Last Minute Review PMHNP Georgette’s LMR Final Exam Review Questions and Answers | 100% Pa, 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.

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PMNHP Psychiatric-Mental Health Nurse Practitioner 2024- Last Minute Review PMHNP Georgette’s LMR Exam Review Questions with Correct Answers | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - What should you not do when advocating for a patient?

• Answer>> Judge or confront What class of medication is contraindicated with tics? - Answer>> Stimulants What should you provide for prior to assessing abuse victims? - Answer>> A safe environment NMS s/s? - Answer>> Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs Treatment of NMS and MOAs? - Answer>> D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant) Serotonin syndrome s/s? - Answer>> Hyperreflexia and myoclonic jerks Serotonin syndrome causes? - Answer>> SSRIs, SNRIs, MAOIs, -triptans (for migraines like sumatriptan/imitrex)

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Treatment for serotonin syndrome? - Answer>> D/C med and administer cyproheptadine Wash out from SSRI to MAOI or vice-versa? - Answer>> 14 days Wash out from Prozac to MAOI? - Answer>> 5-6 weeks Drug choice for patient that is depressed and also has cancer? - Answer>> Celexa or lexapro d/t fewer drug to drug interactions Drug choice for patient with low energy and fatigue with depression? - Answer>> Wellbutrin Drug choice for patient with sexual problems d/t medication or depression? - Answer>> Wellbutrin C/I for Wellbutrin? - Answer>> Seizure disorder or hx or present eating disorder Drug choices for patient with chronic neuropathic pain and depression? - Answer>> 1. SNRI (cymbalta)

2. TCA (amitriptyline)
3. Alpha 2 delta ligand (gabapentin or lyrica) Black box warning for SSRIs in children, adolescents, and young adults? Intervention for this? - Answer>> Increased risk of SI; always assess SI, frequency, and severity

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Alcohol is a form of _______-_________ and a __________ to the treatment of depression. - Answer>> self- medication; barrier Prozac can cause? Intervention? - Answer>> Insomnia; take in AM Disorder that most greatly increases thoughts of self- harm? - Answer>> Depression Disorder that most greatly increases homicidal ideation? - Answer>> Antisocial personality Why is there less evidence available supporting the use of antidepressants in children? - Answer>> Lower placebo rates Schizophrenia age of onset in men? Women? - Answer>> 18-25; 25- Findings on PET scan or MRI in schizophrenia? - Answer>> INCREASED ventricle size; DECREASED everything else No stimulants in schizophrenia due to? - Answer>> Increased dopamine release Tertiary prevention for schizophrenia? - Answer>> Social skills training Why should you refer a patient with schizophrenia to exercise programs, especially aerobic exercise? -

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Answer>> It improves cognition, quality of life, and long term health What are your actions if a child reports abuse? - Answer>> First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? - Answer>> Report to CPS In what setting as an inpatient provider should you interview a patient? - Answer>> Use a private room with the door partially open How should you begin your interview with adolescents?

• Answer>> By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? - Answer>> Without What if an adolescent tells you they are homosexual and they don't want their parents to know? - Answer>> This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? - Answer>> Get informed consent/ROI What do you do if a medical evaluation is needed? - Answer>> Refer out - this is out of scope

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What do you do if a patient is takes something and is feeling really funny/unwell in your office? - Answer>> Collect UDS and then refer out Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment? - Answer>> No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? - Answer>> Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? - Answer>> An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? - Answer>> Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? - Answer>> Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1: Psychoeducation should be based on? - Answer>> Cultural context How do you promote health in a location with multiple ethnicities and education levels? - Answer>> Multiple

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cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? - Answer>> Allow this - remember ROI/informed consent Normal TSH? - Answer>> 0.5-5. TSH < 0.5 =? - Answer>> Hyperthyroidism TSH > 5.0 =? - Answer>> Hypothyroidism Relationship between TSH & T3/T4? - Answer>> Inverse Hyperthyroidism can present as? - Answer>> Mania Hypothyroidism can present as? - Answer>> Depression Normal depakote level? - Answer>> 50- Toxic depakote level? - Answer>> 150+ Birth defect caused by depakote? - Answer>> Spina Bifida S/S of depakote toxicity? - Answer>> Disorientation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? - Answer>> D/C depakote and check VPA level, LFTs, and ammonia

