LMR Georgette's PMHNP Certification Exam/632Questions And Answers 2023-2024 Graded A+, Exams of Nursing

Download LMR Georgette's PMHNP Certification Exam/632Questions And Answers 2023-2024 Graded A+ and more Exams Nursing 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) What is the primary organ where valproic acid is toxic? - Correct Answer -Liver (hepatoxicity) What are 4 signs of hepatoxicity? - Correct Answer -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 - Correct Answer -Hepatoxicity What is the therapeutic range for valproic acid? - Correct Answer -50- 125 mcg/ml What is a toxic level of valproic acid? - Correct Answer ->150 mcg/ml What are 4 signs of valproic acid toxicity? - Correct Answer - Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? - Correct Answer -Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? - Correct Answer -DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? - Correct Answer - Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? - Correct Answer -Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? - Correct Answer -Fever Body aches Severe red rash Peeling skin Facial and tongue swelling 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 Which 3 drugs can increase lithium levels by decreasing renal clearance? - Correct Answer -NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? - Correct Answer -1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? - Correct Answer -1.3 mEq/L or higher With suspected lithium toxicity, what do you do first? - Correct Answer -Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? - Correct Answer -DC lithium Check lithium level What 2 conditions can increase lithium levels? - Correct Answer - Dehydration Hyponatremia What birth defect can lithium cause? - Correct Answer -Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? - Correct Answer -DNS What 3 parts of the brain are affected with ADHD? - Correct Answer - Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? - Correct Answer -ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? - Correct Answer -Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? - Correct Answer -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 - Correct Answer -GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? - Correct Answer -20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? - Correct Answer -20 x daily dose What does thought process assess? - Correct Answer -thoughts and ideas Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? - Correct Answer - Negative symptoms Depressive symptoms The nigrostriatal pathway modulates - Correct Answer -motor movements Dopamine has what type of relationship with acetycholine - Correct Answer -Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? - Correct Answer -Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to - Correct Answer - Increased prolactin What are 5 symptoms of hyperprolactinemia? - Correct Answer - Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long- term) What antipsychotic has the greatest effect on prolactin? - Correct Answer -Risperidone What is the black box warning for carbamazepine? - Correct Answer -Agranulocytosis What are 8 symptoms of aplastic anemia? - Correct Answer - Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of - Correct Answer -Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? - Correct Answer -Asians 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 SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? - Correct Answer -Therapy What type of therapy is used in the treatment of Conduct Disorder? - Correct Answer -Behavioral therapy What is Multisystemic family therapy? - Correct Answer -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)? - Correct Answer -Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? - Correct Answer -Multisystemic family therapy What is the moderate range for MMSE - Correct Answer - 10-20 What is the moderate range for SLUM? - Correct Answer -10-20 What is the moderate range for HAM-D? - Correct Answer -14-18 What is the moderate range for PHQ-9 - Correct Answer -10-14 What is the moderate range for BDI? - Correct Answer -19-29 What is the moderate range for HAM-A? - Correct Answer -18-24 What is the moderate range for GAD-7 - Correct Answer -10-14 What is the moderate range for COWS? - Correct Answer - 13-24 If a patient's COWS score is between 5 - 12, what do you do? - Correct Answer -Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? - Correct Answer -Administer buprenorphine (Suboxone) 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) Extreme muscular rigidity, Mutism, Elevated CPK (creatine phosphokinase), Myoglobinuria, Leukocytosis, and Elevated LFTs are symptoms of - Correct Answer -NMS What are 2 symptoms of Serotonin Syndrome? - Correct Answer -Hyperreflexia Myoclonic jerks Hyperreflexia and myoclonic jerks are symptoms of - Correct Answer -Serotonin Syndrome How do you treat NMS? - Correct Answer -DC antipsychotic Bromocriptine or Dantrolene What does Dantrolene treat in NMS? - Correct Answer -Muscle rigidity How do you treat Serotonin Syndrome? - Correct Answer -DC Antidepressant Cyproheptadine What combination medications increases the risk of Serotonin Syndrome - Correct Answer -multiple antidepressants (SSRI/SNRI/TCA/MOAI) When switching from an MAOI to SSRI/SNRI, how long should you wait? - Correct Answer -2 weeks When switching from Prozac to an MAOI, how long should you wait? - Correct Answer -5-6 weeks When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? - Correct Answer -5-6 weeks When switching from an SSRI/SNRI to a MAOI, how long should you wait? - Correct Answer -2 weeks What is the function of compulsions in OCD? - Correct Answer - Reduce subjective anxiety level What is PANDAS? - Correct Answer -Pediatric Autoimmune Neuropsychiatric Disorder associated with streptococcal infections in children If a child has both intrusive thoughts and tics, his most likely diagnosis is - Correct Answer -OCD If a child has multiple tics both no ruminating thoughts, his diagnosis is most likely - Correct Answer -Tourette's What 2 neurotransmitters are associated with OCD? - Correct Answer -Serotonin Norepinephrine A childhood depressive disorder that is diagnosed in children older than 6 but younger than 18 is most likely - Correct Answer -DMDD A child with chronic dysregulated mood ("mood"), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? - Correct Answer -DMDD The age criteria for a DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) is - Correct Answer ->6 and <18 (7- 17 yrs.) A child who is chronically "moody" is most likely to have what diagnosis? - Correct Answer -DMDD What are 2 symptoms associated with lead poisoning? - Correct Answer -Developmental delay (learning difficulties) Pica (paint chips) also gastrointestinal Which 2 demographic characteristics are associated with lead poisoning? - Correct Answer -rural areas 1970's A child with developmental delay who eats things (such as paint chips) may have - Correct Answer -Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? - Correct Answer -BMI Hip-to-waist ratio Glucose Lipid panel Where is norepinephrine produced? - Correct Answer -Locus coeruleus Medullary reticular formation The neurotransmitter produced in the locus coeruleus and medullary reticular formation is - Correct Answer -Norepinephrine 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 Singl e Whit e Male What are 5 physical characteristics of Anorexia Nervosa? - Correct Answer -Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? - Correct Answer -Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa - Correct Answer - Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? - Correct Answer -Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? - Correct Answer -Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? - Correct Answer - Intrusive re- experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD - Correct Answer - SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? - Correct Answer -EMDR CBT What are the 12 components/symptoms of the COWS? - Correct Answer -Pulse Sweating Restlessnes s Pupil size 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 What are 3 characteristics of Structural Family Therapy? - Correct Answer - Hierarchie s Boundarie s Genogra ms 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 Answer - 18-25 What is the onset of schizophrenia in females? - Correct Answer -25-35 What question should ask schizophrenic patients at each visit? - Correct Answer -SI What is the most likely diagnosis in a patient with homicidal ideation? - Correct Answer -Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? - Correct Answer -All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? - Correct Answer -Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? - Correct Answer -Prefrontal cortex Amygdala Hippocamp us What is Assertive Community Treatment (ACT)? - Correct Answer - Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to - Correct Answer -Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? - Correct Answer -No Which services can be provided in the home for SMI patients? - Correct Answer -Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? - Correct Answer -Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? - Correct Answer -Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? - Correct Answer -Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? - Correct Answer -20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? - Correct Answer ->100 mg (administer weekly if necessary) What class of drugs are primarily inhibitors? - Correct Answer - Antibiotics How does erythromycin and clarithromycin affect CYP240? - Correct Answer -Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? - Correct Answer -Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? - Correct Answer -Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? - Correct Answer - Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? - Correct Answer -Insomnia Tremors Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations) A patient who c/o pain after eating, bloating and fullness, what do you suspect? - Correct Answer -Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? - Correct Answer -Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? - Correct Answer -H2 antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? - Correct Answer -Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) What