NRNP 6675 Midterm Exam(2Versions, 200 Q&A, 2023-2024) 100% Verified Q&A Walden University, Exams of Nursing

Download NRNP 6675 Midterm Exam(2Versions, 200 Q&A, 2023-2024) 100% Verified Q&A Walden University and more Exams Nursing in PDF only on Docsity! NRNP 6675 Midterm Exam(2Versions, 200 Q&A, 2023/2024) 100% Verified Q&A Walden University Discrepancy between anatomical sex and gender is known as? - B) Gender Discordance Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply - Rapid dose escalation; parental route of administration; higher potency typical antipsychotics Antipsychotic medication provides D2 blockage in the meso-coritcal pathway causing which of the following effects? - B) Increases EPS Incorrect: reduces negative s/s, causes prolactinemia, reduces positive symptoms Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors? - D) NMDA type receptors Incorrect: GABA, serotonin, dopamine "receptors" The diagnosis used to describe a syndrome characterized by specific s/s resulting from recent ingestion or exposure to a substance is known as which of the folllowing? - C) Substance use disorder Incorrect: substance intox, substance withdrawal, all of the above Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue jaw is known as which of the following? - C) Tardive dyskinesia Incorrect: akathisia, dystonia, EPS A deeply held belief despite evidence to the contrary, lasting at least 1 month, without prominent hallucinations, with functional impairment that relates to the delusional system disorder called? - Delusional disorder Which of the following is true about preoccupation with castration? - A) This can be serious and life threatening if castration is carried out without medical supervision Incorrect: consistent with transvestiatic disorder, other specified paraphillic disorder, or sexual machochism disorder Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostics services rendered by clinicians? - CPT Incorrect: HIPPA, DSM5-, DRG A patient on Chlorpromazine states his orgasm is dry and afterwards he will commonly have milky urine. The APRN realizes this is which of the following? - A) This is likely a harmless response to the Chlorpromazine "Thorazine" A condition which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus and infertility is known as which of the following? - B) Turners Syndrome Turners syndrome: tx involves hormone therapy; fertility treatments for women when they decide to have a baby Which of the following would be characterized as a negative s/s of schizophrenia? - B & C only B) impaired social and occupational functioning C) isolation and impaired self-care Which of the following are keys to distinguishing OCD from psychosis? - Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms ) Having an adequate legal description of nurse practitioner (NP) scope of practice according to state law is important for which of the following reasons? - All of the above (to avoid any charges of practicing medicine without a license, to place accountability for both benefits and harm to patients squarely on the NP, to get reimbursed for physician services when provided by a NP Which of the following is the most widely consumed psychoactive substance? - B) Caffeine A federal program administered nationally and locally which covers enrolled individuals 65+ who pays premiums and disabled individuals - Both A& B (Medicare and Medicaid The nursing practice model recommendation for NPs by the NAtional Academy of Medicine and the National Council of State Boards of Nursing is which of the following? - A) Full practice Which of the following groups does medicare cover? Select all the above - A) Individuals 65+ years and older who have enrolled and pay premiums B) Disabled individuals who quality for social security disability payments and benefits Which of the following neurotransmitters increases libidio? - D) Dopamine Incorrect: GABA, serotonin, oxytocin Which of the following factors are associated with poor prognosis for patients with OCD? - D) A & C (Childhood onset & Co-existing major depressive disorder) Which of the following is inconsistent with current knowledge about schizophrenia? - C) Dopamine level is a laboratory tests that assists in the diagnosis of schizophrenia A chronic disorder characterized by repetitive hair pulling leading to variable hair loss that may be..to others known as? - C) Trichotillomania Which of the following are risk factors for neuroleptic malignant syndrome? - B) Rapid dose escalation C) Parental route of admin D) High potency typical antipsychotics A method of therapy used to tx individuals with substance use based on the fundamental principle of a psychology that reinforced behaviors are likely to be..is known as the following? - B) Contingency Management The conditions in which people are born, grow, work, live and age are known as? - Social determinants of health All of