LMR Georgette’s PMHNP Certification Exam/632 Questions And Answers., Exams of Health sciences

Download LMR Georgette’s PMHNP Certification Exam/632 Questions And Answers. and more Exams Health sciences in PDF only on Docsity! LMR Georgette’s PMHNP Certification Exam/632 Questions And Answers. What drugs should be avoided with Kava Kava? - Correct Answer -Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? - Correct Answer -Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? - Correct Answer - cultural assessment What is the normal range for TSH? - Correct Answer -0.5 - 5.0 mu/L What are lab values in Hyperthyroidism - Correct Answer - Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? - Correct Answer - Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? - Correct Answer -Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? - Correct Answer -Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Correct Answer -Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Correct Answer -Mania Valproic acid produces what teratogenic effect? - Correct Answer -Spina bifida (neural tube defect) Which mood stabilizer causes the least weight gain? - Correct Answer -Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? - Correct Answer - Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? - Correct Answer -Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? - Correct Answer - Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of - Correct Answer -Delirium How are agitation and psychotic symptoms treated in delirium? - Correct Answer -Low dose Haldol What 4 drugs can cause mania? - Correct Answer - Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce - Correct Answer -Mania What 6 drugs can induce depression? - Correct Answer -Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? - Correct Answer - Mania Depression Psychosis What medication to treat acne cause cause birth defects? - Correct Answer -Isotretinoin (Accutane) What is the therapeutic range for lithium? - Correct Answer -0.6- 1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? - Correct Answer -Lithium What is the gold standard for treating manic episodes - Correct Answer -Lithium What mood stabilizer has anti-suicidal effects? - Correct Answer - Lithium What 5 labs should be drawn with lithium? - Correct Answer - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - Correct Answer -0.6-1.2 mg/dL What is the normal range for BUN? - Correct Answer -10-20 mg/dL When should you suspect kidney disease with a urinalysis? - Correct Answer -4+ protein 4+ protein in the kidney suggests - Correct Answer -Kidney disease What are 7 side effects of lithium? - Correct Answer - 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? - Correct Answer -Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking What does thought process assess? - Correct Answer - thoughts and ideas The way a patient organizes his thoughts and ideas is called - Correct Answer -Thought process A normal thought process is described as - Correct Answer -Logical Linear Coherent Goal- oriented Moving from thought to thought and never getting to the point is called - Correct Answer -Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called - Correct Answer -Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called - Correct Answer -Thought content Thought content includes 3 items - Correct Answer -Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes - Correct Answer -Concentration Attention Calculatio n Asking the year, season, date, month, and location measures - Correct Answer -Orientation Asking a patient to repeat "bed, bad, ball" measures - Correct Answer -Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures - Correct Answer -Recall (memory) Asking the patient who is the president of the US or governor of state is measuring - Correct Answer -Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? - Correct Answer -Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to - Correct Answer -Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway modulates - Correct Answer -positive psychotic symptoms Having the HLA-B*1502 allele increases the risk for - Correct Answer -SJS Which ethic group is at most likely to have the HLA-B*1502 allele? - Correct Answer -Asians Asians are most likely to have what allele? - Correct Answer - HLA-B*1502 In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? - Correct Answer -Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? - Correct Answer -Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of - Correct Answer -Agranulocytosis What are 4 symptoms of agranulocytosis - Correct Answer -A sudden fever Chills Sore throat Weaknes s At what ANC should clozapine be stopped (even if asymptomatic)? - Correct Answer -<1000 What is neutropenia? - Correct Answer - <2000 PMNs What is agranulocytosis? - Correct Answer -<500 ANC What does DIGFAST stand for? - Correct