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S/S of hepatotoxicity? - Answer>> RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? - Answer>> 5- Normal ALT? - Answer>> 5- Kava kava can cause? - Answer>> Liver damage and heavy sedation Kava kava is c/i with? - Answer>> Benzos or sedatives Mood stabilizer most associated with SJS? - Answer>> Lamictal Mood stabilizer with least weight gain? - Answer>> Lamictal SGAs with least weight gain? - Answer>> ziprasidone, abilify, and latuda Least sedating SGA? - Answer>> Abilify Routine labs with SGAs? - Answer>> BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? - Answer>> 1. Nonpharm = exercise or nutritional counseling

2. Pharm = switch to other SGA with lower chance of metabolic syndrome

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Carbamazepine can cause? - Answer>> Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? - Answer>> HLAB Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? - Answer>> If ANC is < 1000 with or without s/s of infection Lithium range? - Answer>> 0.6 - 1. What to do if lithium is 1.3 or 1.4? - Answer>> Monitor What to do if lithium is 1.5+? - Answer>> D/C Benefits of lithium? - Answer>> Gold standard for mania, neuroprotective, and antisuicidal effects S/S of lithium toxicity? - Answer>> Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor What to do if lithium toxicity is suspected? - Answer>> D/C and check serum levels prior to checking VS Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs? - Answer>> NSAIDs, ace inhibitors for heart failure (- pril), and thiazides (HCTZ)

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What demonstrates understanding of education on lithium? - Answer>> Taking extra water with patient when they go hiking Benefits of assertive community treatment (ACT)? - Answer>> Rehab post-hospitalization, case management approach, and good for long term hx of noncompliance Oral haldol to IM conversion? - Answer>> 20x daily dose of oral dose Max IM dose of haldol per visit? How long until next injection? - Answer>> 100 mg; 5-7 days 5 mg oral haldol BID =? IM - Answer>> 200 mg Firm belief that is maintained despite lack of evidence?

• Answer>> Delusion Example of a delusion? - Answer>> Believing church members or class members are a cult MSE in preschooler (3-5 yo)? - Answer>> Listen and observe; dependent on clinical observation Thought process? - Answer>> Organization of patients thoughts and ideas Circumstantial speech? - Answer>> Go in circles but eventually answers

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Tangential speech? - Answer>> Never gets to answer of question Thought content? - Answer>> What themes occupy patient's mind; i.e. SI, HI, and A/VH MMSE also known as? - Answer>> Folstein scale Serial 7s or months backwards assesses patient's? - Answer>> Concentration, attention, and calculation Name 3 objects assesses? - Answer>> Registration Name 3 objects after 5 minutes assesses? - Answer>> Recall/memory Asking patient to name president of governor assesses?

• Answer>> Fund of knowledge If a clock drawing test is abnormal this indicates? - Answer>> Right parietal lobe/hemisphere damage What makes SGAs different from FGAs? - Answer>> 5HT2A = less likely to experience EPS SGAs that can be administered IM? - Answer>> Invega, geodon, zyprexa, and abilify Mesolimbic DA pathway? - Answer>> Increased DA leads to + symptoms Mesocortical DA pathway? - Answer>> Decreased dopamine leads to - symptoms

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Nigrostriatal DA pathway? - Answer>> Decreased dopamine and increased acetylcholine lead to EPS (dystonia, akathisia, and TD) Tuberoinfundibular pathway? - Answer>> Decreased dopamine and increased prolactin lead to amenorrhea, galactorrhea, sexual dysfunction, and gynecomastia Long term increased prolactin causes? - Answer>> Osteoporosis Normal prolactin levels for men? Women? - Answer>> <20; < Which CYP450 enzyme metabolizes clozaril? - Answer>> 1A Cigarettes are inducers of what CYP450 enzyme? - Answer>> 1A Cigarette smoking in patients taking clozaril requires increased or decreased doses? - Answer>> Increased Cigarette cessation in patients taking clozaril requires increased or decreased doses? - Answer>> Decreased Most antibiotics are inducers or inhibitors? Intervention with substrate? - Answer>> Inhibitors; reduce substrate