the following is consistent with the ANCCs rules regarding recertification EXCEPT: - A) You are required to have a maximum of 25 credit hours during each certification period Correct: B) you can start the recert process 1 year before your expiration date, but no later than 3 months before C) You must have 1000 clinical practice hours in a clinical speciality within the preceding 5 years D)you must have at least 25 contact hours in pharmacotherapy Risks factors for school violence include which of the following? Select all that apply - A) Bullying B) Being bullied C) Isolation Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas in the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics with which of the following personality disorders? - C) Dependent personality disorder Incorrect: avoid PD, passive PD, antisocial PD Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels? - D) >25 mEq/L (TOXICITY) A form of child abuse in which a patient or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought in an ER is known as which of the following? - D) Munchausen Syndrome by Proxy Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT? - D) plan to study for short periods over a longer period of time A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with..trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects that the pt likely has which of the following PDs? - B) Paranoid PD Incorrect: schizoid PD, BDP, Antisocial PD A pt will a hx of alcohol use presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. Symptoms are consistent with which of the following psychiatric emergencies? - C) Wernickes Encephalopathy Incorrect: akathisia, korsakoff's syndromes, idiosyncratic alcohol intoxication Cluster A personality disorders are more common in biological families of pts with which of the following disorders? - D) Schizophrenia Incorrect: depression, OCD, alcohol use disorder NP core competencies for INDEPENDENT practice includes all of the following EXCEPT: - B) Demonstrates the highest level of accountability for professional practice NP competencies for independent practice: - A) Maintain a collaboration agreement with physician C) Practices independently managing previously diagnosed and under-diagnosed pts D) Practices patient centered care recognizing culture diversity and the pt or designee as a full practice in decision making Cluster A personality traits consists of which of the following? - A) Schizotypal, schizoid, and paranoid subtypes The misuse of the charge's funds for personal gain is known as which of the following? - C) Financial abuse /exploitation the ARNP recognizes which of the following as long term effects of sex trafficking on victims? - D) All of the above A) Severe depression B) Spiritual questions C) Trauma bonding In about half of the cases in which suicides occur while pts are on a psychiatric unit, a lawsuit results; which of the following is NOT consistent with what courts..related to impatient psychiatric unit suicide events? - B) Courts provide ZERO suicide rates in inpt setting Cultural Dimensions Therapy is a framework for cross-cultural communication that describes the effects of a society's culture on the values of its members..by which of the following therorists? - A) Hofstede The tx of choice for pts with paranoid PD includes which of the following? - D) B&C B) Behavioral Therapy and C) Psychotherapy The differences in quality of healthcare actions across individuals or groups regard to access, tx options and p..following? - B) Health disparities The incidence of suicide is highest for which of the following populations? - D) Older African American men only A & B A) Medicare/medicaid B) Managed care organization (MCOs) Which of the following are risk factors for sexual assault EXCEPT: - A) Religion Incorrect: serious mental illness, substance use disorder, family hx of sexual abuse Which of the following is consistent with what is known about PP depression? - D) All of the above (feelings of guilt/ and inadequacy are often present and excessive; thoughts of harming the baby are often present; typical onset is within 3-06 months of delivery) Affirmatively acting to benefit another or others, going beyond what is required by law is known as which of the following?