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

Download LMR Georgette’s PMHNP Certification Exam Latest Questions and Correct Answers 2024 and more Exams Nursing in PDF only on Docsity! LMR Georgette’s PMHNP Certification Exam Latest Questions and Correct Answers (Verified) 2024 What are assessed in the Thought Content of the MSE - ANSWER>>SI/HI, Plan, Hallucinations • PNEUMOIC - Old Age Parents Love Grandchildren - ANSWER>>• Oral (0-18 months), Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +) • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3- 6 years old - ANSWER>>• 3-year-old masturbates, play with self, says naughty things • This is NORMAL for children this age. What do you do when a patient has an increased prolactin level? - ANSWER>>• Stop prolactin (stop the agent that cause increase prolactin) • ACUTE STRESS DISORDER - ANSWER>>• A d/o resulting from exposure to a major stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP to ONE MONTH - Less than 1 month. • If LONGER than 1 month = PTSD - Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder What would you do if a 5-year-old tells you his brother sodomized him? - ANSWER>>• Tell mom don't leave him alone with patient and call CPS implement crisis If a child is playing with doll in a sexual way, what do you do first? - ANSWER>>• You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH another provider that is the same as you (ie psych) - you must refer to a neurologist or another specialist or PCP What is a priority consideration for a 16-year-old that shows up with mother for first therapy? - ANSWER>>• Confidentiality (ex. mom sits in lobby) What is important to know about ACE inhibitors (Meds for Heart failure/HTN) - ANSWER>>• This medication can cause increased lithium levels to toxic levels - must collaborate with PCP to determine whether to change ACE or change Lithium - Can't use both What medication INCREASES Lithium serum level up to double - ANSWER>>Ibuprofen Why is Lithium used? - ANSWER>>• First-line neuro-protective for bipolar • Lab Values concerning for patient on Lithium: - ANSWER>>• Leukocytosis • Creatinine • BUN • NA+ • 4 + PORTEIN in Urine • + Pregnancy Test • Lithium (Eskalith/Lithobid) Toxicity - ANSWER>>• Normal Range of LITHIUM LEVEL - 0.5 - 1.2 mEq/L • MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l • Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic taste and SEVERE tremor. Common side effects of Lithium (Eskalith/Lithobid) - ANSWER>>Nausea, fine-hand tremors (start monitoring for toxicity), increased urination and thirst What pregnancy category is Lithium (Eskalith/Lithobid) - ANSWER>>CATEGORY D: AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect What increases risk of lithium (Eskalith/Lithobid) toxicity? - ANSWER>>NSAID, dehydration and Thiazides What co-morbid risk in increased with Lithium (Eskalith/Lithobid)? - ANSWER>>• Risk of Hypothyroidism What do symptoms of hypothyroidism (decreased T4 & increased TSH) mimic? - ANSWER>>Unipolar mood disorders: - confusion - decreased libido - impotence - decreased apetite - memory loss - lethargy - constipation - headaches - slow or clumsy movements - syncope - weight gain - fluid retention - muscle aches and stiffness - slowed reflexes - somatic discomfort including aching and joint stiffness - slowed speech and thinking - sensory disturbances including hearing - cerebellar ataxia (may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements) - loss of amplitude in ECG What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic? - ANSWER>>Bipolar affective disorders - motor restlessness - emotional lability - short attention span - compulsive movements - fatigue - tremor - insomnia - impotence - weight loss - increased appetite - abdominal pain - excessive sweating - flushing - elevated upper eyelid leading to decreased blinking, starring, and fine tremor - tachycardia - dysrhythmias What does ADPIE stand for? - ANSWER>>• Assessment • Diagnosis • Planning • Implementation • Evaluation Recommend CBT for - ANSWER>>Depression & Anxiety (keep a daily log) pg 209 and every PB pages for each dx - ANSWER>>all thing for each disorder • BMI less than 18.5 • BMI < 16 = AUTOMATIC ADMISSION • An eating disorder in which an irrational fear of weight gain leads people to starve themselves • Anorexia admission criteria for hospitalization - Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L). • Set up family therapy (especially adolescent pts since they have no control over food choices) • ANOVA (analysis of variance) - ANSWER>>• 3 or more • An inferential statistical test for comparing the means of three or more groups PROZAC Causes What? - ANSWER>>• Increase Anxiety in Elderly • Apoptosis - ANSWER>>• Cell death in aging/elderly • Appreciative inquiry - ANSWER>>• An organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work • An organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements • Discovery (best of what is) • Dream (wishes or dreams of organization) • Design (decide what you want to change) • Destiny (make it happen, implanting change) • Identify the problem • Analyze the problem • Generate solutions • Implement best solution • Assertive Community Treatment (ACT) - ANSWER>>• Community-based programs that provide many of the services that are necessary for successful community living; include case management, problem solving, social skills training, support teaching on a 24/7 basis • Assertive questions - ANSWER>>• Use "I want", "I need", or "I feel" to convey basic assertions and get your point across firmly. For example "I feel strongly that we need to bring in a third party to medicate this disagreement" another example "Dave, your request has caught me off guard. I'll get back to you within the half hour". Transtheoretical Model of Change - ANSWER>>• States that change such as in health behaviors occurs in six predictable stages • Precontemplation: The person has no intention to change. • Contemplation: The person is thinking about changing; is aware that there is a problem but not committed to changing. • Preparation: The person has made the decision to change; is ready for action. • Action: The person is engaging in specific, overt