LMR - Georgette's Review PMHNP 2024-2025| Questions and 100% Solved Answers| Complete A+ R, Exams of Nursing

Download LMR - Georgette's Review PMHNP 2024-2025| Questions and 100% Solved Answers| Complete A+ R and more Exams Nursing in PDF only on Docsity! What drugs should be avoided with Kava Kava? S & = ot > o 3 ; BL 4 gS s gg o > 5 4 wn x nS What are lab values in Hyperthyroidism What are labs in Hypothyroidism? x a 5 a a z z a o 3 2 x 3 & = g g : 3 ~ What are 4 primary symptoms of Hypothyroidism? Hypothyroidism mimics symptoms of what psychiatric disorder? Hyperthyroidism mimics symptoms of what psychiatric disorder? Valproic acid produces what teratogenic effect? What is the primary organ where valproic acid is toxic? S at are 4 signs of hepatoxicity? 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) Tsoniazid (TINH) Disulfiram (Antabuse) What 6 drugs can induce depression? "SIP BARB" Stcroids Interferon, Progesterone Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines Steroids can induce what 3 psychiatric states? Mania Depression Psychosis REMEMBER SAFETY FIRST; pt s/p assault, lst thing youdois What is the best environment to interview this pt in? reassure safety, provide environment of safety private area with door open/partially open What is the therapeutic range for lithium? 0.6-1.2 mEq/L Many postpartum women have SI after delivery, yct they don't have psych evals before leaving the hospital, what could a possible solution be? 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 [docs/does not] apply? 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? fax; so the new provider has them for follow-up appointment Coarse hand tremor Unsteadiness while standing or walking Bold =must knows Which 3 drugs can increase lithium levels by decreasing renal clearance? NSAIDs (ibuprofen, indomethacin) Thiazides ACE-I What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinuc)? 1.3 -1.4 mEq/L or higher With suspected lithium toxicity, what do you do first? D/C Li and draw Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? D/C lithium Cheek lithium level What 2 conditions can increase lithium levels? If this pt is going on a hike, what would you recommend ? Dehydration Hyponatremia Take extra water to avoid dehydration What birth defect can lithium cause? 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 an Ethical dilemma When building a therapeutic alliance w/ adolescents, it is important to stress confidentiality; what they say remains confidential unless they are wanting to harm sclf/ somcone 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? interview the teen w/o the parents; call CPS What 3 neurotransmitters are associated with ADHD? DA, NE, S5HT aka serotonin -->(DNS) The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalitics 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 anxicty about events or activitics 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 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 lcads 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 Conduct Disorder What are 3 "hallmark" characteristics of Conduct Disorder? aggression Destruction of property Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? 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? Behavioral therapy/ problem solving skills What is the goal of multisystemic family therapy (MFT)? Reduce barriers to resources for youth with problematic behavior What is Multisystemic family therapy? 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? score 0-30. Higher the better 25+ normal 21-24 mild 10-20 moderate 0-9 severe What is the range for SLUM? score 0-30 Higher the better 27+ normal 21-26 mild <21 dementia What is the range for HAM-D? 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-9 13-24 Ifa patient's COWS score is between 5 - 12, what do you do? Administer clonidine (mild score) Tf a patient's COWS score is between 13 - 24, what do you do? Administer buprenorphine (Suboxone) (moderate score) ‘When do you administer clonidine on the COWS? Definitely at score of >7; prior to that (scores 5-6) it can be given When do you administer buprenorphine (Suboxone) on the COWS? moderate symptoms (13-24) What is a moderate range on the CIWA? 16-20 When do you administer prn meds such as benzodiazepine or for N/V/D on the CIWA? Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine +PRN's on the CIWA? moderate symptoms (15 or higher) If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDD), how do you treat it? Medication and/or therapy Assess for suicidal ideation Ifa patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it? Medication and/or therapy Ifa patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it? Therapy or nothing Ifa patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? Therapy or nothing Ifa patient has severe anxiely (>24 on HAM-A) (>14 on GAD-7) how do you treat? Medication and/or therapy Ifa 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 thal can cause aggression, impulsivity, and difficulty with abstract thinking? Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalitics 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 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 MAOD, 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 Ifa child has both intrusive thoughts and tics, his most likely diagnosis is OcD Ifa 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 paint) A child with developmental delay who eats things (such as paint chips) may have Lead poisoning ‘What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? BMI Hip-to-waist ratio (waist circumference) Glucose Lipid panel Where is norepinephrine produced? Locus coeruleus Medullary reticular formation Serotonin is produced in raphe nuclei in the brainstem What 3 areas of the brain is dopamine produced? 