LMR Georgette's PMHNP Certification Exam632Questions And Answers, Exams of Nursing

Download LMR Georgette's PMHNP Certification Exam632Questions And Answers 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 Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of - Correct Answer -Stephen's Johnson Syndrome 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 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 Calculation 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 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 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) 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 Hippocampus 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 Leukocytosis Elevated LFTs 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 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 (Caucasian) What 4 demographic characteristics are risk factors for suicide? - Correct Answer -45 and older Single White 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 Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability 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 Agitation 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 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 -Hierarchies Boundaries Genograms Hierarchies, Boundaries, and Genograms are characteristics of what therapy? - Correct Answer -Structural Family Therapy Genograms are used in which 2 family therapies? - Correct Answer -Family system therapy Structural therapy What type of therapy should be performed when a patient presents with a cultural syndrome? - Correct Answer -Brief supportive therapy What type of therapy should be used in a patient who has just lost their job? - Correct Answer -Brief supportive therapy What is the most important concept in working with patients from different cultues? - Correct Answer -Respect What should you teach a patient interested in meditation? - Correct Answer -muscle relaxation How to Mexican American's view mental illness? - Correct Answer -An imbalance between an individuals' relationship with the world Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? - Correct Answer -Native American Which ethnic group has the highest incidence of suicidal attempt and completion? - Correct Answer -Native American Cultural syndrome is - Correct Answer -A culturally expected response to a stressor A culturally expected response to a stressor is called - Correct Answer -Cultural Syndrome How should multicultural teaching be conducted? - Correct Answer -Ethnospecific If a patient is regularly taking Kava, what lab should you get? - Correct Answer -LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? - Correct Answer -Fever 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 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 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 A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed - Correct Answer -Valproic acid 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 What is the initial treatment for a patient with dementia and psychosis? - Correct Answer -Nonpharmacologic treatment If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? - Correct Answer -Administer SGA What type of dementia is HIV-related? - Correct Answer -Subcortical What are 3 early signs/symptoms of HIV-related dementia? - Correct Answer -Cognitive deficit Motor abnormalities (decreased coordination) Behavioral symptoms A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? - Correct Answer -HIV-related In a patient with suspected HIV-related dementia, what is your initial action? - Correct Answer -Obtain HIV test What is first-line pharmacologic treatment for a patient with HIV-related dementia? - Correct Answer -Antiretroviral treatment An older adult who has had cognitive impairment for over a year and who tries to answer (may not be able to) or confabulates is most likely to have a diagnosis of - Correct Answer -Dementia An older adult who has had cognitive impairment for less than 5 months and who answers your questions with "I don't know," most likely has a diagnosis of - Correct Answer -Depression (pseudodementia) An older patient who has symptoms of irritability, agitation, hallucinations, and delusions is most likely to have - Correct Answer -Depression (vs. dementia) What are 2 ways to determine whether an older person with decreased memory has depression or dementia? - Correct Answer -SLUMS, Mini-Cog onset of symptoms What screening instrument can hep differentiate dementia from pseudodementia (depression)? - Correct Answer -MMSE A patient with frontal lobe (Pick's) dementia is most likely to present with what 4 symptoms? - Correct Answer -Executive dysfunction Slurred speech (expressive aphasia) Language comprehension (receptive aphasia) 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 Norepinephrine 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 therapeutic factor does open-ended questions instill? - Correct Answer -empathy If only the wife shows up for a couple appointment, what do you do? - Correct Answer -Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? - Correct Answer -Contact CPS Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? - Correct Answer -crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis - Correct Answer -ESR When is an ESR indicated? - Correct Answer -Patient with rheumatoid arthritis What does PICO stand for? - Correct Answer -P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? - Correct Answer -Have access to current journals A baby with a shrill cry is likely to have - Correct Answer -Increased intracranial pressure A sign of increased intracranial pressure in a baby is - Correct Answer -shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? - Correct Answer -That is normal between 3-6 yrs old (Phallic stage) What do you tell an adolescent who is concerned about nipple swelling and tenderness and breast enlargement? - Correct Answer -This is normal between 9-16 yo. It will disappear within 6 mo. How do you treat decreased sexual drive in a older female patient? - Correct Answer -Testosterone (improves blood flow to pelvic region) 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 exam What is Disseminated Encephalomyelitis and what are 3 symptoms? - Correct Answer -Autoimmune viral infection - children Paresthesia 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, 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 Nonmaleficence Fidelity Autonomy Veracity 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) What 3 neurotransmitters are associated with Tourette's? - Correct Answer -DNS (especially DA) What 5 neurotransmitters are associated with bipolar disorder? - Correct Answer -DNS Glutamate (increased) GABA What 2 neurotransmitters are involved with Addictive Disorders? - Correct Answer -DA (decreased) GABA (decreased) What 2 neurotransmitters are involved with OCD? - Correct Answer -5HT (decreased) NE (decreased) What 4 neurotransmitters are associated with schizophrenia? - Correct Answer -DA (increased) Glutamate (increased) GABA (decreased) 5HT (decreased) What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Correct Answer -Glutamate (increased) GABA (decreased) 5HT (decreased) What neurotransmitters are associated with anxiety? - Correct Answer -NE (increased) 5HT (decreased) GABA (decreased) What neurotransmitters are associated with Alzheimer's? - Correct Answer -ACh (decreased) Glutamate (decreased) What neurotransmitters are associated with Parkinson's Disease? - Correct Answer -DA (decreased) ACh (Increased) What 4 psychiatric disorders have dysregulation of dopamine, norepinephrine, and serotonin (DNS)? - Correct Answer -ADHD MDD BPD Tourette's 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)