actions to change. • Maintenance: The person is engaging in behaviors to prevent relapse. erectile dysfunction medications - ANSWER>>• Avanafil (Stendra) 15 minutes prior to sex • Tadalafil (Cialis) 45 minutes prior to sex • Vardenafil (Levitra) 45 minutes prior to sex • Sildenafil (Viagra) 1 hour prior to sex - brand-name version of the generic drug. It is a phosphodiesterase type 5 (PDE5) inhibitor. • Beck depression inventory - ANSWER>>• A questionnaire useful for determining the level of depression • 0-13 minimal depression • 14-19 mild depression • 19-29 Moderate depression • 30-63 severe depression Intimate therapy for child with a score 10 Big Freaking Problems - ANSWER>>• Bupropion Fluoxetine Paxil • Those are strong inhibitors of 2D6 • Borderline personality disorder treatment - ANSWER>>• Dialectical behavior therapy If a boy patient states that he wishes to be a girl and tells you not to tell his parent, what do you do? - ANSWER>>Don't tell If you see a bruise on the padded part of patient's arm, what do you do? - ANSWER>>• Say I see you have bruises on your arm • Ask what happened • Can an advanced directive ever be revoked? - ANSWER>>• Yes, at any time Can asthma medications cause depression? - ANSWER>>• Yes • Examples: INTERFERON • Co-morbidities of bipolar - ANSWER>>• Anxiety, alcohol and substance abuse • Inducer; Pushes the substrate out of the exit pathways, < the serum level of other drugs, < therapeutic effect. - ANSWER>>I'll Come See Pumpkin Pie Tomorrow or Monday And Chow • Carbamazepine/Oxcarba (1A2, 2C19 and 3A4) • St. John's Wart (3A4) • Phenytoin • Phenobarbital • Tobacco (1A2) • OCP (1A4) (watch with use of Topamax/Tegretol) • Methadone (1A2) • Antiretroviral • Cyclosporine Or Bull Shit CRAPGPS • Barbiturates • St. Johns Wart • Carbamazepine • Rifampin • Alcohol (chronic use) • Phenytoin • Griseofulvin • Phenobarbital • Sulfonylureas • Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion, Increase the serum level of other drugs, Increase toxic risk - ANSWER>>Sickfaces.com • Sodium Valproate • Isoniazid • Cimetidine • Ketoconazole • Fluconazole • Alcohol • Chloramphenicol • Erythromycin • Sulfonamides • Ciprofloxacin • Omeprazole • Metronidazole Plus Grapefruit juice • DBT (Dialectical behavior therapy) - ANSWER>>• Relaxation muscle prior to DBT • Borderline Patients - NO meds - DBT therapy what therapy uses a diary log - ANSWER>>• CBT what medication is used for ENURESIS - ANSWER>>• DDAVP (Desmopressin) Works in the SAME manner of ANTIDIEURTIC HORMONE • Makes less urine - Used for ENURESIS what medications increase INR? - ANSWER>>Depakote and Disulfiram What medication causes Spina bifida? - ANSWER>>Depakote, so check HCG level • DIGFAST for Mania - ANSWER>>• Distractibility • Indiscretion • Grandiosity • Flight of ideas • Activity increase • Sleep deficit involuntary contractions of the face and neck muscles and can be painful. - akathisia: Once the patient has been taking an antipsychotic for a few days, they can start to experience another side effect of consistently feeling restlessness or jittery - Parkinsonism: typically occur withing a few weeks after starting an antipsychotic. Parkinsonism can include muscle motor deficits such as rigidity, postural shuffle, tremors, a shuffling gait, and difficulty initiating movements - tardive dyskinesia: Long term continuation of antipsychotics for three months or more, which can sometimes be irreversible if it is not attended to quickly enough. Symptoms of tardive dyskinesia can include involuntary rhythmic movements such as grimacing, lip smacking, chewing, tongue flicking, as well as excessive eye blinking what mood stabilizer is least cause metabolic syndrome - ANSWER>>lamictal depakote can cause - ANSWER>>hepatoxicity (liver) = RUQ pain & reddish brown urine valproic acid - ANSWER>>range is 50 - 125, toxicity is greater than 150 depakote toxicity - ANSWER>>confusion, lethargy, and respiratory depression - do you liver function test - check ammonia levels - increase ammonia causes confusion patients taking Kava for anxiety or insomnia need? - ANSWER>>A liver function test, can cause hepatoxicity there is a drug to drug interaction with kava and Benzodiazepines TCA can cause - ANSWER>>hepatoxicity - give cyproheptadine *NDRIs (Wellbutrin) do not increase serotonin levels How long should you wait to switch medications that are serotonin meds - ANSWER>>2 weeks (ex. SSRIs to MAOI) wait 5-6 weeks for fluoxetine to MAOI *prozac has a long half life Why are SSRIs first line? - ANSWER>>They are safer and less potential for causing injury with potential overdose depression + cancer, give what meds - ANSWER>>Give a SSRI like citalopram or escitalopram because they have less potential for drug to drug interactions depressed + neuropathic pain - ANSWER>>SNRI - duloxetine (Cymbalta) TCAs Gabapentin Schizophrenia - ANSWER>>Age on onset: 18-25 in males 25-35 in females - the dx has the highest rate of dx's that increases risk for self harm - even more than depression or bipolar - can aggression, impulsivity, abstract thinking problems, - changes or abnormalities in the prefrontal cortex, amygdala, basal ganglia, hippocampus, and limbic regions of the brain can cause aggression & impulsivity - MRI/PET will show a decrease in size of the lobes of the brain, and an INCREASE is the ventricles d/t increased cerebral blood flow - Do not give stimulants - increased dopamine - positive symptoms of schizo is due to too much dopamine - Tx: - assertive community treatment - Long term non-compliance of meds then should refer to ACT team (ACT is a form or rehabilitation post hospitalization in the home) - social skills rehabilitation (is a tertiary level of prevention) - refer to exercise program (aerobic exercises can help improve cognition and quality of life and long term health what is the dx that increases HI the most - ANSWER>>antisocial personality disorder How do you calculate dose of monthly IM haldol - ANSWER>>You multiply their daily dose by 20 ex. if a PT is taking 5mg BID, you would multiply 10X20= 200 but you can only give 100mg, so give 100mg and tell them to come back in two weeks for their other 100mg What is a delusion? - ANSWER>>Is the false belief