce suicidal behaviors Emphasizes accepting freedom and making responsible choices - ANSWER ->existential 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 - ANSWER ->Existential therapy therapy that is person centered self-directed growth self-actualization - ANSWER ->Humanistic therapy 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