Georgette's LMR PMHNP Certification Exam Review-with 100 verified solutions.docx, Exams of Nursing

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Georgette's LMR PMHNP Certification Exam Review-with 100% verified solutions What drugs should be avoided with Kava Kava? - Correct Answer - Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? - Correct Answer -Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? - Correct Answer - cultural assessment What is the normal range for TSH? - Correct Answer -0.5 - 5.0 mu/L What are lab values in Hyperthyroidism - Correct Answer -Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? - Correct Answer -Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? - Correct Answer - Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? - Correct Answer - Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Correct Answer -Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Correct Answer -Mania Valproic acid produces what teratogenic effect? - Correct Answer -Spina bifida (neural tube defect) Which mood stabilizer causes the least weight gain? - Correct Answer -Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? - Correct Answer - Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? - Correct Answer -Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? - Correct Answer - Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of - Correct Answer -Delirium How are agitation and psychotic symptoms treated in delirium? - Correct Answer -Low dose Haldol What 4 drugs can cause mania? - Correct Answer - Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce - Correct Answer -Mania What 6 drugs can induce depression? - Correct Answer - Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? - Correct Answer -Mania Depression Psychosis What medication to treat acne cause cause birth defects? - Correct Answer -Isotretinoin (Accutane) What is the therapeutic range for lithium? - Correct Answer -0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? - Correct Answer -Lithium What is the gold standard for treating manic episodes - Correct Answer -Lithium What mood stabilizer has anti-suicidal effects? - Correct Answer - Lithium What 5 labs should be drawn with lithium? - Correct Answer - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - Correct Answer -0.6-1.2 mg/dL What is the normal range for BUN? - Correct Answer -10-20 mg/dL When should you suspect kidney disease with a urinalysis? - Correct Answer -4+ protein 4+ protein in the kidney suggests - Correct Answer -Kidney disease What are 7 side effects of lithium? - Correct Answer - 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? - Correct Answer -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? - Correct Answer -NSAIDs (ibuprofen, indomethacin) Thiazide s ACEI Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? - Correct Answer - Negative symptoms Depressive symptoms The nigrostriatal pathway modulates - Correct Answer -motor movements Dopamine has what type of relationship with acetycholine - Correct Answer -Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? - Correct Answer -Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to - Correct Answer - Increased prolactin What are 5 symptoms of hyperprolactinemia? - Correct Answer - Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long- term) What antipsychotic has the greatest effect on prolactin? - Correct Answer -Risperidone What is the black box warning for carbamazepine? - Correct Answer -Agranulocytosis What are 8 symptoms of aplastic anemia? - Correct Answer - Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of - Correct Answer -Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? - Correct Answer -Asians Having the HLA-B*1502 allele increases the risk for - Correct Answer - SJS Which ethic group is at most likely to have the HLA-B*1502 allele? - Correct Answer -Asians Asians are most likely to have what allele? - Correct Answer -HLA- B*1502 In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? - Correct Answer -Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? - Correct Answer -Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of - Correct Answer -Agranulocytosis What are 4 symptoms of agranulocytosis - Correct Answer -A sudden fever Chills Sore throat Weaknes s At what ANC should clozapine be stopped (even if asymptomatic)? - Correct Answer -<1000 What is neutropenia? - Correct Answer -<2000 PMNs What is agranulocytosis? - Correct Answer - <500 ANC What does DIGFAST stand for? - Correct Answer -Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms in Conversion Disorder? - Correct Answer -Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) s Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? - Correct Answer -Therapy What type of therapy is used in the treatment of Conduct Disorder? - Correct Answer -Behavioral therapy What is Multisystemic family therapy? - Correct Answer -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)? - Correct Answer -Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? - Correct Answer -Multisystemic family therapy What is the moderate range for MMSE - Correct Answer - 10-20 What is the moderate range