Download Georgettes LMR study set/PMHNP Review items (Latest 2024/2025) Verified Answers and more Exams Nursing in PDF only on Docsity! Georgettes LMR study set/PMHNP Review items When questions ask for a priority action...think about... - THE CORRECT ASNWER IS ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: - THE CORRECT ASNWER IS the umbrella answer What is the most common side effect of olanzapine/zyprexa - THE CORRECT ASNWER IS metabolic syndrome what is the difference between typical and atypical antipsychotics - THE CORRECT ASNWER IS Atypical 5HT2A specific 1st psychotic break... two actions to take - THE CORRECT ASNWER IS UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain - THE CORRECT ASNWER IS Latuda, Abilify, Geodon Always encourage interprofessional collaboration - THE CORRECT ASNWER IS between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 - THE CORRECT ASNWER IS T3, T4 low TSH low, then...t3/t4 - THE CORRECT ASNWER IS T3, T4 high cold/hot sensitivity with t3/t4 relationship - THE CORRECT ASNWER IS T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? - THE CORRECT ASNWER IS Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? - THE CORRECT ASNWER IS Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat - THE CORRECT ASNWER IS anxiety and insomnia Rash and fever associated with tegretol, suspect - THE CORRECT ASNWER IS What allele is HLAB 1502 associated? - THE CORRECT ASNWER IS Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol - THE CORRECT ASNWER IS Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis - THE CORRECT ASNWER IS unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue if starting a woman on lithium what test should be done? why? - THE CORRECT ASNWER IS HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine - THE CORRECT ASNWER IS SJS labs to checke BEFORE starting on lithium - THE CORRECT ASNWER IS BUN CRE urine protein What does protein in urine indicate - THE CORRECT ASNWER IS kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. - THE CORRECT ASNWER IS lithium best choice med for si in schizophrenia - THE CORRECT ASNWER IS clozaril best choice med for SI in borderline - THE CORRECT ASNWER IS lithium What medications will INCREASE Li levels - THE CORRECT ASNWER IS NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels - THE CORRECT ASNWER IS dehydration hyponatremia lithium s/e inc N/V, which will effect electrolytes, and dehydration status what type of tremors will you see with lithium toxicity? - THE CORRECT ASNWER IS course tremors lithium can cause what other comorbidities? - THE CORRECT ASNWER IS hypothyroidism maculopapular rash leukocytosis twave inversion on MRI /PET schizonphrenia - THE CORRECT ASNWER IS ventrical enlargement positive sx of schizophrenia caused by... - THE CORRECT ASNWER IS excess DA in mesolimbic pathway positive sx of schizophrenia on a stimulant? - THE CORRECT ASNWER IS will potentiate DA release (worsening schizophrenias positive symtpoms) bc stimulants tap into the reward and addiction pathway inc dopamine What is ACT - THE CORRECT ASNWER IS Assertive community treatment Post hospital DC not in the hospital delusions, you respond how? - THE CORRECT ASNWER IS do not try to disprove If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction - THE CORRECT ASNWER IS interpret a proverb assess thought process why? and potential findings - THE CORRECT ASNWER IS to assess organization of patients thoughts tangential: no rip to a ? circumstantial: gets around to anss after going in circles with unnecessary details MMSE thought content include - THE CORRECT ASNWER IS SI HI plan Hallucinations delusions MMSE/ Folstein Test assesses? - THE CORRECT ASNWER IS tool used to assess cognitive status in adults concentration/attention/calculation assessed how? - THE CORRECT ASNWER IS spell a word backward or serial 7's Registration/ability to learn new material assessed how? - THE CORRECT ASNWER IS remember 3 words orientation is assessed by - THE CORRECT ASNWER IS Person place time fund of knowledge assessed how? - THE CORRECT ASNWER IS Who is the president? Governor? clock drawing assesses? - THE