Georgette's LMR PMHNP Certification Exam Review Questions and Answers 2024, Exams of Advanced Education

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Georgette's LMR PMHNP Certification Exam Review Questions and Answers 2024 What drugs should be avoided with Kava Kava? - Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? - Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? - cultural assessment What is the normal range for TSH? - 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism - Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? - Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? - Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? - Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Mania Valproic acid produces what teratogenic effect? - Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? - Liver (hepatoxicity) What 4 drugs can cause mania? - Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce - Mania What 6 drugs can induce depression? - Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Which 3 SGAs cause the least weight gain? - Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? - Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? - Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of - Delirium How are agitation and psychotic symptoms treated in delirium? - Low dose Haldol Steroids can induce what 3 psychiatric states? - Mania Depression Psychosis What medication to treat acne cause cause birth defects? - Isotretinoin (Accutane) What is the therapeutic range for lithium? - 0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? - Lithium What is the gold standard for treating manic episodes - Lithium What mood stabilizer has anti-suicidal effects? - Lithium What 5 labs should be drawn with lithium? - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - 0.6-1.2 mg/dL What is the normal range for BUN? - 10-20 mg/dL When should you suspect kidney disease with a urinalysis? - 4+ protein 4+ protein in the kidney suggests - Kidney disease What are 7 side effects of lithium? - Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? - Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Which 3 drugs can increase lithium levels by decreasing renal clearance? - NSAIDs (ibuprofen, indomethacin) Thiazid es ACEI A normal thought process is described as - Logical Linear Coherent Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes - Concentration Attention Calculation Asking the year, season, date, month, and location measures - Orientation Asking a patient to repeat "bed, bad, ball" measures - Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures - Recall (memory) Asking the patient who is the president of the US or governor of state is measuring - Fund of Knowledge Goal-oriented Moving from thought to thought and never getting to the point is called - Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called - Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called - Thought content Thought content includes 3 items - Suicidal ideation Homicidal ideation Hallucinations/Delusions What is a simple test that can be administered in a minute or two to measure possible dementia? - Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to - Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway modulates - positive psychotic symptoms Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? - Negative symptoms Depressive symptoms The nigrostriatal pathway modulates - motor movements Dopamine has what type of relationship with acetycholine - Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? - Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to - Increased prolactin What are 5 symptoms of hyperprolactinemia? - Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long- term) What antipsychotic has the greatest effect on prolactin? - Risperidone What is the black box warning for carbamazepine? - Agranulocytosis What are 8 symptoms of aplastic anemia? - Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of - Aplastic anemia What ethnic group is most susceptible to SJS with display to meet DSM-5 criteria? - 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of - Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? - Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? - Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? - Conduct Disorder What are 3 characteristics of Conduct Disorder? - Destruction of property Deceit or theft Lack of remorse What are 5 stressful events in a child's life that can cause adjustment disorder? - Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? - Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? - 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) What 2 factors differentiate Conduct Disorder from ODD? - Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? - Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? - Therapy What is the moderate range for SLUM? - 10-20 What is the moderate range for HAM-D? - 14-18 What is the moderate range for PHQ-9 - 10-14 What is the moderate range for BDI? - 19-29 What is the moderate range for HAM-A? - 18-24 What is the moderate range for GAD-7 - 10-14 What is the moderate range for COWS? - 13-24 If a patient's COWS score is between 5 - 12, what do you do? - Administer clonidine What type of therapy is used in the treatment of Conduct Disorder? - Behavioral therapy What is Multisystemic family therapy? - Home-based model for youth with serious antisocial and criminal offenses by empowering parents with resources and skills and reducing barriers to resources needed for effective management of youth What is the goal of multisystemic family therapy (MFT)? - Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? - Multisystemic family therapy What is the moderate range for MMSE - 10-20 If a patient's COWS score is between 13 - 24, what do you do? - Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? - mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? - moderate symptoms (13-24) What is a moderate range on the CIWA? - 16-20 how do you