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Medications that cause mania? - Answer>> Steroids, antabuse, isoniazid (INH), and antidepressants in patients with bipolar disorder Medications that cause depression? - Answer>> Steroids, accutane, interferon, retrovirals, antineoplastics, BZDs, progesterone, and beta blockers Accutane can cause? - Answer>> Birth defects Steroids can also cause? - Answer>> Psychosis Intervention for patient on flonase or prednisone? - Answer>> Increase mood stabilizer, antidepressant, or antipsychotic based on targeted disorder Neurotransmitters indicated in addiction? - Answer>> Dopamine and GABA S/S of stimulant abuse? - Answer>> Insomnia, anxiety, irritability, tremors, palpitations, increased HR, and increased BP Patients with anorexia complain of pain, bloating, and fullness with eating due to? - Answer>> Delayed gastric emptying Other causes of delayed gastric emptying? - Answer>> Ranitidine, famotidine, and omeprazole Education for patient taking both psychotropics and antacids/PPIs? - Answer>> Take 2 hours apart

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What to monitor for in older adults on SSRIs? - Answer>> Increased anxiety and hyponatremia Paradoxical effect? Examples? Intervention? - Answer>> Opposite reaction from expected; i.e. BZDs -> increased anxiety or trazodone -> insomnia; avoid med in future Apoptosis? - Answer>> Neuronal loss or cell death Greatest risk factor for bipolar disorder? - Answer>> Family history, it is very inheritable Patient presenting with first manic episode after age 45? - Answer>> Look for medical cause Main determinations for BPD? - Answer>> Self-harm and recurrent SI Tx for BPD and originator? - Answer>> DBT by Marsha Linehan Patient with BPD has depressed mood and emotional lability, what is your treatment? - Answer>> Depakote Conversion disorder presents after? S/S? - Answer>> Stressful event like losing sibling; blindness, mutism, paralysis, paresthesia all medically unexplained Adjustment disorder presents after? Timeline? - Answer>> Stressful event like loss of pet or parent; within 3 months of event

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Subtypes of adjustment disorder? Examples? - Answer>> With depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbances of conduct (think change in school), and with mixed disturbances of emotions and conduct (think of divorce leading to truancy, peer conflict, verbal altercations, insomnia, and frequent crying) ODD timeline? - Answer>> Lasts 6+ months ODD s/s? - Answer>> Deliberately annoys others, is spiteful, and is vindictive; NO AGGRESSION Tx for ODD? - Answer>> Family therapy Conduct disorder s/s? - Answer>> Think juvenile detention, AGGRESSION, NO REMORSE Tx of conduct disorder? - Answer>> Target mood and aggression (antipsychotics, mood stabilizers, SSRIs, and alpha agonists); therapy Dx of Tourette's syndrome? - Answer>> 2 motor tics and 1 vocal tic lasting 1 year+ Childrens motor tics are? - Answer>> Fairly common and can be temporary Primary neurotransmitters indicated in tics? - Answer>> DOPAMINE, NE, and serotonin Tx of tics? - Answer>> Haldol, pimozide, abilify, clonidine, and guanfacine

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Acute stress disorder timeline? - Answer>> 4 weeks or less A patient assaults you at work and you don't want to return to work for 2-3 weeks. This can be an example of? - Answer>> Acute stress disorder PTSD timeline? - Answer>> Lasts 1 month or more S/S of PTSD? - Answer>> Intrusive re-experiencing, increased arousal, and avoidance of stimuli Tx for PTSD? - Answer>> SSRI, TCAs, prazosin for nightmares, EMDR, and CBT EMDR stages? - Answer>> 1. Desensitization

2. Instillation
3. Body scan ADHD neurotransmitters? - Answer>> DA, NE, and serotonin Area of brain indicated in ADHD? Its functions? - Answer>> 1. Dorsolateral prefrontal cortex; executive function, cognitive processes, and attention
4. Basal ganglia
5. Abnormalities of reticular activating system
6. Abnormalities of prefrontal cortex = inattentive type When does aftercare plan begin and what does it include? - Answer>> On admission; behavioral management, support, and psychoeducation

