LMR GEORGETTE’S PMHNP FINAL EXAM LATEST QUSTIONS WITH ANSWERS LATEST UPDATE 2024, Exams of Nursing

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LMR GEORGETTE’S PMHNP FINAL

EXAM LATEST QUSTIONS WITH

ANSWERS LATEST UPDATE 2024

What drugs should be avoided with Kava Kava?ANS== Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) What is the normal range for TSH?ANS== 0.5 - 5.0 mu/L What are lab values in HyperthyroidismANS== Decreased TSH Increased T4 and T What are labs in Hypothyroidism?ANS== Increased TSH Decreased T4 and T What are 5 primary symptoms of Hyperthyroidism?ANS== Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism?ANS== Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder?ANS== Depression Hyperthyroidism mimics symptoms of what psychiatric disorder?ANS== Mania Valproic acid produces what teratogenic effect?ANS== Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic?ANS== Liver (hepatoxicity) Abdominal pain in the URQ Reddish-brown urine What are 4 signs of hepatoxicity?ANS==

Yellowing of the skin and sclera Fatigue What is the therapeutic range for valproic acid?ANS== 50-125 mcg/ml

What is a toxic level of valproic acid?ANS== >150 mcg/ml

What are 4 signs of valproic acid toxicity?ANS== 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?ANS== Hepatotoxicity; hold med, draw LFT's (priority), DVP level With suspected toxicity with valproic acid, what steps/labs should be drawn?ANS== 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?ANS== 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?ANS== Kava Kava liver damage What are 5 symptoms of Stephen's Johnson Syndrome?ANS== 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?ANS== Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain?ANS== Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating?ANS== Aripiprazole (Abilify) Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add?ANS== Aripiprazole (least sedating) What are 2 hallmark symptoms of delirium?ANS== Acute onset disturbance of LOC impaired cognition inattention

How are agitation and psychotic symptoms treated in delirium?ANS== Low dose Haldol (QTc check first) 16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action?ANS== Do UDS; chances are they may be abusing other substances What 4 drugs can cause mania?ANS== "SAID" Steroids Antidepressants (in BPD) Isoniazid (INH) Disulfiram (Antabuse) What 6 drugs can induce depression?ANS== "SIP BARB" Steroids Interferon, Progesterone Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines Steroids can induce what 3 psychiatric states?ANS== Mania Depression Psychosis REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is. What is the best environment to interview this pt in?ANS== reassure safety, provide environment of safety private area with door open/partially open What is the therapeutic range for lithium?ANS== 0.6-1.2 mEq/L Many postpartum women have SI after delivery, yet they don't have psych evals before leaving the hospital, what could a possible solution be?ANS== collaborating care between psych and OBGYN to provide the best care for that pt If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does/does not] apply?ANS== Does not, ie pt will need to sign consent for labs/ chart to be sent When discharging from inpatient you want [to fax/print off-give to pt.] labs for the outpatient provider before pt discharge?ANS== fax; so the new provider has them for follow-up appointment

Before referring a pt out or discharging them, it is good to ask yourself what question?ANS== is there something that I could do for this patient first? What 3 things are MUST KNOWS about Lithium?ANS== has neuroprotective effect for bipolar disorder the gold standard for treating manic episodes the mood stabilizer w/ anti- suicidal effects What mood stabilizer has anti-suicidal effects?ANS== Lithium What 5 labs should be drawn with lithium?ANS== Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SerumCr range?ANS== 0.6-1.2 mg/dL What is the normal range for BUN?ANS== 10-20 mg/dL When should you suspect kidney disease with a urinalysis?ANS== 4+ protein; if pt on Lithium-->monitor closely toxicity What are 7 side effects of lithium?ANS== 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?ANS== Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Bold =must knows Which 3 drugs can increase lithium levels by decreasing renal clearance?ANS== NSAIDs (ibuprofen, indomethacin) Thiazide s ACE-I What is a toxic level of lithium?ANS== 1.5 mEq/L or higher