treat it? - Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Medication and/or therapy If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? - Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? - Prefrontal cortex Amygdala Basal ganglia Hippocampus When do you administer prn benzodiazepine on the CIWA? - Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? - moderate symptoms (15 or higher) If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how do you treat it? - Medication and/or therapy Assess for suicidal ideation If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it? - Medication and/or therapy If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? - Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? - Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis What are 2 symptoms associated with lead poisoning? - Developmental delay (learning difficulties) Pica (paint chips) also gastrointestinal Which 2 demographic characteristics are associated with lead poisoning? - rural areas 1970's A child with developmental delay who eats things (such as paint chips) may have - Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? - BMI Hip-to-waist ratio Glucose Lipid panel What 2 neurotransmitters are associated with OCD? - Serotonin Norepinephrine A childhood depressive disorder that is diagnosed in children older than 6 but younger than 18 is most likely - DMDD A child with chronic dysregulated mood ("mood"), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? - DMDD The age criteria for a DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) is - >6 and <18 (7-17 yrs.) A child who is chronically "moody" is most likely to have what diagnosis? - DMDD Where is norepinephrine produced? - Locus coeruleus Medullary reticular formation The neurotransmitter produced in the locus coeruleus and medullary reticular formation is - Norepinephrine What neurotransmitter is produced in the raphe nuclei in the brainstem? - Serotonin Serotonin is produced in - raphe nuclei in the brainstem What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? - Dopamine What 3 areas of the brain is dopamine produced? - Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? - Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? - Acetycholine What is the function of the amygdala? - Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? - Amygdala What are 4 functions of the hippocampus? - Emotions Stress Learni ng Memor y Emotions, stress, learning, and memory are functions of what structure of the brain? - Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Glutamate GABA Serotonin A child who does not respond when called by name may have - Autism A child that has little or no eye contact may have - Autism Whit e Male What are 5 physical characteristics of Anorexia Nervosa? - Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? - Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa - Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? - Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? - Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? - Intrusive re- experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD - SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? - EMDR CBT What are the 12 components/symptoms of the COWS? - Pulse Sweating Restlessn ess Pupil size Bone aches Running nose or tearing GI upset Yawnin g Tremo rs Anxiety/ irritability Gooseflesh skin Dilated pupils Projects designed to improve systems, decrease cost, and improve productivity are called - Quality Improvement The process/strategy of Quality Improvement is called - PDSA Cycle Plan Do Stud y Act The PDSA Cycle is - The process/strategy of Quality Improvement The 4 components of Health Policy are - Process Policy reform Policy environment Policy makers Process, Policy reform, Policy environment, and Policy makers are the 4 components of - Health Policy What is 3-part "process" component of Health Policy? - Formulation, Implementation, and Evaluation (FIE) Formulation, Implementation, and Evaluation (FIE) are - The "process" component of Health Policy What is the "policy reform" component of Health Policy? - Changes in programs and practices Changes in programs and practices in Health Policy is called - Policy Reform What is the "policy environment" component of Health Policy? - The arena the process takes place in (government, media, public) The arena the process takes place in (government, media, public) is what component of Health Policy? - Policy environment What is the "policy makers" component of Health Policy? - Key players and stake holders on continual growth and occasional setbacks What are 3 characteristics of the Recovery Model? - Learning from experience (e.g. relapse) Nonlinear Self-directed, Individualized and Person-Centered The treatment approach that emphasizes "learning from experience," nonlinear, and self-directed/individualized/person-centered? - Recovery Model What is the SBIRT - Screens for Substance Use Disorders Screening Brief Intervention Referral Treatment What component of Health Policy are Key players and stake holders? - Policy Makers What is the first action when developing Health Policy? - Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called - Recovery Model What is the Recovery Model? - A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called What is a nonlinear treatment approach? - Not a step-by-step process, but one based What instrument screens for Substance Use Disorders - SBIRT Screening Brief Intervention Referral Treatment What is the Tarasoff Principle - Duty to warn victim of imminent danger of homicidal patients What is the Donaldson vs. O'Connor court case? - You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? - Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? - Strategic Which 3 techniques are used in Solution-Focused Therapy? - Miracle Questions Exception-finding questions Scaling Questions What is the Duty to warn victim of imminent danger of homicidal