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What to do if parent is uncomfortable with stimulant medication after education? - Answer>> Encourage clonidine or guanfacine; 6-17 years old Parent is anxious about starting medication on child - what interventions? - Answer>> Address anxiety and offer brief supportive therapy ADHD medication wears off - intervention? - Answer>> Multiple dosing or extended release OCD s/s? - Answer>> 1. Recurrent and persistent thoughts, impulses, or images

2. Compulsions -- can be a tic PANDAs? - Answer>> Can cause OCD in children and occurs after a strep infection Differentiation between OCD with tics as compulsion and Tourette's? - Answer>> OCD also has intrusive thoughts Factitious disorder s/s? - Answer>> Foreign substances introduced into body with NO SECONDARY GAIN Factitious disorder imposed on another? - Answer>> ABUSE - report to CPS Malingering? - Answer>> Faking symptoms for SECONDARY GAIN

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Reactive attachment d/o s/s? - Answer>> Fearful, inhibited, withdrawn, apathetic, no emotion toward caregivers, can also be aggressive, disruptive, and disorganized GAD timeline? - Answer>> 6+ months Panic attacks symptom and tx? - Answer>> Impending doom; beta blockers, SSRIs C/I to beta blockers? - Answer>> Asthma (can cause bronchospasms) DMDD ages & s/s? - Answer>> 6-17 yo; chronic dysregulated mood and frequent intense temper outbursts Anorexia s/s? - Answer>> Low BMI <18, amenorrhea, emaciation, bradycardia, and hypotension 16 yo comes into office with parents showing s/s of anorexia. What is your tx? - Answer>> Refer for medical evaluation What if parents are refusing medical evaluation for child with s/s of anorexia? - Answer>> Contact CPS Neurotransmitters indicated in Autism? - Answer>> Glutamate, GABA, and serotonin S/S of Autism? - Answer>> Decreased social communication and interaction, no response to name, little or no eye contact, and organizing toys

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Thought to be cause of Autism? - Answer>> DYSFUNCTION OF MIRROR NEURON Patient presents with irritability and labile mood. Screener? - Answer>> MDQ Nightmares in children can be due to? - Answer>> Genetic factors - is there a family pattern of nightmares? Delerium s/s? - Answer>> ACUTE ONSET, LOC disturbance, cognition, and inattention Tx of agitation and psychotic symptoms in delirium? - Answer>> Low dose haldol Labs for delirium? - Answer>> UA with culture and sensitivity Dementia s/s? - Answer>> Slow progression, mental decline, irritability, personality changes Labs for dementia? - Answer>> B12 & folic acid levels Tx of agitation and psychotic symptoms with dementia?

• Answer>> 1. Nonpharm = quiet environment

2. Pharm = atypical antipsychotics Pseudodementia cause? - Answer>> MDD leading to memory impairment

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Screening in pseudodementia? - Answer>> MMSE, SLUM, MoCA, and Mini-cog Pseudodementia s/s? - Answer>> Acute onset (can be months), irritability, agitation, hallucinations, delusions, IDK ANSWERS Dementia vs pseudodementia? - Answer>> Dementia is chronic (years) & they confabulate Pseudodementia is acute (can be months) and the give IDK answers Subcortical dementia? - Answer>> Motor symptoms Cortical dementia? - Answer>> Language and memory impairments HIV dementia? - Answer>> Subcortical dementia = motor abnormalities, behavioral abnormalities, and cognitive decline Lewy body dementia? - Answer>> = VISUAL HALLUCINATIONS Pick's disease or frontal lobe dementia? - Answer>> = slurred speech, personality and behavioral changes Huntington's disease? - Answer>> = subcortical dementia, motor abnormalities, depression, and psychosis Amygdala =? - Answer>> Aggression