firmly maintained despite the evidence to the contrary (ex. their family member is part of a cult) Mini Mental Status Exam - ANSWER>>Thought process - you want to assess your PT's thoughts if they are normal or abnormal - organization of thoughts Tangential thinking- Thought process - ANSWER>>the patient never gets to the point. they move from thought to thought with never getting to the point Circumstantial thinking - thought process - ANSWER>>a PT goes in circle and provide unnecessary details before getting to the point What is another name for the MMSE - ANSWER>>Folstein Scale What areas of the brain does the clock function test target? - ANSWER>>If cannot draw the clock it can indicate a problem with the right hemisphere/right parietal lobe Hyperactivity of dopamine in the mesolimbic pathway mediates what type of psychotic symptoms - ANSWER>>positive symptoms = mesolimbic pathway decreased dopamine in the mesocortical projection to the dorsolateral prefrontal cortex is postulated to be responsible for what types of schizophrenia symtoms? - ANSWER>>negative and depressive symptoms = mesocortical pathway What are the positive symptoms of schizophrenia? - ANSWER>>delusions, hallucinations, disorganized speech, disorganized or catatonic behavior What are the negative symptoms of schizophrenia? - ANSWER>>flat affect, social withdrawal, lack of motivation, lack of speech or thought, anhedonia Akathisia - ANSWER>>restlessness, pacing, difficulty standing, feet constantly in motion (rocking) TX: - beta blocker - propranolol (first line) - avoid giving beta blockers to PT's taking bronchodilators like albuterol (since beta blockers can cause bronchospasm) - anticholinergics (cogentin) 2nd line - benzodiazepines (3rd line) Akinesia - ANSWER>>Absence of movement, difficulty initiating motion, subjectively feeling lack of motivation to move - often mistaken for laziness or lack of interest TX: cogentin peusdo-parkinsonian symptoms - ANSWER>>Presence of symptoms of Parkinson's disease produced by D2 blockade - muscle rigidity - shuffling gait - motor slowing - mask-like facial expression - pill rolling, tremors in fingers - cog wheel rigidity TX: - cogentin *mask-like facial expression often confused as affective blunting or flattening Tardive dyskinesia (TD) - ANSWER>>involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that progress to limbs; can be irreversible - protrusions and rolling of the tongue - lip smacking and sucking - chewing motion/grinding of the teeth - facial dyskinesia - involuntary movement TX: is to either stop the offending antipsychotic, reduce the dose, or switch to clozapine (clozapine can help tx TD) * COGENTIN should NOT be used as it could worsen symptoms - can take 1-2 years to occur - can occur as an acute process at initiation of medications or as a chronic condition at any point in tx - Reglan (metoclopramide) or Compazine can cause TD Reglan (metoclopramide) or Compazine can cause what? - ANSWER>>Tardive dyskinesia, don't take with antipsychotics Inducers do what? - ANSWER>>Decrease - in"D"ucers = Decrease - smoking (not nicotine lozenges or gum, the actually smoking) - (ex. If you have a PT started on X dose of antipsychotic, and then come back to the follow up and says they start smoking, you should increase the dose of X because smoking decreases the serum levels. If they stop smoking, then decrease the dose the again) Inhibitors do what? - ANSWER>>Increase - in"H"ibitors = High what do you need to consider with Tegretol? - ANSWER>>There is a warning if you are giving it with erithromycin or clarithromycin because they are an inHibitor so it will make the Tegtrol have higher serum levels, so you must decrease the dose of tegretol - High levels of tegretol can cause mania and psychosis what medications can cause mania - ANSWER>>- steroids (steroids can also cause psychosis) - disulfiram (Antabuse) - isoniazid (INH) - antidepressants in persons with bipolar disorder what medications can cause depression - ANSWER>>- steroids (steroids can also cause psychosis) - beta blockers - interferon - isotretinoin (accurate) - some retroviral drugs - antineoplastic drugs - benzodiazepines - progesterone What should you consider if your patient is on a mood stabilizer like depakote, oxcarbazepine, or lithium and the PCP starts them on Flonase or prednisone? - ANSWER>>The Flonase or prednisone has steroids so they can be worsening the mood symptoms, so you must make adjustments on the mood stabilizers. - blindness - paresthesia (numbness and tingling) - adjustment disorder - ANSWER>>The PT is unable to adjust to a change. (dx of medical condition, child dx with illness, loss of job) - If they develop depression (adjustment dx with depression) - if they have anxiety (adjustment disorder with anxiety) How long does adjustment disorder take to develop - ANSWER>>Within 3 months difference between adjustment disorder and MDD - ANSWER>>If your PT presents with depressed mood, and the questions identifies a reason for the depressed mood (identifiable stressor), its likely adjustment disorder adjustment dx with mixed disturbance of emotions and conduct - ANSWER>>Common with children, maybe the child lost a loved one or their parents got divorced - child cries alot - unable to sleep - peer conflict - verbal altercations - truancy factitious disorder - ANSWER>>Caused when PT or people introduce toxic things to their body to make themselves sick (drinking urine) malingering - ANSWER>>When someone is faking illness for gain (will not be on the test, no longer in the DSM but may be used as a distractor) factitious disorder imposed on another - ANSWER>>a condition in which one person induces illness symptoms in someone else - parents fakes that their child sick (must report to CPS, a form of abuse) Oppositional Defiant Disorder (ODD) - ANSWER>>- defiant - doesn't want to follow request or rules - do things do deliberately annoys others TX: - family and child Mgt skills - teach parenting skills - positive reinforcement - boundary setting - can progress to conduct disorder Conduct Disorder (CD) - ANSWER>>PT must be at least 18 y/o to be dx with a personality disorder, so over 18 is anti-social personality dx under 18 = conduct dx - very aggressive - lack of remorse (can inflict pain on other without being remorseful) TX: Therapy to target mood and agression - behavior and family therapy Medications - mood stabilizers - antipsychotics - SSRI's - Alpha agonists (ex. clonidine/guanaficine) what are the 3 phrases of EMDR - ANSWER>>1. 