Georgettes LMR study set/PMHNP Review items (Latest 2024/2024) Verified Answers, Exercises of Nursing

Download Georgettes LMR study set/PMHNP Review items (Latest 2024/2024) Verified Answers and more Exercises Nursing in PDF only on Docsity! Georgettes LMR study set/PMHNP Review items (Latest 2024/2024) Verified Answers When questions ask for a priority action...think about... - Answer- ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: - Answer- the umbrella answer What is the most common side effect of olanzapine/zyprexa - Answer- metabolic syndrome what is the difference between typical and atypical antipsychotics - Answer- Atypical 5HT2A specific 1st psychotic break... two actions to take - Answer- UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain - Answer- Latuda, Abilify, Geodon Always encourage interprofessional collaboration - Answer- between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 - Answer- T3, T4 low TSH low, then...t3/t4 - Answer- T3, T4 high cold/hot sensitivity with t3/t4 relationship - Answer- T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? - Answer- Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? - Answer- Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat - Answer- anxiety and insomnia Rash and fever associated with tegretol, suspect - Answer- What allele is HLAB 1502 associated? - Answer- Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol - Answer- Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis - Answer- unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue if starting a woman on lithium what test should be done? why? - Answer- HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine - Answer- SJS labs to checke BEFORE starting on lithium - Answer- BUN CRE urine protein What does protein in urine indicate - Answer- kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. - Answer- lithium best choice med for si in schizophrenia - Answer- clozaril Black box warning on SSRI - Answer- inc SI in kids, esp Required education for rx ssri - Answer- long time for effect side effects esp n/v/d NO ABRUPT stopping d/t Serotonin discontinuation syndrome Sx's of serotonin discontinuation syndrome - Answer- fever, shivering, muscle aches and nausea diarrhea, agitation, cog impairment... (think flu like sx's) disequilibrium What are some scenarios that place patients at risk of a hypertensive crisis? - Answer- MAOI and tyramine MAOI and TCA MAOI and Atypical AP MAOI and decongestant MAOI and stimulants MAOI and asthma meds Sx of Hypertensive crisis - Answer- HA Diaphoresis fever facial flushing pupillary dilation palpitation Treatment for HTN Crisis - Answer- DC Agent Give Phenolamine age of onset for male / female schizophrenia - Answer- male 18-25 female 25-35 schizophrenia has high rate of suicide - Answer- always be assessing for SI what is the cause of schizophrenia - Answer- inadequate synapse formation excessive pruning of synapses intrauterine insult (drugs/toxin/viral agent/malnutrition/substance use, mental illness, o2 deprivation) on MRI /PET schizonphrenia - Answer- ventrical enlargement positive sx of schizophrenia caused by... - Answer- excess DA in mesolimbic pathway positive sx of schizophrenia on a stimulant? - Answer- will potentiate DA release (worsening schizophrenias positive symtpoms) bc stimulants tap into the reward and addiction pathway inc dopamine What is ACT - Answer- Assertive community treatment Post hospital DC not in the hospital delusions, you respond how? - Answer- do not try to disprove If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction - Answer- interpret a proverb assess thought process why? and potential findings - Answer- 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 - Answer- SI HI plan Hallucinations delusions MMSE/ Folstein Test assesses? - Answer- tool used to assess cognitive status in adults concentration/attention/calculation assessed how? - Answer- spell a word backward or serial 7's Registration/ability to learn new material assessed how? - Answer- remember 3 words orientation is assessed by - Answer- Person place time fund of knowledge assessed how? - Answer- Who is the president? Governor? clock drawing assesses? - Answer- takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP - Answer- haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP - Answer- rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine 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? - Answer- TD what medication can worsen TD? - Answer- benztropine/cogentin Inducers - Answer- cause low serum levels inhibitors - Answer- cause high serum levles reglan and compazine can both cause - Answer- TD Smoking and dosing of meds - Answer- smoking is a strong inducer. therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase. Always assess for smoking/cessation of. Antibiotics/macroglides are INHIBITORS and greatly effect what medication - Answer- tegratol what meds can cause mania - Answer- disulfram steroids isoniazide antidepressants what meds can cause depression - Answer- steroids beta blockers interferon accutane-can cause birth defects too if patient taking meds for a mood disorder and is on flonase or prednisone. What do you do with your dose of oxcarbazepine - Answer- increase the dose to adjust for the medication (steroids) influencing mania treating a patient with zoloft and starts taking interferon. what do you do with zoloft dosing? - Answer- increase dose of zoloft to adjust for the increase in depression for