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Hippocampus =? - Answer>> Emotions & stress Anterior cingulate =? - Answer>> Cognitive functions, decision making, empathy, impulse control, and emotions Cerebellum =? - Answer>> Maintenance of balance and posture NE produced in? - Answer>> Locus coeruleus and medullary reticular formation Serotonin produced in? - Answer>> Raphe nuclei of the brainstem Dopamine produced in? - Answer>> Substantia nigra (regulates motor movements), VTA, and nucleus accumbens Acetylcholine produced in? - Answer>> Nucleus of Meynert S/S of lead poisoning? - Answer>> Developmental delay, learning difficulties, irritability, loss of appetite, weight loss, sluggishness and fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, and pica What lobe causes social skills to be affected? - Answer>> Frontal lobe What to do if infant is dying? - Answer>> Give infant to parents to hold

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Grief and loss in children? - Answer>> Normalize it as responses vary. Provide psychoeducation and group therapy. Child needs INTACT family. Mood neurotransmitters? - Answer>> DA, NE, Serotonin, GABA, and glutamate Risks for osteoporosis? - Answer>> Smoking, caffeine, decreased weight bearing exercises, decreased calcium, and decreased vitamin D Interpersonal learning? - Answer>> Encourage pt to continue group sessions and adjunctive individual therapy Cognitive therapy? - Answer>> Replace distorted thoughts with rational ones Behavioral therapy? - Answer>> Skills training, problem solving, modeling, exposure, role playing, and relaxation CBT? - Answer>> Cognitive restructuring and JOURNALING Humanistic therapy? - Answer>> Person-centered, SELF-ACTUALIZATION, & SELF-DIRECTED GROWTH Interpersonal therapy? - Answer>> Interpersonal issues & marital conflict; lasts 12-16 weeks

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Multisystemic family therapy? - Answer>> ANTISOCIAL Reduces barriers to families Strategic therapy? - Answer>> Problem and symptom focused. PARADOXICAL STRATEGY Reframe belief system Straightforward directive Solution-focused therapy? - Answer>> MIRACLE QUESTIONS Exception finding Scaling questions Structural family therapy? - Answer>> HIERARCHIES BOUNDARIES Genograms Family system therapy? - Answer>> TRIANGLES SELF-DIFFERENTIATION Genograms Meditation =? - Answer>> Muscle relaxation Physical activity =? - Answer>> Improve body image, RESILIENCE, and improve relationships & social anxiety Ask what kinds of questions? - Answer>> Open-ended What kinds of questions if patient can not construct narrative? - Answer>> Yes/No

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What to do if a joint appt is scheduled but only 1 person shows up? - Answer>> Reschedule What to do if parent calls over phone and says 5-year- old was raped by 15-year-old brother? - Answer>> 1. Educate to not leave child alone with brother

2. Call CPS
3. Crisis therapy What to check with rheumatoid arthritis? - Answer>> ESR PICOT meaning? - Answer>> Population Intervention Comparison intervention Outcome Time Hierarchy of evidence? - Answer>> I. Systematic review or meta-analysis of all RCTs
4. One or more well-designed RCT How to promote evidence-based research? - Answer>> Have access to current journals Infant with shrill cry =? - Answer>> Increased intracranial pressure 3-6 year old is masturbating? - Answer>> Normal. This is the phallic stage 9-16 yo boy with tenderness, swelling, and breast enlargement? - Answer>> Normal for up to 6 months

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Reason for decreased sex drive in elderly women? - Answer>> Decreased testosterone & decreased blood flow to pelvic region Alcohol dehydragenase? - Answer>> Women have lower quantity compared to men = women are more likely to get drunk = more likely to have liver problems How to increase psychiatric access to those who need it the most? - Answer>> Integrated care Palmer reflex normal until? - Answer>> 5-6 months Grasps finger in palm Moro reflex normal until? - Answer>> 5-6 months Startle reflex Babinski reflex normal until? - Answer>> 2 years Fans toes Phosphodiesterase (PDS) medications? - Answer>> Viagra Are rapidly absorbed after PO administration Normocytic macrocytic anemia? - Answer>> Check folic acid, B12, and iron levels Adolescent with ADHD =? - Answer>> Increased risk of SUDs Screen all adolescents for SUDs & vice-versa Acupuncture =? - Answer>> Pain and depression

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