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Georgette's LMR; Georgette's PMHNP
Certification Exam Review 202 5 V2 with complete
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What should you not do when advocating for a patient? {{Ans- Judge or confront What class of medication is contraindicated with tics? {{Ans- Stimulants What should you provide for prior to assessing abuse victims? {{Ans- A safe environment What are your actions if a child reports abuse? {{Ans- First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? {{Ans- Report to CPS In what setting as an inpatient provider should you interview a patient?
{{Ans- Use a private room with the door partially open How should you begin your interview with adolescents? {{Ans- By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? {{Ans- Without What if an adolescent tells you they are homosexual and they don't want their parents to know? {{Ans- This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initialaction? {{Ans- Get informed consent/ROI What do you do if a medical evaluation is needed? {{Ans- Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/unwell in
What ethnic group has the highest rate of suicidality in the US? {{Ans- Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? {{Ans- Teach cultural sensitivity and make accommodations for patient to have healing stick availablesuch as 1: Psychoeducation should be based on? {{Ans- Cultural context How do you promote health in a location with multiple ethnicities and education levels? {{Ans- Multiple cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? {{Ans- Allow this - remember ROI/informed consent Normal TSH? {{Ans- 0.5-5.
TSH < 0.5 =? {{Ans- Hyperthyroidism TSH > 5.0 =? {{Ans- Hypothyroidism Relationship between TSH & T3/T4? {{Ans- Inverse Hyperthyroidism can present as? {{Ans- Mania Hypothyroidism can present as? {{Ans- Depression Normal depakote level? {{Ans- 50 - 125 Toxic depakote level? {{Ans- 150+ Birth defect caused by depakote? {{Ans- Spina Bifida S/S of depakote toxicity? {{Ans- Disorientation, lethargy, decreased respiratory rate,
Kava kava can cause? {{Ans- Liver damage and heavy sedation Kava kava is c/i with? {{Ans- Benzos or sedatives Mood stabilizer most associated with SJS? {{Ans- Lamictal Mood stabilizer with least weight gain? {{Ans- Lamictal SGAs with least weight gain? {{Ans- ziprasidone, abilify, and latuda Least sedating SGA? {{Ans- Abilify Routine labs with SGAs? {{Ans- BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? {{Ans- 1. Nonpharm = exercise or nutritional counseling
- Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? {{Ans- Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? {{Ans- HLAB1502 Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? {{Ans- If ANC is < 1000 with or without s/s of infection Lithium range? {{Ans- 0.6 - 1. What to do if lithium is 1.3 or 1.4? {{Ans- Monitor What to do if lithium is 1.5+? {{Ans- D/C Benefits of lithium? {{Ans- Gold standard for mania, neuroprotective, and antisuicidal effects
What demonstrates understanding of education on lithium? {{Ans- Taking extra water with patient when they go hiking NMS s/s? {{Ans- Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs Treatment of NMS and MOAs? {{Ans- D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant) Serotonin syndrome s/s? {{Ans- Hyperreflexia and myoclonic jerks Serotonin syndrome causes? {{Ans- SSRIs, SNRIs, MAOIs, - triptans (for migraines like sumatriptan/imitrex) Treatment for serotonin syndrome? {{Ans- D/C med and administer cyproheptadine
Wash out from SSRI to MAOI or vice-versa? {{Ans- 14 days Wash out from Prozac to MAOI? {{Ans- 5 - 6 weeks Drug choice for patient that is depressed and also has cancer? {{Ans- Celexa or lexapro d/t fewer drug to drug interactions Drug choice for patient with low energy and fatigue with depression? {{Ans- Wellbutrin Drug choice for patient with sexual problems d/t medication or depression? {{Ans- Wellbutrin C/I for Wellbutrin? {{Ans- Seizure disorder or hx or present eating disorder Drug choices for patient with chronic neuropathic pain and depression? {{Ans- 1. SNRI (cymbalta) 2. TCA (amitriptyline)
- Alpha 2 delta ligand (gabapentin or lyrica)