CORRECT ASNWER IS takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP - THE CORRECT ASNWER IS haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP - THE CORRECT ASNWER IS rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway - THE CORRECT ASNWER IS positive sx of schizophrenia decreased DA in mesocoritcal pathway - THE CORRECT ASNWER IS negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway - THE CORRECT ASNWER IS excess DA in this pathway but it doesn't cause any sx, but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx Tuberoinfundibular pathway - THE CORRECT ASNWER IS excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia what does high prolactin levels lead to - THE CORRECT ASNWER IS breast DC amenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia - THE CORRECT ASNWER IS risperidone Male prolactin female prolactin---normals - THE CORRECT ASNWER IS male less than 20ng/ml female less than 25ng/ml EPS caused by - THE CORRECT ASNWER IS DA blockade in the NS pathway acute dystonia - THE CORRECT ASNWER IS acute sustained contraction of muscles, usually of the head and neck spasms painful treatment of acute dystonia - THE CORRECT ASNWER IS cogentin/benztropine IM, but may need Oral follow up for several days akathisia - THE CORRECT ASNWER IS ANXIETY restless cannot sit still pacing rocking 1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? - THE CORRECT ASNWER IS propranolol/or beta blocker client with asthma on bronchodilators due to increased risk of bronchospasm when given beta blockers 2nd line: cogentin/benztropine 3rd line: benzos akanesia - THE CORRECT ASNWER IS difficulty iniating motion treatment for akanesia - THE CORRECT ASNWER IS cogentin/benztropin Sx of akinesia - THE CORRECT ASNWER IS DIFFICULTY INITIATING MOVEMENT; PSEUDO PARKINSONIAN SX'S: muscle rigidity shuffling gait mask like facial expression affect may be flat or blunted pill rolling tremors (motor slowing) Tardive dyskinesia (TD)/timeframes - THE CORRECT ASNWER IS chewing/lip smacking facial dyskinesia Treatment: dec dose of offending agent or switch to a different AP or can switch to clozaril. can have onset between a few weeks and 2 years post starting of medication Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? - THE CORRECT ASNWER IS TD what medication can worsen TD? - THE CORRECT ASNWER IS benztropine/cogentin blindness Mutism adjustment disorder (anxiety/depressive/mixed) - THE CORRECT ASNWER IS an emotional disturbance caused by ongoing stressors within the range of common experiences (dx of a new disease) (recent move) (loss of loved one) factitious disorder - THE CORRECT ASNWER IS Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick. Ie drinking contaminated urine Reactive Attachment Disorder - THE CORRECT ASNWER IS common in kids from foster care kid goes back to real parent and may appear withdrawn, no emotions toward caregiver, FOSTER is key word Doesn't seek comfort when distressed ODD - THE CORRECT ASNWER IS NO AGGRESSION in ODD defiant to authority deliberately annoy others treatment for ODD - THE CORRECT ASNWER IS • Family Therapy with emphasis on child management skills CD conduct disorder - THE CORRECT ASNWER IS no remorse violent raping/beating theft arson INTENSE AGE 6-17 When 18; think of Antisocial personality disorder Treatment for CD - THE CORRECT ASNWER IS Medication and therapy to target symptoms of mood and aggression Alpha agonist aka alpha 2 adrenergic receptor blockers (clonidin, guanfacine) Family therapy acute stress disorder - THE CORRECT ASNWER IS An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last LESS THAN 1 MONTH Over 1 month is PTSD PTSD cluster of sx - THE CORRECT ASNWER IS Increased arousal Reexperiencing the event avoidance nightmares nightmare trmt in ptsd - THE CORRECT ASNWER IS prazosin/minipress PTSD treatment - THE CORRECT ASNWER IS EMDR SSRI CBT phases of EMDR - THE CORRECT ASNWER IS see purple book Panic attack vs disorder - THE CORRECT ASNWER IS panic attack: acute/seldom disorder: leads to feelings of impending doom Tourette dx criteria - THE CORRECT ASNWER IS 2 motor tic 1 vocal tic for ONE year (even if ? says 6 months) its still most likely the correct answer NT in tourette - THE CORRECT ASNWER IS DA-da dysfunction is major NT in tourette NE S tics can be caused by what type of medication - THE CORRECT ASNWER IS stimulant how do you treat a kid with tics for adhd - THE CORRECT ASNWER IS non stimulant guanfacine and clonidine are good choice for adhd in kid with tics - THE CORRECT ASNWER IS TRUE Meds for tourettes - THE CORRECT ASNWER IS FDA approved haldol abilify pimozide guanfacine clonidine esp if kid is having impulse control problems are tics in kids normal - THE CORRECT ASNWER IS yes normal. normally by teen years they disappear. no treatment unless meeting dsm criteria for tourettes. tourettes needs trmt. 2 motor 1 vocal brain region affected in adhd - THE CORRECT ASNWER IS frontal cortex basal ganglia- dorsolateral PFC--executive function, attention, cognitive processes (problem solving, working memory) reticular activating OCD NT's - THE CORRECT ASNWER IS S NE Pandas - THE CORRECT ASNWER IS causes OCD from strep infection treat with SSRI prozac in kids, in adults use sertraline. adults can also get TCA like clomipramine DMDD (disruptive mood dysregulation disorder) - THE CORRECT ASNWER IS in kids, mood d/o 6-17yo kid has bipolar disorder but is not 18 yet moody for no reason irritible for no reason tantrums for no reason Mad/Sad for no reason IED (intermittent explosive disorder) - THE CORRECT ASNWER IS reacts grossly out of proportion to the situation violent aggressive HAVE REMORSE, feel bad about it all later irritibility, depression, labile mood...utilize a________ - THE CORRECT ASNWER IS mood questionnaire nightmares in children can be genetic or psychological - THE CORRECT ASNWER IS assess the family tree/hx for this GAD (Generalized Anxiety Disorder) - THE CORRECT ASNWER IS AT LEAST SIX MONTHS If less it is ASD Autism Spectrum Disorder NTs - THE CORRECT ASNWER IS Gaba glutamate SE Broken mirror theory of autism-responsible for childs presentation of autism symptoms - THE CORRECT ASNWER IS mirror neuron is dysfunctional Risk factors for autism - THE CORRECT ASNWER IS male intellectual disability genetic loading-inc risk with family member with autism screeners for autism? - THE CORRECT ASNWER IS M-Chat: modified checklist for autism ADOS-G: autism diagnostic observation schedule-generic ASQ: ages and stages questionnaire nightmares in children - THE CORRECT ASNWER IS can be genetic so ASSESS family for same problem NT in Autism Spectrum disorder - THE CORRECT ASNWER IS Gaba and Glutamate If patient presents with irritibility, personality changes, check their: - THE CORRECT ASNWER IS Vit B12 and folic acid if ? presents lack of coordination, slowing, motor symptoms, and apathy, depression, irritability think about this dx - THE CORRECT ASNWER IS subcortical dementia cortical dementia effects mostly... - THE CORRECT ASNWER IS memory and language cognitive deficits - THE CORRECT ASNWER IS motor, behavioral pseudo dementia - THE CORRECT ASNWER IS cognitive screening present with: agitation irritability what disorder does a provider hear a lot of "I don't know answers" - THE CORRECT ASNWER IS pseudo dementia aphasia is associated with which region of the brain - THE CORRECT ASNWER IS prefrontal cortex visual hallucinations are associated with which type of dementia - THE CORRECT ASNWER IS lewy body frontotemoporal dementia - THE CORRECT ASNWER IS frontal lobe picks disease personality changes behavioral language (slurred) Signs of lead abuse - THE CORRECT ASNWER IS developmental delay learning difficulties irritability loss of appetite weight loss sluggishness fatigue abd pain vomiting constipation hearing loss seizures pica TEST LEAD LEVELS Components of the COW Scale - THE CORRECT ASNWER IS Pulse sweating restlessness pupil size bone aches running nose tearing GI upset yawning tremors anxiety/irritability goosebumps anterior cingulate is responsible for what - THE CORRECT ASNWER IS cognitive functions decision making emotions impulse control NE is produced in the locus ceruleus and the ... - THE CORRECT ASNWER IS medullary reticular formation SE is produced