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LMR Georgette’s PMHNP Certification
Exam Latest Questions And Correct
Answers(Verified Answers)
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
INFO BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you have to have something (assessment data) to report - Assess = FIRST If a 13-year-old tells you he want to smoke, what would be an appropriate response? - ANSWER>>• Ask him of his plan to stop smoking If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect? - ANSWER>>• Cranial nerve V-Trigeminal nerve (FIVE) What cranial nerve is responsible for Bells Palsy? - ANSWER>>7 = Facial Paralysis What cranial nerves do you assess for corneal sensation - ANSWER>>Nerves 5 & 7 What cranial nerves do you assess for papillary reaction to light and accommodation? - ANSWER>>Nerves 3,4,& 6 What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular movements? - ANSWER>>Nerves 3, 4, & 6 What cranial nerves do you assess for corneal light reflex? - ANSWER>>3, 4, & 6 Cranial Nerve 1 - ANSWER>>Olfactory (smell) Cranial Nerve 2 - ANSWER>>Optic - vision Cranial Nerve 3 - ANSWER>>Oculomotor (eye movement): The occulomotor nerve is responsible for motor enervation of upper eyelid muscle, extraocular muscle and pupillary muscle. Cranial Nerve 4 - ANSWER>>Trochlear (eye movement): The trochlear nerve controls an extraocular muscle.
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
- 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)
What medication is best for an aggressive patient? - ANSWER>>IM Geodon Medications to improve anxiety... - ANSWER>>act directly or indirectly on GABA system
- SSRIs
- Benzodiazepines
- Tricyclics (TCA)
- Buspirone
- Tiagabine (Gabitril)
- gabapentin
- propranolol in children:
- alpha agonists : clonidine (catapres) & guanfacine (tenex) advantages of Benzodiazepines with short have lives - ANSWER>>- less daytime sedation
- less drug accumulation
- quick onset
- useful for tx of insomnia disadvantages of Benzodiazepines with short have lives - ANSWER>>increase risk of addiction non-pharmacological Management for anxiety - ANSWER>>- behavioral therapy
- CBT
- interpersonal therapies
- community self help groups
- alternate therapies as adjunct tx
SSRI's - ANSWER>>- first line tx for anxiety
- act on serotonin and indirectly on GABA
- takes 3-4 weeks to reach symptom control
- black box warning for kids is SI Agoraphobia treatment - ANSWER>>• BZs: Short term symptom relief
- SSRIs: long term maintenance
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- SNRIs: long term maintenance
- Venlafaxine (Effexor) TCAs: long term maintenance
- Beta blockers (off-label use) used for discrete episodes of social anxiety - contraindicated for clients with asthma Alprostadil (PGE1) - ANSWER>>• Ductal-dependent Congenital Heart disease (all forms)
- Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
- 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO Amygdala - ANSWER>>• A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression Anorexia nervosa - ANSWER>>• Anorexia (SAFETY = KEY)
- 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 2D
- 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
There are nine TCAs approved by the FDA for depression (amitriptyline, amoxapine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine), and one approved for OCD - clomipramine (Anafranil). Tertiary TCAs (more sedating): Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg. Secondary TCAs (less sedating): Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5 mL oral solution. Side Effects: Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision. Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT prolongation, AV block. Clozaril (Clozapine) - ANSWER>>• DC Clozapine at
- ANC < 1000
- WBC 2000- 3000 ANC & WBC WEEKLY for 6 months:
- When a patient is on Clozapine monitor for signs for agranulocytosis such as:
- Sores in the mouth, throat,
- Chronic infections of the gums, throat, or skin,
- Fever
- Chills
- 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
- Talking increase
- Disseminated Encephalomyelitis - ANSWER>>• Assess for asymmetry of extremities
- Along with this pattern, the patient usually get neurological symptoms which may include
- Confusion, drowsiness, and even coma
- Unsteadiness and falling
- Visual blurring or double vision (occasionally)
- Trouble swallowing
- Weakness of the arms or legs
- Fever
- Headache Disulfiram - ANSWER>>Disulfiram (sold under the trade name Antabuse) is a drug used to support the treatment of alcohol use disorder by producing an acute sensitivity to ethanol (drinking alcohol). Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption.