for SLUM? - Correct Answer -10-20 What is the moderate range for HAM-D? - Correct Answer -14-18 What is the moderate range for PHQ-9 - Correct Answer -10-14 What is the moderate range for BDI? - Correct Answer -19-29 What is the moderate range for HAM-A? - Correct Answer -18-24 What is the moderate range for GAD-7 - Correct Answer -10-14 What is the moderate range for COWS? - Correct Answer - 13-24 If a patient's COWS score is between 5 - 12, what do you do? - Correct Answer -Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? - Correct Answer -Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? - Correct Answer - mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? - Correct Answer -moderate symptoms (13-24) What is a moderate range on the CIWA? - Correct Answer -16-20 When do you administer prn benzodiazepine on the CIWA? - Correct Answer -Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? - Correct Answer -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? - Correct Answer - 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? - Correct Answer - Medication and/or therapy If a patient has mild depression (<14 on HAM-D) (<10 on PHQ- 9) (<19 on BDI), how do you treat it? - Correct Answer -Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Correct Answer -Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Correct Answer -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? - Correct Answer -Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? - Correct Answer - Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? - Correct Answer - Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? - Correct Answer -Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosi s Elevated LFTs Serotonin is produced in - Correct Answer -raphe nuclei in the brainstem What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? - Correct Answer -Dopamine What 3 areas of the brain is dopamine produced? - Correct Answer -Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? - Correct Answer -Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? - Correct Answer -Acetycholine What is the function of the amygdala? - Correct Answer -Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? - Correct Answer -Amygdala What are 4 functions of the hippocampus? - Correct Answer - Emotions Stress Learning Memory Emotions, stress, learning, and memory are functions of what structure of the brain? - Correct Answer -Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - Correct Answer -Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Correct Answer -Glutamate GABA Serotonin A child who does not respond when called by name may have - Correct Answer -Autism A child that has little or no eye contact may have - Correct Answer - Autism A child who likes to line up, stack, or organize objects and toys in on tidy rows may have - Correct Answer -Autism What theory claims that dysfunction of a particular neuron system may be a cause of poor social interaction and cognition in autism? - Correct Answer -Broken Mirror Theory What is the DSM-5 criteria for number of tics in Tourette's Disorder? - Correct Answer -Motor: 2 or more and Vocal: 1 or more (not necessarily at same time) What are the DSM-5 criteria for the duration of symptoms in Tourette's Disorder? - Correct Answer ->1 year What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder? - Correct Answer -<18 yrs What is the pharmacological treatment of Tourette's Disorder? - Correct Answer -Antipsychotic (haloperidol, pimozide, aripiprazole*) What are the 3 primary neurotransmitters involved in Tourette's Disorder? - Correct Answer -DNS What are 11 risk factors for suicide? - Correct Answer -Previous suicide attempt 45 and older (55 for women) Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss Male gender What age is a risk factor for suicide? - Correct Answer -45 and older What gender is a risk factor for suicide? - Correct Answer - Male What race is a risk factor for suicide? - Correct Answer -White (Caucasian) What 4 demographic characteristics are risk factors for suicide? - Correct Answer -45 and older Tremors Anxiety/irritabilit y Gooseflesh skin Dilated pupils Pulse, Sweating, Restlessness, Pupil size, Bone aches, Running nose or tearing, GI upset, Yawning, Tremors, Anxiety/irritability, Gooseflesh skin, and Dilated pupils are components of what scale? - Correct Answer -COWS What are the 9 components/symptoms of the CIWA Scale? - Correct Answer - Nausea/ vomiting Tremor Sweats Anxiety Agitatio n Tactile disturbances Auditory disturbances Headaches Orientation Nausea/vomiting, Tremor, Sweats, Anxiety, Agitation, Tactile disturbances, Auditory disturbances, Headaches, and Orientation are components of which Scale - Correct Answer -CIWA What are 3 treatments for Alcohol Use Disorder? - Correct Answer -Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Vivitrol, ReVia) Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver? - Correct Answer -Acamprosate (Campral) Installation of hope, universality, group cohesiveness, and altruism are therapeutic factors of what group therapy? - Correct Answer -Yalom What are 4 therapeutic factors in Yalom's Group Therapy? - Correct Answer -Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses? - Correct Answer -Appreciative Inquiry What is appreciative inquiry? - Correct Answer -An approach to organizational change which focuses on strengths rather than weaknesses What are the 3 goals of Quality Improvement? - Correct Answer - Projects designed to improve systems, decrease cost, and improve productivity Projects designed to improve systems, decrease cost, and improve productivity are called - Correct Answer -Quality Improvement The process/strategy of Quality Improvement is called - Correct Answer -PDSA Cycle Plan Do Study Act The PDSA Cycle is - Correct Answer -The process/strategy of Quality Improvement The 4 components of Health Policy are - Correct Answer - Process Policy reform Policy environment Policy makers Process, Policy reform, Policy environment, and Policy makers are the 4 components of - Correct Answer -Health Policy What is 3-part "process" component of Health Policy? - Correct Answer -Formulation, Implementation, and Evaluation (FIE) Formulation, Implementation, and Evaluation (FIE) are - Correct Answer -The "process" component of Health Policy What is the "policy reform" component of Health Policy? - Correct Answer -Changes in programs and practices Changes in programs and practices in Health Policy is called - Correct Answer -Policy Reform What is the "policy environment" component of Health Policy? - Correct Answer -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? - Correct Answer -Policy environment What is the "policy makers" component of Health Policy? - Correct Answer An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) - Correct Answer -Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? - Correct Answer -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? - Correct Answer -Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? - Correct Answer - You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? - Correct Answer - 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? - Correct Answer -Strategic Which 3 techniques are used in Solution-Focused Therapy? - Correct Answer -Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - Correct Answer -Solution- Focused Which therapy uses triangles/triangulation, an self-differentiation? - Correct Answer -Family Systems Therapy What are 3 characteristics of Family Systems Therapy ? - Correct Answer - Triangles/ Triangulation Self- differentiation Genograms What are 3 characteristics of Structural Family Therapy? - Correct Answer -Hierarchies Boundaries Genograms Hierarchies, Boundaries, and Genograms are characteristics of what therapy? - Correct Answer -Structural Family Therapy Genograms are used in which 2 family therapies? - Correct Answer - Family system therapy Structural therapy What type of therapy should be performed when a patient presents with a cultural syndrome? - Correct Answer -Brief supportive therapy What type of therapy should be used in a patient who has just lost their job? - Correct Answer -Brief supportive therapy What is the most important concept in working with patients from different cultues? - Correct Answer -Respect What should you teach a patient interested in meditation? - Correct Answer -muscle relaxation How to Mexican American's view mental illness? - Correct Answer - An imbalance between an individuals' relationship with the world Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? - Correct Answer -Native American Which ethnic group has the highest incidence of suicidal attempt and completion? - Correct Answer -Native American Cultural syndrome is - Correct Answer -A culturally expected response to a stressor A culturally expected response to a stressor is called - Correct Answer -Cultural Syndrome How should multicultural teaching be conducted? - Correct Answer -Ethnospecific If a patient is regularly taking Kava, what lab should you get? - Correct Answer -LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? - Correct Answer -Fever Which antipsychotic has the least weight gain? - Correct Answer - Ziprasidone (Geodon) What question should ask schizophrenic patients at each visit? - Correct Answer -SI What is the most likely diagnosis in a patient with homicidal ideation? - Correct Answer -Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? - Correct Answer -All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? - Correct Answer -Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? - Correct Answer -Prefrontal cortex Amygdala Hippocampus What is Assertive Community Treatment (ACT)? - Correct Answer -Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to - Correct Answer -Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? - Correct Answer -No Which services can be provided in the home for SMI patients? - Correct Answer -Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? - Correct Answer -Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? - Correct Answer -Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? - Correct Answer -Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? - Correct Answer -20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? - Correct Answer ->100 mg (administer weekly if necessary) What