in the_________? And is involved in ______? - THE CORRECT ASNWER IS raphe nuclei of the brainstem/sleep DA is produce in the substantia nigra and ______? - THE CORRECT ASNWER IS the ventral tegmental area VTA and nucleus accumbens Acetylcholine is synthesized by the basal nucleus of _____? - THE CORRECT ASNWER IS Meynert NT in mood disorders - THE CORRECT ASNWER IS SE and NE risk factors for osteoporosis - THE CORRECT ASNWER IS smoking caffeine lack of exercise diet low in cal and vit D What is the hippocampus responsible for? - THE CORRECT ASNWER IS ST to LT memory emotions stress learning Amygdala - THE CORRECT ASNWER IS fear anger anxiety aggression stress cerebellum - THE CORRECT ASNWER IS balance anterior cingulate - THE CORRECT ASNWER IS cognitive functions decision making empathy impulse control emotions decision making frontal lobe issues - THE CORRECT ASNWER IS social skills tumor here can cause behavioral problems If you are caring for an infant that is dying and the parents are present, what action should you take - THE CORRECT ASNWER IS give the infant to the parents to hold and grieve their loss osteoporosis can be prevented by a diet rich in what? and other ways to prevent - THE CORRECT ASNWER IS calcium and vitamin d weight bearing exercises normal for young boys to develop breast enlargement/swelling/tenderness. Usually goes away in....? - THE CORRECT ASNWER IS six months sex drive is driven by what hormone? - THE CORRECT ASNWER IS testosterone. so check this if c/o dec libido. Testosterone decreases as we...? - THE CORRECT ASNWER IS age if male or female c/o dec sex drive, chec...? - THE CORRECT ASNWER IS testosterone Alcohol dehydrogenase - THE CORRECT ASNWER IS etoh enzyme women have less than men so get intoxicated faster compared to men best way to normalize the grieving process in children? - THE CORRECT ASNWER IS supportive group therapy do psychoeducation do not give prescriptive advise these reflexes go away at what age: grasp/palmar moro/startle babinski - THE CORRECT ASNWER IS grasp/palmar 5-6 months moro/startle 5-6 months babinski 9-12 months what class of medications are PDE5? - THE CORRECT ASNWER IS sexual dysfunction viagra short absorption, rapidly absorbed know diff between AN and BN - THE CORRECT ASNWER IS AN BMI is very low, high chance of hospital admission VS changes like bradycardia. if parents won't admit call cps. bmi to admit are 12, 13, 14. Screen all adhd presentations for substance use - THE CORRECT ASNWER IS high risk for sub use in depression population - THE CORRECT ASNWER IS use early screening and early intervention recommend accupuncture for - THE CORRECT ASNWER IS depression and pain inform adolescents all info is confidential except - THE CORRECT ASNWER IS harm to self or others what is habeus corpus - THE CORRECT ASNWER IS legal, not medical concept, that protects patients from unlawful hospitalization substance induced psychosis has a very high rate of ? - THE CORRECT ASNWER IS HI. even more than ASPD. disseminated encephalomyelitis - THE CORRECT ASNWER IS nervous system is affected asymmetrical body movements do a neuro exam patient has a mood disorder. started depakote and been stable. BMI 25 now 30. eating alot of sweets and juices. recommendations? A. switch med b. dec depakote c. ask them to exercise - THE CORRECT ASNWER IS how can you help your client remember something by anchoring their memory. how do you do thta? - THE CORRECT ASNWER IS ask a specific question that will provide an anchor to a timeline, like a wedding, bday, new job, etc. ask what they know about medications before rxing - THE CORRECT ASNWER IS assesses their knowledge of meds polypharmacy can lead to adverse side effects - THE CORRECT ASNWER IS assess medication hx iatrogenic - THE CORRECT ASNWER IS an iatrogenic illness is an illness that is caused by a medication or physician. tardive dys: caused by a med rx'd by a doc post online forms to give responses to influence - THE CORRECT ASNWER IS policy making advocacy autoimmune diseases can lead to increased....? - THE CORRECT ASNWER IS cytokine levels Desmopressin (DDAVP) - THE CORRECT ASNWER IS