At what level do you monitor lithium closely (but not discontinue)?ANS== 1.3 -1.4 mEq/L or higher With suspected lithium toxicity, what do you do first?ANS== D/C Li and draw Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L?ANS== D/C lithium Check lithium level What 2 conditions can increase lithium levels? If this pt is going on a hike, what would you recommend ?ANS== Dehydration Hyponatremia Take extra water to avoid dehydration What birth defect can lithium cause?ANS== Ebstein anomaly (congenital heart defect) When working with adolescents, parents often feel they have a right to know what is going on with their child, but the teen has a right to confidentiality. This can create anANS== Ethical dilemma When building a therapeutic alliance w/ adolescents, it is important to stressANS== confidentiality; what they say remains confidential unless they are wanting to harm self/ someone else, [or they are in a relationship with someone much older (like 14 y/o seeing a 30 y/o)] if an adolescent C/O abuse, even if they make the claim in the presence of the parents, what should you do?ANS== interview the teen w/o the parents; call CPS What 3 neurotransmitters are associated with ADHD?ANS== DA, NE, 5HT aka serotonin -->(DNS) The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder?ANS== ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain?ANS== Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)?ANS== 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 isANS== GAD if ADHD and tic both present, what is contraindicated?ANS== Stimulants

if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean?ANS== the medication has been cleared from the body What are the lower age limits for stimulants for ADHD?ANS== AMPH = 3yrs MPH = 6yrs When considering Clonidine or Guanfacine for a pt, the PMHNP knows? ANS== Clonidine is more sedating than Guanfacine; Guanfacine lasts longer than Clonidine What does thought process assess?ANS== thoughts and ideas A normal thought process is described asANS== Logical Linear Coherent Goal- oriented Moving from thought to thought and never getting to the point is calledANS== Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is calledANS== Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is calledANS== Thought content Thought content includes 3 itemsANS== Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s), or anything going backwards measures what?ANS== Concentration Attention Asking the year, season, date, month, and location measuresANS== Orientation Asking a patient to repeat "bed, red, ball" measuresANS== Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measuresANS== Recall (memory) Asking the patient who is the president of the US or governor of state is measuringANS== Fund of Knowledge

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 What is a simple test that can be administered in a minute or two to measure possible dementia?ANS== Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage toANS== Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway to the dorsolateral prefrontal cortex (DLPFC) modulatesANS== positive psychotic symptoms Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms?ANS== Negative symptoms: affect, anhedonia, asociality, alogia, apathy, avolition, Depressive symptoms The nigrostriatal pathway modulatesANS== motor movements Dopamine has what type of relationship with acetycholineANS== Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? ANS== Acute dystonia: stiff neck, muscle spasms neck/back, painful Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking DA in the tuberoinfundibular pathway leads toANS== Increased prolactin What are 5 symptoms of hyperprolactinemia?ANS== Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long- term) What antipsychotic has the greatest effect on prolactin?ANS== Risperidone What is the black box warning for carbamazepine?ANS== Agranulocytosis and SJS in Asians (+) for HLA-B*1502 allele What are 8 symptoms of aplastic anemia?ANS== Pallor Fatigue Headache Fever Nosebleeds Bleeding gums

Skin rash SOB In which ethnic group must you screen for the HLA-B1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary?ANS== Asians risk for SJS in Asians (+) for HLA-B1502 allele Which 2 drugs have the highest likelihood of causing agranulocytosis?ANS== Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms ofANS== Agranulocytosis At what ANC should clozapine be stopped (even if asymptomatic)?ANS== < What is neutropenia?ANS== <2000 PMNs or WBC < What is agranulocytosis?ANS== <500 ANC What does DIGFAST stand for?ANS== Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What neurological symptoms might one see in Conversion Disorder?ANS== Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder?ANS== After a stressful experience (suddenly) What are 5 stressful events in a child's life that can cause adjustment disorder?ANS== 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?ANS== Not going to school, destroying property, driving recklessly, or fighting

What are some key sx of Oppositional Defiant Disorder (ODD)?ANS== 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)?ANS== Therapy, individual and family What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)?ANS== Child and parent problem-solving skills training, boundary setting A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder if under age 18?ANS== Conduct Disorder What are 3 "hallmark" characteristics of Conduct Disorder?ANS== aggression Destruction of property Lack of remorse What 2 factors differentiate Conduct Disorder from ODD?ANS== Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder?ANS== Things to target mood and aggression --Antipsychotics --Mood stabilizers --SSRIs --Alpha agonists (Clon. and Guan) What type of therapy is used in the treatment of Conduct Disorder?ANS== Behavioral therapy/ problem solving skills What is the goal of multisystemic family therapy (MFT)?ANS== Reduce barriers to resources for youth with problematic behavior What is Multisystemic family therapy?ANS== Home-based model for youth (12-17) with serious antisocial problematic bx and criminal offenses by empowering parents with resources and skills and reducing barriers to resources that prevent families from accessing services needed for effective management of youth helps to develop natural support systems