is a delusion? - Correct Answer -A firm belief despite contrary evidence A firm belief despite contrary evidence is - Correct Answer - delusion How often is Haldol Decanoate typically adminitered? - Correct Answer -monthly How do you conduct a MSE in a preschooler (3-5 yo) - Correct Answer -Clinical observation (listen/observe) What is thought content? - Correct Answer -SI/HI, plan What are the 5 components of the MMSE (Folstein's) - Correct Answer -Concentration/attention/ calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? - Correct Answer -5- HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? - Correct Answer -5HT2-antagonism What antipsychotic should you give to a patient with their first psychotic episode? - Correct Answer -SGA (IM) Which 4 SGAs are available in IM form? - Correct Answer - Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? - Correct Answer -Metoclopramide (Reglan) What is a normal prolactin level in men? - Correct Answer - <20 What is a normal prolactin level in women? - Correct Answer -<25 What is a paradoxical effect of benzodiazepines? - Correct Answer - Increased anxiety (avoid in future) What is apotosis? - Correct Answer -Cell death/neuronal loss What is the name for cell death/neuronal loss? - Correct Answer - apotosis What is the greatest risk factor for bipolar disorder? - Correct Answer -genetics (very heritable) What is the first question you ask with a patient with suspected bipolar disorder? - Correct Answer -family history What should you consider in a 45 yo patient that presents with manic symptoms? - Correct Answer -Medical condition At what age should you consider a patient with manic symptoms to be medically-induced - Correct Answer -45 and older What are 2 differences between mania and hypomania? - Correct Answer -More severe Increased duration (7 days vs. 4 days) A patient that presents with grandiosity or exaggerated self-esteem is most likely to have - Correct Answer -Mania or hypomania A patient who is manic, irritable mood, and uncooperative is most likely to have what disorder? - Correct Answer -bipolar disorder What is a key symptom to consider in a patient you suspect of mania or hypomania? - Correct Answer -Grandiosity or exaggerated self esteem What is a hallmark feature of borderline personality disorder? - Correct Answer -Self-harming behavior (recurrent) Self-harming behavior (recurrent) is a key factor in which disorder? - Correct Answer -Borderline personality disorder What therapy in borderline personality disorder been shown to decrease suicidal ideation? - Correct Answer -DBT Who developed DBT? - Correct Answer -Marsha Linehan In DBT, diagnosis of borderline disorder requires activity? - Correct Answer -journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed - Correct Answer - Valproic acid A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? - Correct Answer - Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? - Correct Answer -Reactive Attachment Disorder A disorder that presents like PTSD, but symptoms last less than a month is most likely to have - Correct Answer -Acute Stress Disorder What is the required duration for a DSM-5 diagnosis of GAD? - Correct Answer -6 months How does a panic attack differ from Panic Disorder? - Correct Answer -acute, impending doom How does Panic Disorder differ from a panic attack? - Correct Answer -Chronic, recurrent, unexpected How do you treat a patient with panic disorder who is taking albuterol for asthma? - Correct Answer -SSRI or benzodiazepine (don't give beta blocker) What is the treatment of choice for acute symptoms of panic disorder? - Correct Answer -Beta blocker (not addictive) How do you treat test anxiety for maintenance therapy? - Correct Answer -SSRI How do you treat text anxiety acutely? - Correct Answer -Beta blocker Benzodiazepine What structure of the brain is involved with attention, executive function, and cognitive processes (working memory, problem solving) that affects ADHD? - Correct Answer -Dorsolateral prefrontal cortex Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? - Correct Answer - prefrontal Dysfunction of the prefrontal cortex is most likely in what type of ADHD? - Correct Answer -Inattentive What do you recommend to a mother of a child with ADHD as an aftercare plan on admission? - Correct Answer -Brief supportive therapy (not after dc) If a patient present with irritability, depression, and lability, which questionnaire do you administer? - Correct Answer -Mood Disorder Questionnaire (MDQ) When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? - Correct Answer -Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? - Correct Answer -Disruptive Mood Dysregulation Disorder (DMDD) A child with intense temper outbursts is most likely to have what DSM-5 diagnosis? - Correct Answer -Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? - Correct Answer -If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? - Correct Answer -Persistent deficits in social communication and social interaction across multiple settings A child with persistent deficits in social communication and social interaction across multiple settings is most likely to have what DSM- 5 