- Increase Coumadin
- Does impaired judgement mean one is incompetent? - ANSWER>>No
- Does the de facto rule of proxy apply in same sex marriages? - ANSWER>>• No Drug affects with Flonase - ANSWER>>(just know that Flonase has interaction with Zantac & Tegretol)
- Zantac (histamine 2 blocker) antagonist
- Per ANCC study material - Flonase (ALL Steroids) can induce MANIA and DEPRESSION - If you have a patient with bipolar disorder who is stable on a mood stabilizer and becomes manic after prescription of a steroid, the mood stabilizer will need to be increased. If you have a patient with MDD who is stable on an antidepressant and becomes depressed after starting a steroid, you may need to increase the antidepressant - just remember though, make sure you understand what the question is asking - safety first
- Early onset of HIV dementia - ANSWER>>• Apathy : lack of interest
- Abnormal of MRI_ slow
- Cognitive functions: memory, reasoning, judgment, concentration, and problem solving
- Other common symptoms are changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance
- Show brain atrophy (shrinkage) therapies & dx - ANSWER>>• EMDR - PTSD - Shapiro
- DBT - Borderline Personality D/O - Linehan
- Interpersonal therapy - Interpersonal conflict - Klerman and Weismann
- CBT - if nothing fits CBT works for most.
- Encopresis Treatment - ANSWER>>Behavior management:
- Toilet refusal behavior,
- scheduled toileting time,
- incentives
- prevention of constipation EPS - ANSWER>>• Clients who experience any form of EPS are at increased risk of TD
- Acute dystonia: is the first symptom that an individual will develop, and it can occur within hours of taking the medication. It usually presents as involuntary contractions of the face and neck muscles and can be painful.
What can Steven Johnson syndrome - ANSWER>>lamictal and carbamazepine (tegretal) Tegretal increases risk for SJS in Asians S/S: fever and rash Tegretal (Carbamazepine) and clozaril - ANSWER>>can cause agranulocytosis d/c for ANC for less than 1,000 and monitor for s/s of infection Clozaril (Clozapine) can.. - ANSWER>>decrease SI in PTs with schizophrenia what is gold standard medication for bipolar - ANSWER>>Lithium - it can decrease SI for bipolar PT's check what levels with lithium - ANSWER>>TSH, HCG, bun, creatinine, UA what medication can increase lithium toxicity - ANSWER>>NSAIDS, thiazides, and ACE inhibitors (lisinopril) they reduce renal clearance why should you not take lithium in pregnancy? - ANSWER>>causes ebstein anomaly (especially in the first trimester) lithium can cause - ANSWER>>leukocytosis, hypothyroidism, maculopapular rash, t- wave inversion, tremors (fine hand Tremors), GI upset,
- course hand tremors = can indicate toxicity
Signs of lithium toxicity - ANSWER>>muscle weakness, confusion, incoordination, palpitations, severe GI upset, drowsiness, find hand tremors priority action - d/c lithium and check serum levels NMS (neuroleptic malignant syndrome) - ANSWER>>Can be caused by antipsychotics
- extra muscle rigidity that can lead to mutism
- increase CPK levels
- myoglobinuria (muscle contractions and muscle destruction which is what is responsible for increase CPK levels
- increase WBC & LFT *If the patient goes to the gym a lot with a reddish/cherry color that would indicate myoglobinuria Tx:
- stop med
- give bromocriptine (dopamine agonsit)
- give dantrolene (muscle relaxant) Serotonin Syndrome - ANSWER>>Caused by antidepressants - SSRIs, TCA, SNRIs, MAOIs
- Triptans - migraine medications, also are risk for SS
- hyperflexia (myoclonic jerks) TX:
- stop med