2. 3. . When PT comes in reporting a traumatic event such as returning from war and lost a friend... what do you do first - ANSWER>>Asess data Panic Attack vs Disorder - ANSWER>>Panic attack is acute and disorder is chronic and has feeling of impending doom To dx tics... - ANSWER>>- at least two motor tics - at least 1 vocal tic both lasting more than a year stimulant medications can cause tics, so assess medications before dx with tics d/c the stimulant even if they are stable if tics develop and give them a non- stimulant it is normal for young children to have tics... (ex. 6 year old having 1 motor tic), the tics should disappear by adulthood TX of tics - guanaficine and clonidine - haldol - pimozide - Abilify Autism Spectrum Disorder - ANSWER>>- deficits in social interaction and communication skills - lack of eye contact - may not respond when called by name - line up their toys in long tidy rows The broken mirror theory of autism - ANSWER>>claims that a dysfunction of the mirror neuron system may be a cause of poor social interaction & cognition in individuals with autism - tries to explain why the child presents in this way delirium - ANSWER>>ACUTE (occurs within hours or days) of sudden disturbances of - level of consciousness - cognition (memory problems) - inattention TX of psychosis and agitation: - Haldol - atypical antipsychotics *if an OLDER female PT (65 or older) presents with delirium, it is important to do an urinalysis with culture and sensitivity, b/c UTI can cause delirium dementia - ANSWER>>CHRONIC, progressive decline in cognitive status (takes months to years to dx) - irritability - personality changes IF you suspect this dx check folic acid levels and Vitamin b-12 types of dementia - ANSWER>>HIV related dementia: subcortical dementia Early signs: - cognitive defect - behavioral and motor abnormalities - lack of coordination IF an IV drug user comes to your office with these early symptoms, test for HIV TX: - antiviral medications to target the primary cause of the cognitive problem Pseudodementia - ANSWER>>The primary dx is depression - when a PT is depressed, they can have memory problems caused by depression - Common in older PTs - Do a cognitive screening when and older PT is depressed (MMSE to screen) *ask PT the onset of the memory problems - if it started months ago think depression - if started years ago think dementia Dementia = lack answers or make up answers Pseudo = answers questions with general responses like " I don't know" Lewy's bodies dementia - ANSWER>>It can cause visual hallucinations Frontotemporal Dementia - Picks disease - ANSWER>>The frontal lobes deals with expressive speech - the most focal area for personality development - slurred speech / language changes - social skills are affected - change in personality and behavior Temporal lobe = speech comprehension Where is norepinephrine produced - ANSWER>>in the locus ceruleus and medullary reticular formation where is serotonin produced - ANSWER>>in the raphe nuclei of the brainstem dopamine - ANSWER>>produced in the substania nigra (regulates motor movements) and the ventral tegmental area (VTA), and nucleus accumbens where is acetylcholine produced - ANSWER>>synthesized by the basal nucleus of Meynert Symptoms of lead poisoning - ANSWER>>developmental delay, learning difficulties, irritability, loss of appetite, weight loss, sluggishness and fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, pica neurotransmitters in mood disorders - ANSWER>>DNS (dopamine, norepinephrine, and serotonin + gaba) Risk factors for osteoporosis - ANSWER>>smoking, caffeine, lack of exercise, lack of Vit D in diet Who made DBT - ANSWER>>marsha linnenhan physical activity - ANSWER>>benefits in children - can improve body image - self esteem - self awareness - self worth - can promote resilience - improve relationship - help with social anxiety what is the best kind of questions for communication - ANSWER>>- open ended questions - use empathy I am sorry this has happened to you how has this affected you? - you don't have to jump right into assessment what questions are best if a child cannot construct a narrative - ANSWER>>if they cannot answer open ended questions then ask closed questions like yes or no then ask their parents to get more information what should you do if a only a husband or wife showed up for a couple's therapy - ANSWER>>reschedule until they are both present how should you prescribe meds to someone who is moving - ANSWER>>if they are stable, give them 2 or 3 months worth until they can establish a new provider if there is no imminent risk Rheumatoid arthriitis - ANSWER>>check ESR level PICOT question - ANSWER>>P- patient population of interest I- intervention of interest C- comparison of interest O- outcome T- time provide evidenced based care by reading current journals what does a shrill cry in infants mean - ANSWER>>intracranial pressure Is it normal to develop swelling on their genitals or Breast swelling in 9- 16 y/o boys - ANSWER>>yes what can cause decreased sex drive in elderly female - ANSWER>>- decreased testosterone - decreased blood flow to the pelvic region alcohol dehydrogenase - ANSWER>>women have a decreased quanity of this enzyme that causes them to get drunk quicker women are more likely to develop liver problem than men lack of enzyme makes it more difficult for the alcohol to metabolize how to normalize grief and loss in children - ANSWER>>- grief responses vary (there is no standard guidelines on how someone is suppose to grieve, do not tell someone how to grieve - what is most important is an intact family system - encourage parents to take child to group therapy to learn coping skills from children who always experienced loss grasp (palmar) reflex - ANSWER>>normal 5-6 months Babinski reflex - ANSWER>>normal up to 2 years PDE5 medications - ANSWER>>these medications are rapidly