Answer - Distractibility Indiscretion Grandiosit y FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms in Conversion Disorder? - Correct Answer - Blindnes s Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? - Correct Answer -After a stressful experience (suddenly) What are 5 stressful events in a child's life that can cause adjustment disorder? - Correct Answer -Family move 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? - Correct Answer -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)? - Correct Answer -6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? - Correct Answer -4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of - Correct Answer -Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? - Correct Answer -Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? - Correct Answer -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? - Correct Answer -Conduct Disorder What are 3 characteristics of Conduct Disorder? - Correct Answer -Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? - Correct Answer -Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? - Correct Answer When do you administer clonidine on the COWS? - Correct Answer -mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? - Correct Answer -moderate symptoms (13-24) What is a moderate range on the CIWA? - Correct Answer -16-20 When do you administer prn benzodiazepine on the CIWA? - Correct Answer -Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? - Correct Answer -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? - Correct Answer -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? - Correct Answer - 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? - Correct Answer - Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Correct Answer -Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Correct Answer -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? - Correct Answer -Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? - Correct Answer - Prefrontal cortex Amygdala Basal ganglia Hippocamp us Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? - Correct Answer - Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? - Correct Answer -Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytos is Elevated LFTs What neurotransmitter is produced in the raphe nuclei in the brainstem? - Correct Answer -Serotonin Serotonin is produced in - Correct Answer -raphe nuclei in the brainstem What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? - Correct Answer -Dopamine What 3 areas of the brain is dopamine produced? - Correct Answer -Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? - Correct Answer -Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? - Correct Answer -Acetycholine What is the function of the amygdala? - Correct Answer - Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? - Correct Answer -Amygdala What are 4 functions of the hippocampus? - Correct Answer -Emotions Stress Learning Memory Emotions, stress, learning, and memory are functions of what structure of the brain? - Correct Answer -Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - Correct Answer -Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Correct Answer -Glutamate GABA Serotonin A child who does not respond when called by name may have - Correct Answer -Autism A child that has little or no eye contact may have - Correct Answer -Autism A child who likes to line up, stack, or organize objects and toys in on tidy rows may have - Correct Answer -Autism What theory claims that dysfunction of a particular neuron system may be a cause of poor social interaction and cognition in autism? - Correct Answer -Broken Mirror Theory What is the DSM-5 criteria for number of tics in Tourette's Disorder? - Correct Answer -Motor: 2 or more and Vocal: 1 or more (not necessarily at same time) What are the DSM-5 criteria for the duration of symptoms in Tourette's Disorder? - Correct Answer ->1 year What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder? - Correct Answer -<18 yrs What is the pharmacological treatment of Tourette's Disorder? - Correct Answer -Antipsychotic (haloperidol, pimozide, aripiprazole*) What are the 3 primary neurotransmitters involved in Tourette's Disorder? - Correct Answer -DNS What are 11 risk factors for suicide? - Correct Answer -Previous suicide attempt 45 and older (55 for women) Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss Male gender What age is a risk factor for suicide? - Correct Answer - 45 and older What gender is a risk factor for suicide? - Correct Answer -Male What race is a risk factor for suicide? - Correct Answer -White Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritabilit y Gooseflesh skin Dilated pupils Pulse, Sweating, Restlessness, Pupil size, Bone aches, Running nose or tearing, GI upset, Yawning, Tremors, Anxiety/irritability, Gooseflesh skin, and Dilated pupils are