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LMR PMHNP EXAM | CERTIFIED QUESTIONS
WITH CORRECT SOLUTIONS
Abnormalities or changes/deficits in the PFC, amygdala, basal ganglia, hippocampus, and limbic regions of the brain can cause? - Correct-answer- schizophrenia = aggression, impulsivity, and abstract thinking problems
What does the mesolimbic consist of? - Correct-answer- Nucleus accumbens (NA)
- Ventral tegmental are (VTA)
What does the Mesocorticol pathway consist of? - Correct-answer- Ventral tegmental area (VTA) connects to the cortex of the brain.
What does the Nigrostriatal pathway consist of - Correct-answer- Substantia nigra
. What happens when meds are used to decrease dopamine in mesolimbic and mesocortical pathways? - Correct-answer- We decrease dopamine in the Nigrostriatal causing PARKINSONISM
What happens in the mesocortical system if there is decreased dopamine? - Correct-answer- -It causes negative symptoms in schizophrenic symptoms.
-Decreased pleasure, facial expressions, they are not happy!
What happens in the mesolimbic pathway if there is too much dopamine? - Correct-answer- This causes positive schizophrenia symptoms like DELUSIONS + HALLUCINATIONS
What does the tuberoinfundibular pathway consist of? - Correct-answer- It consists of the pituitary gland
What happens in the tuberoinfundibular pathway when dopamin increases and decreases? - Correct-answer- -When dopamine increases it will decrease prolactin.
-When dopamine decreases it will increase prolactin resulting in galactorrhea
What are 2nd generation antipsychotics? - Correct-answer- Risperdal
Olanzapine
Ziprasidone
Lurasidone
Clozapine
Quetiapine
Aripiprazole (least sedating)
- What receptors do 2nd gen antipsychotic meds block? - Correct-answer- D
What lab to test when starting a 2nd gen antipsychotic? - Correct-answer- CBC
What are the highest risks while on 2nd gen antipsychotics? - Correct-answer- - Weight gain (way more than 1st gen)
-Hyperprolactinemia
-Agranulocytosis
What medication is agranulocytosis most common in? - Correct-answer- Clozapine (Monitor cloz-ly)
What medications cause MANIA? - Correct-answer- - *Steroids
-Disulfiram (antabuse)
-Isoniazid (INH)
-Antidepressants ( in person w/ bipolar)
What does tobacco do to meds and what should you do? - Correct-answer- Decrease the effectiveness, increase the dose if patient starts smoking
What puts patient at higher risk for EPS? - Correct-answer- Metoclopramide (Reglan) + Antipsychotics
What is the difference between OCD and Tourrets? - Correct-answer- - OCD- Persistent with thoughts and tics
-Tourettes- Tics ONLY
What is Amenorhhea? - Correct-answer- Is the absence of menstrual period in females.
1 What happens when prolactin increases? - Correct-answer- Amenorrhea + galactorrhea
What happens when prolactin increases in males? - Correct-answer- Galactorrhea
What does striatum consist of? - Correct-answer- Caudate Putamen
Why does prolactin decrease? - Correct-answer- Too much dopamine in the Tuberoinfundibular pathway
.What happens when antipsychotic block alpha-1 receptors? - Correct-answer- Orthostasis
Hypotension
Priapism
Sexual dysfunction
What antipsych med is the most common in cousin hyperprolactemia? - Correct- answer- Risperidone
Atipcals have what? - Correct-answer- Serotonin (5HT2A) less like to cause EPS
What are the extrapyramidal symptoms? - Correct-answer- Dystonia
Akathisia
Parkinsonism
Tardive dyskinesia
What causes EPS? - Correct-answer- Decreased dopamine due to anti psych meds
What is Akathesia? - Correct-answer- Restlessness, pacing, tapping
What is the treatment for akathisia? - Correct-answer- Beta blocker (propanolol)
What does the - Nism in parkinsonism mean? - Correct-answer- Caused by/ induced by medication
What is tardive dyskinesia? - Correct-answer- Lip tongue smacking, repetitive uncontrolled movements
What is the treatment for dyskanesia? - Correct-answer- DC medication
Possibly use clozipine (May or may not work)
What should you do with someone who is on oxazapine and is smoking? - Correct- answer- If they start= increase
If they stop= decrease
Why would you give a dopamine agonist in pt with NMS? - Correct-answer- - Dopamine agonist will increase dopamine