What is the range for MMSE?ANS== score 0-30. Higher the better 25+ normal 21-24 mild 10-20 moderate 0-9 severe What is the range for SLUM?ANS== score 0-30 Higher the better 27+ normal 21-26 mild <21 dementia What is the range for HAM-D?ANS== range 0-76 0-7 normal

8 mild 14 moderate 19 mod-severe 23+ severe Just moderate 14- 18 What is the moderate range for PHQ-9ANS== range 0-27 0-4 normal 5 mild 10 moderate 15 mod-severe 20 severe Just moderate 10- 14 What is the moderate range for BDI?ANS== range 0-63 0-9 normal 10 mild 19 moderate 30 severe Just moderate 19- 29 What is the moderate range for HAM-A? ANS== 0-56 0-17 mild 18 moderate 25 severe Just moderate 18- 24 What is the moderate range for GAD-7ANS== range 0-23 0-4 normal 5 mild 10 noderate 15 severe

Just moderate 10- 14 What is the moderate range for COWS?ANS== 13- 24 If a patient's COWS score is between 5 - 12, what do you do?ANS== Administer clonidine (mild score) If a patient's COWS score is between 13 - 24, what do you do?ANS== Administer buprenorphine (Suboxone) (moderate score) When do you administer clonidine on the COWS?ANS== Definitely at score of >7; prior to that (scores 5-6) it can be given When do you administer buprenorphine (Suboxone) on the COWS?ANS== moderate symptoms (13-24) What is a moderate range on the CIWA?ANS== 16- 20 When do you administer prn meds such as benzodiazepine or for N/V/D on the CIWA?ANS== Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine +PRN's on the CIWA? ANS== 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?ANS== 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?ANS== 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?ANS== Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat?ANS== Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat?ANS== 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?ANS== Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking?ANS== Prefrontal cortex Amygdala

Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms?ANS== Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS?ANS== *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 fromANS== muscle contraction and destruction What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome?ANS== Hyperreflexia Myoclonic jerks S/S of serotonin syndrome include: what are the 4 most often seen (in bold)?ANS== "Shits and Shivers" § Diarrhea (shits) § Shivering, § Hyperreflexia/myoclonic jerks § Increased temperature § Vital sign instability § Encephalopathy § Restlessness/anxiety § Sweating How do you treat NMS?ANS== DC offending agent Bromocriptine or Dantrolene What does Dantrolene treat in NMS?ANS== Muscle rigidity How do you treat Serotonin Syndrome?ANS== 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?ANS== 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?ANS== 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?ANS== 5-6 weeks When switching from an SSRI/SNRI to a MAOI, how long should you wait? Why?ANS== 2 weeks; for the SSRI to degenerate What is the function of compulsions in OCD?ANS== Reduce subjective anxiety level What is PANDAS? When would you suspect PANDAS?ANS== 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 isANS== 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?ANS== Tourette's, NOTE: (the tics do not necessarily have to occur at same time) What 2 neurotransmitters are associated with OCD?ANS== Serotonin Norepinephrine vocal ticsANS== 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?ANS== DMDD What are some symptoms associated with lead poisoning?ANS== Developmental delay (learning difficulties) Pica (paint chips) irritability gastrointestinal sx low weight Which 2 demographic characteristics are associated with lead poisoning? ANS== rural areas

houses built in 1970's (lead was in the paint) A child with developmental delay who eats things (such as paint chips) may haveANS== Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain?ANS== BMI Hip-to-waist ratio (waist circumference) Glucose Lipid panel Where is norepinephrine produced?ANS== Locus coeruleus Medullary reticular formation Serotonin is produced inANS== raphe nuclei in the brainstem What 3 areas of the brain is dopamine produced?ANS== Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized?ANS== Basal nucleus of Meynert What is the function of the amygdala?ANS== Emotional memories (aggression, fear, anxiety, rage [think amygdala], stress) What are 5 functions of the hippocampus?ANS== Emotions Stress Learning Motivation Memory conversion ST to LT BOLD =HY What disorder is associated with persistent deficits in social communication and social interactions across multiple settings?ANS== Autism Spectrum Disorder A child who likes to line up, stack, or organize objects and toys in tidy rows, little or no eye contact and does not respond when called by name may haveANS== Autism What theory claims that dysfunction of a particular neuron system may be a cause of the poor social interaction and cognition in autism?ANS== Broken Mirror Theory What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder?ANS== tics appeared before age 18 yrs What is the pharmacological treatment of Tourette's Disorder?ANS== Antipsychotic (haloperidol, pimozide, aripiprazole*)

