LMR - Georgette's 2024 Qbank/ Georgette's PMHNP Certification Exam Review; May 2024., Exams of Nursing

Download LMR - Georgette's 2024 Qbank/ Georgette's PMHNP Certification Exam Review; May 2024. and more Exams Nursing in PDF only on Docsity! LMR - Georgette's 2024 Qbank/ Georgette's PMHNP Certification Exam Review; May 2024. LMR - Georgette's 2023 Qbank What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? cultural assessment What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania Valproic acid produces what teratogenic Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of Hepatoxicity What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? >150 mcg/ml What are 4 signs of valproic acid toxicity? Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least 4+ protein 4+ protein in the kidney suggests Kidney disease What are 7 side effects of lithium? 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? 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? NSAIDs (ibuprofen, indomethacin) Thiazide s ACEI What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? 1.3 mEq/L or higher With suspected lithium toxicity, what do you do first? Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? DC lithium Check lithium level What 2 conditions can increase lithium levels? Dehydration Hyponatremia What birth defect can lithium cause? Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? DNS What 3 parts of the brain are affected with ADHD? Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? 20 x daily dose What does thought process assess? thoughts and ideas The way a patient organizes his thoughts and ideas is called Thought process A normal thought process is described as Logical Linear Coherent Goal- oriented Moving from thought to thought and never getting to the point is called Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called Thought content Thought content includes 3 items Suicidal ideation Homicidal ideation Hallucinations/Delusion s Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes Concentrati on Attention Calculation Asking the year, season, date, month, and location measures Orientation Asking a patient to repeat "bed, bad, ball" measures Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures Recall (memory) Asking the patient who is the president of the US or governor of state is measuring Fund of Knowledge Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? Conduct Disorder What are 3 characteristics of Conduct Disorder? Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? Therapy What type of therapy is used in the treatment of Conduct Disorder? Behavioral therapy What is Multisystemic family therapy? 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)? Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? Multisystemic family therapy What is the moderate range for MMSE 10-20 What is the moderate range for SLUM? 10-20 What is the moderate range for HAM-D? 14-18 What is the moderate range for PHQ-9 10-14 What is the moderate range for BDI? 19-29 What is the moderate range for HAM-A? 18-24 What is the moderate range for GAD-7 10-14 What is the moderate range for COWS? 13-24 If a patient's COWS score is between 5 - 12, what do you do? Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? moderate symptoms (13-24) What is a moderate range on the CIWA? 16-20 When do you administer prn benzodiazepine on the CIWA? Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? 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? 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? 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? Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? 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? Medication and/or therapy PMHNP certification Exam May 2022 Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank *2 risk factors D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors COWS scale components · Opioid W/D Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (gooseflesh skin), insomnia What does COWS stand for? Clinical Opiate Withdrawal Scale What does CIWA stand for? Clinical Institute Withdrawal Assessment What does CIWA assess for? --used to determine likelihood of ETOH withdrawal or DTs --usually occur within the first 24-72 hours after cessation o used to determine when to administer medications for ETOH withdrawal What does CIWA NOT test for? Alcohol Use Disorder What are the CIWA scale components? · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, H/A, orientation Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)- 4 (disoriented) Score: <10: Very mild Start PRN meds at score of 8 >10 to 15: Mild scheduled + PRN meds >16 to 20: Moderate >21: Severe Diazepam, Librium, Ativan When interview teenagers (16 y/o) that arrive with their parents what should you do? interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. Which Ethnic group has the highest rate of suicide? Native Americans Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism C. Increased Lipids D. Metabolic Syndrome D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY Which mood stabilizer have the least weight gain? Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocamp us Hypothalamus A, B, & D are all part of the limbic system so you can rule that out When a patient is hesitant to participate in treatment you should encourage? Bring a support person like a husband Thyroid-Stimulating hormone normal level 0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance Hypothyroidism Hyperthyroid can mimic Mania Hypothyroid can mimic Depression A patient on depakote complains of RUQ pain and has reddish/brown urine Hepatoxicity -Check LFTs Signs of Depakote toxicity Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? Kava Kava When taking Kava Kava in combinations with other medications you should caution about Risk of Hepatoxicity and Sedation TCAs carry a risk of Hepatotoxicity Signs of Stevens-Johnson Syndrome -fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome lamictal and tegretol What nationality is most suseptible of getting steven johnson? Asians When treating asians with tegretol