diagnosis? - Correct Answer -Autism A child that does not establish eye contact is likely to have - Correct Answer -autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? - Correct Answer -Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered - Correct Answer -Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? - Correct Answer -UA C/S An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for - Correct Answer -Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? - Correct Answer -B12 Folic acid 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? - Correct Answer -Frontotemporal (Pick's) A patient with visual hallucinations is most likely to have what type of demenetia? - Correct Answer -Lewy Body A patient with Lewy Body Dementia is most likely to have what presenting symptoms? - Correct Answer -Visual hallucinations A patient with damage to the anterior cingulate will demonstrate what 3 symptoms? - Correct Answer -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? - Correct Answer -Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? - Correct Answer -Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? - Correct Answer -Cerebellum What condition may cause pica (eating things that are not food - paint chips)? - Correct Answer -Lead poisoning What 5 neurotransmitters are associated with mood disorders? - Correct Answer -Dopamine Norepinephri ne Serotonin GABA Glutamate What do do yo do when an infant is about to die? - Correct Answer - Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? - Correct Answer -Family support Support groups (don't give prescriptive advice) What are 5 risk factors for osteoporosis? - Correct Answer - 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 - Correct Answer -Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? - Correct Answer -Yes If a patient is reluctant to participate in group therapy, what do you do? - Correct Answer -Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? - Correct Answer -CBT What are 5 techniques used in behavioral therapy? - Correct Answer -Problem-solving Skills training Exposure therapy Role- playing/modeli ng Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in - Correct Answer -Behavioral Therapy What are 2 common techniques used in CBT? - Correct Answer - Cognitive restructuring Journaling Cognitive restructuring and journaling are common techniques used in - Correct Answer -CBT 2 key concepts of Humanistic (person-centered) therapy are - Correct Answer -Self-directed growth Self- actualization Self-directed growth and self-actualization are key concepts of what type of therapy? - Correct Answer -Humanistic (person-centered) Which therapy is based on the principle that each person has the potential to self-actualize and find meaning in life? - Correct Answer - Humanistic (person- centered) What is the best therapy for dealing with conflicts with others (e.g., spouse, co-workers)? - Correct Answer -Interpersonal therapy Interpersonal therapy is recommended in what situation? - Correct Answer -conflict and relationship (marital) problems How long does interpersonal therapy typically last? - Correct Answer - 12-16 weeks If a patient is noncompliant, what is a technique that is used in Strategic Therapy? - Correct Answer -Paradoxical directive/intervention When is a paradoxical directive/intervention given in Strategic Therapy? - Correct Answer -With a noncompliant member If a patient is compliant, what is a technique that is used in Strategic Therapy? - Correct Answer -Straight Forward Directive When is a Straight Forward Directive given in Strategic Therapy? - Correct Answer -When a member is compliant What type of therapy is a therapist using when he asks "what worked before when you had this problem" - Correct Answer -Solution-focused Meditation is a form of - Correct Answer -Muscle relaxation What 4 positive effects does physical activity have on children? - Correct Answer -Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? - Correct Answer -Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened-ended question? - Correct Answer -Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? - Correct Answer -talk to parents Macrocytic What deficiency is associated with microcytic anemia? - Correct Answer -Iron An iron deficiency causes what type of anemia? - Correct Answer -Microcytic Acute or chronic blood loss (GI bleeding, heaving menses) can cause what type of anemia? - Correct Answer -Normocytic Normocytic anemia is due to - Correct Answer -Chronic or acute blood loss (GI bleeding, menses) What is the BMI in a patient with Bulimia Nervosa? - Correct Answer - Normal When vital signs are not normal in a thin women, you suspect - Correct Answer -Anorexia nervosa You see a patient with suspected anorexia nervosa. What do you do? - Correct Answer -Refer out for medical evaluation If a patient with anorexia nervosa refuses to see a PCP, what do you do? - Correct Answer -Contact CPS If AN patient is medically unstable and parents refuse hospital treatment, what do you do? - Correct Answer -contact CPS What 2 conditions is acupuncture used? - Correct Answer -Pain Depression What alternative medicine treatment is used with