patients? - Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) - Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? - Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? - Donalson vs. O'Connor Court Case Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? - Family Systems Therapy What are 3 characteristics of Family Systems Therapy ? - Triangles/Triangulation Self-differentiation Genograms What are 3 characteristics of Structural Family Therapy? - Hierarchies One of your patients receiving psychiatric medication develops an infection. What do you consider? - Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? - Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? - HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? - DC lithium What is one of the most important teaching points you should make in a patient taking lithium? - Stay hydrated A patient with what medical condition is at risk for lithium toxicity? - Cardiac failure (hyponatremia) Which SGA is the least sedating? - Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? - Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? - nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? - ANC < 1,000 (even if asymptomatic) What is the key indicator for NMS? - Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of - NMS What is the key indicator of Serotonin Syndrome? - Muscle jerks (myoclonic) Muscle jerks (myoclonic) are the key indicator of - Serotonin Syndrome If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? - Bupropion What is first line treatment for MDD? - SSRIs What are the 2 antidepressants of choice in a depressed patient with cancer? - Citalopram (Celexa) Escitalopram (Lexapro) What is the antidepressant of choice in a depressed patient with sexual dysfunction? - Bupropion What is the antidepressant of choice in a depressed patient with decreased energy? - Bupropion What are 3 treatments for depressed patients with neuropathic pain? - SNRI (safety) TCA Gabapentin Which SSRI is most likely to cause insomnia? - Fluoxetine (Prozac) What question is important to ask in the social history with a depressed patient? - Alcohol intake (self-medicating) What BBW do all antidepressants have? - Suicidal ideation (<24 yrs.) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? - Antidepresssants What question should ask all adolescent patients at each visit? - Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit? - Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? - Few evidence-based studies What is the onset of schizophrenia in males? - 18-25 What is the onset of schizophrenia in females? - 25- 35 What question should ask schizophrenic patients at each visit? - SI When converting oral Haldol to depo form, what the maximum dose should administer? - >100 mg (administer weekly if necessary) What is a delusion? - A firm belief despite contrary evidence A firm belief despite contrary evidence is - delusion How often is Haldol Decanoate typically adminitered? - monthly How do you conduct a MSE in a preschooler (3-5 yo) - Clinical observation (listen/observe) What is thought content? - SI/HI, plan What are the 5 components of the MMSE (Folstein's) - Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? - 5-HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? - 5HT2- antagonism What antipsychotic should you give to a patient with their first psychotic episode? - SGA (IM) Which 4 SGAs are available in IM form? - Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? - Metoclopramide (Reglan) What is a normal prolactin level in men? - <20 What is a normal prolactin level in women? - <25 What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? - Decrease olanzapine dose What effect does tobacco have on CYP450? - 1A2 inducer What class of drugs are primarily inhibitors? - Antibiotics How does erythromycin and clarithromycin affect CYP240? - Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? - Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? - Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? - Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? - Insomnia Tremors Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations) A patient who c/o pain after eating, bloating and fullness, what do you suspect? - Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? - Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? - H2 antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? - Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) In DBT, diagnosis of borderline disorder requires activity? - journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed - Valproic acid When should valproic acid be prescribed in a patient with borderline personality disorder? - Depressed mood + lability A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? - Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? - Conduct Disorder Is a child with ODD or Conduct Disorder more likely to need medication? - Conduct Disorder If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? - No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? - Not always What 3 neurotransmitters are involved with Tourette's? - DNS What is factitious disorder imposed on another? - Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? - Report to CPS Child abuse (duty to report) What is Factitious Disorder - Faking illness to get medical attention or sympathy A patient who feigns illness to get sympathy or attention is most likely to have - Factitious disorder A patient with factitious disorder is most likely to have what type of demographic? - Unmarried healthcare worker What is malingering? - Feigning illness for secondary gain ($) (not a psychiatric diagnosis) A patient who claims disability or worker's comp when there is no injury is most likely - Malingering (not a psychiatric diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? - Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? - Reactive Attachment Disorder s like PTSD, but symptoms last less than a month is most likely to have - Acute Stress Disorder uration for a DSM-5 diagnosis of GAD? - 6 months