absorbed after oral administration if a pt has normocytic microcytic anemia - ANSWER>>check - folic acid - vit b 12 - iron levels if a BMI is very low - ANSWER>>think anorexia nervosa BMI within normal limits think bulimia how would you apply the knowledge that you know ADHD adolescents have an increased risk of substance abuse - ANSWER>>you can screen all ADHD kids for substances or screen all SUD kid for ADHD acupuncture - ANSWER>>can be used for pain or depression CIWA >= 15 - ANSWER>>start scheduled meds and PRNs like diazepam, librium, or Ativan check for liver disease first - if they do give Ativan rather than diazepam d/t short life half of Ativan If a PT is pregnant and presents with alcohol or opioid use, what is your priority action - ANSWER>>priority action is to refer that PT to resident tx center & detox first action is NOT to call CPS If a PT presents outpatient with anxiety that is in alcohol withdrawal what is your priority action - ANSWER>>Do not give a benzodiazepine since they will start that in the ED when you refer them to detox, start on non- benzodiazepine altruism - ANSWER>>installation of hope Irvin Yalom Appreciative inquiry - ANSWER>>an approach to organizational change which focuses on strengths rather than weakness reflective practice - ANSWER>>the goal is trying to improve practice - provide feedback - debriefing strategies (you may notice something is wrong that needs to be fixed) what medications can cause insomnia - ANSWER>>most antidepressants - especially prozac to prescribe in the morning scope of practice - ANSWER>>is determined by State legislative statues (state board of nursing) - defines NP roles and actions - varies broadly from state to state when questions ask where you get information - you want to contact your state board of nursing standard of practice - ANSWER>>determined by ANA provide a way to judge nature of care provided Confidentiality - ANSWER>>- client's right to assume that information given to provider will not be disclosed - requires provider to obtain signed medical authorization and consent forms to release medical records and information when requested by client's family or another health care provider Exceptions to confidentiality - ANSWER>>- when appropriate persons or organizations determine that the need for information outweighs the principle of confidentiality - if client reveals intent to harm self or others - information given to an attorney involved in litigations - releasing records to insurance companies - answering court orders, subpoenas, or summons (PREJURY) - meeting states requirements for mandatory reporting of disease or condition informed consent - ANSWER>>communication process between provider and PT that results in the PT's acceptance or rejection of proposed tx. you need to get informed consent before - ANSWER>>you start medications and send a medication to the pharmacy (incase there is someone at the pharmacy they do not want to know their dx) Involuntary tx - ANSWER>>if a PT is so sick they cannot sign consent justice - ANSWER>>doing what is fair; fairness in all aspects of care Nonmaleficence - ANSWER>>do no harm - imminent danger (if a PT asks for a benzo, if you give it then it puts them at risk for addiction and that is harm) Benefience - ANSWER>>doing good; promoting well being fidelity - ANSWER>>faithfulness; loyalty; being true veracity - ANSWER>>truthfulness - PTs need to know the truth about their medical conditions & treatment options autonomy - ANSWER>>PT's right to self determination A new male PT has a 10 yr hx of SUD, MDD, GAD. He is requesting Xanax. which principle should the PMHNP employ moving forward - ANSWER>>Non-malficience rights of PT - ANSWER>>least restrictive environment crisis stabilization vs. inpatient admission the chief nursing officer of a large psych unit approached the PMHNP to discuss the new health effectiveness. she is asked to do a retrospective chart review. what is the PMHNP asked to do - ANSWER>>qualitative improvement initiative (the retrospective chart review is a QI initiative) the PMHNP is responsible for initiating QI at MH clinic, the effective strategy to evaluate the services is for - ANSWER>>(effective strategy is the key word) - a plan to do study act process 4 components of health care policy - ANSWER>>- process: formulation, implementation, anf evaluation (FIE) - policy reform: changes in programs and practice - policy environment: arena the process takes place in (government, media, public) - policy makers: key players and steak holders before implementing evidence-based practice changes, an adult PHMNP's initial action is to - ANSWER>>(ASSESS FIRST) identify potential barriers and facilitators the reflect patient's values and experiences you want to assess & address barriers - ANSWER>>before you meet with the stake holders Tarasoff v. Regents of the University of California (Tarasoffs Principle) - ANSWER>>Duty to warn potential victims of danger (HI) (DOES NOT APPLY IN EVERY STATE, must check with your state board of nursing) Donalson vs O'Connor - ANSWER>>(confinement) it is unconstitutional to commit a person involuntary who is not imminently dangerous to self or others If your PT tells you that her husband just texted her that he wants to commit suicide, what is your priority action - ANSWER>>Get address of the husband and call the police Paiget's Preoperational stage - ANSWER>>(2- 7 y/o) Magical thinking is normal Paiget's formal operational stage - ANSWER>>(12 - adult) - use logic: science project or test hypothesis in science - abstract thinking: solve algebra Which Patient is at the highest risk of suicide? A. 30 y/o married African American female with previous suicide attempt B. 35 y/o single asian male with a previous SA C. 38 y/o single African American male who is a manager of a bank D. 68 y/o single white male with depression - ANSWER>>Count the risk factors: Previous SA is the highest risk factor A. 1 factor - previous SA B. 3 - single, male, SA C. 2 - single, male D. 5 - age, single, white, male, depression A 72 y/o female is brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a hx of HTN and is being treated end in "pril" what medications are used for neuropathic