for nighttime bed wetting reduces urine production esp at noc guanfacine and clonidine is disliked by some patients due to? - THE CORRECT ASNWER IS have low tolerability due to lowers BP cannot look up patietns information on Social media - THE CORRECT ASNWER IS violates trust treatment for nighttime wetting under 12yo? - THE CORRECT ASNWER IS nonpharm setting alarms bladder training if addicts are still blamining others they are not ready for....? - THE CORRECT ASNWER IS discharge. If still blaming others they are not ready. Need to take responsibility for their actions. non compliant with medication? - THE CORRECT ASNWER IS intervention based on why they are not compliant assess data before changing anything if patient comes to your with concerns make sure you - THE CORRECT ASNWER IS validate their concerns to promote communication come to office or discuss by phone documentation for off label use? do this.... - THE CORRECT ASNWER IS document why. and document support for off label use. MSL or trials risk factors for sleep apnea - THE CORRECT ASNWER IS excessive weight obesity diabetes smoking HTN narrowed airways what is macrocytic anemia - THE CORRECT ASNWER IS vit B12 deficiency MMSE high score means? - THE CORRECT ASNWER IS Good! low score is severe cognitive deficit if depression is "severe" assess for - THE CORRECT ASNWER IS SI MMSE scale - THE CORRECT ASNWER IS 25-30 is normal 21-24 mild 10-20 moderate intellectualization - THE CORRECT ASNWER IS new diagnosis so you go home and do tons of research scope of practice - THE CORRECT ASNWER IS varies state to state defines role and action varies broadly standard of practice - THE CORRECT ASNWER IS determined by american nurses association judges care given reasonably prudent is standard confidentiality - THE CORRECT ASNWER IS the assurance that messages and information are available only to those who are authorized to view them exceptions to confidentiality - THE CORRECT ASNWER IS when info outweighs risk (think murder trial) intent to harm self or others info given to atty in litigation releasing records to insurance companies answering court orders, subpoenas, summons Meeting state requirements for mandatory reporting of dx of condition informed consent in apt with dementia - THE CORRECT ASNWER IS if client can repeat the benefits and risks o the med/ autonomy is: - THE CORRECT ASNWER IS right to self determination EXCEPT rennie vs klein: right to refuse medication if NOT-found incompetent Rights of patient re environment - THE CORRECT ASNWER IS least restrictive first just culture - THE CORRECT ASNWER IS safety continual learning designing safe systems managing behavioral choices Recovery model - THE CORRECT ASNWER IS treatment approach doesn't really focus on the dx/illness looking beyond the dx and search out abilities dreams goals self direction finding meaning in life despite the dx person centered individualized NON LINEAR not step by step but based on growth setbacks and learning experiences quality improvement projects focus on... - THE CORRECT ASNWER IS improving systems decrease cost improve productivity a retrospective chart review would be a type of.... - THE CORRECT ASNWER IS quality improvement initiative PDSA is a process - THE CORRECT ASNWER IS not a project an effective strategy reflective practice - THE CORRECT ASNWER IS linking theory to practice providing feedback industry vs inferiority - THE CORRECT ASNWER IS school age 6-12 becoming industrious and getting confidence about what they can do... fx is feeling bad and inferior intimacy vs isolation - THE CORRECT ASNWER IS age 20-35 in a loving relationship starting a family fx is feeling alone and isolated piaget age 2-7 - THE CORRECT ASNWER IS magical thinkeers preoperational "if i think about a new dress I will get one" piaget 11 and up - THE CORRECT ASNWER IS formal operations logical and abstract algebra etc primary prevention example - THE CORRECT ASNWER IS screening and community education secondary prevention - THE CORRECT ASNWER IS crisis intervention hotlines disaster response tertiary prevention - THE CORRECT ASNWER IS rehab active treatment