LMR - Georgette's Qbank/ Georgette's PMHNP Certification Exam Review 2024, Exams of Psychology

Download LMR - Georgette's Qbank/ Georgette's PMHNP Certification Exam Review 2024 and more Exams Psychology in PDF only on Docsity! LMR - Georgette's Qbank/ Georgette's PMHNP Certification Exam Review 2024 LMR - Georgette's 2024 Qbank What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? cultural assessment 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 Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of Hepatoxicity 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 Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of Stephen's Johnson Syndrome 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) What are 3 hallmark symptoms of delirium? 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) 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 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 Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking 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 What are 8 symptoms of aplastic anemia? Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? Asians Having the HLA-B*1502 allele increases the risk for SJS Which ethic group is at most likely to have the HLA-B*1502 allele? Asians Asians are most likely to have what allele? HLA-B*1502 In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? Asian 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 What are 4 symptoms of agranulocytosis A sudden fever Chills Sore throat Weakness At what ANC should clozapine be stopped (even if asymptomatic)? <1000 What is neutropenia? <2000 PMNs What is agranulocytosis? <500 ANC What does DIGFAST stand for? Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms 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 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 Elevated LFTs Extreme muscular rigidity, Mutism, Elevated CPK (creatine phosphokinase), Myoglobinuria, Leukocytosis, and Elevated LFTs are symptoms of NMS What are 2 symptoms of Serotonin Syndrome? Hyperreflexia Myoclonic jerks Hyperreflexia and myoclonic jerks are symptoms of Serotonin Syndrome How do you treat NMS? DC antipsychotic Bromocriptine or Dantrolene What does Dantrolene treat in NMS? Muscle rigidity How do you treat Serotonin Syndrome? DC Antidepressant Cyproheptadine What combination medications increases the risk of Serotonin Syndrome multiple antidepressants (SSRI/SNRI/TCA/MOAI) When switching from an MAOI to SSRI/SNRI, how long should you wait? 2 weeks When switching from Prozac to an MAOI, how long should you wait? 5-6 weeks 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? 2 weeks Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank *2 risk factors D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors COWS scale components · Opioid W/D Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (gooseflesh skin), insomnia What does COWS stand for? Clinical Opiate Withdrawal Scale What does CIWA stand for? Clinical Institute Withdrawal Assessment What does CIWA assess for? --used to determine likelihood of ETOH withdrawal or DTs --usually occur within the first 24-72 hours after cessation o used to determine when to administer medications for ETOH withdrawal What does CIWA NOT test for? Alcohol Use Disorder What are the CIWA scale components? · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, H/A, orientation Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)- 4 (disoriented) Score: <10: Very mild Start PRN meds at score of 8 >10 to 15: Mild scheduled + PRN meds >16 to 20: Moderate >21: Severe Diazepam, Librium, Ativan When interview teenagers (16 y/o) that arrive with their parents what should you do? interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. PMHNP certification Exam May 2022 Which Ethnic group has the highest rate of suicide? Native Americans Example 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 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 Cherry colored urine in a patient that exercises a lot test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome is caused by "think 'antidepressants'" anything that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) to excess levels Treatment for NMS Stop Offending Medication -Dantrolene (Mr Dan the relaxed muscle man) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for….dopamine agonist vs muscle relaxer Serotonin Syndrome s/s most common sx : SAD AF-shivering -anxiety/restless-diaphoretic -Agitation-Fever “Shits and Shivers” -Diarrhea (shits) -Shivering, -Hyperreflexia/myoclonus -Increased temperature -Vital sign instability -Encephalopathy (agitation/restlessness/anxious/SZ) -Restlessness -Sweating Treatment for Serotonin Syndrome Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine (5-HT2 receptor antagonist). 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 (bulimia also) Which medications are best for neuropathic pain? 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; TCA's Symptoms of discontinuation syndrome flu like symptoms (fatigue, lethargy, myalgia, decreased concentration), n/v, impaired memory, paresthesia, irritability, anxiety, insomnia, crying w/o reason, dizziness, and vertigo Tx w/periactin 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) MRI or PET scan what is seen in schizophrenia EVERYTHING DECREASES EXCEPT VENTRICLES enlarged ventricles, decreased activity in the frontal cortex, decreased Gaba and glutamate decrease total brain volume. Stimulants can potentiate the release of what neurotransmitter? Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) a form of rehabilitation post hospitalization, in home treatment - for people w/ serious mental illness ACT is provided once they d/c from hospital -Primary goal: to help people become independent -Secondary Goal: reduce the reliance on hospitals - Treatment is centered around the patient’s personal strengths, needs, and desires for the future What level of prevention is ACT? Tertiary What adjunctive treatment is important in schizophrenia -social skills training -Exercise Exercise for mental health patients can promote Cognition Quality of Life Long-term health ACT is ideal for patients with a history of Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality Antisocial In the MMSE how do you test for abstraction? proverb interpretation (everyone that lives in glass houses shouldn’t throw stones) Are they able to think abstractly Thought Process-Tangential means that their response has nothing to do with the question Circumstantial means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes SI/HI/AH/VH Another name for MMSE Folstein Scale How to assess concentration on MMSE Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material repeat 3 words after me Assess ability to recall repeat 3 words after 5 minutes Assess fund of knowledge Who is the president What is a quick and easy way to assess for neurological issues Clock drawing test If patient is unable to draw a clock this indicates Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer Medications that cause depression steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone -may need to increase antidepressant Accutane (isotretinoin) Can cause depression and birth defects Flonase As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression Flonase can trigger mood instability but it can also cause an increase in Psychosis patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis -increase the dose of antipsychotic Neurotransmitters involved in Addiction Dopamine and GABA Symptoms of Stimulant Abuse 1. agitation/aggression 2. impaired judgment 3. euphoria 4. elevated BP 5. tachycardia 6. dilated pupils 7. hallucinations 8. TREMORS 9. IMSOMNIA If an anorexic patient complains of pain or bloating after eating this may indicate delayed gastric emptying Medications that delay gastric emptying Omeprazole, ranitidine, famotidine Proton Pump Inhibitors (omeprazole & Protonix) Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI When initiating an SSRI on an elderly patient you should advise about increased anxiety Paradoxical effect when meds cause the opposite effect than expected Apoptosis 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 -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 -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 Neurotransmitters involved in mood disorders DNS: Dopamine, Norepinephrine, Serotonin + GABA Neurotransmitters involved in ADHD DNS: Dopamine, Norepinephrine, Serotonin