What are the 3 primary neurotransmitters involved in Tourette's Disorder? What is special about DA?ANS== DA, NE, 5HT or (DNS) hyperactivity of DA can lead to tourettes What are 11 risk factors for suicide?ANS== Previous suicide attempt

45 and older ( > 55 for women) Male gender Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss bold (must knows) What are 5 physical characteristics of Anorexia Nervosa?ANS== Low BMI (below 18.5 is underweight) Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension What is the BMI in a patient with Bulimia NervosaANS== Normal range (18.5- 24.9) Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM- criteria for what disorder?ANS== Acute Stress Disorder What are the 3 hallmark symptoms of PTSD?ANS== Intrusive re-experiencing of the trauma Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSDANS== SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD?ANS== EMDR CBT What are the 12 components/symptoms of the COWS?ANS== Pulse Sweating Restlessness

Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritabi lity Gooseflesh skin What are the 9 components/symptoms of the CIWA Scale?ANS== Nausea/vomiting Tremor Sweats Anxiety Agitation Tactile disturbances Auditory disturbances Headaches Orientation What are 3 treatments for Alcohol Use Disorder?ANS== Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Vivitrol, ReVia) Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver?ANS== Acamprosate (Campral) What to avoid while taking Acamprosate and for at least 2 weeks post use? ANS== anything with ETOH, mouthwash, aftershave, vinegars, perfume, cough/cold meds What are 4 therapeutic factors in Yalom's Group Therapy?ANS== Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses?ANS== Appreciative Inquiry What are the 3 goals of Quality Improvement?ANS== Projects designed to --improve systems, --decrease cost, --improve productivity The process/strategy of Quality Improvement is calledANS== PDSA Cycle Plan Do Study

Act Process, Policy reform, Policy environment, and Policy makers are the 4 components ofANS== Health Policy Changes in programs and practices in Health Policy is calledANS== Policy Reform What is the "policy environment" component of Health Policy?ANS== The arena the process takes place in (government, media, public) What is the "policy makers" component of Health Policy?ANS== Key players and stake holders What is the first action when developing Health Policy?ANS== 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 calledANS== Recovery Model What are 3 characteristics of the Recovery Model?ANS== Nonlinear recovery, continual growth and occasional setbacks; Learning from experience (e.g. relapse) Self-directed -pt is not told what to do Individualized and Person-Centered-pt is the center of the therapy What is the SBIRT, and what is it used for?ANS== Screening Brief Intervention Referral Treatment Screens for Substance Use Disorders What is the Tarasoff PrincipleANS== Duty to warn victim of imminent danger of homicidal patients...varies by state What is the Rennie vs Klein Court case? "Rennie's Right to Refuse and appeal"ANS== An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications What is the Donaldson vs. O'Connor court case? "You can't confine Donald"ANS== You cannot confine (commit a person involuntarily) who is not imminently dangerous to self or others What are 4 key components of Strategic Therapy?ANS== Problem and Symptom focused Paradoxical directive/intervention (reverse psychology) when pt non- compliant

Straight forward directive- when pt compliant Reframe belief system Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy?ANS== Solution-Focused therapy Which therapy uses triangles/triangulation, and self-differentiation?ANS== Family Systems Therapy The paradoxical directive, a technique to be used with caution, is used in which therapy?ANS== Strategic Therapy Hierarchies, Boundaries, and Genograms are characteristics of what therapy? ANS== Structural Family Therapy Genograms are used in which 2 family therapies?ANS== Family system therapy Structural therapy What type of therapy should be performed when a patient presents with a cultural syndrome?ANS== Brief supportive therapy What type of therapy should be used in a patient who has just lost their job?ANS== Brief supportive therapy What is the most important concept in working with patients from different cultues?ANS== Respect What should you teach a patient interested in meditation?ANS== muscle relaxation Which ethnic group views mental illness as an imbalance between an individuals' relationship with world?ANS== Native American Which ethnic group has the highest incidence of suicidal attempt and completion?ANS== Native American A culturally expected response to a stressor is calledANS== Cultural Syndrome How does the PMHNP perform health promotion education in a community setting with different ethnicitiesANS== provide multi-cultural teaching/education by using ethno- specific assessment parameters If a patient is regularly taking Kava, what lab should you get?ANS== LFTs Releasing information to a traditional healerANS== is okay after you get clearance for informed consent