pain? - ANSWER>>- TCA - SNRI - Lyrica - Elavil - Pamelor - Cymbalta what medications specifically should not be stopped abruptly? - ANSWER>>SNRIs/SSRIs They will cause discontinuation syndome when should you stop Tegretol (carbamazepine) or Clozaril immediately - ANSWER>>less than a 1,000 and repeat labs a nurse attacked 3 weeks ago in the parking lot and not into an argument with her boss that same day and is now scared to go to work? what is happening to the nurse? A. a panic dx B. acute stress disorder C. PTSD D. GAD - ANSWER>>B. acute stress disorder if PT tells you at an appointment and tells you she was raped, what is priority - ANSWER>>assure her of being safe in the environment before proceeding with care Priority for a PT that comes into the ER after cutting risk - ANSWER>>first ABC's - check vitals and then safety first Should you interview a 15 y/o PT that reports abuse with their parents present? - ANSWER>>Yes Less than 18 then interview with parents a 16 y/o PT comes in with the parent and her BMI is <16, HR 40, amenorrhea. As the provider you try to admit PT but the parent refuses... what do you do - ANSWER>>Call CPS PT must be admitted and if need to be transferred then use squad If a PT comes in with psychosis, what is priority? - ANSWER>>check urine/toxicology first before anything What would it be called if a PT was not allowed to participate in med trial due to not having insurance? - ANSWER>>Justice - you are violating justice (fairness in all aspect) Which PT's score is most severe for an MMSE score? 17, 20, 30 - ANSWER>>17 - lowest number is most severe what should you do if your PT scores a 27 on the MMSE, and their PCP dx the PT with alzhiemers - ANSWER>>rethink the PCP's dx Can you give erythromycin and tegretol together? - ANSWER>>Yes, but you need to decrease the tegretol level because erythromycin is an inhibitor and will cause a toxic level A PT is treated for schizo with zyprexa, which of the following is most common side effect of zyprexa? A. increased waist circumference B. EPS C. metabolic syndrome D. increased lipids - ANSWER>>C. metabolic syndrome * If a question has more than one correct answer, use the umbrella answer, meaning there may be more than one correct answer option - look for the answer that covers all the choice options what differentiates atypical from typical? A. 5HT2a receptors antagonist properties B. 5HT2a receptor agonist properties C. specific dopamine receptor 3 and 5HT2a blockade D. dopamine receptor 2 antagonist properties - ANSWER>>A. 5HT2a receptors antagonist properties Serotonin antagonism differentiates atypical from typical *There is most of the time a trick for answering questions... if you have 2 answers that are the exact opposite of each other, then one is likely correct - ANSWER>> If a patient presents with the first psychotic episode, you want to place them on what kind of antipsychotic? - ANSWER>>Atypical first such as geode, Invega, IM olanzapine if they are acting out with active psychosis, give IM geodon DO NOT GIVE ORAL, MUST GIVE IM with active psychosis what medication should you give if a PT presents with a dx of delirium with psychosis including paranoid delusions, AH, VH - ANSWER>>give • Hamilton anxiety rating scale (HAP-A) - ANSWER>>• 0-7 normal • 14-18 moderated • > 20 Severe depression • Hamilton D score of 28 - ANSWER>>• Assess for suicide • Health care policy Model - ANSWER>>• Access • Cost • Quality • Health literacy - ANSWER>>• A person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness • Man taking insulin - check literacy by asking him to read blood glucose level • A client with Herpes Zoster - 3 weeks later experiences sleep difficulties and sad mood - ANSWER>>• Adjustment Disorder WITH Depressed Mood (lasts less than 6 months requires only 2 symptoms of depression) • Adjustment D/O ONLY 2 Symptoms - Depression requires 5 + Sx. • Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do? - ANSWER>>Validate his experience and provide care in a culturally specific way to that patient • How are Medicaid benefits determined? - ANSWER>>• State determines qualification- partnership between state and fed govt • Must be impoverished • Must be US resident and low or very low income • How do Asians see HC providers? - ANSWER>>• AS in a position of authority - Expect to give instructions and help make decisions • How do you assess the competency of a medical procedure? - ANSWER>>• Identify a pen and recall 3 words - Mental Status Exam - part of assessing competency • How do you protect from the evil eye? - ANSWER>>• Red ribbon on an infant • Amulet for adults • How do you treat for Evil eye? • Access traditional healer + traditional care • How is tele-psychiatry evaluated? - ANSWER>>• Outcome based • Measure at intervals • How many generations do you included for genogram? - ANSWER>>• 3 generations How to treat a child with depression - ANSWER>>• Zoloft and therapy • Of all the antidepressants, only fluoxetine (Prozac™) has been FDA approved to treat pediatric depression. For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (Prozac™), sertraline (Zoloft™), fluvoxamine, and clomipramine (Anafranil™) • If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? - ANSWER>>• Microalbumin? • If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? - ANSWER>>• Zyprexa • Impulsivity (ADHD) - ANSWER>>• Pre-frontal cortex • Involves hasty actions taken without consideration of possible negative consequences to self or others. It often shows up as a kind of social intrusiveness, such as excessively interrupting others. • Inducers of CYP 450 - ANSWER>>I'll Come See Pumpkin Pie Tomorrow or Monday And Chow • Carbamazepine/Oxcarba (1A2, 2C19 and 3A4) • St. John's Wart (3A4) • Phenytoin • Phenobarbital • Tobacco (1A2) • OCP (1A4) (watch with use of Topamax/Tegratol) • Methadone (1A2) • Antiretroviral • Cyclosporine • Inducers of CYP 450 - ANSWER>>Chronic Alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs • Chronic Alcohol use • St. John's wart • Phenytoin • Phenobarbital • Nevirapine • Rifampin • Griseofulvin • Carbamazepine Inferential statistics : - ANSWER>>Numerical values that enable one to reach conclusions that extend beyond the