components of what scale? - Correct Answer -COWS What are the 9 components/symptoms of the CIWA Scale? - Correct Answer -Nausea/ vomiting Tremor Sweats Anxiety Agitatio n Tactile disturbances Auditory disturbances Headaches Orientation Nausea/vomiting, Tremor, Sweats, Anxiety, Agitation, Tactile disturbances, Auditory disturbances, Headaches, and Orientation are components of which Scale - Correct Answer -CIWA What are 3 treatments for Alcohol Use Disorder? - Correct Answer -Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Vivitrol, ReVia) Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver? - Correct Answer -Acamprosate (Campral) Installation of hope, universality, group cohesiveness, and altruism are therapeutic factors of what group therapy? - Correct Answer - Yalom What are 4 therapeutic factors in Yalom's Group Therapy? - Correct Answer -Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses? - Correct Answer - Appreciative Inquiry What is appreciative inquiry? - Correct Answer -An approach to organizational change which focuses on strengths rather than weaknesses What component of Health Policy are Key players and stake holders? - Correct Answer -Policy Makers What is the first action when developing Health Policy? - Correct Answer -Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called - Correct Answer -Recovery Model What is the Recovery Model? - Correct Answer -A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called What is a nonlinear treatment approach? - Correct Answer -Not a step-by- step process, but one based on continual growth and occasional setbacks What are 3 characteristics of the Recovery Model? - Correct Answer -Learning from experience (e.g. relapse) Nonlinear Self-directed, Individualized and Person-Centered The treatment approach that emphasizes "learning from experience," nonlinear, and self-directed/individualized/person-centered? - Correct Answer -Recovery Model What is the SBIRT - Correct Answer -Screens for Substance Use Disorders Screening Brief Interventio n Referral Treatment What instrument screens for Substance Use Disorders - Correct Answer -SBIRT Screening Brief Interventio n Referral Treatment What is the Tarasoff Principle - Correct Answer -Duty to warn victim of imminent danger of homicidal patients What is the Duty to warn victim of imminent danger of homicidal patients? - Correct Answer -Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) - Correct Answer -Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? - Correct Answer -Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? - Correct Answer -Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? - Correct Answer -You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? - Correct Answer -Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? - Correct Answer -Strategic Which 3 techniques are used in Solution-Focused Therapy? - Correct Answer -Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - Correct Answer - Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? - Correct Answer -Family Systems Therapy What are 3 characteristics of Family Systems Therapy ? - Correct Answer - Triangles/ Triangulation Self- differentiation Genograms Which antipsychotic has the least weight gain? - Correct Answer -Ziprasidone (Geodon) Which SGA is the least sedating? - Correct Answer -Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? - Correct Answer - Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? - Correct Answer -nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? - Correct Answer - ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? - Correct Answer - Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? - Correct Answer -Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? - Correct Answer -HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? - Correct Answer -DC lithium What is one of the most important teaching points you should make in a patient taking lithium? - Correct Answer -Stay hydrated A patient with what medical condition is at risk for lithium toxicity? - Correct Answer -Cardiac failure (hyponatremia) What is the key indicator for NMS? - Correct Answer -Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of - Correct Answer -NMS What is the key indicator of Serotonin Syndrome? - Correct Answer -Muscle jerks (myoclonic) Muscle jerks (myoclonic) are the key indicator of - Correct Answer -Serotonin Syndrome If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? - Correct Answer -Bupropion What is first line treatment for MDD? - Correct Answer -SSRIs What are the 2 antidepressants of choice in a depressed patient with cancer? - Correct Answer -Citalopram (Celexa) Escitalopram (Lexapro) What is the antidepressant of choice in a depressed patient with sexual dysfunction? - Correct Answer -Bupropion What is the antidepressant of choice in a depressed patient with decreased energy? - Correct Answer -Bupropion What are 3 treatments for depressed patients with neuropathic pain? - Correct Answer -SNRI (safety) TCA Gabapentin Which SSRI is most likely to cause insomnia? - Correct Answer - Fluoxetine (Prozac) What question is important to ask in the social history with a depressed patient? - Correct Answer -Alcohol intake (self- medicating) What BBW do all antidepressants have? - Correct Answer - Suicidal ideation (<24 yrs.) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? - Correct Answer - Antidepresssants What question should ask all adolescent patients at each visit? - Correct Answer -Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit? - Correct Answer -Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? - Correct Answer -Few evidence-based studies What is the onset of schizophrenia in males? - Correct When converting oral Haldol to depo form, what the maximum dose should administer? - Correct Answer ->100 mg (administer weekly if necessary) What is a delusion? - Correct Answer -A firm belief despite contrary evidence A firm belief despite contrary evidence is - Correct Answer -delusion How often is Haldol Decanoate typically adminitered? - Correct Answer -monthly How do you conduct a MSE in a preschooler (3-5 yo) - Correct Answer -Clinical observation (listen/observe) What is thought content? - Correct Answer -SI/HI, plan What are the 5 components of the MMSE (Folstein's) - Correct Answer -Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? - Correct Answer -5- HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? - Correct Answer -5HT2-antagonism What antipsychotic should you give to a patient with their first psychotic episode? - Correct Answer -SGA (IM) Which 4 SGAs are available in IM form? - Correct Answer - Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? - Correct Answer -Metoclopramide (Reglan) What is a normal prolactin level in men? - Correct Answer -<20 What is a normal prolactin level in women? - Correct Answer -<25 What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? - Correct Answer -Decrease olanzapine dose What effect does tobacco have on CYP450? - Correct Answer - 1A2 inducer What is apotosis? - Correct Answer -Cell death/neuronal loss What is the name for cell death/neuronal loss? - Correct Answer -apotosis What is the greatest risk factor for bipolar disorder? - Correct Answer -genetics (very heritable) What is the first question you ask with a patient with suspected bipolar disorder? - Correct Answer -family history What should you consider in a 45 yo patient that presents with manic symptoms? - Correct Answer -Medical condition At what age should you consider a patient with manic symptoms to be medically-induced - Correct Answer -45 and older What are 2 differences between mania and hypomania? - Correct Answer -More severe Increased duration (7 days vs. 4 days) A patient that presents with grandiosity or exaggerated self-esteem is most likely to have - Correct Answer -Mania or hypomania A patient who is manic, irritable mood, and uncooperative is most likely to have what disorder? - Correct Answer -bipolar disorder What is a key symptom to consider in a patient you suspect of mania or hypomania? - Correct Answer -Grandiosity or exaggerated self esteem What is a hallmark feature of borderline personality disorder? - Correct Answer -Self-harming behavior (recurrent) Self-harming behavior (recurrent) is a key factor in which disorder? - Correct Answer -Borderline personality disorder What therapy in borderline personality disorder been shown to decrease suicidal ideation? - Correct Answer -DBT Who developed DBT? - Correct Answer -Marsha Linehan In DBT, diagnosis of borderline disorder requires activity? - Correct Answer -journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed - Correct Answer -Valproic acid When should valproic acid be prescribed in a patient with borderline personality disorder? - Correct Answer -Depressed mood + lability A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? - Correct Answer -Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? - Correct Answer - Conduct Disorder Is a child with ODD or Conduct Disorder more likely to need medication? - Correct Answer -Conduct Disorder If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? - Correct Answer -No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? - Correct Answer -Not always What 3 neurotransmitters are involved with Tourette's? - Correct Answer -DNS What is factitious disorder imposed on another? - Correct Answer -Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? - Correct Answer -Report to CPS Child abuse (duty to report) What is Factitious Disorder - Correct Answer -Faking illness to get medical attention or sympathy A patient who feigns illness to get sympathy or attention is most likely to have - Correct Answer -Factitious disorder A patient with factitious disorder is most likely