pain and depression? - Correct Answer -Acupuncture Habeas Corpus Act - Correct Answer -Protects a patient from unlawful hospitalization (able to leave AMA) What act prevents a patient from unlawful hospitalization (can leave AMA)? - Correct Answer -Habeus corpus (usually max of 28 days) A patient presents with paresthesia, fatigue and asymmetric body movement of extremities. What do you suspect and what do you do? - Correct Answer -Disseminated Encephalomyelitis Neuro exam What is Disseminated Encephalomyelitis and what are 3 symptoms? - Correct Answer -Autoimmune viral infection - children Paresthesia A patient calls because he read on the internet about a BBW on his medication. What do you do? - Correct Answer -You don't need to discontinue drug. Research benefits and risks What are 2 things you should do when you prescribe off-label? - Correct Answer -Document Provide full disclosure (risks/benefits) When you prescribe trazodone to a male patient, what should you do? - Correct Answer -Warn about priapism and document What are 3 risk factors for Sleep Apnea? - Correct Answer - Smoking Increase weight/obesity DM Smoking, increased weight/obesity, and DM are risk factors for what disorder? - Correct Answer -Sleep Apnea What is tolerance? - Correct Answer -Decreased effect with continuous use Decreased effect with continuous use results in - Correct Answer -Tolerance What is the goal or Reflective Practice? - Correct Answer -Improve practice What is Reflective Practice? - Correct Answer -Providing debriefing techniques, feedback to staff, and strategies to learn from experiences Providing debriefing techniques, feedback to staff and strategies to learn from experiences is called - Correct Answer -Reflective Practice If a patient has mild symptoms on the COWs, what should you do? - Correct Answer -Give clonidine or a muscle relaxant When should you administer clonidine or a muscle relaxant to a patient withdrawing from opiates? - Correct Answer -mild symptoms (8 or higher) If a patient scores 8 or more on the COWS during opiate withdrawal, what should you do? - Correct Answer -Administer clonidine or a muscle relaxant If a patient has moderate symptoms on the COWS what should you do? - Correct Answer -Administer buprenorphine/naloxone (Suboxone) When should you administer buprenorphine/naloxone (Suboxone) in a patient withdrawing from opiates? - Correct Answer -Moderate symptoms (13 or higher) If a patient scores 13 or higher on the COWS scale during opiate withdrawal, what do you do? - Correct Answer -Administer buprenorphine/naloxone (Suboxone) Why should methadone not be used to treat opiate withdrawal? - Correct Answer -Arrhythmias Which benzodiazepine is used most often to treat alcohol withdrawal? - Correct Answer -Diazepam (longer half-life) If a patient with liver dysfunction or hepatitis is undergoing alcohol withdrawal, what benzodiazepine should he receive? - Correct Answer -Lorazepam If a patient presents with opiate withdrawal, what should you do? - Correct Answer -Refer to residential center to administer protocol (don't initiate in outpatient setting) If a pregnant patient presents with opiate withdrawal, what do you do? - Correct Answer -Refer to residential center (not CPS) What are 4 symptoms/categories of alcohol withdrawal? - Correct Answer -CNS activation: Hand tremor, insomnia, psychomotor agitation, anxiety, seizures) Autonomic hyperactivity (sweating, increased HR/BP) N/V Hallucinations/illusions What do you suspect when a patient presents with CNS activation (hand tremor, insomnia, anxiety, psychomotor agitation, seizures) and Autonomic hyperactivity (sweating, increased HR, increased BP) and N/V and hallucinations/illusions? - Correct Answer -alcohol withdrawal What are 7 symptoms/categories of opioid withdrawal? - Correct Answer -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 Group members dealing with the meaning of their existence is which of Yalom's therapeutic factors? - Correct Answer -Existential factors Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic is which of Yalom's Therapeutic Factors? - Correct Answer -Corrective refocusing Openly expressing their feelings which were previously suppressed is which of Yalom's Therapeutic Factors? - Correct Answer -Catharsis What is the key component of Appreciate Inquiry? - Correct Answer - Focusing on strength of the group Focusing on the strength of the group is key to what organizational change strategy? - Correct Answer -Appreciative Inquiry Who determines the Scope of Practice? - Correct Answer -State legislature (BON) (varies state to state) Who determines the Standard of Practice? - Correct Answer - ANA (doesn't change) What are 8 exceptions to confidentiality? (know all) - Correct Answer -Unconscious (to save a life) Intends to harm self/others Court order (subpoena, summons) Attorneys in litigation Insurance companies Mandatory reporting (diseases) Tarasoff (duty to warn) Child or elder abuse What are the 5 elements of informed consent? - Correct Answer - Nature and purpose of treatment/procedure Risks and benefits of treatment Risks and benefits of not undergoing treatment Alternative procedures or treatments Diagnosis and prognosis