immediate data alone; generated by quantitative research designs • Kid with nightmares screaming out does not remember the next morning what do you do? - ANSWER>>• Ask about sleep disorder in family • Latuda and Geodon - ANSWER>>• Take with food • Lesion in frontal cortex - ANSWER>>• Impaired cognitive functions • Limbic system - ANSWER>>A donut shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus , amygdala, and hypothalamus A man states his wife was so good if he could only be like her. - What is this - ANSWER>>IDEALIZATION Intellectualization - is a defense mechanism by which reasoning is used to block confrontation with an unconscious conflict • Man working at the Gym and his urine is cherry color - ANSWER>>• Order Myoglobinuria • Medicare A, B, C, D - ANSWER>>• A: inpatient services • B: Outpatient services • C: Private insurance can provide Medicare benefits • D: Drugs • Medication that contradicts Albuterol - ANSWER>>• Sertraline (Zoloft) is used to treat social anxiety disorder and the patient is on albuterol. Therefore the Non-selective Beta blocker Inderal is contraindicated with Albuterol due to the risk of increased CNS stimulation • Mental health parity Act 1996 - ANSWER>>Ensures equal coverage for mental and physical illness equal life time and annual limits • Mesocortical pathway - ANSWER>>• VTA to prefrontal cortex • Reduced dopamine in this pathway cause NEGATIVE symptoms of Schizophrenia • Mesolimbic system - ANSWER>>• Increased dopamine in this pathway causes POSITIVE symptoms of Schizophrenia • Metabolic syndrome - ANSWER>>• * First sign = Increased Waist Circumference • Group of signs and symptoms including insulin resistance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDL • Mini-Cog - ANSWER>>• Is another screening tool that can be administered in 5 minutes or less and requires minimal training: • 3 item recall • clock drawing test (CDT) • MMSE (FOLSTEIN) - MEMORIZE THESE NUMBERS - ANSWER>>• 25-30 May be normal • 21-24 Mild/Early • 10-21 Moderate • 0-9 Severe • Mood disorder questionnaire screening - ANSWER>>• Use mood questionnaire on any patient with mood lability - LABILE MOOD Positive Screen - All 3 of the following criteria must be met: • Question 1: 7 out of 13 positive (yes) responses • Question 2: Positive (yes) response • Question 3: "Moderate" or "Serious" response • Moro reflex absent - ANSWER>>• Do X-ray • The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement in response to the sound, the baby throws back his or her head, extends out the arms and legs, cries then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months • All reflexes should go away by 4-6 months EXCEPT for Babinski reflex that may persist until 24 months • Motivational interviewing - ANSWER>>• Focused, goal-directive therapy • Builds on the Trans-theoretical Model of Change • Motivation is elicited from the client • Non-confrontational, non-adversarial Examples • May we talk about • Your test shows • You are very courageous • You want to change but • Let's see if I got it • A collaborative • Person-centered form of guiding to elicit and strengthen motivation for change NEUROTRANSMITTERS - ANSWER>>• Alzheimer's - DECREASED ACH. - Impaired Memory • Parkinsonian SX - INCREASED ACH. • Bipolar - INCREASED GLUTAMATE NSAID, dehydration and Thiazides increases risk of - ANSWER>>• Lithium toxicity OCD (Obsessive Compulsive Disorder) - ANSWER>>• TCA : Clomipramine • ODD what will you do to prevent it from becoming Conduct disorder - ANSWER>>• Therapy to target Mood and aggression • PANDAS - ANSWER>>• Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS happens after a child has a strep throat or some type of infection cause OCD type behaviors) • Patient comes with vague symptoms depression irritability - how should you assess - ANSWER>>• BECK depression scale • Patient Health Questionnaire (PHQ-9) - ANSWER>>A brief 9 item self- report questionnaire used as a screening tool to assess severity of depression. Widely used by health care providers, in validity is well established, particularly for identifying severe depression • 1-4 Minimal • 5-9 Mild depression • 10-14 Moderate • 15-19 Moderate severe depression • 20-27 severe depression • Patient on antidepressants for 3 weeks and attempted suicide - ANSWER>>• Stop medication immediately • Patient shows symptoms of dizziness, tremors, sweating, what medical diagnosis - ANSWER>>• Hypoglycemia • Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis - ANSWER>>Delusional disorder - Patient believes it is true, even if there is evidence that it is not true. • Pincer Grasp - ANSWER>>• 9 months • Uses thumb and index finger (pincer grasp) to pick up small objects like cheerios • Placement of chronically mental ill - ANSWER>>• Assertive community treatment (ACT) • Primary prevention - ANSWER>>• Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse • Problems in the parietal lobe can lead - ANSWER>>• Sensory- perceptual disturbances and agnosia (inability to perceive objects) • R-L confusion • Difficulty writing (agraphia) • Aphasia (difficulty of language) • Promote resilience in schizophrenia for a patient that lives along and doing well - ANSWER>>• Refer peer support • OR Case Manager OR ACT Team • Pt on lithium and Depakote with temp, right flank pain, brown colored urine, what do you - ANSWER>>• LFT • It does NOT matter which med the client is on, you want to check LIVER function • Hepatitis could be indicated by right flank pain (If patient complains of right upper quadrant pain at home - needs to go to ER) • Check LFT first - if fine, check CREATININE - due to dark colored urine • Pt states that God did this to me - ANSWER>>• Assess spiritual needs • PT taking a breathing treatment Albuterol/Proventil - ANSWER>>• Do not take MAOI or TCA • Abilify • Zyprexa • What are the 3 CK muscle enzyme test? - ANSWER>>• CKBB • CKMM • CKMB (normal 0.3 mmcg/L) • What are the various controlled substance classes? - ANSWER>>• Schedule I: Nobody has these (researchers sometimes) not good for health/heroin, PCP, MDMA • Schedule II: Significant abuse potential Morphine, methadone, methylphenidate • Schedule III: Moderate abuse potential Hydrocodone, codeine • Schedule IV: Low abuse