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

Download LMR Georgette’s PMHNP Certification Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 LMR Georgette’s PMHNP Certification Exam Questions and Answers 2024 A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism C. Increased Lipids D. Metabolic Syndrome D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY Which mood stabilizer have the least weight gain? Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus 2 C. Limbic System D. Hippocampus Hypothalamus A, B, & D are all part of the limbic system so you can rule that out When a patient is hesitant to participate in treatment you should encourage? Bring a support person like a husband Thyroid-Stimulating hormone normal level 0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance Hypothyroidism Hyperthyroid can mimic Mania Hypothyroid can mimic Depression A patient on depakote complains of RUQ pain and has reddish/brown urine Hepatoxicity -Check LFTs Signs of Depakote toxicity Disorientation, confusion, lethargy 5 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity Signs of lithium toxicity confusion, ataxia, GI upset, palpitation, tremor NMS muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Treatment for NMS Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for….dopamine agonist vs muscle relaxer Treatment for Serotonin Syndrome Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine 6 Triptans Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP How long do you wait when switching between an SSRI to an MAOI? 2 weeks How long do you wait when switching between Prozac and MAOI? 5-6 weeks wash out period What is the first line treatment for depression and why? SSRI-First line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? Treating with a medication with minimal drug/drug side effects like Lexapro Patient with depression worries about sexual dysfunction what would be the medication of choice? Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? Wellbutrin Wellbutrin is contraindicated in patients with Seizures and anorexia Which medications are best for neuropathic pain? 7 SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome Those with short half lives such as zoloft Symptoms of serotonin withdrawal syndrome Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females -MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia excessive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) 10 -Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia Nigrostriatal Pathway -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to tardrive dyskinesia Tuberoinfundibular pathway -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN Long-term hyperprolactinemia can be associated with what condition osteoporosis Normal Prolactin Level in Men level less than 20ng/ml Normal Prolactin Level in Women less than 25ng/ml Which medication is the highest offender for increasing prolactin Risperdal Acute Dystonia + Treatment 11 neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment may mimic anxiety, restlessness, can’t sit still, rocking, pacing -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos Beta-Blockers such as Inderal are contraindicated with what type of asthma medication -DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN tardive dyskinesia + Treatment abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT Does Cogentin Treat TD COGENTIN MAKES TD WORSE Typical onset of TD OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO 12 What non-psych med can cause TD? REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops InDucers CYP450 DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylureas Crap GPS Induces me to Madness! InhIbitors of CYP450 INCREASE Ciprofloxacin Ritonavir Amiodarone Cimetidine Ketoconazole Acute Etoh Macrolides INH Grapefruit Juice Omeprazole Crack Amigos 15 programmed cell death/neuronal loss At age 45 and above the patient displays mania for first time what should be ruled out MEDICAL CONDITION Patient with bipolar disorder presents with depressed mood & emotional lability Give Depakote Hallmark sx of Borderline Personality Recurrent self harm Treatment for Borderline Personality DBT Creator of DBT Marsha Linehan What activity is helpful in making a diagnosis of borderline personality Journaling or diary keeping Conversion Disorder STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism Adjustment Disorder adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying) -Symptoms occur within 3 months of the stressor If question states recently moved, recent death….THINK ADJUSTMENT factitious disorder when patients introduce foreign substances into their body or contaminate their food 16 -Faking illness but NO MOTIVE BEHIND IT Malingering Faking illness for financial gain Reactive Attachment common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver ODD They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting Conduct Disorder violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine Acute Stress Disorder similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH PTSD -OVER ONE MONTH 17 -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT Panic attack vs Panic disorder (treatment) Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom Tourette's Syndrome Criteria for diagnosis -TWO moto tics and ONE vocal tics -LASTS more than ONE YEAR -By age 18 **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Child presents with one tic and the parent is worried **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Neurotransmitters involved in Tourettes DNS: Dopamine, Norepinephrine, Serotonin Treatment for tourettes Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them Stimulants 20 ask if someone in the family has a similar issue with sleep…look for family patterns of sleep problems GAD Worry, apprehension, fear must LAST ATLEAST 6 MONTHS Delirium -ACUTE (within hours to days) onset of disturbance of LOC, COGNITION, inattention -Urinary Tract Infections are common cause for DELIRIUM always check UA -Treatment is antipsychotics like HALDOL Dementia -Chronic and slow onset (months to years to develop) -Mental decline in cognition, irritability, personality changes -When asked questions they may try to answer or MAKE UP ANSWERS (confabulate) Low levels of what labs may mimic dementia Vit B12 and Folic Acid Cortical Dementia Language and memory (aphasia and amnesia) Subcortical Dementia Motor abnormalities/Mood issues like apathy, depression, irritability HIV Dementia is a type of subcortical dementia Early signs of HIV dementia subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordination, unsteady gait 21 Treatment for HIV dementia Antivirals Pseudo Dementia Depression causes the memory issues, common in older adults -Also assess onset of symptoms, pseudo dementia is more acute onset -When asked questions they often say “I DON’T KNOW” Instruments to use to differentiate between dementia and pseudo dementia -Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE -Older individuals with depression may present with irritability and agitation If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present ... hallmark of lewy body dementia visual hallucinations Frontotemporal lobe Dementia PICKs Disease -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes -May see slurred speech or difficulty getting words out What lobe is associated with ability to understand what others are saying (comprehending speech) Temporal Lobe Neurotransmitters involved in Autism GABA, Glutamate, Serotonin Autism 22 a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement When play they often like to line up their toys, stack them in tidy rows Broken Mirror Theory of Autism Explains that the child’s presentation is caused by the mirror neuron i.e dysfunction in the mirror neuron Risk Factors for Autism Male gender, genetic loading, intellectual disability, parents ages, preterm Screening tools for Autism ADOS-G (autism diagnostic observation schedule-genetic) ASQ (ages and stages questionnaire) M-CHAT (modified-checklist for autism-toddler) Where is Norepinephrine produced? locus coeruleus and medullary reticular formation Where is serotonin produced? raphe nuclei Where is dopamine produced? substantia nigra, ventral tegmental area, nucleaus accumbens Where is acetylcholine synthesized? Basal nucleus of Meynert Hippocampus a neural center located in the limbic system; helps process memory and manage stress Limbic System The limbic system is the part of the brain involved in our behavioral and emotional responses, especially when it comes to behaviors we need for survival: feeding, reproduction and caring for our young, and fight or flight responses. 25 Victor Frankl -an insight therapy that focuses on the elemental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices. -Emphasizes accepting freedom and making responsible choices -Focus on the present Why am I here, What is my purpose Interpersonal Therapy Gerald Kierman & Myrna Weissman --Used for people who have trouble interacting with others, relationship distress -Marital conflict -12-16 weeks (3-4 months) EMDR Phases Desensitization Phase: visualize the trauma, verbalize negative thoughts but remain attentive to physical sensations Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within Group therapy: Installation of hope participants develop hope for creating a different life; they gain hope from others Group therapy: Universality people have similar problems, thoughts, and feelings and they are NOT ALONE Group Therapy: Altruism sharing of oneself with another and helping another Group Therapy: Imitative Behavior Patients can increase their skills by imitating the bx of others 26 Group Therapy: Interpersonal learning interacting with others increases adaptive interpersonal relationships Group Therapy: Group Cohesiveness Patients develop an attraction to the group and other members as well as a sense of belonging Group Therapy: Catharsis Patients openly express their feelings which were previously suppressed Group Therapy: Existential Factors Groups enable participants to deal with the mean of their own existance Group Therapy: Corrective Refocusing Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic Group Phases forming, storming, norming, performing, adjourning Family Systems Therapy Murray Bowen -a person's problematic bx may serve a function for the family or be a symptoms of dysfunctional patterns KEY WORDS* Self-Differentiation, Triangulation, Triangles Structural Family Therapy Salvador Minuchin -How, when, and