Last Minute Review Georgette’s LMR Comprehensive PMHNP Exam Review Questions with Correct, Exams of Psychiatry

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Walden University

PMNHP Psychiatric-Mental Health Nurse

Practitioner PMHNP Last Minute Review LMR

Exam

Course Title and Number: PMHNP Last Minute Review LMR Exam Exam Title: Board Exam Exam Date: Exam 2024- 2025 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]

Examination

180 minutes

Instructions:

**1. Read each question carefully.

2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you** **have completed the Exam.
6. This test has a time limit, The test will save and submit** **automatically when the time expires
7. This is Exam which will assess your knowledge on the course** Learning Resources.

Good Luck!

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PMNHP Psychiatric-Mental Health Nurse Practitioner 2024- Last Minute Review Georgette’s LMR Comprehensive PMHNP Exam Review Questions with Correct Answers | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - When many answers are remarkably similar, they are usually _____________ - Answer>> wrong Interprofessional collaboration is encouraged. - Answer>> Collaborate is usually right. Delegate is usually wrong. ADPIER - Answer>> Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - Answer>> Normal 0.6-1. Lithium toxicity occurs at levels - Answer>> > 1. Signs of Lithium toxicity - Answer>> severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - Answer>> MANIA Lithium has evidence shown to - Answer>> reduce suicidal ideation

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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

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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

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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 best choice med for SI in borderline - Answer>> lithium What medications will INCREASE Li levels - Answer>> NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels - Answer>> 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?

- Answer>> course tremors lithium can cause what other comorbidities? - Answer>> hypothyroidism maculopapular rash

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leukocytosis twave inversion what is a defining characteristic of NMS vs SS - Answer>> muscle rigidity Sx's/labs associated with NMS - Answer>> Inc CPK, WBC, LFT Rhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does - Answer>> DC the offending agent bromocriptin-D2 agonis dantrolene: muscle relaxant Make sure if? is asking for agonist or relaxant Sx of SS - Answer>> HYPERREFLEXIA myoclonic jerks treatment for SS - Answer>> ciproheptadine how to best PREVENT SS - Answer>> follow proper transition protocols SSRI to MAOI=14 days Prozac to MAOI=5-6 weeks Triptans can also cause SS due to serotonin increase with use

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Why are SSRIs considered the safest for use in depression - Answer>> safest for OD depressed patient presents with fatigue and low energy, consider: - Answer>> NDRI wellbutrin sexual s/e with ssri? try... - Answer>> wellbutrin due to lower risk of sexual s/e What medication must be avoided if client has seizure history or eating disorder? why? - Answer>> wellbutrin due to decreasing the seizure threshold if client has depression and neuropathic pain - Answer>> SNRI or TCA for treatment of BOTH What med class treats neuropathic pain well - Answer>> alpha 2 delta ligands Gabapentin Lyrica What medication class is good for depression with comorbid CA - Answer>> SSRI least chance of drug drug interactions Celexa and lexapro are good choices 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

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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- female 25- schizophrenia has high rate of suicide - Answer>> always be assessing for SI

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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, o 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

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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- minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP - Answer>> haldol

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fluphenazine Chlorpromazine thioridazine 2nd gen AP - Answer>> rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway - Answer>> positive sx of schizophrenia decreased DA in mesocoritcal pathway - Answer>> negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway - Answer>> 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 - Answer>> excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia

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what does high prolactin levels lead to - Answer>> breast DC amenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia - Answer>> risperidone Male prolactin female prolactin---normals - Answer>> male less than 20ng/ml female less than 25ng/ml EPS caused by - Answer>> DA blockade in the NS pathway acute dystonia - Answer>> acute sustained contraction of muscles, usually of the head and neck spasms painful treatment of acute dystonia - Answer>> cogentin/benztropine IM, but may need Oral follow up for several days akathisia - Answer>> ANXIETY restless cannot sit still pacing rocking

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1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? - Answer>> 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 - Answer>> difficulty iniating motion treatment for akanesia - Answer>> cogentin/benztropin Sx of akinesia - Answer>> 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 - Answer>> 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

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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

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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

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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

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Marsha Linehan Conversion Disorder (Functional Neurological Symptom Disorder) - Answer>> can be result of a stressful experience present with neuro sx: parasthesia paralysis blindness Mutism adjustment disorder (anxiety/depressive/mixed) - Answer>> 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 - Answer>> 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 - Answer>> 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 - Answer>> NO AGGRESSION in ODD defiant to authority deliberately annoy others

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treatment for ODD - Answer>> • Family Therapy with emphasis on child management skills CD conduct disorder - Answer>> no remorse violent raping/beating theft arson INTENSE AGE 6- When 18; think of Antisocial personality disorder Treatment for CD - Answer>> 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 - Answer>> 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 - Answer>> Increased arousal Reexperiencing the event avoidance nightmares

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nightmare trmt in ptsd - Answer>> prazosin/minipress PTSD treatment - Answer>> EMDR SSRI CBT phases of EMDR - Answer>> see purple book Panic attack vs disorder - Answer>> panic attack: acute/seldom disorder: leads to feelings of impending doom Tourette dx criteria - Answer>> 2 motor tic 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

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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

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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-

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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 erythromycin quinidine grapefruit juice pneumonic for inducers - Answer>> CRAP GPS induces my rage Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin

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Phenobarbital Sulfonylureas 450 subtypes 1A2 2E1 2C9 2D6 3A4 - Answer>> 1A2. AcetAminophen- 1 big word with 2A 2E1 - 21 years to drink ETOH 2C9- Warfarin factors 2, C, 9 2D6- 2D echo-cardiac drug metabolism 3A4- most common, metabolizes up to 60% of ALL medications, so if its not one of the above it is likely 3A4. What NT are involved with OCD - Answer>> NE SE Trmt med for kid with ocd - Answer>> SSRI: prozac trmt med for adult with ocd - Answer>> ssri: sertralin or TCA (clomipramine) GAD pneumonic - Answer>> WATCHERS x 6 months Worry Anxiety Tension Concentration Hyperarousal Energy Loss Restlessness

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Sleep issues Stages of change - Answer>> precontemplation: Not acknowledged an issue. " I don't have a drug problem" contemplation: acknowledges, but NOT YET ready to change. "i know heroin is killing me, but i have no time for rehab"... some self doubt preparation: acknowledges issue, intends to eventually act. "Ive been thinking about rehab or buprenorphine, what do you think?" No action or behavioral modification yet... researching action: behavioral change occurs. "I'm in inpatient rehab and I'm feeling much better!" maintenance: effort made to sustain the change. "Ive been on buprenorphine for a year and I'm still doing well" relapse: reversion to a previous stage... goes back to a prior stage to start over. Autism hallmarks - Answer>> impaired communication impaired social interaction poor eye contact sensory issues poor cognition

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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

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