{{Ans- Insomnia; take in AM Disorder that most greatly increases thoughts of self-harm? {{Ans- Depression Disorder that most greatly increases homicidal ideation? {{Ans- Antisocial personality Why is there less evidence available supporting the use of antidepressants in children? {{Ans- Lower placebo rates Schizophrenia age of onset in men? Women? {{Ans- 18 - 25; 25 - 35 Findings on PET scan or MRI in schizophrenia? {{Ans- INCREASED ventricle size; DECREASED everything else No stimulants in schizophrenia due to? {{Ans- Increased dopamine release Tertiary prevention for schizophrenia? {{Ans- Social skills training Why should you refer a patient with schizophrenia to exercise programs, especially aerobic exercise? {{Ans- It improves cognition, quality of life, and long term health
Benefits of assertive community treatment (ACT)? {{Ans- Rehab post- hospitalization, case management approach, and good for long term hx of noncompliance Oral haldol to IM conversion? {{Ans- 20x daily dose of oral dose Max IM dose of haldol per visit? How long until next injection? {{Ans- 100 mg; 5- 7 days5 mg oral haldol BID =? IM {{Ans- 200 mg Firm belief that is maintained despite lack of evidence? {{Ans- Delusion Example of a delusion? {{Ans- Believing church members or class members are a cult MSE in preschooler (3- 5 yo)? {{Ans- Listen and observe; dependent on clinical observationThought process? {{Ans- Organization of patients thoughts and ideas Circumstantial speech? {{Ans- Go in circles but eventually answers Tangential speech? {{Ans- Never gets to answer of question
lead to amenorrhea, galactorrhea, sexual dysfunction, and gynecomastia Long term increased prolactin causes? {{Ans- Osteoporosis Normal prolactin levels for men? Women? {{Ans- <20; <25 Which CYP450 enzyme metabolizes clozaril? {{Ans- 1A2 Cigarettes are inducers of what CYP450 enzyme? {{Ans- 1A Cigarette smoking in patients taking clozaril requires increased or decreased doses? {{Ans- Increased Cigarette cessation in patients taking clozaril requires increased or decreased doses? {{Ans- Decreased Most antibiotics are inducers or inhibitors? Intervention with substrate? {{Ans- Inhibitors; reduce substrate
Medications that cause mania? {{Ans- Steroids, antabuse, isoniazid (INH), and antidepressants in patients with bipolar disorder Medications that cause depression? {{Ans- Steroids, accutane, interferon, retrovirals, antineoplastics,BZDs, progesterone, and beta blockers Accutane can cause? {{Ans- Birth defectsSteroids can also cause? {{Ans- Psychosis Intervention for patient on flonase or prednisone? {{Ans- Increase mood stabilizer, antidepressant, orantipsychotic based on targeted disorder Neurotransmitters indicated in addiction? {{Ans- Dopamine and GABA S/S of stimulant abuse? {{Ans- Insomnia, anxiety, irritability, tremors, palpitations, increased HR, andincreased BP Patients with anorexia complain of pain, bloating, and fullness with eating due to? {{Ans- Delayed gastricemptying
Conversion disorder presents after? S/S? {{Ans- Stressful event like losing sibling; blindness, mutism, paralysis, paresthesia all medically unexplained Adjustment disorder presents after? Timeline? {{Ans- Stressful event like loss of pet or parent; within 3months of event Subtypes of adjustment disorder? Examples? {{Ans- With depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbances of conduct (think change in school), and with mixed disturbances of emotions and conduct (think of divorce leading to truancy, peer conflict, verbal altercations, insomnia, and frequent crying) ODD timeline? {{Ans- Lasts 6+ months ODD s/s? {{Ans- Deliberately annoys others, is spiteful, and is vindictive; NO AGGRESSIONTx for ODD? {{Ans- Family therapy Conduct disorder s/s? {{Ans- Think juvenile detention, AGGRESSION, NO
REMORSE
Tx of conduct disorder? {{Ans- Target mood and aggression (antipsychotics, mood stabilizers, SSRIs, andalpha agonists); therapy Dx of Tourette's syndrome? {{Ans- 2 motor tics and 1 vocal tic lasting 1 year+ Childrens motor tics are? {{Ans- Fairly common and can be temporary Primary neurotransmitters indicated in tics? {{Ans- DOPAMINE, NE, and serotonin Tx of tics? {{Ans- Haldol, pimozide, abilify, clonidine, and guanfacine Acute stress disorder timeline? {{Ans- 4 weeks or less A patient assaults you at work and you don't want to return to work for 2-3 weeks. This can be anexample of? {{Ans- Acute stress disorder PTSD timeline? {{Ans- Lasts 1 month or more S/S of PTSD? {{Ans- Intrusive re-experiencing, increased arousal, and avoidance of stimuli Tx for PTSD? {{Ans- SSRI, TCAs, prazosin for nightmares, EMDR, and CBT