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? Low BMI (bclow 18.5 is underweight) Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension What is the BMI in a patient with Bulimia Nervosa Normal range (18.5-24.9) Intense anxicty and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-S criteria for what disorder? Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? Intrusive re-cxpericncing of the trauma Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? EMDR CBT What are the 12 components/symptoms of the COWS? Pulse Sweating Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability Gooseflesh skin What are the 9 components/symptoms of the CIWA Scale? Nausea/vomiting Tremor Sweats Anxiety Agitation Tactile disturbances Auditory disturbances Headaches Oricntation What are 3 treatments for Alcohol Use Disorder? What is the first action when developing Health Policy? Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called Recovery Model What are 3 characteristics of the Recovery Model? Nonlinear recovery, continual growth and occasional setbacks; Learning from experience (c.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? Screening Brief Intervention Referral Treatment Screens for Substance Use Disorders What is the Tarasoff Principle 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" 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" You cannot confine (commit a person involuntarily) who is not imminently dangerous to self or others What are 4 key components of Strategic Therapy? 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? Solution-Focused therapy Which therapy uses triangles/triangulation, and self-differentiation? Family Systems Therapy The paradoxical directive, a technique to be used with caution, is used in which therapy? Strategic Therapy Hierarchies, Boundaries, and Genograms are characteristics of what therapy? Structural Family Therapy Genograms are used in which 2 family therapics? Family system therapy Structural therapy ‘What type of therapy should be performed when a patient presents with a cultural syndrome? Brief supportive therapy What type of therapy should be used in a patient who has just lost their job? What is the first action to take with a patient who is gaining weight from an SGA? nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? Agranulocytosis What antipsychotic is anti-suicidal in schizophrenia? Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? HCG Ifa patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? DC lithium A patient with what medical condition is at risk for lithium toxicity? Cardiac failure (hyponatremia) What are the key indicators for NMS? Extreme muscle rigidity Increased CPK Ifa depressed patient is taking a triptan for migraines, what should you prescribe for depression? Bupropion What is first line treatment for MDD? Why? SSRIs Safer in OD What are the 2 antidepressants of choice in a depressed patient with cancer? Why? Citalopram (Celexa) Escitalopram (Lexapro) less risk for Drug-Drug Interaction What is the antidepressant of choice in a depressed patient with sexual dysfunction? Bupropion What is the antidepressant of choice in a depressed patient with decreased energy? Bupropion What are 3 treatments for depressed patients with neuropathic pain? SNRI TCA (think safety tho) Gabapentin/Pregabalin (alpha2 delta ligands) BOLD = know Which SSRI is most likely to cause insomnia? Fluoxetine (Prozac) What question is important to ask in the social history with a depressed paticnt? Alcohol intake (self-medicating) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? all Antidepressants What question should ask all adolescent patients at each visit? Social skills training in a schizophrenic patient is what type of prevention? Tertiary What are 3 benefits of acrobic exercise in schizophrenic paticnts? Increased cognition mproves Quality of Life improves Long-term health What is a delusion? A firm belicf despite contrary evidence Ex: Church members are part of a cult How often is Haldol Decanoate typically adminitered? monthly If a patient is reeciving 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? 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? 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) Clinical observation (listen/observe) What is included in thought content? SI/HI, plan What are the 5 components of the MMSE (Folstein's) Concentration/attention/calculation. Oricntation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? What does this help prevent? 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? SGA IM Invega, Geodon or Abilify increase risk for EPS (acute dystonia) Which 4 SGAs are available in IM form? Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics can increase prolactin and can cause TD? Mctoclopramide (Reglan) What do you do ifa patient is on olanzapine (Zyprexa) and stops smoking? Decrease olanzapine dose (he stopped the inducer) What effect does tobacco have on CYP450? genetics (very heritable) fm Hx What should you consider in a 45 y/o patient that presents with manic symptoms? Medical condition if a pt w/ SCZ is controlled on Risperdal; but has been prescribed a steroid by the PCP, what might you need to do? increase the anti-psychotic What are 2 differences between mania and hypomania? More severe Increased duration (7 days vs. 4 days) A patient who is manic, irritable mood, and uncooperative is most likely to have what disorder? bipolar disorder What are key symptoms to consider in a paticnt you suspect of mania or hypomania? Grandiosity or exaggerated self esteem lack of sleep (and not tired) talkativeness or pressured speech What is a hallmark feature of borderline personality disorder? Self-harming behavior (recurrent) What therapy in borderline personality disorder been shown to decrease suicidal ideation? DBT Who developed DBT? Marsha Linehan In DBT, diagnosis of borderline disorder requires activity? journaling/diary A patient with borderline personality disorder with symptoms of depressed mood, rejection sensitivity, and emotional lability should be prescribed? A patient with borderline personality disorder with symptoms of irritability, anger, self-harm could be given? Valproic acid/Depakote/DVP Lithium A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? Conduct Disorder Ts a child with ODD or Conduct Disorder more likely to need medication? Conduct Disorder Ifa child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? Not always What is factitious disorder imposed on another? Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? Report to CPS Child abuse (duty to report) What is Factitious Disorder Faking illness to get medical attention or sympathy Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? prefrontal What do you recommend to a mother of a child with ADHD as an aftercare plan on admission? Brief supportive therapy (not after dc) Ifa patient present with irritability, depression, and lability, which questionnaire do you administer? Mood Disorder Questionnaire (MDQ) What disorder resembles bipolar disorder in children (7 and 17 years)? Disruptive Mood Dysregulation Disorder (DMDD) What should you assess initially in a child who presents with nightmares? Tf other family members have the same problem aflercare starts upon admission What are 2 key factors in the diagnosis of Autism Spectrum Disorder? Persistent deficits in social communication and social interaction across multiple settings A child that does not establish eye contact is likely to have autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? Alcohol or substance withdrawal An older female has delirium and you suspect a UTI, what 2 labs should you order? UA Cc/S An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? B12 Folic acid What is the initial treatment for a patient with dementia and psychosis? Nonpharmacologic treatment If a patient with dementia docs not respond to nonpharmacologic treatment, what do you do? Administer SGA What type of dementia is HIV-related? cortical or subcortical Subcortical A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? HIV-related In a patient with suspected HIV-related dementia, what is your initial action? Obtain HTV test What is first-line pharmacologic treatment for a patient with HIV-related dementia? Antiretroviral treatment An older adult who has had cognitive impairment for over a year and who tries to answer (may not be able to) or confabulates is most likely to have a diagnosis of Dementia An older adult who has had cognitive impairment for less than 5 months and who answers your questions with "I don't know," most likely has a diagnosis of Depression (pseudodementia) An older patient who has symptoms of irritability, agitation, hallucinations, and delusions is most likely to have Depression (vs. dementia) Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? CBT Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in Behavioral Therapy What are 2 common techniques used in CBT? Cognitive restructuring Journaling Self-directed growth and sclf-actualization to find meaning in life are key concepts of what type of therapy? Humanistic (person-centered) What is the best therapy for dealing with conflicts with others (e.g., spouse, co- workers)? Interpersonal therapy How long does interpersonal therapy typically last? 12-16 weeks If a paticnt is noncompliant, what is a technique that is used in Strategic Therapy? Paradoxical directive/intervention What is the benefit of paradoxical directive Promote self-awareness (ie med adherence or fear of failure) If a paticnt is compliant, what is a technique that is used in Strategic Therapy? Straight Forward Directive What type of therapy is a therapist using when he asks "what worked before when you had this problem" Solution-focused therapy How can a child's body image, resilience, relationships, and social anxiety be improved? Physical activity When may a closed-cnded question (yes/no) be necessary rather than an opened- ended question? Children (when a narrative cannot be constructed) If a child docs not respond or open or closed-cnded questions, what to you do? talk to parents What therapeutic factor does open-ended questions instill? empathy Example of open ended questions How did you fall? Why do you think you are feeling sad? Tell me more Tf only the wife shows up for a couple appointment, what do you do? Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? Contact CPS Crisis therapy A mother reports her 5-y/o was raped by his 16 y/o brother. What 2 things do you do? crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis ESR What does PICOT stand for? P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome T - Time Normocytic When vital signs are not normal in a thin women, you suspect Anorexia nervosa You see a patient with suspected anorexia nervosa. What do you do? Refer out for medical evaluation Ifa patient with anorexia nervosa refuses to see a PCP, what do you do? Contact CPS If AN patient is medically unstable and parents refuse hospital treatment, what do you do? contact CPS What alternative medicine treatment is used with pain and depression? Acupuncture What act prevents a patient from unlawful hospitalization (can leave AMA)? Habeus corpus (usually max of 28 days) A pedi patient presents with paresthesia, fatigue, unsteady gait, confusion, arm/leg weakness and asymmetric body movement of extremities. What do you suspect and what do you do? Disseminated Encephalomyelitis Neuro exam Ifa patient is unable to remember events, how do you establish a diagnosis? Provide anchor (memorable events) to establish diagnosis How do you implement policy affecting NPs nationwide? Host online forum/give survey to obtain information (vs. letters) How do you implement policy that coworkers are against? Tell them how the policy will increase quality of patient care What is the initial step in providing continuous improvement of Quality of Care in an outpatient setting? Create an instrument to monitor outcomes What will you see in a laboratory test in a patient with an autoimmune disease? Increased cytokine levels What are 2 ways to treat enuresis (night-time bedwetting)? Alarm clock Desmopressin (DDAVP) What is the mechanism of action of Desmopressin (DDAVP)? Decreases urine production (via antidiuretic hormone - vasopressin) When considering the relationship between receiving samples from a drug rep and sponsored education, what is there a concern for, and what should you do? Conflict of Interest Create policy to address COI A conflict of interest may occur in what 2 scenarios? Receiving samples of drug rep Attending an industry sponsored educational program A patient calls because he read on the internet about a BBW on his medication. What do you do? You don't need to discontinue drug. Research benefits and risks What are 2 things you should do when you prescribe off-label? Document Provide full disclosure (risks/benefits) When you prescribe trazodone to a male patient, what should you do? ‘Warn about priapism and document Smoking, increased weight/obesity, and DM arc risk factors for what disorder? Sleep Apnea What is tolerance? Decreased effect with continuous use What is the goal or Reflective Practice? Improve practice privacy Instillation of Hope, Universality, Altruism, Increased development of socialization skills, Imitative behaviors, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors, and Corrective refocusing are BOLD= focus on more Therapeutic Factors which differentiate group therapy from individual therapy Experiencing optimism through observing the improvement of others in the group is which of Yalom's therapeutic factors? Instillation of Hope Learning to give to others is which of Yalom's therapeutic factors? Altruism Sharing experiences/feelings in group clients realize they are not alone is which of Yalom's therapeutic factors? Universality The "natural laboratory" is which of Yalom's therapeutic factors? Increased development of social skills Group members modeling their behavior after other members of group/therapist is which of Yalom's therapeutic factors? Imitative behavior Developing a sense of belonging in the group is which of Yalom's therapcutic factors? Group cohesiveness Interacting with others to increase adaptive interpersonal relationships is which of Yalom's therapeutic factors? Interpersonal learning Group members dealing with the meaning of their existence is which of Yalom's therapeutic factors? Existential factors Participants reexperience family conflicts, allows them to recognize and change/correct behaviors that may be problematic is which of Yalom's Therapeutic Factors? Corrective refocusing Openly expressing their feelings which were previously suppressed is which of Yalom's Therapeutic Factors’? Catharsis Focusing on the strength of the group is key to what organizational change strategy? Appreciative Inquiry Who determines the Scope of Practice? State legislature (BON) (varies state to state) Who determines the Standard of Practice? ANA (doesn't change) What are 8 exceptions to confidentiality? (know all) Unconscious (to save a life) Intends to harm self/others Treating everyone with equal respect is what ethical principle? Respect What are 2 important roles to perform as a clicnt advocate? support the client's best interest while respecting family's role reduce stigma of Mental illness What is the best way to reduce stigma? Education (esp. large audicnec) A work environment that improves patient safety through continuous lcarning designing safe systems is Just Culture What treatment approach does not focus on mental illness, is nonlinear (occasional setbacks), and stresses learning from experience? Recovery Model In the recovery model, the clinician focuses less on the Dx and trices to focus/foster the the pts? interests, abilities and dreams What is the PDSA cycle A quality improvement process or strategy What is an example of a Quality lLmprovement Project? RETROSPECTIVE Chart review When implementing health policy, what is the first thing you do? Assess barriers and facilitators (prior to meeting with stakeholders) What should you do before warning someone about harm (Tarisoff act)? Contact Board of