to have what type of demographic? - Correct Answer -Unmarried healthcare worker aftercare plan on admission? - Correct Answer -Brief supportive therapy (not after dc) If a patient present with irritability, depression, and lability, which questionnaire do you administer? - Correct Answer -Mood Disorder Questionnaire (MDQ) When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? - Correct Answer -Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? - Correct Answer -Disruptive Mood Dysregulation Disorder (DMDD) A child with intense temper outbursts is most likely to have what DSM-5 diagnosis? - Correct Answer -Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? - Correct Answer -If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? - Correct Answer -Persistent deficits in social communication and social interaction across multiple settings A child with persistent deficits in social communication and social interaction across multiple settings is most likely to have what DSM- 5 diagnosis? - Correct Answer -Autism A child that does not establish eye contact is likely to have - Correct Answer -autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? - Correct Answer -Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered - Correct Answer -Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? - Correct Answer -UA C/S An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for - Correct Answer -Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? - Correct Answer - B12 Folic acid Personality and behavior changes Social skills A patient who presents with difficulties with executive function, slurred speech, personality, and behavior changes, difficulties with language comprehension, and poor social skills is most likely to have what type of dementia? - Correct Answer -Frontotemporal (Pick's) A patient with visual hallucinations is most likely to have what type of demenetia? - Correct Answer -Lewy Body A patient with Lewy Body Dementia is most likely to have what presenting symptoms? - Correct Answer -Visual hallucinations A patient with damage to the anterior cingulate will demonstrate what 3 symptoms? - Correct Answer -Cognitive dysfunction (decision making) Lack of empathy Difficulty with impulse control and emotions A patient who presents with cognitive dysfunction (decision making), lack of empathy, and difficulty with impulse control and emotions is most likely to have damage in what brain structure? - Correct Answer -Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? - Correct Answer -Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? - Correct Answer -Cerebellum What condition may cause pica (eating things that are not food - paint chips)? - Correct Answer -Lead poisoning What 5 neurotransmitters are associated with mood disorders? - Correct Answer -Dopamine Norepinephri ne Serotonin GABA Glutamate What do do yo do when an infant is about to die? - Correct Answer -Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? - Correct Answer -Family support Support groups (don't give prescriptive advice) What are 5 risk factors for osteoporosis? - Correct Answer -Smoking Caffeine Low calcium/vitamin D in diet Decreased weight Lack of weight bearing exercises Smoking, Caffeine, Low calcium/vitamin D in diet, Decreased weight, and Lack of weight bearing exercises are risk factors for - Correct Answer -Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? - Correct Answer -Yes If a patient is reluctant to participate in group therapy, what do you do? - Correct Answer -Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? - Correct Answer -CBT What are 5 techniques used in behavioral therapy? - Correct Answer -Problem-solving Skills training Exposure therapy Role-playing/modeli ng Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in - Correct Answer -Behavioral Therapy What are 2 common techniques used in CBT? - Correct Answer - Cognitive restructuring Journaling Cognitive restructuring and journaling are common techniques used in - Correct Answer -CBT 2 key concepts of Humanistic (person-centered) therapy are - Correct Answer -Self-directed growth Self- actualization Self-directed growth and self-actualization are key concepts of what type of therapy? - Correct Answer -Humanistic (person-centered) Which therapy is based on the principle that each person has the potential to self-actualize and find meaning in life? - Correct Answer -Humanistic (person- centered) What is the best therapy for dealing with conflicts with others (e.g., spouse, co-workers)? - Correct Answer -Interpersonal therapy Interpersonal therapy is recommended in what situation? - Correct Answer -conflict and relationship (marital) problems How long does interpersonal therapy typically last? - Correct Answer -12-16 weeks If a patient is noncompliant, what is a technique that is used in Strategic Therapy? - Correct Answer -Paradoxical directive/intervention