potential Benzos, Ambien, Phentermine • Schedule V: Very low abuse potential Anti-tussive, Lomotil • What classes of Controlled Substances is the NP approved to prescribe? - ANSWER>>• Schedules II-V only • What do Birth control pills do to Lamictal? - ANSWER>>• Inducer- will low level of Lamictal • What does a 17 on MMSE mean? - ANSWER>>• Moderate Cognitive impairment • What does a decreased retic count indicate? - ANSWER>>• Anemia: Acute or chronic bleeding • Normal range: 0.5 percent to 1.5 percent • What does an increased retic count indicate? - ANSWER>>• Bone marrow disorder or Vitamin deficiency • Normal range: 0.5 percent to 1.5 percent • What does a sed rate measure? - ANSWER>>• Inflammation (ESR: Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour. • The sed rate test measures how fast red blood cells fall to the bottom of a tube. Inflammation creates proteins that make red blood cells fall more quickly. • Infection (including of the bones) • Cancer • Arteritis (inflammation of the blood vessels) • Lupus (an autoimmune disease that damages the skin, joints, and other parts of your body) • Polymyalgia rheumatica (causes stiff and painful muscles) • Rheumatoid arthritis (autoimmune disease in which the immune system attacks your joints) • Systematic vasculitis (inflammation in your blood vessels) • What does Depakote do to Lamictal - ANSWER>>• Depakote inhibit (note that it is not related to CYP) Lamictal metabolism and cause INCREASING Lamictal level • Lamictal is well known for Risk of Rash and Steven-Johnson Syndrome • What does Erythromycin to Trileptal? - ANSWER>>• Erythromycin is INHIBITOR which Increase Trileptal level • You will need to decrease Trileptal dose • What does it mean when an Asian patient does not make eye contact with the NP? - ANSWER>>• Sign of respect What does messenger RNA code for? - ANSWER>>• Amino Acids • What do you do when a patient is on Tegretol and their ANC < 1000? - ANSWER>>• Stop and repeat lab • Normal is 1500-8000 mm3 • What happens to the brain during adolescence? - ANSWER>>• Dendritic pruning • Emotions are controlled by amygdala • By adulthood, PFC involved as well • What happens when you mix Tegretol and Macrolides (Macrolides are a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin) - ANSWER>>• Macrolides are inhibitors so it increases Tegretol levels. You will need to decrease Tegretol dose • What happens with a patient taking lithium and who drinks a lot of water? - ANSWER>>• Level decreased • Patient taking lithium who gets dehydrated? - ANSWER>>• Levels increased LITHIUM - ANSWER>>• WEIGHT GAIN • Impaired Thyroid Functioning CNS • Fine hand tremors • Fatigue • Mental cloudiness • Headaches • Coarse hand tremors (WITH TOXICITY) • Nystagmus • Postherpetic Neuralgia (PHN) - pain that appears before, during, or after having shingles (Lyrica & Gabapentin) • FIBROMYALGIA - LYRICA ONLY • Neuropathic Pain associated with spinal cord injuries ( LYRICA) • Neuropathic pain associated with Diabetes (LYRICA ONLY) • What is often common to patients with fibromyalgia? - ANSWER>>• Sexual abuse • What is pseudo-dementia? - ANSWER>>• Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve • What is Tegretol (Carbamazepine) in the CYP 450 system? - ANSWER>>•INDUCER!!! Inducer: Will decrease level of Lamictal and birth control pills • What is the benefit of play therapy? - ANSWER>>• Don't have to confront emotions head on • What is the concern when prescribing Lamictal with Depakote? - ANSWER>>• divalproex added to lamotrigine will essentially double lamotrigine blood levels and can increase risk of a serious rash • What is the different between a healthcare agent, proxy, surrogate, and attorney in fact? - ANSWER>>• Nothing, they are all the same • What is the evil eye? (CULTURAL) - ANSWER>>• When a stronger or more powerful person looks at a weaker person- often infant/child resulting in a hex which presents in illness such as headache, fever, diarrhea, disturbed sleep, increased fussiness • What is the impact of steroid inhalers on children? - ANSWER>>• Slows bone growth and may decrease ultimate height • Steroids CAN cause MANIA • If you have a client with Bipolar who has been stabilized on meds and becomes manic AFTER starting steroid inhaler - it is due to the med and the psych med will need to be adjusted accordingly. • What is the long-term impact of using steroid inhalers? - ANSWER>>• Cataracts, Glaucoma, thinning of bones and skin • What is the neurotransmitter problem in ADHD (ADH anN D: N for NE D for DA)? - ANSWER>>• Dopamine, Norepinephrine, and serotonergic dysfunction • What is the neurotransmitter problem in schizophrenia? - ANSWER>>• Excess dopamine in Mesolimbic pathway (positive symptoms) • Decreased dopamine in mesocortical pathway (negative symptoms) • What is the purpose of HIPAA? - ANSWER>>• National standards for electronic HC transactions • National ID for providers, health plans and employers • NOT simply confidentiality • What is the purpose of Motivational interviewing? - ANSWER>>• Explore ambiguity • Maintain passive position • What is the purpose of telepsychiatry? - ANSWER>>• Increase the ability to reach rural and underserved areas • What is the risk of a seriously elevated CKMB? - ANSWER>>• Polymyositis • Rhabdomyolysis • What is the scoring with the Beck depression inventory? - ANSWER>>• Self-report 0- 63 • 0-13 minimal • 14-19 mild • 20-28 moderated • 29-63 severe • What labs do you get for RA? - ANSWER>>• Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP • CRP and ESR are both increased in AR but NOT in osteoarthritis • What medications are at risk to cause SJS in Asian population? - ANSWER>>• HLAB 1502 Allele increase risk of SJS • Trileptal • Tegretol • Other Anti-epileptic medications • What neurotransmitters are involved in the bioamine hypothesis of depression? - ANSWER>>• Serotonin • Norepinephrine • Dopamine • MAOIs inhibit MSO's which break down neurotransmitters. So it allow increase it the amount in the synapse • What part of the brain is involved with OCD? - ANSWER>>• Occipitofrontal • Basal Ganglia • What psycho medications are first line treatment for Fibromyalgia? - ANSWER>>• Cymbalta • Effexor • Elavil • Pamelor • Lyrica