Nursing A key component of Piaget's Scnsorimotor stage is Object permanence Object permanence develops in which of Piaget's developmental stages? Sensorimotor What are 2 key components of Piaget's Preoperational Stage? Magical thinking Symbols and language thoughts of monsters being real, if they think of someone getting hurt and it happens, they think they caused it. According to Piaget, at what stage do children display magical thinking and use language and symbols more? Preoperational What is a key component of Piaget's Concrete Operations Stage? See things from other's perspectives (less egocentric) develops concepts of --conservation: clay is always clay --reversibility: water to ice turns back to water According to Piaget, during what stage do children see things from other's perspectives - less egocentric? Concrete operations Conservation and reversibility occur during what stage per Piaget? Concrete What is the key component of Piaget's Formal Operations stage? Abstract logic (science projects, hypotheses) According to Erikson, what period (age) is the development of meaningful relationships important? Infancy (0 - 1 yr.) According to Erikson, what period (age) is self-control a key component? Early childhood (1 - 3 yrs.) Glutamate (increased) GABA (decreased) SHT (deercased) What neurotransmitters are associated with anxiety? NE (increased) 5HT (decreased) GABA (decreased) What neurotransmitters are associated with Alzheimer's? ACh (decreased) Glutamate (decreased) What neurotransmitters are associated with Parkinson's Discase? DA (decreased) ACh (Increased) What 4 psychiatric disorders have dysregulation of dopamine, norepinephrine, and scrotonin (DNS)? ADHD MDD BPD Tourette's Which 5 psychiatric disorders have dysregulation of the GABA receptor? BPD Schizophrenia Autism SUD Anxiety What 4 psychiatric disorders have dysregulation of glutamate receptors? BPD Schizophrenia ASD Alzheimer's Which 2 psychiatric disorder have dysregulation of aectylcholine receptor? Alzheimer's Parkinson's What 3 disorders have dysregulation of glutamate and gabapentin? autism spectrum disorder bipolar disorder schizophrenia You are concerned a 5-yo child may be sexually abused. How do you conduct the interview? Interview child and parents separately if child can communicate You see a child playing with a toy in a sexual manner. What do you do? contact CPS What are the 2 most important aspects of interviewing an adolescent? Rapport Confidentiality (explain exceptions) How should an adolescent be interviewed separately form parents Tf an adolescent is dating someone the same age, do you need to tell the parents? No If an adolescent is dating someone of the same gender, do you need to tell the parents? No What should you ensure before discharging a patient from the hospital? can they stay safe and cope effectively Should a patient be interviewed in a day room? No (not confidential) When do you draw a T3 or T4 If TSH is abnormal What symptom occurs with high levels of ammonia? confusion How do you apply your knowledge of a relationship between ADHD and substance abuse to practice? Serecn ADHD patients for substance use Screen SUD patients for ADHD When you look up data about a patient in social media, what are you violating? patient's trust Prior to sending prescriptions to a pharmacy, what do you need to do? obtain patient consent If patient is unable to give consent, what do you do? assess for involuntary treatment (don't forcefully give medication) The ethical principle that is associated with preventing imminent danger to paticnt is? nonmaleficence Sending a patient to a crisis stabilization unit rather than a hospital is honoring what patient right? least restrictive environment You plan to teach the patient about their illness. What do do you do first? assess knowledge In what age groups should you obtain HCG? 12-51 What are normal prolactin levels for males and females? Male: <20 Female: <25 serotonin is implicated in what 2 areas? mood and sleep What 2 symptoms might you see in a patient with a frontal lobe tumor? social skill deficit inappropriate affect What is the term for symptoms caused by a medical treatment or drug therapy? How do you assess it? Tatrogenic S/S, assess medical history to ID if S/S are caused by the medication or not If you refer a patient to a residential center for alcohol withdrawal, what can you provide them for symptom control? Hydroxyzine or buspirone (not benzodiazepinc) What does perjury mean? Lying or withholding information under oath Which 2 parties can you not disclose information without the patient's consent? family member another provider As part of reflective practice, what strategy is used post event? debriefing strategies When a medication error occurs, what is the first thing to assess per just culture? Pt safety; assess the patient What cardiac SE is geodon (ziprasidone) known for? QTc prolongation the max dose of Citalopram is 20mg/day in the elderly client, why? tisk for QTc prolongation (Note:max 40mg in adults <65) Parkinson's disease is caused by damage or loss of the dopamine-producing cells of the midbrain, leading to dopamine deplction in the basal ganglia Pseudoparkinsonism caused by DA blockade in the nigrostriatal pathway causing sx resembling Parkinson's Ds; tremor, shuffling gait, drooling, rigidity In a trauma focused cognitive interview, what questions help build rapport? non-judgmental questions "how has that trauma affected you?" "When did this happen" There are 3 phases to EMDR, they arc...