LMR Georgette’s PMHNP Certification Exam Question Bank 2024 , Exams of Nursing

Download LMR Georgette’s PMHNP Certification Exam Question Bank 2024 and more Exams Nursing in PDF only on Docsity! LMR Georgette’s PMHNP Certification Exam Question Bank 2024 What are 4 primary symptoms of Hypothyroidism? - Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Mania Valproic acid produces what teratogenic effect? - Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? - Liver (hepatoxicity) What mood stabilizer has anti-suicidal effects? - Lithium What 5 labs should be drawn with lithium? - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - 0.6-1.2 mg/dL What is the normal range for BUN? - 10-20 mg/dL When should you suspect kidney disease with a urinalysis? - 4+ protein 4+ protein in the kidney suggests - Kidney disease What are 7 side effects of lithium? - 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? - 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? - NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? - 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? - 1.3 mEq/L or higher What 3 parts of the brain are affected with ADHD? - Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? - ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? - Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? - 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 - GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? - 20 x 10 mg = 200 mg (q month) With suspected lithium toxicity, what do you do first? - Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? - DC lithium Check lithium level What 2 conditions can increase lithium levels? - Dehydration Hyponatremia What birth defect can lithium cause? - Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? - DNS What is the formula for converting oral Haldol to depot form? - 20 x daily dose What does thought process assess? - thoughts and ideas The way a patient organizes his thoughts and ideas is called - Thought process A normal thought process is described as - Logical Linear Coherent Goal-oriented Moving from thought to thought and never getting to the point is called - Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called - Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called - Thought content Thought content includes 3 items - Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes - Concentration Attention Calculation Asking the year, season, date, month, and location measures - Orientation Asking a patient to repeat "bed, bad, ball" measures - Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures - Recall (memory) Asking the patient who is the president of the US or governor of state is measuring - Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? - Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to - Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway modulates - positive psychotic symptoms Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? - Negative symptoms What are 5 stressful events in a child's life that can cause adjustment disorder? - Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? - Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? - 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? - 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of - Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? - Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? - Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? - Conduct Disorder What are 3 characteristics of Conduct Disorder? - Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? - Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? - Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? - Therapy What type of therapy is used in the treatment of Conduct Disorder? - Behavioral therapy What is Multisystemic family therapy? - 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)? - Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? - Multisystemic family therapy What is the moderate range for MMSE - 10-20 What is the moderate range for SLUM? - 10-20 What is the moderate range for HAM-D? - 14-18 What is the moderate range for PHQ-9 - 10-14 What is the moderate range for BDI? - 19-29 What is the moderate range for HAM-A? - 18-24 What is the moderate range for GAD-7 - 10-14 What is the moderate range for COWS? - 13-24 If a patient's COWS score is between 5 - 12, what do you do? - Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? - Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? - mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? - moderate symptoms (13-24) What is a moderate range on the CIWA? - 16-20 When do you administer prn benzodiazepine on the CIWA? - Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? - 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? - 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? - 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? - Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - 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? - Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? - Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? - Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? - Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? - Dopamine What 3 areas of the brain is dopamine produced? - Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? - Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? - Acetycholine What is the function of the amygdala? - Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? - Amygdala What are 4 functions of the hippocampus? - Emotions Stress Learning Memory Emotions, stress, learning, and memory are functions of what structure of the brain? - Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Glutamate GABA Serotonin A child who does not respond when called by name may have - Autism A child that has little or no eye contact may have - Autism A child who likes to line up, stack, or organize objects and toys in on