> - C) Beneficence Which of the following is used for treating alcohol dependence individuals seeking to continue to remain alcohol free after they have stopped drinking? - D) Acamprosate The NP can impact health policy and healthcare by doing which of the following? - D) All of the above -becomes an active member of local, state, and/or national NP -becomes familiar with the resources available on NP organization websites -Volunteer to serve on legislature committees within professional NP organizations The tx of others equitably and distribution of benefits/burdens fairly is known as? - B) Justice Which of the following is INCONSISTENT with current literature about victims of sexual abuse? - C) The pre-existing relationship and\ familiarity with the abuser may impeded the victim's ability to make rational decisions Which of the following would constitute negligence? Select all that apply - A) Failure to give necessary care B) Failure to refer when necessary C) Failure to follow up with a patient D) Failure to disclose necessary info to a patient Which of the following developed a biblically-based cultural competence model for healthcare professionals? - B) Camipinha-Cacote` the ARNP recognizes which of the following as long term effects of sex trafficking on victims? - D) All of the above -severe depression -spiritual questions -trauma bonding A patient appears odd, with a pervasive hx of magical thinking, ideas of reference, illusions or derealization. This is consistent with which of the folllowing PDs? - C) Schizotypal PD Which of the following are criteria for a particular suicide to be considered inevitable? - D) All of the above -strong genetic hx of suicide in one or more family members -a strong genetic loading of mental illness in the family -the pt may have received the highest standard of tx and that txd failed A pt with a hx of alcohol use disorder presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. The ARNP recognizes these symptoms as consistent with which of the following psych emergencies? - C) Wernicke's encephalopathy The emotional burnout and lack of empathy towards clients that healthcare providers experience after treating victims is known as the following? - B) Primary traumatization The ACE study found that which of the following relationships between child traumatic events and high-risk behaviors exhibited by adults? - D) The study revealed an indirect relationship between child traumatic events and high risk adult behaviors Walking on eggshells and appeasement/avoidance behaviors by the victim is characteristic of which phase of the cycle of DV? - A) Honeymoon phase What are the different phases of DV? - 1. Tension building phase 2. Incident 3. Reconciliation 4. Calm The only appproved therapy in the US for moderate to severe Alzheimers Disease is which of the following? - B) Memantine Memantine is? - A) Namenda, cognition enhancing medication for alzheimers/dementia A term that defines a person who has distress with clinical symptomology because their gender identity is not consistent with gender assigned at birth is which of the following? - D) Gender Dysphoria Narcissistic, borderline, antisocial, and histrionic subtypes are associated with which cluster of PDs? - B) Cluster B Odd, eccentric cluster of PDs? - Cluster A a. Paranoid PD b. Schizoid PD C. Schizotypal PD Characterized by appearing dramatic, emotional, or erratic PD? - Cluster B a., antisocial b. borderline c. histrionic d. narcissistic inner emptiness, unstable relationships and emotional dysregulation? - BPD Attention seeking and excessive emotionability? - Histrionic Social irresponsibility, diregard for others, deceitfulness, and manipulation of others for personal gain - Antisocial Self-grandiosity, need for admiration and lack of empathy - Narcissistic PD Eccentric ideas and behaviors PD? - Schizotypal PD Disinterest in others PD? - Schizoid Mistrust and suspicion PD? - Paranoid PD Characterized by appearing anxious or fearful. it includes which PDs? - Cluster C a. avoidant PD b. dependent PD c. obsessive compulsive PD Perfectionism, rigidity and obstinacy traits PD? - OCD PD Avoidance of interpersonal contact due not rejection sensitivity PD? - `Avoidant EXCEPT: - C) Drink lots of caffeine and eat high concentrated sugars good self care strategies: -plan to study for short periods over a long time -study in a distraction free environment -6-8 hours of sleep is recommended Which of the following professionals would be able to precept a NP student? - D) A&B A) ARNP B) Physician the ARNP is txing a 27 year old female who bipolar disorder who is obese and has renal; dysfunction. Which of the following is true? - C) An atypical antipsychotic such as olanzapine or risperidone should be used Pts with this PD are described as excitable, emotional and behave in a colorful, dramatic, extroverted, attention-seeking fashion, often with an inability to maintain deep long-lasting attachments - B) Histrionic PD a PD characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness and a pattern of perfectionism and inflexibility is known as which of the following? - D) OCD PD Which of the following core competencies are quality competencies? - D) A&C A) use best available evidence to continually improve quality of practice C) evaluates the relationship among access cost quality safety and their influence on health care Non-pharmacologic tx for abuse includes all of the following EXCEPT: - D) Involve the abuser in the tx planning Non-pharmacologic tx options for abuse victims? - CBT -build a community of support -assist pt to devise a safe escape plan a PD characterized by extraordinarily unstable affect, mood, behavior, object relations and self-image is known as? - BPD A particular form of psychotherapy based on Otto Kernbeg's object relations theory is known as which of the following?