who whom family members relate KEY WORDS* Mapping 27 Hierarchies Boundaries Strategic Therapy Jay Haley -Symptoms are a way to communicate metaphorically in a family -Symptom focused KEY WORDS* Straightforward directive Paradoxical directive (reverse psychology) Reframing (you are not jealous of your sister you just care for her so much) Solution Focused Therapy -MIRACLE QUESTIONS -EXCEPTION-BASED FINDING -SCALING QUESTIONS Meditation if teaching about meditation must tell them about MUSCLE RELAXATION If patient tells you something BEFORE you ASSESS- EXPRESS EMPATHY “I’m sorry this happened to you.” ... USE OPEN ENDED QUESTIONS unless talking to a child or someone that is unable to construct a narrative then use CLOSED ENDED or YES/NO ... PICOT P: Population I: Intervention C: Comparison O: Outcome T: Time 30 If not present within the normal age->Xray may be a sign of a broken bone, nerve injury, or spinal injury Babinski reflex Normal up to 2 years If present past normal range->refer to specialist PDE-5 inhibitors Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) RAPIDLY ABSORBED Used for erectile disfunction Difference between BMI in anorexia vs Bulemia Anorexia-Low BMI Bulemia-Normal BMI Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and you determine the patient needs to be sent for medical evaluation but the parents refuse Contact CPS You read and article that says that most children with ADHD abuse substances… -To translate this information into practice what should you do? -Screen ALL children for ADHD for SUBSTANCE USE -OR Screen ALL children with SUBSTANCE USE for ADHD accupuncture used for pain and depression Habeas Corpus legal concept that protects patients from unlawful hospitalization 31 -May be a reason to leave AMA Disseminated Encephalomyelitis inflammation of nervous system -MUST DO NEURO EXAM -EXAM: May present with ASSYMETRICAL BODY MOVEMENTS Assume you are interviewing a patient and you want them to provide information in a specific timeline, but they are unable TO help ask them specific questions which helps to ANCHOR their memory Before you administer a medication, you must educate them about the medication but first you should assess BUT FIRST ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION Patient presents with iatrogenic effect assess ALL the medications that the patient is taking -Don’t assume that it is from the medication you prescribed When trying to pass a policy and your co-workers are against it what should you do educate them on how the policy will benefit patient care To promote a policy how do you get the word out there Think most FEASIBLE option with WIDE net or audiance Working in outpatient setting and you want to ensure continuous improvement in quality of care. -Create an instrument to monitor clinical outcomes (this helps to identify what you are doing right or wrong) Autoimmune disease can lead to increased Cytokine level If a child is urinating the bed 32 -Teach parents to use alarm clock to wake up to urinate (NON PHARM FIRST) -If that doesn’t work try DESMOSPRESSIN (decreased enuresis) Are you allowed to look up a patient on social media? No it violates their trust Assume you started a patient on a medication and they go home and find out that there is a black box warning on the medication that you were unaware of. They call with concerns… -First, go online and do your own research -Research the RISK vs BENEFIT before you tell the patient to stop the medication Risk factors for sleep apnea excessive weight, obesity, diabetes, smoking Tolerance you need higher doses of the medication in order for the medication to be effective PHQ-9 > 5 mild depression > 10 moderate > 15 moderately severe > 20 severe Max score 27 HAM-D >10 Mild >14 Moderate >17 Severe HAM-A 35 Scope of practice is determined by State board of Nursing Scope of practice defines NP roles and actions -Varies broadly state to state If you would like to perform ECT as an NP what should you review The state scope of practice standards to see if it is allowed and what certification is needed Standard of practice is determined by ANA -Provides a way to judge nature of the care provided The PMHNP is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high-quality care consistent with established standards is critical Exceptions to Confidentiality -Answering court orders, subpoenas, or summonses *high yield (if you don’t release or lie about knowing this is PERJURY) -Insurance companies -Giving information to attorneys involved in litigation -Intent to harm self or others -Meeting state of federal requirements for reporting disease states -When the need for information outweighs the principle of confidentiality i.e unconscious patient and their life is at stake Tarasoff principle 1976 - duty to warn victims of potential harm from client may vary by state so you must check with your state board of nursing first…it may not be your responsibility to notify 36 If you are taking care of a patient and during the process of interview she tells you that her husband just texted her that her husband is going to kill self -Call the police, provide the address informed consent -Communication process between the provider and client that results in client’s acceptance or rejection of proposed treatment -Ensure they