the interferon addiction neurotransmitters - Answer- DA GABA Gamma-aminobutyric acid main function - Answer- major inhibitory neurotransmitter Sx's of stimulant abuse - Answer- irritability insomnia tremors delayed gastric emptying-feeling fullness/bloated Pt with anorexia complains of pain after eating/bloating/fullness - Answer- Signs of delayed gastric emptying what meds can delay gastric empying? - Answer- PROTON PUMP INHIBITORS famotidine omeprazole ranitidine ANTACIDS /PPI do what to psychotropic medications? - Answer- Decrease absorption of psychotropic medication advise client to take other meds 2 hours AFTER antacids/PPI Older adults and SSRIs for anxiety? - Answer- May increase anxiety paradoxical effect Older adults and benzos? - Answer- May increase agitation paradoxical effect apoptosis - Answer- neuronal loss or cell death BP1 pneumonic - Answer- DIGFAST DIGFAST - Answer- Distractible Impulsive choices Grandiosity Flight of ideas Active Sleep not needed Talkative Borderline sx in regard to impulsivity - Answer- impulsivity is often with associated with recurrent SI and self harming behavior Therapy for BPD/goal/founder - Answer- DBT to decrease recurrent SI Marsha Linehan Conversion Disorder (Functional Neurological Symptom Disorder) - Answer- can be result of a stressful experience present with neuro sx: parasthesia paralysis blindness 1 vocal tic for ONE year (even if ? says 6 months) its still most likely the correct answer NT in tourette - Answer- DA-da dysfunction is major NT in tourette NE S tics can be caused by what type of medication - Answer- stimulant how do you treat a kid with tics for adhd - Answer- non stimulant guanfacine and clonidine are good choice for adhd in kid with tics - Answer- TRUE Meds for tourettes - Answer- FDA approved haldol abilify pimozide guanfacine clonidine esp if kid is having impulse control problems are tics in kids normal - Answer- 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 - Answer- frontal cortex basal ganglia- dorsolateral PFC--executive function, attention, cognitive processes (problem solving, working memory) reticular activating OCD NT's - Answer- S NE Pandas - Answer- 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) - Answer- 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) - Answer- reacts grossly out of proportion to the situation violent aggressive HAVE REMORSE, feel bad about it all later irritibility, depression, labile mood...utilize a________ - Answer- mood questionnaire nightmares in children can be genetic or psychological - Answer- assess the family tree/hx for this GAD (Generalized Anxiety Disorder) - Answer- AT LEAST SIX MONTHS If less it is ASD Autism Spectrum Disorder NTs - Answer- Gaba glutamate SE impaired communication poor cognition broken mirror theory of autism- what two things do you have to have to diagnose adhd - Answer- a teacher and a parent evaluation Do stimulants increase DA? - Answer- Yes, so don't give a vmat 2 and a stimulant together. wipes one another out P450 Inducer meds - Answer- carbamazepine rifampin alcohol phenytoin griseofulvin phenobarbital sulfonylureas P450 inhibitor - Answer- Valproate ketoconazole isoniazid sulfonomides choramphenical amiodarone sensory issues poor cognition Broken mirror theory of autism-responsible for childs presentation of autism symptoms - Answer- mirror neuron is dysfunctional Risk factors for autism - Answer- male intellectual disability genetic loading-inc risk with family member with autism screeners for autism? - Answer- M-Chat: modified checklist for autism ADOS-G: autism diagnostic observation schedule-generic ASQ: ages and stages questionnaire nightmares in children - Answer- can be genetic so ASSESS family for same problem NT in Autism Spectrum disorder - Answer- Gaba and Glutamate If patient presents with irritibility, personality changes, check their: - Answer- Vit B12 and folic acid if ? presents lack of coordination, slowing, motor symptoms, and apathy, depression, irritability think about this dx - Answer- subcortical dementia cortical dementia effects mostly... - Answer- memory and language cognitive deficits - Answer- motor, behavioral pseudo dementia - Answer- cognitive screening present with: agitation irritability what disorder does a provider hear a lot of "I don't know answers" - Answer- pseudo dementia aphasia is associated with which region of the brain - Answer- prefrontal cortex visual hallucinations are associated with which type of dementia - Answer- lewy body frontotemoporal dementia - Answer- frontal lobe picks disease personality changes behavioral language (slurred) Signs of lead abuse - Answer- 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 - Answer- Pulse sweating restlessness pupil size bone aches running nose tearing GI upset yawning tremors anxiety/irritability goosebumps anterior cingulate is responsible for what - Answer- cognitive functions decision making emotions impulse control NE is produced in the locus ceruleus and the ... - Answer- medullary reticular formation SE is produced in the_________? And is involved in ______? - Answer- raphe nuclei of the brainstem/sleep DA is produce in the substantia nigra and ______? - Answer- the ventral tegmental area VTA and nucleus accumbens Acetylcholine is synthesized by the basal nucleus of _____? - Answer- Meynert structural family therapy - Answer- hierarchies keyword structural mapping genograms strategic family therapy - Answer- problem focused/symptom focused paradoxical strategies or