> - C) Transference-focused psychotherapy generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following Lithium levels? - C) > 2.5 mEq/L nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, oliguria and renal failure - Moderate Lithium toxicity: 2.0-2.5 Lithium therapeutic window - 0.6-1.2 mEq/L first med approved for bipolar d/o - lithium Common side effects of Lithium, - tremor, nausea., fatigue, increased thirst, slowed thinking Important serious side effects of Lithium: - hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity How do we decrease the risk of lithium toxicity? - Blood level monitoring therapeutic range: 0.6 - 1.2 Lithium levels are known to (increase/decrease) when used concurrently with diuretics, thiazides, ACE inhibitors and NSAIDs? - Increase ACE inhibitors: lisinopril, catopril, enalapril Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline - Decrease concurrent use of lithium and antidepressants and/or antipsychotics can cause what? - Serotonin syndrome & Neuroleptic malignant syndrome The term "suicide survivor" refers to which of the following? - A) those who have lost a loved one to suicide At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all the above - C) is the problem organic, functional or a combination? A pt presents with a formal, tense manner. He reluctantly responds a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the pt likely has which of the following PDs? - B) Paranoid PD The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following? - B) Beneficence `In about 1/2 the cases in which suicides occur while pts are in a psychiatric unit, a lawsuit occurs. Which of the following is NOT consistent with what court expects related to inpt psych unit suicide events? - D) Evidence of formulation of a tx plan with a high level of security Using the LIAASE: A general cultural competency tool, the ARNP would do which of the following? - D) all of the above -agree to disagree on differences in values -solicit other options or points of view -acknowledge and validate powerful emotions when expressed Which of the following is NOT consistent with what is known about PP psychosis? - A) symptoms of PP psychosis can often begin within days of delivery Concerns when treating geriatric patients with psychotherapeutic drugs includes all of the following EXCEPT: - B) Elderly persons may be more susceptible to adverse effects of psychotherapeutic drugs A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specific number of days is known as which? - C) Termination clause Standards of care are now being set, modified, monitored and publicized by certain self- appointed consumer-oriented agencies as well as government agencies, including which of the following? - D) All of the above -Medicare -the Joint Commission -The agency for healthcare research and quality The differences in the quality of healthcare across individuals and groups in regards to access of care, treatment options, and preventative services is known as? - B)Health disparities incorrect: racism, vulnerable populations, SDOH Cluster A PD includes which 3 disorders? - Schizotypal, schizoid, paranoid subtypes Cultural dimensions therapy: - Hofstede describes the effects of a society's culture on the values of its members Tx of choice with a pt with paranoid PD? - B&C -behavioral therapy -psychotherapy Which of the following is NOT a common physical effect of cannabis? - B) Mild bradycardia s/.s of cannabis physical effects? - Mild tachycardia, orthostatic hypotension, dilation of the conjunctival blood vessels A conscious standard recurrent behavior such as counting, checking, avoiding that interferes with the person's normal routine and functioning is known as? - A_ Compulsion Most everyone has a firm conviction that they are male or female by which age range? - B) 2-3 years of age A pt who presents absent movements with difficulty starting activities, flat affect and avolition would be assessed as having? - D)_ Pseduo-parkinsonism What of the following is consistent with current epidemiology literature about gender and OCD? - D) Adult men and women are equally likely to have OCD A type of schizophrenia in which the individual has a marked disturbance of motor function and may involve stupor, negativism, rigidity, excitement or posturing or mutism is? - B) Catatonic A pt who presents with the inability to remain still with motor restlessness, would be assessed to have? - B) Akathisia method of therapy used to tx individuals with substance use disorders? - B) Contingency Management Ethnocentrism