When is a paradoxical directive/intervention given in Strategic Therapy? - Correct Answer -With a noncompliant member If a patient is compliant, what is a technique that is used in Strategic Therapy? - Correct Answer -Straight Forward Directive When is a Straight Forward Directive given in Strategic Therapy? - Correct Answer -When a member is compliant What type of therapy is a therapist using when he asks "what worked before when you had this problem" - Correct Answer -Solution- focused Meditation is a form of - Correct Answer -Muscle relaxation What 4 positive effects does physical activity have on children? - Correct Answer -Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? - Correct Answer -Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened-ended question? - Correct Answer - Children (when a narrative cannot be constructed) Why are women more likely to get intoxicated and have alcohol- induced hepatotoxicity? - Correct Answer -Decreased alcohol dehydrogenase What are the 2 effects of decreased alcohol hydrogenase in women - Correct Answer -Increased intoxication Increased alcohol-induced hepatotoxicity What is the grasp/palmar reflex? - Correct Answer -infant grabs anything put into his or her hand What primitive reflex causes a newborn to grasp vigorously any object touching the palm or fingers or placed in the hand? - Correct Answer -Grasp/palmar reflex When does the palmar grasp reflex disappear? - Correct Answer -5-6 months What is the moro (startle) reflex? - Correct Answer -Loud noise or sudden loss of support will cause infant to abduct/extend UE's and trunk followed by a return to flexion Infant reflex where a baby will startle in response to a loud sound or sudden movement is called - Correct Answer -Moro/startle reflex When does the Moro reflex disappear? - Correct Answer -5-6 months What is the Babinski (Plantar) reflex? - Correct Answer -the big toe is extended and the other toes fan in response to the brushing of the sole of the foot When does the Babinski (Plantar) reflex disappear? - Correct Answer -2 years What is the absorption rate of PDE-5 inhibitors (Viagra)? - Correct Answer -Rapid What 2 deficiencies are associated with macrocytic anemia? - Correct Answer - Folic acid B12 Folic acid deficiency creates what type of anemia? - Correct Answer -Macrocytic With normocytic, macrocytic anemia, what 3 labs do you obtain? - Correct Answer -B12, folic acid, Fe B12 deficiency creates what type of anemia? - Correct Answer - Macrocytic What deficiency is associated with microcytic anemia? - Correct Answer -Iron An iron deficiency causes what type of anemia? - Correct Answer -Microcytic Acute or chronic blood loss (GI bleeding, heaving menses) can cause what type of anemia? - Correct Answer -Normocytic Normocytic anemia is due to - Correct Answer -Chronic or acute blood loss (GI bleeding, menses) What is the BMI in a patient with Bulimia Nervosa? - Correct Answer -Normal When vital signs are not normal in a thin women, you suspect - Correct Answer -Anorexia nervosa You see a patient with suspected anorexia nervosa. What do you do? - Correct Answer -Refer out for medical evaluation If a patient with anorexia nervosa refuses to see a PCP, what do you do? - Correct Answer -Contact CPS If AN patient is medically unstable and parents refuse hospital treatment, what do you do? - Correct Answer -contact CPS What 2 conditions is acupuncture used? - Correct Answer -Pain Depression What alternative medicine treatment is used with pain and depression? - Correct Answer -Acupuncture Habeas Corpus Act - Correct Answer -Protects a patient from unlawful hospitalization (able to leave AMA) What act prevents a patient from unlawful hospitalization (can leave AMA)? - Correct Answer -Habeus corpus (usually max of 28 days) A patient presents with paresthesia, fatigue and asymmetric body movement of extremities. What do you suspect and what do you do? - Correct Answer -Disseminated Encephalomyelitis Neuro What does a black box warning provide? - Correct Answer - Benefits and risks A patient calls because he read on the internet about a BBW on his medication. What do you do? - Correct Answer -You don't need to discontinue drug. Research benefits and risks What are 2 things you should do when you prescribe off-label? - Correct Answer -Document Provide full disclosure (risks/benefits) When you prescribe trazodone to a male patient, what should you do? - Correct Answer -Warn about priapism and document What are 3 risk factors for Sleep Apnea? - Correct Answer -Smoking Increase weight/obesity DM Smoking, increased weight/obesity, and DM are risk factors for what disorder? - Correct Answer -Sleep Apnea What is tolerance? - Correct Answer -Decreased effect with continuous use Decreased effect with continuous use results in - Correct Answer -Tolerance What is the goal or Reflective Practice? - Correct Answer -Improve practice What is