How does a panic attack differ from Panic Disorder? - acut er differ from a panic attack? - Chronic, recurrent, unexpected tient with panic disorder who is taking albuterol for asthma? - (don't give beta blocker) of choice for acute symptoms of panic disorder? - Beta blocker (not addictive) anxiety for maintenance therapy? - SSRI How do you treat text anxiety acutely? - Beta blocker Benzodiazepine What structure of the brain is involved with attention, executive function, and cognitive processes (working memory, problem solving) that affects ADHD? - Dorsolateral prefrontal cortex Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? - prefrontal Cog onset of symptoms What screening instrument can hep differentiate dementia from pseudodementia (depression)? - MMSE A patient with frontal lobe (Pick's) dementia is most likely to present with what 4 symptoms? - Executive dysfunction Slurred speech (expressive aphasia) Language comprehension (receptive aphasia) Personality and behavior changes Social skills A patient who presents with difficulties with executive function, slurred speech, personality, and behavior changes, difficulties with language comprehension, and poor social skills is most likely to have what type of dementia? - Frontotemporal (Pick's) A patient with visual hallucinations is most likely to have what type of demenetia? - Lewy Body A patient with Lewy Body Dementia is most likely to have what presenting symptoms? - Visual hallucinations A patient with damage to the anterior cingulate will demonstrate what 3 symptoms? - Cognitive dysfunction (decision making) Lack of empathy Difficulty with impulse control and emotions A patient who presents with cognitive dysfunction (decision making), lack of empathy, and difficulty with impulse control and emotions is most likely to have damage in what brain structure? - Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? - Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? - Cerebellum What condition may cause pica (eating things that are not food - paint chips)? - Lead poisoning What 5 neurotransmitters are associated with mood disorders? - Dopamine Norepinephrine Seroton in GABA Glutamate What do do yo do when an infant is about to die? - Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? - Family support Support groups (don't give prescriptive advice) What are 5 risk factors for osteoporosis? - Smoking Caffeine Low calcium/vitamin D in diet Decreased weight Lack of weight bearing exercises Smoking, Caffeine, Low calcium/vitamin D in diet, Decreased weight, and Lack of weight bearing exercises are risk factors for - Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? - Yes If a patient is reluctant to participate in group therapy, what do you do? - Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? - CBT What are 5 techniques used in behavioral therapy? - Problem-solving Skills training Exposure therapy Role-playing/ modeling Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in - Behavioral Therapy What are 2 common techniques used in CBT? - Cognitive anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? - Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened- ended question? - Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? - talk to parents What therapeutic factor does open-ended questions instill? - empathy If only the wife shows up for a couple appointment, what do you do? - Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? - Contact CPS Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? - crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis - ESR When is an ESR indicated? - Patient with rheumatoid arthritis What does PICO stand for? - P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? - Have access to current journals A baby with a shrill cry is likely to have - Increased intracranial pressure A sign of increased intracranial pressure in a baby is - shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? - That is normal between 3-6 yrs old (Phallic stage) Folic acid deficiency creates what type of anemia? - Macrocytic With normocytic, macrocytic anemia, what 3 labs do you obtain? - B12, folic acid, Fe B12 deficiency creates what type of anemia? - Macrocytic What deficiency is associated with microcytic anemia? - Iron An iron deficiency causes what type of anemia? - Microcytic Acute or chronic blood loss (GI bleeding, heaving menses) can cause what type of anemia? - Normocytic Normocytic anemia is due to - Chronic or acute blood loss (GI bleeding, menses) What is the BMI in a patient with Bulimia Nervosa? - Normal When vital signs are not normal in a thin women, you suspect - Anorexia nervosa You see a patient with suspected anorexia nervosa. What do you do? - Refer out for medical evaluation If a patient with anorexia nervosa refuses to see a PCP, what do you do? - Contact CPS If AN patient is medically unstable and parents refuse hospital treatment, what do you do? - contact CPS What 2 conditions is acupuncture used? - Pain Depression What alternative medicine treatment is used with pain and depression? - Acupuncture Habeas Corpus Act - Protects a patient from unlawful hospitalization (able to leave AMA) What act prevents a patient from unlawful hospitalization (can leave AMA)? - Habeus corpus (usually max of 28 days) How do you implement policy affecting NPs nationwide? - Host online forum/give survey to obtain information (vs. letters) How do you implement policy coworkers are against? - Tell them how the policy will increase quality of patient care What is the initial step in providing continuous improvement of Quality of Care in an outpatient setting? - Create an instrument to monitor outcomes What will you see in a laboratory test in a patient with an autoimmune disease? - Increased cytokine levels Increased cytokine levels on a laboratory test suggests what disease? - autoimmune What are 2 ways to treat enuresis (night-time bedwetting)? - Alarm clock Desmopressin (DDAVP) A patient presents with paresthesia, fatigue and asymmetric body movement of