results in which of the following? - C) provides care givers the ability to care for pts of various cultures Which of following demographic characteristics is consistent with high suicide risk? - D) Over age 45 In educating the pt beginning to take Lithium, the ARNP explains which of the following is related to diet and fluid intake? - D) All of the above -caffeine and alcohol act as hydration agents and can raise your lithium concentrations -drink @ least 1 gal of water or more each day & limit your salt intake -if you go on A diet, your doctor may need to increase the frequency of blood tests Three major neurotransmitters associated with ANXIETY, based on animal studies and response to drug tx include? - B) GABA, norepinephrine and serotonin What neurotransmitter increases libidio? - D) Dopamine Concerns when treating geriatric pts with psychotherapeutic drugs includes all of the following EXCEPT? - C) Elderly persons may metabolize psychotherapeutic drugs more rapidly Concerns when treating geriatric pts with psychotherapeutic drugs? - A) Elderly people can be more susceptible to adverse effects of drugs B) Elderly persons may metabolize drugs more slowly D) Elderly people may excrete psychotherapeutic drugs more slowly. Persons who subordinate their own needs to those of others, get other to assume responsibility for major areas of their lives, lack self-confidence and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics consistent with what PD? - C) Dependent PD According to Sullivan, which of the following are consistent with a mentor/mentee relationship? - C) Goals for the mentoring relationship are set mutually incorrect: mentors are assigned; mentor relationships are shorter term; A&B only The need for NPs to practice to their full extent of their education and training is necessary: select all of the above - ALl of the above The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? - A) Diet What are social determinants of health and lifestyle choices? - The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. In educating the pt about Lithium, the NP explains which of the following is related to diet and fluid intake? - D) All of the above The goal of psychotropic tx is to eliminate all manifestations of a disorder to below the syndromal threshold, which is defined as which of the following? - B) Remission The NP can impact health policy and healthcare by doing which of the following? - D) All of the above A term used to describe individuals and families who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following? - D) A& B Which of the following is consistent with current literature regarding the epidemiology of dependent PD? - C) Persons with chronic physical illness in childhood may be the most susceptible to this disorder Pts who injure themselves by self-mutalization but usually do not wish to die are said to have which of the following? - C) Parasuicidial behaviors The NP preceptor should have which of the following? - D) All of the above The tx choice of pts with histrionic PD include which of the following? - D) A & B The antipsychotics that are most likely to cause neuroleptic induced parkinsonism have which of the following effects? - C) High potency drugs with high levels of anticholinergic activity Tx aimed at reducing intimate partner violence and DV includes which of the following? - D) A&B only Pt presents with a formal, tense manner. He reluctantly reports a longstanding pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns that others are deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP; we suspect the pt most likely has the following PDs? - B) Paranoid PD Which of the following is consistent with current perspectives on NP competencies? - A) The National Organization of NPs Faculties have developed a list of core competencies that all students should have upon graduation from a master's program Which of the following core competencies are quality competencies? - D) A& C other oculomotor s/s: include cranial nerve involvement of oculomotor, abducens and vestibular nuclei causing conjugate gaze palasises; pupillary sluggishness, ptsosis and anisocoria is also common Some pts can present with hyperactive delirium secondary to possible alcohol withdrawal symptoms alongside this disorder? - WE Can WE cause death? - Yes- less than 5% of pts with WE can present with a severely depressed level of consciousness that will eventually lead to coma or death Warning s/s of WE that could indicate coma or death? - Hyperthermia and hypotension other s/s include peripheral neuropathy--lower extremities are normally involved and the exam would reveal distal sensory los clinical dx of WE is present if the pt has two of the following features: - A) eye signs B) Dietary deficiency in thiamine C) AMS D) Cerebellar dysfunction Normal brain imaging cannot rule out? - WE -therefore not very beneficial