Reflective Practice? - Correct Answer -Providing debriefing techniques, feedback to staff, and strategies to learn from experiences Providing debriefing techniques, feedback to staff and strategies to learn from experiences is called - Correct Answer -Reflective Practice If a patient has mild symptoms on the COWs, what should you do? - Correct Answer -Give clonidine or a muscle relaxant When should you administer clonidine or a muscle relaxant to a patient withdrawing from opiates? - Correct Answer -mild symptoms (8 or higher) If a patient scores 8 or more on the COWS during opiate withdrawal, what should you do? - Correct Answer -Administer clonidine or a muscle relaxant If a patient has moderate symptoms on the COWS what should you do? - Correct Answer -Administer buprenorphine/naloxone (Suboxone) When should you administer buprenorphine/naloxone (Suboxone) in a patient withdrawing from opiates? - Correct Answer -Moderate symptoms (13 or higher) pupil dilation increased BP/HR and yawning? - Correct Answer - Opiate withdrawal What are Yalom's 10 therapeutic factors? - Correct Answer - Instillation of Hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing Instillation of Hope, Universality, Altruism, Increased development of socialization skills, Imitative behaviors, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors, and Corrective refocusing are - Correct Answer -Therapeutic Factors which differentiate group therapy from individual therapy Experiencing optimism through observing the improvement of others in the group is which of Yalom's therapeutic factors? - Correct Answer -Instillation of Hope Sharing experiences/feelings in group clients realize they are not alone is which of Yalom's therapeutic factors? - Correct Answer - Universality Learning to give to others is which of Yalom's therapeutic factors? - Correct Answer -Altruism The "natural laboratory" is which of Yalom's therapeutic factors? - Correct Answer -Increased development of social skills Group members modeling their behavior after other members of group/therapist is which of Yalom's therapeutic factors? - Correct Answer -Imitative behavior Interacting with others to increase adaptive interpersonal relationships is which of Yalom's therapeutic factors? - Correct Answer -Interpersonal learning Developing a sense of belonging in the group is which of Yalom's therapeutic factors? - Correct Answer -Group cohesiveness Group members dealing with the meaning of their existence is which of Yalom's therapeutic factors? - Correct Answer - Existential factors Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic is which of Yalom's Therapeutic Factors? - Correct Answer - Corrective refocusing Openly expressing their feelings which were previously suppressed is which of Yalom's Therapeutic Factors? - Correct Answer - Catharsis What is the key component of Appreciate Inquiry? - Correct Answer -Focusing on strength of the group Focusing on the strength of the group is key to what organizational change strategy? - Correct Answer -Appreciative Inquiry Who determines the Scope of Practice? - Correct Answer -State legislature (BON) (varies state to state) Who determines the Standard of Practice? - Correct Answer -ANA (doesn't change) What are 8 exceptions to confidentiality? (know all) - Correct Answer -Unconscious (to save a life) Intends to harm self/others Court order (subpoena, summons) Attorneys in litigation Insurance companies Mandatory reporting (diseases) Tarasoff (duty to warn) Child or elder abuse What are the 5 elements of informed consent? - Correct Answer - Nature and purpose of treatment/procedure Risks and benefits of treatment Risks and benefits of not undergoing treatment Alternative procedures or treatments Diagnosis and prognosis What are the 7 ethical principles? - Correct Answer -Justice Beneficence Nonmaleficenc e Fidelity Autonomy Veracity A work environment that improves patient safety through continuous learning is - Correct Answer -Just Culture Recovery Model - Correct Answer -A model that does not focus on mental illness, is nonlinear (occasional setbacks) and stresses learning from experience What treatment approach does not focus on mental illness, is nonlinear (occasional setbacks), and stresses learning from experience? - Correct Answer -Recovery Model A process or strategy of quality improvement is called - Correct Answer -PDSA Cycle Plan Do Stud y Act What is the PDSA cycle - Correct Answer -A quality improvement process or strategy What is an example of a Quality Improvement Project? - Correct Answer -Chart review What are the 4 components of health policy? - Correct Answer - Process Policy reform Policy environment Policy makers When implementing health policy, what is the first thing you do? - Correct Answer -Assess barriers and facilitators (prior to meeting with stakeholders) What is SBIRT Assessment? - Correct Answer -Screening, Brief Intervention, and