Which antipsychotic has the least weight gain?ANS== Ziprasidone (Geodon) If your patient doesn't understand English, the PMHNP shouldANS== get a translator/interpreter for them so they can understand you and know you are culturally competent NativeAmericans have healing sticks that can heal them of illnesses, if the patient is hospitalized inpatient, what should you do?ANS== inform/educate the staff members of cultural competency/sensitivity re: the healing stick, the healing stick doesn't need to be taken away (make accommodations for the patient ) Which SGA is the least sedating?ANS== Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain?ANS== Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA?ANS== nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued?ANS== ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider?ANS== Agranulocytosis What antipsychotic is anti-suicidal in schizophrenia?ANS== Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially?ANS== HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do?ANS== DC lithium A patient with what medical condition is at risk for lithium toxicity? ANS== Cardiac failure (hyponatremia) What are the key indicators for NMS?ANS== Extreme muscle rigidity Increased CPK If a depressed patient is taking a triptan for migraines, what should you prescribe for depression?ANS== Bupropion What is first line treatment for MDD? Why?ANS== SSRIs

Safer in OD What are the 2 antidepressants of choice in a depressed patient with cancer? Why?ANS== Citalopram (Celexa) Escitalopram (Lexapro) less risk for Drug-Drug Interaction What is the antidepressant of choice in a depressed patient with sexual dysfunction?ANS== Bupropion What is the antidepressant of choice in a depressed patient with decreased energy?ANS== Bupropion What are 3 treatments for depressed patients with neuropathic pain? ANS== SNRI TCA (think safety tho) Gabapentin/Pregabalin (alpha2 delta ligands) BOLD = know Which SSRI is most likely to cause insomnia?ANS== Fluoxetine (Prozac) What question is important to ask in the social history with a depressed patient?ANS== Alcohol intake (self-medicating) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications?ANS== all Antidepressants What question should ask all adolescent patients at each visit?ANS== Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit?ANS== Adolescence Schizophrenics Alpha 2 adrenergic receptor blockers (Clonidine and Guanfacine) have lower tolerability in patients with schizophrenia. What effects from these meds are limited in this population?ANS== the neuroprotective effects Why do children have a decreased placebo response with antidepressants?ANS== Few evidence-based studies What is the onset of schizophrenia in males?ANS== 18- 25 What is the onset of schizophrenia in females?ANS== 25- 35 What question should ask schizophrenic patients at each visit?ANS== SI

What is the most likely diagnosis in a patient with homicidal ideation?ANS== Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia?ANS== All structures decreased EXCEPT Ventricles, they are enlarged Which class of agents should be avoided in patients with schizophrenia? ANS== Stimulants (will increase DA) Abnormalities, changes/deficits in which structures of the brain are associated with aggressive and impulsive behavior ?ANS== Prefrontal cortex Amygdala Hippocampu s Basal ganglia limbic Regions What is Assertive Community Treatment (ACT)?ANS== Form of rehabilitation post hospitalization for Severe Mental Illness (SMI) Case management approach 24/7 services Can patients receive Assertive Community Treatment (ACT) while in the hospital?ANS== No; think "community" in ACT What is the best treatment program for SMI patients with a long Hx of poor medication adherence?ANS== Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention?ANS== Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients?ANS== Increased cognition mproves Quality of Life improves Long-term health What is a delusion?ANS== A firm belief despite contrary evidence Ex: Church members are part of a cult How often is Haldol Decanoate typically adminitered?ANS== monthly If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive for the 1st month? 20 x [total daily dose] = first month dose What is their maintenance dose?ANS== 20 x 10 mg = 200 mg (first month) Maintenance: 10-15 x previous daily oral dose

When converting oral Haldol to depot form, what the maximum dose should administer at a time?ANS== 100 mg R/T adverse SE; then 5-7 days later then give an additional 100 mg How do you conduct a MSE in a preschooler (3-5 yo)ANS== Clinical observation (listen/observe) What is included in thought content?ANS== SI/HI, plan What are the 5 components of the MMSE (Folstein's)ANS== Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? What does this help prevent?ANS== 5-HT2A receptor antagonism EPS What antipsychotic should you give to a patient with their first psychotic episode? If they are a harm to themselves or others how should it be administered? What is the risk of this type of administration?ANS== SGA IM Invega, Geodon or Abilify increase risk for EPS (acute dystonia) Which 4 SGAs are available in IM form?ANS== Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics can increase prolactin and can cause TD?ANS== Metoclopramide (Reglan) What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? ANS== Decrease olanzapine dose (he stopped the inducer) What effect does tobacco have on CYP450?ANS== 1A2 inducer What class of drugs are primarily inhibitors?ANS== Antibiotics How does erythromycin and clarithromycin affect CYP450?ANS== Inhibitors