What does thiamine do? - help brain cells produce energy from sugar Korsakoff's syndrome is often, but not always, preceded by an episode of? - WE however, it can occur in someone who has never had a prior episode of WE S/s of Korsakoff's syndrome? - problems learning new information, inabilty to remember recent events and long-term memory gaps. =confabulation -hallucinations may be present Cornerstone of effective long term tx of Korsakoffs /WEs? - Abstaining fro alcohol and maintaining a healthy diet pt on lithium with a hx of ETOH presents with dry mouth, ataxia, dizziness, abdominal pain and slurred speech-the NP should do what? - B) recognizes these are s/s of mild to moderate lithium toxicity--the NP decreases the lithium by half and encourages the pt to drink more fluids walking on eggshells, appeasement and avoidance behaviors by the victim is characteristic of what phase of DV? - C) Tension building phase what stage of the cycle of DV is characterized by overt aggressive behavior towards the victim? - B) Abusive incident inability to conform to the social norms that ordinarily govern many aspects of a person's behavior? (PD) - B) Antisocial PD Which of the following medical conditions can present with prominent mental health status changes that mimic common psych illnesses? select all that apply - A, B, D According to teh AANP Process of Care Standards, performing or ordering prevenatjve and diagnostic procedures based on the pt's age and hx is part of what component? - A) Assessment of health status A pt on lithium and quetiapine presents to the ED with anorexia, persistent nausea, persistent vomiting, blurred vision, choreoathetoid movements, muscle fasciculations and hyperactive deep tendon reflexes- the ARNP should do all of the following EXCEPT: - A) DC the lithium A pt on risperidone presents to the ED with increased agitation, restlessness, muscle discomfort, and dysphoria. The NP recognizes these symptoms of _____ and recommends which of the following? Select all that applies - D) B& C Only In order to qualify for ANCC BC testing you must have a minimal amount of supervised clinical hours in the specialty you are seeking certification in? - B) 500 supervised clinical hours in the judical system, 1 organization may publish one standard of care and an expert may testify to an alternative version of the standard of care. In this scenario who is the final arbiter of the standard of care? - A) The organization where the NP worked for at the time A pt appears odd with a pervasive hx of magical thinking, ideas of reference, illusions and derealization. This is consistent with which of the following? - C) Schizotypal PD Which of the following symptoms of BPD assist in differetianting BPD from schizophrenia? - D) A& C only pt is exhibiting being unapproachable, poor eye contact, reporting a lifetime pattern of isolation, uncomfortableness with human interaction and constricted affect. This presentation is consistent with which of the PDs? - A) Schizoid PD NP preceptors should have at least how much experience as a NP in the specialty prior to precepting? - D) Minimum of 2 years as an experienced NP in the specialty Heightened sense of self-importance, grandiose feelings of uniqueness, lacking empathy for others and is very sensitive to minor criticism? - C) Narcissistic PD the NP recognizes which of the following are short-term effects of sex trafficking on victims? - D) A&C only according to Freud, stubborn, parsimonious (frugal) and high conscientious traits are associated with what stage of development? - C) Phallic stage Which of the following is NOT consistent with common recommendations for good sleep? - B) Set up a cool room temp Curriculum content that supports the NP scientific foundation competency areas includes which of the following? Select all that apply - A&C In Canterbury V Spence, listed physician responsibilities for disclosure--which is not listed? - D) Inform the pt about precautionary therapy that he/she should seek in the future Which of the following is the tx of choice for pts with depressive personality? - C) Insight-oriented psychotherapy Which of the following should be avoided when working with practice guidelines? - A) write guidelines with minute details that everyone will follow in the exact same way A claim of malpractice requires a pt/plaintiff prove which of the following? select all that apply - B, C & D C) a casual link between the NPs failure to conform to tx standards and harm to the pt D) actual injury to the pt Which of the following is consistent with what is known about terrorist-bomber suicides? - D) A&B NP working as an at will employee realizes which of the following. Unless the NP has a contract for a specified term of employment, the employee: - D) A&C only The US supreme court upheld the psychotherapist-pt privilege in which of the following cases? - A) Jaffee vs