is a common side effect of SSRIs in the older population - Correct Answer -Anxiety What is a paradoxical effect of benzodiazepines? - Correct Answer - Increased anxiety (avoid in future) 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 diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? - Correct Answer - Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? - Correct Answer -Reactive Attachment Disorder A disorder that presents like PTSD, but symptoms last less than a month is most likely to have - Correct Answer -Acute Stress Disorder What is the required duration for a DSM-5 diagnosis of GAD? - Correct Answer -6 months How does a panic attack differ from Panic Disorder? - Correct Answer - acute, impending doom How does Panic Disorder differ from a panic attack? - Correct Answer -Chronic, recurrent, unexpected How do you treat a patient with panic disorder who is taking albuterol for asthma? - Correct Answer -SSRI or benzodiazepine (don't give beta blocker) What is the treatment of choice for acute symptoms of panic disorder? - Correct Answer -Beta blocker (not addictive) How do you treat test anxiety for maintenance therapy? - Correct Answer -SSRI How do you treat text anxiety acutely? - Correct Answer -Beta blocker Benzodiazepine What structure of the brain is involved with attention, executive function, and cognitive processes (working memory, problem solving) that affects ADHD? - Correct Answer -Dorsolateral prefrontal cortex Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? - Correct Answer -prefrontal Dysfunction of the prefrontal cortex is most likely in what type of ADHD? - Correct Answer -Inattentive What do you recommend to a mother of a child with ADHD as an 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) If a child does not respond or open or closed-ended questions, what to you do? - Correct Answer -talk to parents 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 exam What is Disseminated Encephalomyelitis and what are 3 symptoms? - Correct Answer -Autoimmune viral infection - children Paresthesia symptoms (13 or higher) If a patient scores 13 or higher on the COWS scale during opiate withdrawal, what do you do? - Correct Answer -Administer buprenorphine/naloxone (Suboxone) Why should methadone not be used to treat opiate withdrawal? - Correct Answer -Arrhythmias Which benzodiazepine is used most often to treat alcohol withdrawal? - Correct Answer -Diazepam (longer half-life) If a patient with liver dysfunction or hepatitis is undergoing alcohol withdrawal, what benzodiazepine should he receive? - Correct Answer -Lorazepam If a patient presents with opiate withdrawal, what should you do? - Correct Answer -Refer to residential center to administer protocol (don't initiate in outpatient setting) If a pregnant patient presents with opiate withdrawal, what do you do? - Correct Answer -Refer to residential center (not CPS) What are 4 symptoms/categories of alcohol withdrawal? - Correct Answer -CNS activation: Hand tremor, insomnia, psychomotor agitation, anxiety, seizures) Autonomic hyperactivity (sweating, increased HR/BP) N/V Hallucinations/illusions What do you suspect when a patient presents with CNS activation (hand tremor, insomnia, anxiety, psychomotor agitation, seizures) and Autonomic hyperactivity (sweating, increased HR, increased BP) and N/V and hallucinations/illusions? - Correct Answer -alcohol withdrawal What are 7 symptoms/categories of opioid withdrawal? - Correct Answer -Muscle cramps, Bony aches Diarrhea/abdominal cramps Rhinorrhea, Lacrimation Goosebumps Pupil dilation Increased BP/HR Yawning What do you suspect when a patient who presents with muscle cramps, bony aches, diarrhea/abdominal cramps, rhinorrhea, lacrimation, goosebumps, Respect Fairness (according to gender, orientation, or ethnicity) is what ethical principle? - Correct Answer -Justice "Doing no harm" to the patient is what ethical principle? - Correct Answer -Nonmaleficence Discontinuing a medication that causes side effects is an example of what ethical principle? - Correct Answer -Nonmaleficence Denying a benzodiazepine to a patient with a SUD is an example of what ethical principle? - Correct Answer -Nonmaleficence "Doing good" and promoting well-being is what ethical principle? - Correct Answer -Beneficence Giving a patient a medication to treat symptoms is an example of - Correct Answer -Beneficence Being true and loyal is what ethical principle? - Correct Answer - Fidelity "Telling the truth" is what ethical principle? - Correct Answer -Veracity Allowing the patient to "do for self" is what ethical principle? - Correct Answer -Autonomy A patient's right to refuse medication is an example of what ethical principle? - Correct Answer -Autonomy Treating everyone with equal respect is what ethical principle? - Correct Answer -Respect Collecting data or conducting a survey is an example of - Correct Answer -assessment What is an important role to play as a client advocate? - Correct Answer -reduce stigma What is the best way to reduce stigma? - Correct Answer -Education (esp. large audience) just culture - Correct Answer -A work environment that improves patient safety through continuous learning 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