understand the risks vs benefits If patient is able to reiterate the risks vs benefits of procedure or treatment, they are able to give consent* Example patient comes to the hospital, and they are unable to give consent i.e to sick to agree to treatment you must assess need for involuntary treatment Justice doing what is fair, fairness in all aspects of care Nonmaleficence do no harm Beneficence doing good/promoting well-being Fidelity being true and loyal Veracity telling the truth, patients have the right to know the truth about their treatment Autonomy doing for self (right to self-determination) New male patient has a 10 year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward? 37 A. Beneficence B. Fidelity C. Non-Maleficence D. Veracity C. Non-Maleficence *Do no harm, giving Xanax would endanger him secondary to the high abuse potential and imminent danger if he were to overdose on Xanax* If no history of substance use, then beneficence would be appropriate because the Xanax would help the anxiety Acute agitation and anxiety vs acute agitation and psychosis IM ordered IM ativan for agit/anx IM antipsychotic for agit/psychosis Patients have the right to be treated in the Least Restrictive Setting The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP's next step is to: A. Create interdisciplinary teaching team B. Develop Outcome measures C. Market the educational plan D. Utilize a survey to assess the educational needs of the staff D. Utilize a survey to assess the educational needs of the staff *3 Interventions vs 1 Assessment* FIRST YOU NEED TO ASSESS FIRST What is the best way to reduce stigma THROUGH EDUCATION *THINK WIDEST AUDIENCE 40 The NP is responsible for initiating quality improvement at a community clinic. The effective strategy for evaluating the clients services is to A. Chart review analysis B. A root cause analysis C. Plan DO Study Act D. Failure effect mode analysis C. Plan Do Study Act SBIRT Screening, Brief Intervention, and Referral to Treatment * Use to screen substance use disorders Erikson's stages of psychosocial development 1. trust vs. mistrust 2. autonomy vs. shame and doubt 3. initiative vs. guilt 4. industry vs. inferiority 5. identity vs. role confusion 6. intimacy vs. isolation 7. generativity vs. stagnation 8. integrity vs. despair Piaget's stages of cognitive development 1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational Preoperational Stage includes 2-7 y.o- MAGICAL THINKING IS NORMAL, if they believe that monsters can fly this is NORMAL Egocentric Understand language formal operational stage 41 12+ y/o during which people begin to think logically about abstract concepts KEY WORD is LOGIC think like a scientist or do a science project you must be able to use logic ABSTRACT THINKING such as doing algebra sensorimotor stage in Piaget's theory, the stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities Object permanance concrete operational stage in Piaget's theory, the stage of cognitive development (from about 6 or 7 to 11 years of age) during which children gain the mental operations that enable them to think logically about concrete events i.e finding similarities in objects, grouping things Risk factors for suicide Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking. WHITE Women try more often. Men succeed more often. A 72 year old female brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of HTN and is being treated with Lisinopril. The exam is normal and the MMSE provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the likely diagnosis? A. Alzheimer 42 B. Vascular Dementia C. Depression D. Medication Toxicity C. Depression *2 months=too soon for Alzheimer’s, 24 is mild MMSE, HTN is not enough info to diagnose vascular dementia HALLMARKS FOR VASCULAR DEMENTIA are carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, remember PSEUDO dementia is DEPRESSION HALLMARKS FOR VASCULAR DEMENTIA carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, Patient comes to the office, and you score them on HAM-D a 23 and you start an antidepressant on dose Xmg, 2 weeks later they score a 16 on the HAM-D. What would you do? Leave the dose where it is Patient is taking Zoloft 200mg and on the GAD 7 they score a 2, what do you do Leave the dose where it is Zung Depression Scale Scoring >50 Mild >60 Moderate >70 Severe 25-49 is NORMAL RANGE 100 is max score MMSE scoring 0-10 severe >10 moderate >20 mild >25 Normal 45 Inverse agonist effect Drug causes the opposite effect of agonist partial agonist effect Drug does not fully activate the receptors Antagonist effect Drug binds to the receptor but does not activate a biological response Herbals that interact with warfarin Vitamin E Omega-3 Black Cohosh herbal used for menopause Bellandonna herbal used for anxiety chamomile herbal used for sedation and anxiety Ginko Herbal used to treat memory, dementia, & sexual dysfunction from SSRIs Ginseng Herbal product used for stress reduction, fatigue, and depression Valerian herbal used for sedation Hypertensive crisis can occur when MAOI are taken with Meperidine Decongestants TCAs Atypical Antipsychotics St.Johns wart 46 L-Tryptophan Stimulants Asthma meds Microcytic anemia iron deficiency macrocytic anemia due to folate or vitamin B12 deficiency Labs: Folic Acid, B12, ESR/CRP, HGB, MCV 