Referral to Treatment for SUD What should you do before warning someone about harm (Tarisoff act)? - Correct Answer -Contact Board of Nursing A key component of Piaget's Sensorimotor stage is - Correct Answer -Object permanence Object permanence develops in which of Piaget's developmental stages? - Correct Answer -Sensorimotor What are 2 key components of Piaget's Preoperational Stage? - Correct Answer -Magical thinking Symbols and language According to Piaget, at what stage do children display magical thinking and use language and symbols more? - Correct Answer -Preoperational What is a key component of Piaget's Concrete Operations Stage? - Correct Answer -See things from other's perspectives (less egocentric) According to Piaget, during what stage do children see things from other's perspectives - less egocentric? - Correct Answer - Concrete operations What is the key component of Piaget's Formal Operations stage? - Correct Answer -Abstract logic (science projects, hypotheses) According to Erikson, what period (age) is the development of meaningful relationships important? - Correct Answer -Infancy (0 - 1 yr.) According to Erikson, what period (age) is self-control a key component? - Correct Answer -Early childhood (1 - 3 yrs.) According to Erikson, what period (age) is being a "self-starter" (self- directed) a key factor? - Correct Answer -Late childhood (3 - 6 yrs.) According to Erikson, what period (age) is competence important, especially with classmates? - Correct Answer -School age (6 - 12 yrs.) According to Erikson, what period (age) is personal sense of identity a key factor? - Correct Answer -Adolescence (12 - 20 yrs.) According to Erikson, what period (age) are committed relationships a key factor? - Correct Answer -Early adulthood (20 - 35 yrs.) According to Erikson, what period (age) is the ability to care for others important (e.g., parenting)? - Correct Answer -Middle adulthood (35 - 65 yrs.) According to Erikson, what period (age) does fulfillment and comfort with life occur? - Correct Answer -Late adulthood (>65) What 3 neurotransmitters are associated with ADHD? - Correct Answer -DNS What 3 neurotransmitters are associated with MDD? - Correct Answer -DNS (decreased) Which 5 psychiatric disorders have dysregulation of the GABA receptor? - Correct Answer -BPD Schizophrenia Autism SUD Anxiety What 4 psychiatric disorders have dysregulation of glutamate receptors? - Correct Answer -BPD Schizophrenia ASD Alzheimer's Which 2 psychiatric disorder have dysregulation of acetylcholine receptor? - Correct Answer -Alzheimer's Parkinson's What 3 disorders have dysregulation of glutamate and gabapentin? - Correct Answer -autism spectrum disorder bipolar disorder schizophrenia You are concerned a 5-yo child may be sexually abused. How do you conduct the interview? - Correct Answer -Interview child and parents separately if child can communicate You see a child playing with a toy in a sexual manner. What do you do? - Correct Answer -contact CPS What are the 2 most important aspects of interviewing an adolescent? - Correct Answer -Rapport Confidentiality (explain exceptions) How should an adolescent be interviewed - Correct Answer - separately form parents If an adolescent is dating someone the same age, do you need to tell the parents? - Correct Answer -No If an adolescent is dating someone of the same gender, do you need to tell the parents? - Correct Answer -No What should you ensure before discharging a patient from the hospital? - Correct Answer -Support system (safety) Should a patient be interviewed in a day room? - Correct Answer -No (not confidential) When do you draw a T3 or T4 - Correct Answer -If TSH is abnormal What symptom occurs with high levels of ammonia? - Correct Answer -confusion What 4 symptoms are similar with serotonin syndrome and NMS? - Correct Answer -Hyperthermia Diaphoresi s Tachycard ia Altered LOC Thoughts of self-harm are greatest in what 5 disorders (according to order) - Correct Answer -MDD BPD Alcohol use disorder Eating disorder schizophrenia What is a long-term side effect of the anti-emetic metoclopramide (Reglan)? - Correct Answer -TD Are oral contraceptives inducers or inhibitors? - Correct Answer -inducers A person with pressure speech is most likely to have - Correct Answer -bipolar disorder If you can identify why a person is depressed, what is their mostly likely diagnosis? - Correct Answer -Adjustment disorder with depressed mood Can tics be a normal behavior? - Correct Answer -yes What are the 2 primary deficits in Cortical Dementia? - Correct Answer - Languag e Memory Language and memory are the 2 primary deficits in which type of dementia? - Correct Answer -Cortical Motor and behavioral (depression, irritability, apathy) are the 2 primary deficits in which type of dementia? - Correct Answer - Subcortical What are the 2 primary deficits in Subcortical Dementia? - Correct Answer -Motor