screen for? HLAB-1502 Allele What two medications cause agranulocytosis? Clozaril & Tegretol Agranulocytosis when to discontinue medication Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? HCG Which two medications may decrease the risk of suicide? clozaril and lithium Medications that increase lithium level NSAID-ibuprofen, INDOCIN THIAZIDES- hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? Heart Failure Certain medications are known to increase lithium level, but HOW? by reducing renal clearance When educating a patient about lithium teach them about Wellbutrin Wellbutrin is contraindicated in patients with Seizures and anorexia (bulimia also) Which medications are best for neuropathic pain? SNRI Gabapenti n TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome Those with short half lives such as Zoloft; TCA's Symptoms of discontinuation syndrome flu like symptoms (fatigue, lethargy, myalgia, decreased concentration), n/v, impaired memory, paresthesia, irritability, anxiety, insomnia, crying w/o reason, dizziness, and vertigo Tx w/periactin Ages of onset for schizophrenia in males vs females -MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia excessive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) MRI or PET scan what is seen in schizophrenia EVERYTHING DECREASES EXCEPT VENTRICLES enlarged ventricles, decreased activity in the frontal cortex, decreased Gaba and glutamate decrease total brain volume. Stimulants can potentiate the release of what neurotransmitter? Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) a form of rehabilitation post hospitalization, in home treatment - for people w/ serious mental illness ACT is provided once they d/c from hospital -Primary goal: to help people become independent -Secondary Goal: reduce the reliance on hospitals - Treatment is centered around the patient’s personal strengths, needs, and desires for the future What level of prevention is ACT? Tertiary What adjunctive treatment is important in schizophrenia -social skills training -Exercise Exercise for mental health patients can promote Cognition Quality of Life Long-term health ACT is ideal for patients with a history of Treatment non- compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality Antisocial In the MMSE how do you test for abstraction? proverb interpretation (everyone that lives in glass houses shouldn’t throw stones) Are they able to think abstractly Thought Process-Tangential means that their response has nothing to do with the question Circumstantial means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes SI/HI/AH/VH Another name for MMSE Folstein Scale How to assess concentration on MMSE Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material repeat 3 words after me Assess ability to recall repeat 3 words after 5 minutes Assess fund of knowledge Who is the president What is a quick and easy way to assess for neurological issues Clock drawing test If patient is unable to draw a clock this indicates Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway -Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia Nigrostriatal Pathway -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to tardrive dyskinesia Tuberoinfundibular pathway -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN Long-term hyperprolactinemia can be associated with what condition osteoporosis Normal Prolactin Level in Men level less than 20ng/ml Normal Prolactin Level in Women less than 25ng/ml Which medication is the highest offender for increasing prolactin Risperdal Acute Dystonia + Treatment neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment may mimic anxiety, restlessness, can’t sit still, rocking, pacing -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos Beta-Blockers such as Inderal are contraindicated with what type of asthma medication -DO NOT GIVE WITH BROCHODIALATOR such as ALBUTEROL this combination can cause bronchospasm akinesia/bradykinesia + treatment A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN tardive dyskinesia + Treatment Paradoxical effect when meds cause the opposite effect than expected Apoptosis programmed cell death/neuronal loss At age 45 and above the patient displays mania for first time what should be ruled out MEDICAL CONDITION Patient with bipolar disorder presents with depressed mood & emotional lability Give Depakote Hallmark sx of Borderline Personality Recurrent self harm Treatment for Borderline Personality DBT Creator of DBT Marsha Linehan What activity is helpful in making a diagnosis of borderline personality Journaling or diary keeping Conversion Disorder STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism Adjustment Disorder adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying) -Symptoms occur within 3 months of the stressor If question states recently moved, recent death….THINK ADJUSTMENT factitious disorder when patients introduce foreign substances into their body or contaminate their food -Faking illness but NO MOTIVE BEHIND IT Malingering Faking illness for financial gain Reactive Attachment common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver ODD They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting Conduct Disorder violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine Acute Stress Disorder similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH PTSD -OVER ONE MONTH -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT Panic attack vs Panic disorder (treatment) Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom Tourette's Syndrome Criteria for diagnosis -TWO moto tics and ONE vocal tics -LASTS more than ONE YEAR -By age 18 **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Child presents with one tic and the parent is worried **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Neurotransmitters involved in Tourettes DNS: Dopamine, Norepinephrine, Serotonin Treatment for tourettes Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them Stimulants Neurotransmitters involved in mood disorders DNS: Dopamine, Norepinephrine, Serotonin + GABA Neurotransmitters involved in ADHD DNS: Dopamine, Norepinephrine, Serotonin