tidy rows may have - Autism What theory claims that dysfunction of a particular neuron system may be a cause of poor social interaction and cognition in autism? - Broken Mirror Theory What is the DSM-5 criteria for number of tics in Tourette's Disorder? - 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? - >1 year What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder? - <18 yrs What is the pharmacological treatment of Tourette's Disorder? - Antipsychotic (haloperidol, pimozide, aripiprazole*) What are the 3 primary neurotransmitters involved in Tourette's Disorder? - DNS What are 11 risk factors for suicide? - 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? - 45 and older What gender is a risk factor for suicide? - Male What race is a risk factor for suicide? - White (Caucasian) What 4 demographic characteristics are risk factors for suicide? - 45 and older Single White Male What are 5 physical characteristics of Anorexia Nervosa? - Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? - Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa - Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? - Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? - Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? - Intrusive re-experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD - SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? - EMDR CBT What are the 12 components/symptoms of the COWS? - Pulse Sweating Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability Gooseflesh skin Dilated pupils What component of Health Policy are Key players and stake holders? - Policy Makers What is the first action when developing Health Policy? - Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called - Recovery Model What is the Recovery Model? - A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called What is a nonlinear treatment approach? - Not a step-by-step process, but one based on continual growth and occasional setbacks What are 3 characteristics of the Recovery Model? - Learning from experience (e.g. relapse) Nonlinear Self-directed, Individualized and Person-Centered The treatment approach that emphasizes "learning from experience," nonlinear, and self-directed/individualized/person-centered? - Recovery Model What is the SBIRT - Screens for Substance Use Disorders Screening Brief Intervention Referral Treatment What instrument screens for Substance Use Disorders - SBIRT Screening Brief Intervention Referral Treatment What is the Tarasoff Principle - Duty to warn victim of imminent danger of homicidal patients What is the Duty to warn victim of imminent danger of homicidal patients? - Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) - Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? - Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? - Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? - You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? - Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? - Strategic Which 3 techniques are used in Solution-Focused Therapy? - Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? - Family Systems Therapy What are 3 characteristics of Family Systems Therapy ? - Triangles/Triangulation Self-differentiation Genograms What are 3 characteristics of Structural Family Therapy? - Hierarchies Boundaries Genograms Hierarchies, Boundaries, and Genograms are characteristics of what therapy? - Structural Family Therapy Genograms are used in which 2 family therapies? - Family system therapy Structural therapy What type of therapy should be performed when a patient presents with a cultural syndrome? - Brief supportive therapy What type of therapy should be used in a patient who has just lost their job? - Brief supportive therapy What is the most important concept in working with patients from different cultues? - Respect What should you teach a patient interested in meditation? - muscle relaxation How to Mexican American's view mental illness? - An imbalance between an individuals' relationship with the world Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? - Native American Which ethnic group has the highest incidence of suicidal attempt and completion? - Native American Cultural syndrome is - A culturally expected response to a stressor A culturally expected response to a stressor is called - Cultural Syndrome How should multicultural teaching be conducted? - Ethnospecific If a patient is regularly taking Kava, what lab should you get? - LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? - Fever Which antipsychotic has the least weight gain? - Ziprasidone (Geodon) What is Assertive Community Treatment (ACT)? - Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to - Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? - No Which services can be provided in the home for SMI patients? - Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? - Assertive Community Treatment (ACT) What is the most likely diagnosis in a patient with homicidal ideation? - Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? - All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? - Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? - Prefrontal cortex Amygdala Hippocampus Social skills training in a schizophrenic patient is what type of prevention? - Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? - Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? - 20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? - >100 mg (administer weekly if necessary) What is a delusion? - A firm belief despite contrary evidence A firm belief despite contrary evidence is - delusion How often is Haldol Decanoate typically adminitered? - monthly How do you conduct a MSE in a preschooler (3-5 yo) - Clinical observation (listen/observe) What is thought content? - SI/HI, plan What are the 5 components of the MMSE (Folstein's) - Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? - 5-HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? - 