LMR Georgette’s PMHNP Certification Exam-with 100% verified solutions-2024-2025 .docx, Exams of Nursing

Download LMR Georgette’s PMHNP Certification Exam-with 100% verified solutions-2024-2025 .docx and more Exams Nursing in PDF only on Docsity! LMR Georgette’s PMHNP Certification Exam-with 100% verified solutions-2024-2025 What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss 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 are 4 signs of hepatoxicity? Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? >150 mcg/ml What are 4 signs of valproic acid toxicity? Disorientation Lethargy Respiratory depression Nausea/vomiting A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do? Hepatotoxicity; hold med, draw LFT's (priority), DVP level With suspected toxicity with valproic acid, what steps/labs should be drawn? D/C drug Check drug level Obtain LFTs Obtain ammonia level A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd? Accutane (used for acne; Causes birth Defects!!!) What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava? Kava Kava liver damage What are 5 symptoms of Stephen's Johnson Syndrome? Fever -Key sx to suspect SJS; high yield (HY) burning of mouth/eyes -HY Body aches Severe red rash Peeling skin Facial and tongue swelling Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add? Aripiprazole (least sedating) What are 2 hallmark symptoms of delirium? Acute onset disturbance of LOC impaired cognition inattention How are agitation and psychotic symptoms treated in delirium? Low dose Haldol (QTc check first) 16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action? Do UDS; chances are they may be abusing other substances What 4 drugs can cause mania? "SAID" Steroids Antidepressants (in BPD) What 3 neurotransmitters are associated with ADHD? DA, NE, 5HT aka serotonin -->(DNS) 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 ADHD and tic both present, what is contraindicated? Stimulants if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean? the medication has been cleared from the body What are the lower age limits for stimulants for ADHD? AMPH = 3yrs MPH = 6yrs When considering Clonidine or Guanfacine for a pt, the PMHNP knows? Clonidine is more sedating than Guanfacine;  Guanfacine lasts longer than Clonidine What does thought process assess? thoughts and ideas 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), or anything going backwards measures what? Concentration Attention Asking the year, season, date, month, and location measures Orientation Asking a patient to repeat "bed, red, 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 to the dorsolateral prefrontal cortex (DLPFC) modulates positive psychotic symptoms The safest drug switch strategy is to have a "washout period" of _______ half- lives between cessation of old med and the introduction of the new med. 5 1/2  Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? Negative symptoms: affect, anhedonia, asociality, alogia, apathy, avolition,  Depressive symptoms The nigrostriatal pathway modulates motor movements Dopamine has what type of relationship with acetycholine Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? Acute dystonia: stiff neck, muscle spasms neck/back, painful Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking DA in the tuberoinfundibular pathway leads to Increased prolactin What are 5 symptoms of hyperprolactinemia? Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? Risperidone What is the black box warning for carbamazepine? Agranulocytosis and  SJS in Asians (+) for HLA-B*1502 allele What are 8 symptoms of aplastic anemia? Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB In which ethnic group must you screen for the HLA-B*1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary? Asians risk for SJS in Asians (+) for HLA-B*1502 allele Which 2 drugs have the highest likelihood of causing agranulocytosis? Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of Agranulocytosis At what ANC should clozapine be stopped (even if asymptomatic)? <1000  What is neutropenia? <2000 PMNs or WBC <2000 What is agranulocytosis? <500 ANC What does DIGFAST stand for? Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What neurological symptoms might one see in Conversion Disorder? Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? After a stressful experience (suddenly) 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 are some key sx of Oppositional Defiant Disorder (ODD)? NOT aggressive (key difference vs CD) loses temper easily annoys others angry/resentful argues with authority easily annoyed blames others spiteful refuses to comply with rules/requests from authority figures What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? Therapy, individual and family What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? 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 labs CPK (creatine phosphokinase), LFT's and WBC's Myoglobinuria autonomic instability vBP, ^HR/RR Fever *= top 3 ways to differ from SS Elevated CPK (creatine phosphokinase) in NMS is caused from  muscle contraction and destruction What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome? Hyperreflexia Myoclonic jerks S/S of serotonin syndrome include: what are the 4 most often seen (in bold)? “Shits and Shivers” § Diarrhea (shits) § Shivering, § Hyperreflexia/myoclonic jerks  § Increased temperature § Vital sign instability § Encephalopathy § Restlessness/anxiety § Sweating How do you treat NMS? DC offending agent  Bromocriptine or Dantrolene What does Dantrolene treat in NMS? Muscle rigidity How do you treat Serotonin Syndrome? DC offending agent  Cyproheptadine: H1 antihistamine that acts to block  5-HT1A and 5-HT2A receptors What combination of medications increases the risk of Serotonin Syndrome? What herbal supplement also increases the risk? What class of migraine medications raises the risk? multiple antidepressants (SSRI/SNRI/TCA/MOAI) St John's wort --> with any of the above AD classes Triptans --> with any of the above AD classes When switching from an MAOI to SSRI/SNRI, how long should you wait? Why? 2 weeks;  for the MAO to regenerate (remember MAO-I deplete MAO) When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? 5-6 weeks When switching from an SSRI/SNRI to a MAOI, how long should you wait? Why? 2 weeks; for the SSRI to degenerate What is the function of compulsions in OCD? Reduce subjective anxiety level What is PANDAS? When would you suspect PANDAS? Pediatric Autoimmune Neuropsychiatric Disorder associated with streptococcal infections in children new onset OCD sx- recent strep throat If a child has both intrusive thoughts and tics, his most likely diagnosis is OCD If a child has multiple tics (at least 2 motor and 1 vocal) for at least 1 yr, and no ruminating thoughts, his diagnosis is most likely? Tourette's, NOTE: (the tics do not necessarily have to occur at same time) What 2 neurotransmitters are associated with OCD?  Serotonin Norepinephrine vocal tics can include coughing, grunting, throat clearing, sniffling, or making sudden, vocal outbursts A child between 7-17 years with a chronic dysregulated mood (moody for no reason), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? DMDD What are some symptoms associated with lead poisoning? Developmental delay (learning difficulties) Pica (paint chips) irritability gastrointestinal sx low weight Which 2 demographic characteristics are associated with lead poisoning? rural areas houses built in 1970's (lead was in the p