What are the 7 ethical principles? - Correct Answer -Justice Beneficence Nonmaleficenc e Fidelity Autonomy Veracity Respect Fairness (according to gender, orientation, or ethnicity) is what ethical principle? - Correct Answer -Justice "Doing no harm" to the patient is what ethical principle? - Correct Answer -Nonmaleficence Discontinuing a medication that causes side effects is an example of what ethical principle? - Correct Answer -Nonmaleficence Denying a benzodiazepine to a patient with a SUD is an example of what ethical principle? - Correct Answer -Nonmaleficence "Doing good" and promoting well-being is what ethical principle? - Correct Answer -Beneficence Giving a patient a medication to treat symptoms is an example of - Correct Answer -Beneficence Being true and loyal is what ethical principle? - Correct Answer -Fidelity "Telling the truth" is what ethical principle? - Correct Answer -Veracity Allowing the patient to "do for self" is what ethical principle? - Correct Answer -Autonomy A patient's right to refuse medication is an example of what ethical principle? - Correct Answer -Autonomy Treating everyone with equal respect is what ethical principle? - Correct Answer -Respect Collecting data or conducting a survey is an example of - Correct Answer -assessment What is an important role to play as a client advocate? - Correct Answer -reduce stigma What is the best way to reduce stigma? - Correct Answer - Education (esp. large audience) just culture - Correct Answer -A work environment that improves patient safety through continuous learning What 3 neurotransmitters are associated with Tourette's? - Correct Answer -DNS (especially DA) What 5 neurotransmitters are associated with bipolar disorder? - Correct Answer -DNS Glutamate (increased) GABA What 2 neurotransmitters are involved with Addictive Disorders? - Correct Answer -DA (decreased) GABA (decreased) What 2 neurotransmitters are involved with OCD? - Correct Answer - 5HT (decreased) NE (decreased) What 4 neurotransmitters are associated with schizophrenia? - Correct Answer -DA (increased) Glutamate (increased) GABA (decreased) 5HT (decreased) What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Correct Answer -Glutamate (increased) GABA (decreased) 5HT (decreased) What neurotransmitters are associated with anxiety? - Correct Answer - NE (increased) 5HT (decreased) GABA (decreased) What neurotransmitters are associated with Alzheimer's? - Correct Answer -ACh (decreased) Glutamate (decreased) What neurotransmitters are associated with Parkinson's Disease? - Correct Answer -DA (decreased) ACh (Increased) What 4 psychiatric disorders have dysregulation of dopamine, norepinephrine, and serotonin (DNS)? - Correct Answer -ADHD MDD BPD Tourette's Which 5 psychiatric disorders have dysregulation of the GABA receptor? - Correct Answer -BPD Schizophrenia Autism SUD Anxiety What 4 psychiatric disorders have dysregulation of glutamate receptors? - Correct Answer -BPD Schizophrenia ASD Alzheimer's Which 2 psychiatric disorder have dysregulation of acetylcholine receptor? - Correct Answer -Alzheimer's Parkinson's What 3 disorders have dysregulation of glutamate and gabapentin? - Correct Answer -autism spectrum disorder bipolar disorder schizophrenia You are concerned a 5-yo child may be sexually abused. How do you conduct the interview? - Correct Answer -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? - Correct Answer -contact CPS What are the 2 most important aspects of interviewing an adolescent? - Correct Answer -Rapport Confidentiality (explain exceptions) How should an adolescent be interviewed - Correct Answer -separately form parents If an adolescent is dating someone the same age, do you need to tell the parents? - Correct Answer -No If an adolescent is dating someone of the same gender, do you need to tell the parents? - Correct Answer -No What should you ensure before discharging a patient from the hospital? - Correct Answer -Support system (safety) Should a patient be interviewed in a day room? - Correct Answer -No (not confidential) When do you draw a T3 or T4 - Correct Answer -If TSH is abnormal What symptom occurs with high levels of ammonia? - Correct Answer -confusion What 4 symptoms are similar with serotonin syndrome and NMS? - Correct Answer -Hyperthermia Diaphoresi s Tachycardi a Altered LOC Thoughts of self-harm are greatest in what 5 disorders (according to order) - Correct Answer -MDD BPD Alcohol use disorder Eating disorder schizophrenia What is a long-term side effect of the anti-emetic metoclopramide (Reglan)? - Correct Answer -TD Are oral contraceptives inducers or inhibitors? - Correct Answer - inducers A person with pressure speech is most likely to have - Correct Answer -bipolar disorder If you can identify why a person is depressed, what is their mostly likely diagnosis? - Correct Answer -Adjustment disorder with depressed mood Can tics be a normal behavior? - Correct Answer -yes What are the 2 primary deficits in Cortical Dementia? - Correct Answer -Language Memory Language and memory are the 2 primary deficits in which type of dementia? - Correct Answer -Cortical Motor and behavioral (depression, irritability, apathy) are the 2