-**You would give Bromocriptine **
- What medications cause depression? - Correct-answer- - Steroids**
-Beta blockers
-Interferon
-Isotretinoin (acutate)
-Antiblastic drugs
-Benzodiazepines
What is the main neurotransmitter involved in Tourette's syndrome? - Correct- answer- Dopamine
How is tourette syndrome diagnosed? - Correct-answer- Patient needs to have at least 2 motor tics and at least 1 vocal (phonics) (Does not have to be at the same time
Safest SSRI during pregnancy? - Correct-answer- Sertraline
What do benzos cause during pregnancy? - Correct-answer- Floppy baby syndrome
How soon can acute stress disorder be diagnosed? - Correct-answer- Within 4 weeks of traumatic event
How long does acute stress disorder last? - Correct-answer- They last one month or less
What are the signs and symptoms of stress disorder? - Correct-answer- - Anxiety
-Insomnia
-Poor concentration
-Intense fear
-Helplessness
-Re-experience event
-Avoidance behavior
What are the post traumatic stress disorder hallmarks symptoms? - Correct- answer- - Intrusive re-experiencing of an extreme traumatic event
-Increased arousal
-Avoidance of stimuli associated with trauma
What are the PTSD meds? - Correct-answer- - Prazosin for nightmares*
-SSRI
-TCAS
What is the non-pharm PTSD treatment? - Correct-answer- EMDR supportive group therapy
What are the signs and symptoms of panic attack? - Correct-answer- - Rapid HR
-Sweating
-Shaking
-SOB
-Hot flashes
-Lightheadedness
-*IMPENDING DOOM
If older adults with symptoms of depression present to the office what would you do and see? - Correct-answer- -Cognitive deficits
What causes delirium in adults? - Correct-answer- INFECTIONS can cause delirium in adults
Order: UTI, culture sensitivity
What medication should be used for delirium in patients with symptoms agitation and psychotic in adults? - Correct-answer- -Low dose of Haldol
-NO BENZOS can make it worse
What is delirium? - Correct-answer- - Acute disturbance of level of consciousness cognition, inattention
What medications are used with the Autism spectrum? - Correct-answer- - ADHD- to help with impulsivity
- Antipsychotics to help w/ aggressive behavior
What are some comorbidities with autism? - Correct-answer- - Epilepsy
-Seizures
-Sleep disorder
-Disturbances
-ADHD
what is the Broken mirror theory for autism? - Correct-answer- The Broken mirror theory of autism claims that a dysfunction of the mirror neurons system may be the cause for poor social interaction & cognition in individuals
What is the autism spectrum screening tool? - Correct-answer- M-Chat- modified checklist for autism in toddlers
What are the signs of autism spectrum disorder? - Correct-answer- - Lack of social interaction and communication
-No response when called by name
-Echolalia- meaningless repetition
-Children with autism often like to stack up or organize objects in long tidy rows.
What is an example of breaking confidently? - Correct-answer- Sending a prescription over to a pharmacy that patient did not verify
What is autonomy? - Correct-answer- The right to refuse medications/ right to self determination
What should you do if patient is too manic to give consent? - Correct-answer- Assess for involuntary treatment
How to determine a dementia patient is able to give consent? - Correct-answer- If the patient able to repeat the procedure and risks they can give consents
What are some exceptions of confidentiality? - Correct-answer- - Court orders
-Subpoenas or summonses
-Releasing records to insurance companies.
What is confidentiality? - Correct-answer- - Clients right to assume that into given to the provider will not de disclosed
-Needs consent to disclose info.
Who is standard of practice established by? - Correct-answer- ANA
Who determines scope of practice? - Correct-answer- State legislative statutes (State board of nursing)
What are signs and symptoms of hyperglycemia? - Correct-answer- *Excessive hunger
Excessive thirst
Weakness fatigue
Frequent urination
*Blurred vision
Dry skin
Sores
Nause
Sleepiness
After eating
What are the signs and symptoms of hypoglycemia? - Correct-answer- Hunger