5HT2- antagonism What antipsychotic should you give to a patient with their first psychotic episode? - SGA (IM) Which 4 SGAs are available in IM form? - Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? - Metoclopramide (Reglan) What is a normal prolactin level in men? - <20 What is a normal prolactin level in women? - <25 What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? - Decrease olanzapine dose What effect does tobacco have on CYP450? - 1A2 inducer What class of drugs are primarily inhibitors? - Antibiotics How does erythromycin and clarithromycin affect CYP240? - Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? - Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? - Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? - Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? - Insomnia Tremors Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations) A patient who c/o pain after eating, bloating and fullness, what do you suspect? - Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? - Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? - H2 antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? - Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) What is a common side effect of SSRIs in the older population - Anxiety A disorder that presents like PTSD, but symptoms last less than a month is most likely to have - Acute Stress Disorder What is the required duration for a DSM-5 diagnosis of GAD? - 6 months How does a panic attack differ from Panic Disorder? - acute, impending doom How does Panic Disorder differ from a panic attack? - Chronic, recurrent, unexpected How do you treat a patient with panic disorder who is taking albuterol for asthma? - SSRI or benzodiazepine (don't give beta blocker) What is the treatment of choice for acute symptoms of panic disorder? - Beta blocker (not addictive) How do you treat test anxiety for maintenance therapy? - SSRI What is malingering? - 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 - Malingering (not a psychiatric diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? - Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? - Reactive Attachment Disorder How do you treat text anxiety acutely? - Beta blocker Benzodiazepine What structure of the brain is involved with attention, executive function, and cognitive processes (working memory, problem solving) that affects ADHD? - Dorsolateral prefrontal cortex Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? - prefrontal Dysfunction of the prefrontal cortex is most likely in what type of ADHD? - Inattentive What do you recommend to a mother of a child with ADHD as an aftercare plan on admission? - Brief supportive therapy (not after dc) If a patient present with irritability, depression, and lability, which questionnaire do you administer? - Mood Disorder Questionnaire (MDQ) When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? - Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? - Disruptive Mood Dysregulation Disorder (DMDD) A child with intense temper outbursts is most likely to have what DSM-5 diagnosis? - Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? - If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? - 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? - Autism A child that does not establish eye contact is likely to have - autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? - Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered - Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? - UA C/S An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for - Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? - B12 Folic acid What is the initial treatment for a patient with dementia and psychosis? - Nonpharmacologic treatment If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? - Administer SGA What type of dementia is HIV-related? - Subcortical What are 3 early signs/symptoms of HIV-related dementia? - 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? - HIV- related In a patient with suspected HIV-related dementia, what is your initial action? - Obtain HIV test What is first-line pharmacologic treatment for a patient with HIV-related dementia? - 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 - 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 - Depression (pseudodementia) An older patient who has symptoms of irritability, agitation, hallucinations, and delusions is most likely to have - Depression (vs. dementia) What are 2 ways to determine whether an older person with decreased memory has depression or dementia? - SLUMS, Mini-Cog Cognitive restructuring and journaling are common techniques used in - CBT 2 key concepts of Humanistic (person-centered) therapy are - Self-directed growth Self-actualization Self-directed growth and self-actualization are key concepts of what type of therapy? - Humanistic (person-centered) Which therapy is based on the principle that each person has the potential to self- actualize and find meaning in life? - Humanistic (person-centered) What is the best therapy for dealing with conflicts with others (e.g., spouse, co- workers)? - Interpersonal therapy Interpersonal therapy is recommended in what situation? - conflict and relationship (marital) problems How long does interpersonal therapy typically last? - 12-16 weeks If a patient is noncompliant, what is a technique that is used in Strategic Therapy? - Paradoxical directive/intervention When is a paradoxical directive/intervention given in Strategic Therapy? - With a noncompliant member If a patient is compliant, what is a technique that is used in Strategic Therapy? - Straight Forward Directive When is a Straight Forward Directive given in Strategic Therapy? - When a member is compliant What type of therapy is a therapist using when he asks "what worked before when you had this problem" - Solution-focused Meditation is a form of - Muscle relaxation What 4 positive effects does physical activity have on children? - Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? - Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened- ended question? - Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? - talk to parents What therapeutic factor does open-ended questions instill? - empathy If only the wife shows up for a couple appointment, what do you do? - Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? - Contact CPS Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? - crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis - ESR When is an ESR indicated? - Patient with rheumatoid arthritis What does PICO stand for? - P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? - Have access to current journals A baby with a shrill cry is likely to have - Increased intracranial pressure A sign of increased intracranial pressure in a baby is - shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? - 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? - 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? - Testosterone (improves blood flow to pelvic region) Why are women more likely to get intoxicated and have alcohol-induced hepatotoxicity? - Decreased alcohol dehydrogenase What are the 2 effects of decreased alcohol hydrogenase in women - Increased intoxication Increased alcohol-induced hepatotoxicity What is the grasp/palmar reflex? - 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? - Grasp/palmar reflex When does the palmar grasp reflex disappear? - 5-6 months What is the moro (startle) reflex? - 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 - Moro/startle reflex When does the Moro reflex disappear? - 5-6 months What is the Babinski (Plantar) reflex? - 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? - 2 years What is the absorption rate of PDE-5 inhibitors (Viagra)? - Rapid What 2 deficiencies are associated with macrocytic anemia? - Folic acid B12 When you prescribe trazodone to a male patient, what should you do? - Warn about priapism and document What are 3 risk factors for Sleep Apnea? - Smoking Increase weight/obesity DM Smoking, increased weight/obesity, and DM are risk factors for what disorder? - Sleep Apnea What is tolerance? - Decreased effect with continuous use Decreased effect with continuous use results in - Tolerance What is the goal or Reflective Practice? - Improve practice What is Reflective Practice? - Providing debriefing techniques, feedback to staff, and strategies to learn from experiences A conflict of interest may occur in what 2 scenarios? - Receiving samples of drug rep Attending an industry sponsored educational program What does a black box warning provide? - Benefits and risks A patient calls because he read on the internet about a BBW on his medication. What do you do? - You don't need to discontinue drug. Research benefits and risks What are 2 things you should do when you prescribe off-label? - Document Provide full disclosure (risks/benefits) Providing debriefing techniques, feedback to staff and strategies to learn from experiences is called - Reflective Practice If a patient has mild symptoms on the COWs, what should you do? - Give clonidine or a muscle relaxant When should you administer clonidine or a muscle relaxant to a patient withdrawing from opiates? - mild symptoms (8 or higher) If a patient scores 8 or more on the COWS during opiate withdrawal, what should you do? - Administer clonidine or a muscle relaxant If a patient has moderate symptoms on the COWS what should you do? - Administer buprenorphine/naloxone (Suboxone) When should you administer buprenorphine/naloxone (Suboxone) in a patient withdrawing from opiates? - Moderate symptoms (13 or higher) If a patient scores 13 or higher on the COWS scale during opiate withdrawal, what do you do? - Administer buprenorphine/naloxone (Suboxone) Why should methadone not be used to treat opiate withdrawal? - Arrhythmias Which benzodiazepine is used most often to treat alcohol withdrawal? - Diazepam (longer half-life) If a patient with liver dysfunction or hepatitis is undergoing alcohol withdrawal, what benzodiazepine should he receive? - Lorazepam If a patient presents with opiate withdrawal, what should you do? - Refer to residential center to administer protocol (don't initiate in outpatient setting) If a pregnant patient presents with opiate withdrawal, what do you do? - Refer to residential center (not CPS) What are 4 symptoms/categories of alcohol withdrawal? - CNS activation: Hand tremor, insomnia, psychomotor agitation, anxiety, seizures) Autonomic hyperactivity (sweating, increased HR/BP) N/V Hallucinations/illusions What do you suspect when a patient presents with CNS activation (hand tremor, insomnia, anxiety, psychomotor agitation, seizures) and Autonomic hyperactivity (sweating, increased HR, increased BP) and N/V and hallucinations/illusions? - alcohol withdrawal What are 7 symptoms/categories of opioid withdrawal? - Muscle cramps, Bony aches Diarrhea/abdominal cramps Rhinorrhea, Lacrimation Goosebumps Pupil dilation Increased BP/HR Yawning What do you suspect when a patient who presents with muscle cramps, bony aches, diarrhea/abdominal cramps, rhinorrhea, lacrimation, goosebumps, pupil dilation increased BP/HR and yawning? - Opiate withdrawal What are Yalom's 10 therapeutic factors? - 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 - 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? - Instillation of Hope Sharing experiences/feelings in group clients realize they are not alone is which of Yalom's therapeutic factors? - Universality Learning to give to others is which of Yalom's therapeutic factors? - Altruism The "natural laboratory" is which of Yalom's therapeutic factors? - Increased development of social skills Group members modeling their behavior after other members of group/therapist is which of Yalom's therapeutic factors? - Imitative behavior Interacting with others to increase adaptive interpersonal relationships is which of Yalom's therapeutic factors? - Interpersonal learning just