Redmond Stage 3: Initiative vs Guilt is associated with what age and virtue? - 3-5 years purpose Stage 4: Industry vs Inferiority is associated with what age and virtue? - ages 5-13 competency Stage 5: Identity vs Confusion is associated with what age and virtue? - 13-21 years fidelity Stage 6: Intimacy vs isolation is associated with what age and virtue? - 21-39 years love Stage 7: Generativity vs Stagnation is associated with what age and virtue? - 40-65 years care Stage 8: Integrity vs Dispair is associated with what age and virtue? - 65 + older wisdom at the beginning of early childhood (18 months to 3 years old), the child is still in the _____ stage (Erikson) - stage 2: autonomy vs shame By age 3, the child begins what stage? - Stage 3: initiative vs guilt -children take initiative to talk to think of ideas and act -beginning to use their imagination* build forts, play magic & issue tickets for who wants to come -children are curious at this age, start to ask questions so they can learn about the world Which of the following is not consistent with the purpose of the ANAs code of ethics? - D) It clearly determines how ethical obligations are met Which of the following meds are approved by the FDA for the tx of excessive sleepiness in narcolepsy? - C) Pitolisant (Wakix) Which of the following s/s are assoicated with MDD with melancholic features? - D) B&C sleep related hallucinations that occur at sleep onset are known as? - A) Hypnagogic hallucinations sleep related hallucinations that occur while waking up from sleep are known as? - Hypnopompic hallucinations hypnopompic hallucinations are primarily what type of hallucination? - visual (86%). between 8-34% involve auditory hallucinations Applied behavioral analysis is typically indicated for which disorder? - C) Autism ADHD, impulse contorl, conduct disorder and intellectual disabilities with anxiety disorders are predominant during which age range? - B) ages 6-12 Which of the following is consistent with what is known about Bipolar I disorder? - D) Equal prevalence among men and women Psychotherapy is important tx strategy for young people for which of the following reasons? select all that apply - C & D When evaluating a child with poor academic performance, which of the following diagnostic catergories should be considered first? - B & D Which of the following meds is FDA approved for the tx of MDD with seasonal variation? - D) Buproprion HCL ER a period of at least one week in which both a manic episode and a major depressive episode occur almost daily is consistent with which dx? - C) Bipolar I disorder, mixed episode According to APA "psychologists seek to promote accuracy, honesty and truthfulness in the practice of psychology' reflecting which of the following ethical principles? - A) Integrity Promoting the Welfare of children and adolescents addresses which of the following ethical issues? - C) beneficence Which of the following disorders is characterized by episodic bouts of intake of excessive amount of food without purging or similar compensatory behavior - C) Binge eating The ARNP working w a 5 year old child in a busy pediatric practice is seeking to use levl 1 and level 2 cross-cutting symptoms measures. Which of the following is true in this situation? - B) These level 1 and 2 assessments can help the NP identify the presenting problem for the kid Which of the following meds are approved by the FDA for treating OCD in children ages 6-17? - C) Zoloft (age 6+) A form of CBT that requires attending skills group in addition to individual therapy sessions are known as which of the following? - D) DBT Manic episodes are considered distinct when they are separated by what length of time without significant symptoms of mania or hypomania? - C) 2 months Which of the following meds are NOT FDA approved to tx restless leg syndrome? - B) Modafinil Persistant Depressive Disorder lasts at least? - 2 years MDD episodes are separated by how long? - at least 2 months The clinician asks the adolescent how long they have been sad--greater than 1 year? - C) MDD A dissociation between the pt's experience of sleeping and the objective polygraph measures of sleep is known as which of the following? - A) Sleep state misperception (now known as paradoxial insomnia) -disorder which causes people to feel awake even while they are asleep, leading them to underestimate how many hours they sleep at night Which of the following is NOT consistent with the code of ethics for the profession of nursign? - C) The code of ethics explicit the primary obligations of nursing profession Which of the following is approved by the FKA to tx OCD in children ages 10-17? Check all that apply - D) Clomipramine (Anafranil) -TCA (serotonin and norepinephrine reuptake inhibition) -more SE than SSRIs -considered a second-line med for OCD A variant of Bipolar I disorder characterized by episodes of MDD and