extremities. What do you suspect and what do you do? - Disseminated Encephalomyelitis Neuro exam What is Disseminated Encephalomyelitis and what are 3 symptoms? - Autoimmune viral infection - children Paresthesia Fatigue Asymmetric body movement of extremities If a patient is unable to remember events, how do you establish a diagnosis? - Provide anchor (memorable events) to establish diagnosis An alarm clock and Desmopressin (DDAVP) are 2 methods to treat - Enuresis What is the mechanism of action of Desmopressin (DDAVP)? - Decreases urine production (via antidiuretic hormone - vasopressin) When considering the relationship between receiving samples from a drug rep or sponsored education, what should consider and what should you do? - Conflict of Interest Create policy to address COI What are 7 symptoms/categories of opioid withdrawal? - Muscle cramps, Bony aches Diarrhea/abdominal cramps Rhinorrhea, Lacrimation Goosebumps Pupil dilation Increased BP/HR Yawning What do you suspect when a patient who presents with muscle cramps, bony aches, diarrhea/abdominal cramps, rhinorrhea, lacrimation, goosebumps, pupil dilation increased BP/HR and yawning? - Opiate withdrawal What are Yalom's 10 therapeutic factors? - Instillation of Hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing Instillation of Hope, Universality, Altruism, Increased development of socialization skills, Imitative behaviors, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors, and Corrective refocusing are - Therapeutic Factors which differentiate group therapy from individual therapy Experiencing optimism through observing the improvement of others in the group is which of Yalom's therapeutic factors? - Instillation of Hope Sharing experiences/feelings in group clients realize they are not alone is which of Yalom's therapeutic factors? - Universality Learning to give to others is which of Yalom's therapeutic factors? - Altruism The "natural laboratory" is which of Yalom's therapeutic factors? - Increased development of social skills Group members modeling their behavior after other members of group/therapist is which of Yalom's therapeutic factors? - Imitative behavior Interacting with others to increase adaptive interpersonal relationships is which of Yalom's therapeutic factors? - Interpersonal learning audience) just culture - A work environment that improves patient safety through continuous learning A work environment that improves patient safety through continuous learning is - Just Culture Recovery Model - A model that does not focus on mental illness, is nonlinear (occasional setbacks) and stresses learning from experience What treatment approach does not focus on mental illness, is nonlinear (occasional setbacks), and stresses learning from experience? - Recovery Model A process or strategy of quality improvement is called - PDSA Cycle Plan Do Stud y Act What is the PDSA cycle - A quality improvement process or strategy What is an example of a Quality Improvement Project? - Chart review What are the 4 components of health policy? - Process Policy reform Policy environment Policy makers When implementing health policy, what is the first thing you do? - Assess barriers and facilitators (prior to meeting with stakeholders) What is SBIRT Assessment? - Screening, Brief Intervention, and Referral to Treatment for SUD What should you do before warning someone about harm (Tarisoff act)? - Contact Board of Nursing A key component of Piaget's Sensorimotor stage is - Object permanence Object permanence develops in which of Piaget's developmental stages? - Sensorimotor What 3 disorders have dysregulation of glutamate and gabapentin? - autism spectrum disorder bipolar disorder schizophrenia You are concerned a 5-yo child may be sexually abused. How do you conduct the interview? - Interview child and parents separately if child can communicate You see a child playing with a toy in a sexual manner. What do you do? - contact CPS What are the 2 most important aspects of interviewing an adolescent? - Rapport Confidentiality (explain exceptions) How should an adolescent be interviewed - separately form parents Which 5 psychiatric disorders have dysregulation of the GABA receptor? - BPD Schizophrenia Autis m SUD Anxiety What 4 psychiatric disorders have dysregulation of glutamate receptors? - BPD Schizophrenia ASD Alzheimer's Which 2 psychiatric disorder have dysregulation of acetylcholine receptor? - Alzheimer's Parkinson's If an adolescent is dating someone the same age, do you need to tell the parents? - No If an adolescent is dating someone of the same gender, do you need to tell the parents? - No What should you ensure before discharging a patient from the hospital? - Support system (safety) Should a patient be interviewed in a day room? - No (not confidential) When do you draw a T3 or T4 - If TSH is abnormal What symptom occurs with high levels of ammonia? - confusion What 4 symptoms are similar with serotonin syndrome and NMS? - Hyperthermia Diaphoresis Tachycard ia Altered LOC Thoughts of self-harm are greatest in what 5 disorders (according to order) - MDD BPD Alcohol use disorder Eating disorder schizophrenia What is a long-term side effect of the anti-emetic metoclopramide (Reglan)? - TD Are oral contraceptives inducers or inhibitors? - inducers A person with pressure speech is most likely to have - bipolar disorder If you can identify why a person is depressed, what is their mostly likely diagnosis? - Adjustment disorder with depressed mood Can tics be a normal behavior? - yes What are the 2 primary deficits in Cortical Dementia? - Language Memory Language and memory are the 2 primary deficits in which type of dementia? - Cortical Motor and behavioral (depression, irritability, apathy) are the 2 primary deficits in which type of dementia? - Subcortical What are the 2 primary deficits in Subcortical Dementia? - Motor Behavioral (depression, irritability, apathy) What is the value of integrative medicine (E.g., ObGyn + PMHNP)? - increased mental health access to those who need it most