LMR Georgette’s PMHNP Certification Exam 2024 Questions and Correct Answers (Verified), Exams of Nursing

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LMR Georgette’s PMHNP Certification Exam 2024 Questions and Correct Answers (Verified) 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 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 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 -Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? - Correct Answer -After a stressful experience (suddenly) 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 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 (Caucasian) What 4 demographic characteristics are risk factors for suicide? - Correct Answer -45 and older What is appreciative inquiry? - Correct Answer -An approach to organizational change which focuses on strengths rather than weaknesses What are the 3 goals of Quality Improvement? - Correct Answer - Projects designed to improve systems, decrease cost, and improve productivity Projects designed to improve systems, decrease cost, and improve productivity are called - Correct Answer -Quality Improvement The process/strategy of Quality Improvement is called - Correct Answer -PDSA Cycle Plan Do Study Act The PDSA Cycle is - Correct Answer -The process/strategy of Quality Improvement The 4 components of Health Policy are - Correct Answer - Process Policy reform Policy environment Policy makers Process, Policy reform, Policy environment, and Policy makers are the 4 components of - Correct Answer -Health Policy What is 3-part "process" component of Health Policy? - Correct Answer -Formulation, Implementation, and Evaluation (FIE) Formulation, Implementation, and Evaluation (FIE) are - Correct Answer -The "process" component of Health Policy What is the "policy reform" component of Health Policy? - Correct Answer -Changes in programs and practices Changes in programs and practices in Health Policy is called - Correct Answer -Policy Reform What is the "policy environment" component of Health Policy? - Correct Answer -The arena the process takes place in (government, media, public) The arena the process takes place in (government, media, public) is what component of Health Policy? - Correct Answer -Policy environment What is the "policy makers" component of Health Policy? - Correct Answer -Key players and stake holders -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 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 What is malingering? - Correct Answer -Feigning illness for secondary gain ($) (not a psychiatric diagnosis) A patient who claims disability or worker's comp when there is no injury is most likely - Correct Answer -Malingering (not a psychiatric 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) 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 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 - What is Disseminated Encephalomyelitis and what are 3 symptoms? - Correct Answer -Autoimmune viral infection - children Paresthesia Fatigue Asymmetric body movement of extremities If a patient is unable to remember events, how do you establish a diagnosis? - Correct Answer -Provide anchor (memorable events) to establish diagnosis How do you implement policy affecting NPs nationwide? - Correct Answer -Host online forum/give survey to obtain information (vs. letters) How do you implement policy coworkers are against? - Correct Answer -Tell them how the policy will increase quality of patient care What is the initial step in providing continuous improvement of Quality of Care in an outpatient setting? - Correct Answer -Create an instrument to monitor outcomes What will you see in a laboratory test in a patient with an autoimmune disease? - Correct Answer -Increased cytokine levels Increased cytokine levels on a laboratory test suggests what disease? - Correct Answer -autoimmune What are 2 ways to treat enuresis (night-time bedwetting)? - Correct Answer -Alarm clock Desmopressin (DDAVP) An alarm clock and Desmopressin (DDAVP) are 2 methods to treat - Correct Answer -Enuresis What is the mechanism of action of Desmopressin (DDAVP)? - Correct Answer -Decreases urine production (via antidiuretic hormone - vasopressin) When considering the relationship between receiving samples from a drug rep or sponsored education, what should consider and what should you do? - Correct Answer -Conflict of Interest Create policy to address COI A conflict of interest may occur in what 2 scenarios? - Correct Answer -Receiving samples of drug rep Attending an industry sponsored educational program 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 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 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 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) 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 -Language 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