culture - A work environment that improves patient safety through continuous learning A work environment that improves patient safety through continuous learning is - Just Culture Recovery Model - A model that does not focus on mental illness, is nonlinear (occasional setbacks) and stresses learning from experience What treatment approach does not focus on mental illness, is nonlinear (occasional setbacks), and stresses learning from experience? - Recovery Model A process or strategy of quality improvement is called - PDSA Cycle Plan Do Study Act What is the PDSA cycle - A quality improvement process or strategy What is an example of a Quality Improvement Project? - Chart review What are the 4 components of health policy? - Process Policy reform Policy environment Policy makers When implementing health policy, what is the first thing you do? - Assess barriers and facilitators (prior to meeting with stakeholders) What is SBIRT Assessment? - Screening, Brief Intervention, and Referral to Treatment for SUD What should you do before warning someone about harm (Tarisoff act)? - Contact Board of Nursing A key component of Piaget's Sensorimotor stage is - Object permanence Object permanence develops in which of Piaget's developmental stages? - Sensorimotor What are 2 key components of Piaget's Preoperational Stage? - Magical thinking Symbols and language According to Piaget, at what stage do children display magical thinking and use language and symbols more? - Preoperational What is a key component of Piaget's Concrete Operations Stage? - See things from other's perspectives (less egocentric) According to Piaget, during what stage do children see things from other's perspectives - less egocentric? - Concrete operations What is the key component of Piaget's Formal Operations stage? - Abstract logic (science projects, hypotheses) According to Erikson, what period (age) is the development of meaningful relationships important? - Infancy (0 - 1 yr.) According to Erikson, what period (age) is self-control a key component? - Early childhood (1 - 3 yrs.) According to Erikson, what period (age) is being a "self-starter" (self-directed) a key factor? - Late childhood (3 - 6 yrs.) According to Erikson, what period (age) is competence important, especially with classmates? - School age (6 - 12 yrs.) According to Erikson, what period (age) is personal sense of identity a key factor? - Adolescence (12 - 20 yrs.) According to Erikson, what period (age) are committed relationships a key factor? - Early adulthood (20 - 35 yrs.) According to Erikson, what period (age) is the ability to care for others important (e.g., parenting)? - Middle adulthood (35 - 65 yrs.) According to Erikson, what period (age) does fulfillment and comfort with life occur? - Late adulthood (>65) What 3 neurotransmitters are associated with ADHD? - DNS What 4 neurotransmitters are associated with schizophrenia? - DA (increased) Glutamate (increased) GABA (decreased) 5HT (decreased) What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Glutamate (increased) GABA (decreased) 5HT (decreased) What neurotransmitters are associated with anxiety? - NE (increased) 5HT (decreased) GABA (decreased) What neurotransmitters are associated with Alzheimer's? - ACh (decreased) Glutamate (decreased) What 3 neurotransmitters are associated with MDD? - DNS (decreased) What 3 neurotransmitters are associated with Tourette's? - DNS (especially DA) What 5 neurotransmitters are associated with bipolar disorder? - DNS Glutamate (increased) GABA What 2 neurotransmitters are involved with Addictive Disorders? - DA (decreased) GABA (decreased) What 2 neurotransmitters are involved with OCD? - 5HT (decreased) NE (decreased) What neurotransmitters are associated with Parkinson's Disease? - DA (decreased) ACh (Increased) What 4 psychiatric disorders have dysregulation of dopamine, norepinephrine, and serotonin (DNS)? - ADHD MDD BPD Tourette's What is the most important factor in a child who is grieving? - Intact family How do you treat a child who is grieving? - Normalize grief and loss (don't tell them what to do/how to grieve) (responses vary) How do you apply your knowledge of a relationship between ADHD and substance abuse to practice? - Screen ADHD patients for substance use Screen SUD patients for ADHD When you look up data about a patient in social media, what are you violating? - patient's trust Prior to sending prescriptions to a pharmacy, what do you need to do? - obtain patient consent If patient is unable to give consent, what do you do? - assess for involuntary treatment (don't forcefully give medication) The ethical principle that is associated with preventing imminent danger to patient is? - nonmaleficence The ethical principle that is associated with keeping promises is - Fidelity Sending a patient to a crisis stabilization unit rather than a hospital is honoring what patient right? - least restrictive environment You plan to teach the patient about their illness. What do do you do first? - assess knowledge In what age groups should you obtain HCG? - 12-51 Do you need to tell parents if an adolescent reports she is dating someone of the same age or gender? - no What are normal prolactin levels for males and females? - Male: <20 Female: <25 What 2 labs for a patient with suspected dementia due to anemia? - B12, folic acid What 2 symptoms might you see in a patient with a frontal lobe tumor? - social skill deficit inappropriate affect What is the term for a symptom caused by a medical treatment? How do you assess it? - Iatrogenic, assess medical history If you refer a patient to a residential center for alcohol withdrawal, what can you provide them for symptom control? - Hydroxyzine or buspirone (not benzodiazepine) What does perjury mean? - Lying or withholding information under oath Which 2 parties can you not disclose information without the patient's consent? - family member another provider What are 4 risk factors for sleep apnea? - smoking obesity DM HTN