a straight forward directive Reframe patients belief system solution focused family therapy - Answer- miracle question miracle solution exception based finding questions scaling questions Appreciative inquiry - Answer- focused on the strengths of client if question answers give closed ended questions and one open ended question and all are appropriate, choose open ended because open ended questions promote the relationship - Answer- promote the relationship between client/provider. if they won't talk, you can f/u with closed ended questions if the child remains avoidant... stays avoidant, then go to parents as a last resort therapy session with a couple and only one party shows up, what do you do? - Answer- reschedule both of them. they must both be present. if someone has lost someone, ask them....? - Answer- how is that loss affecting you...how do you feel about it? Not affected? maybe you don't need to focus on it too much If client is moving to another state, how can you assist in not abruptly stopping medications? - Answer- give plenty of meds until they can see a new provider...maybe three month supply Sibling abuse 5yo sodomized by his 15yo borther reported to you. Inform parent to ______, and call______? - Answer- tell parents to separate the siblings cps suspect rheumatoid arthritis, check.....? - Answer- ESR level, which indicates inflammation PICOT - Answer- Population Intervention Comparison Outcome Time Level 1 evidence - Answer- systematic reviews of random control trials (RCTs) -highest internal validity due to randomizations Level 2 evidence - Answer- at least 1 RCT how do you continue to give evidence based care? - Answer- by reading current up to date journals Shrill cry in infant - Answer- intracranial pressure; inconsolable when do you start aftercare plan? - Answer- when patient is admitted masturbating is normal in what age range? Freud stage? - Answer- 3 to six year old phallic stage normal for young boys to develop breast enlargement/swelling/tenderness. Usually goes away in....? - Answer- six months sex drive is driven by what hormone? - Answer- testosterone. so check this if c/o dec libido. Testosterone decreases as we...? - Answer- age if male or female c/o dec sex drive, chec...? - Answer- testosterone Alcohol dehydrogenase - Answer- etoh enzyme women have less than men so get intoxicated faster compared to men best way to normalize the grieving process in children? - Answer- supportive group therapy do psychoeducation do not give prescriptive advise these reflexes go away at what age: grasp/palmar moro/startle babinski - Answer- grasp/palmar 5-6 months moro/startle 5-6 months babinski 9-12 months what class of medications are PDE5? - Answer- sexual dysfunction viagra short absorption, rapidly absorbed know diff between AN and BN - Answer- 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 - Answer- high risk for sub use in depression population - Answer- use early screening and early intervention documentation for off label use? do this.... - Answer- document why. and document support for off label use. MSL or trials risk factors for sleep apnea - Answer- excessive weight obesity diabetes smoking HTN narrowed airways what is macrocytic anemia - Answer- vit B12 deficiency MMSE high score means? - Answer- Good! low score is severe cognitive deficit if depression is "severe" assess for - Answer- SI MMSE scale - Answer- 25-30 is normal 21-24 mild 10-20 moderate 0-9 severe SLUM scale - Answer- 27-30 Normal 21-26 Mild 0-20 dementia HAM D - Answer- 0-7 Normal 8-13 mild 14-18 moderate 19-22 severe 23 plus very severe PHQ 9 - Answer- 0-4 normal 5-9 mild 10-14 moderate 15-19 moderate to severe 20-27 severe Beck - Answer- 0-9 normal 10-18 mild 19-29 moderate 30-63 severe HAM A - Answer- under 17 mild 18-24 moderate 25 plus severe GAD - Answer- 0-4 normal 5-9 mild 10-14 moderate 15-21 severe COWs - Answer- 0-4 none 5-12 mild 13-24 moderate 25-35 mod to severe 35 plus severe CIWA - Answer- 0-9 none 10-15 mild 16-20 moderate 21 plus severe cows criteria - Answer- mod: treatment at 13 and above for scheduled. consider buprenorphine or Suboxone. methadone consider safety concerns and under supervision pulse sweating restlessness pupil size-dilated bone aches runny nose tearing gi upset yawning tremors anxi/irritable goosebumps ciwa - Answer- scheduled medication starts at score of 15 Nausea vomiting tremor sweats anxiety agitation tactile disturbances auditory disturbances HA orientation 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... - Answer- improving systems decrease cost improve productivity a retrospective chart review would be a type of.... - Answer- quality improvement initiative PDSA is a process - Answer- not a project an effective strategy reflective practice - Answer- linking theory to practice providing feedback industry vs inferiority - Answer- school age 6-12 becoming industrious and getting confidence about what they can do... fx is feeling bad and inferior intimacy vs isolation - Answer- age 20-35 in a loving relationship starting a family fx is feeling alone and isolated piaget age 2-7 - Answer- magical thinkeers preoperational "if i think about a new dress I will get one" piaget 11 and up - Answer- formal operations logical and abstract algebra etc primary prevention example - Answer- screening and community education secondary prevention - Answer- crisis intervention hotlines disaster response tertiary prevention - Answer- rehab active treatment Georgettes LMR study set - Answer-