14 y/o with no axillary hair and no period Normal tanner stage, start by 16 Two classes of cardiac meds that should not be used together ACES and ARBS (angiotensin receptor blocker) Together can cause renal dysfunction Abnormal Trendelenburg Test Hip disease, refer child out, assessed during head to toe too little acetylcholine too much acetylcholine Alzheimer's Parkinson's and EPS 4 D's Discover, Dream, Design, Destiny Appreciative Inquiry Cranial Nerve V Trigeminal Clenched Teeth WBC 1500-2000 Biweekly labs Less than 1000 Stop 47 How can you assess cranial nerve XII? Ask patient to stick out their tongue First sign of metabolic syndrome large waist circumference Grade 2/5 hoarse systolic heart murmur aortic stenosis Ibuprofen + lithium increases the serum level of lithium up to double Kleinfelter's Syndrome male with more than one X chromosome (XXY) -Decreased sperm, fertility issues Mental Health Parity Act forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits what does nuchal rigidity indicate? meningitis Patient is on interferon and lexapro, as a provider you understand that interferon can increase depression therefore you may have to increase the lexapro Patient complains of neuropathic pain and neurontin is not working Try Lyrica (pregabalin) its absorbed quickly and the maximum rate of absorption is 3x of Neurontin Patient is in hospital with no family and is failing cognitive test what should you do? MRI Tox Screen Phases of policy making formulation, implementation, evaluation 50 Say I see you have bruises on your arm may I Ask what happened Can an advanced directive be revoked? How? Yes at any time Can you take Buspar during pregnancy? Category B - ok if really needed. Carb and barb + Coumadin Strong Inducers of 3A4 can decrease INR Who is in charge of the DEA? State and Federal Common comorbidities of bipolar anxiety, alcohol, substance use Conjunctival injection, munchies, psychomotor slowness? Marijuana intoxication Diary Log CBT Depakote and Disulfiram increases INR What 3 atypicals can be used with teens? Zyprexa, Abilify, Seroquel - low doses * also Risperdal Np wants to implement a certain policy in nursing. start with nurse manager Phenycyclidine (PCP) can cause? Nystagmus 51 Hildegard Peplau Theory of Interpersonal Relations Nurse as therapeutic tool -Care for the person as well as the illness -Patients are PEOPLE not DIAGNOSES Patient acting out due to missing session what do you do? You relate to childhood abandonment and talk about it with the patient Patient on antidepressants for 3 weeks and attempted Suicide stop the medication immediately Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis hypoglycemia Pearson's r a statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scale pincer grasp 9 months Problems in the parietal lobe can lead Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) To promote resilience in a patient with schizophrenia that lives alone consider referral to -ACT -Peer support Patient on Lithium and Depakote and has temp, right flank pain, brown urine. What do you do FIRST? Check LFT If fine then check creatinine 52 Pt states "god did this to me." Assess spiritual needs first Patient taking breathing treatment Albuterol/Proventil Do not take MAOI or TCA p-value The probability of results of the experiment being attributed to chance. Reliability consistency of measurement Stereogenesis identify an object without sight i.e dice in hand Tagamet (cimetidine) H2 receptor antagonist (antacid) Increases benzo Increases coumadin Trazadone concerns EKG-QT prolongation Priapism Glaucoma Turner Syndrome A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. -Delayed puberty -Amenorrhea -Web neck, osteoporosis, lymphedema -poor social skills To start your own firm as an NP and need to examine economic viability Show Revenue and expenses 3 CK muscle enzyme tests? 55 *In medical diagnosis, testing sensitivity is the ability of a test to correctly identify those with the disease (true positive) whereas test specificity is the ability of the test to correctly identify those without the disease (true negative) What is the purpose of HIPAA? National standards for electronic HC transactions -National ID for providers, health plans and employers. -Not SIMPLY Confidentiality. DETROL interactions Topamax KCL Zonegran Yale-Brown Obsessive Compulsive Scale (Y-BOCS) OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme If you want to decrease the use of seclusion who would be considered the primary change agent Unit staff Rennie vs Klein • right to refuse any treatment Until court orders it "due process" Roger vs. Oken determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment. ROGERS GUARDIAN 56 Donalson vs O'Connor Confinement -It is unconstitutional to commit a person involuntarily who is not imminently dangerous to self or others Donalson was a patient hospitalized for 15 years Dusty vs United States incompetent to stand trial Durham vs King Insanity defense Riese vs St. Mary's Hospital 7/8 8B ruling says that there should be court determination of incompetence for involuntary committed mental persons to receive antipsychotic medications Stark Law Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment. 57 LMR Georgette’s PMHNP Certification Exam Questions and Answers 2024