hypomania is known as which of the following? - D) Bipolar I disorder, hypomanic type Ziprasidone injection is used to tx occurrences with severe agitation in pts with schizophrenia? - help[s restore the balance of neurotransmitters- quick relief antipsychotic ATYPICAL Maximum IM dosage of Zipraisdone? - 40 mg/day Indicators for a good prognosis in MDDD includes which of the following? select all that apply - B & D During an initial interview with a 15 year old female, the PMHNP notes the presence of peripheral edema & Russell's sign; what do these indicate? - Anorexia Nervosa peripheral edema can be caused by a variety of conditions, but the presence of Russell's sign indicates possible anorexia. What is Russell's sign? - scarring or callouses on the dorsal surface of the hand caused by self-induced vomiting anorexia 82 year old woman arrives at the office with her son; over the past year, she has had trouble remembering once-familiar things, such as phone #s and friends names. She also does not recognize family members who visit often; she has become unusually moody and struggles with written tasks. What is the most likely dx? - A) Alzheimers Disease alzheimers can be associated with: deficits in language, motor function and recognition Dementia with Lewy Bodies typically is accompanied by? - EPS Huntington's disease is accompanied by? - spasmodic movement and incoordination Frontotemporal dementia is normally accompanied by? - extremely talkative and disinhibited ___ is one of the most usual symptoms of anxiety and a direct response to the activation of your sympathetic NS - shaking The comorbid psychiatric dx frequently associated with anorexia is? - OCD OCD-PD is also another comorbidity of those with anorexia Ethical questions about what we "ought" to do or be are addressed within which domain of ethics? - Normative ethics looks into the questions that arise regarding how one ought to act in a moral sense. It is also the study of ethical behavior Which of the following meds are approved by the FDA for tx of mania in children 12-17? - Lithium first FDA approved med for children ages 12-17 with mania Which of the following is important to realize when tx a child with an anxiety disorder? - B. Repeated exposures of a feared situation will always help the child to unlearn the fear response Developmental impairments and disruptive behavior problems are predominant issues during which of the age ranges? - A. 0-5 Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical fts of PTSD - A) Intrusive s/s AFAB - assigned female at birth AMAB - assigned male at birth _____is good for older adults with anxiety and depression? - Remeron the smaller the dose of Remeron, the more ________? - sedating What medication decreases psychotic s/s, & ruminating thoughts? - A) Seroquel What medication decreases psychotic s/s, decreases peservation, decreases ruminating thoughts while treating delusional/mixed beliefs and mood disorders/txs bipolar I disorder? - A) Zyprexa Drug used to tx NMS? - Dantrolene + Bromocriptine mesylate Bromocriptine is given to reverse the hypodopaminergic state and is administered orally (or via nasogastric tube), starting with 2.5 mg 2 or 3 times daily and increasing doses by 2.5 mg every 24 hours until a response or until reaching a maximum dose of 45 mg/d. Dantrolene sodium uncouples the heat-generating mechanism in muscle and is the drug of choice in treating malignant hyperthermia and neuroleptic malignant syndrome, which cause excessive muscular heat production. The potential benefit of this drug in treating heat stroke has been debated. S/S of NMS occur within? - rapid onset of 24-72 hours "cis" - matching "Trans" - moving across the range Blockade of muscarinic M3 is linked to? - cardio-metabolic risk but is NOT linked to weight gain specifically Amantadine is a medication that is used to tx? - EPS ex. 100 mg @ bedtime Amantadine is a _______ medication primarily used to tx parkinson's disease but is alos used to help drug-induced parkinsonism - dopaminergic agent; also is a weak NMDA antagonist (similar to Namenda) Fewer anticholinergic SE of cognitive impairment, dry mouth & constipation? - Amantadine Benztropine has increased amount of anticholinergic SE Amantadine (Symmetrel)'s dopaminergic effects can theoretically worsen? - Psychosis however @ doses used to tx EPS, this is not a normal occurance An "analogue" of Amantadine? - Memantine (Namenda) used to tx dementia (NMDA antagonist) When giving Amantadine to older individuals, one may need to ______ the dose of the medication due to impaired renal function - ADJUST Benztropine (Cogentin) - Anticholinergic medication/antihistamine that is to go-to for tx and preventing antipsychotic induced EPS "drys things up" FDA approved to tx EPS and parkinson;'s disease? - Cogentin & Amantadine Meds that cause severe weight gain? - Antipsychotics- especially clozapine, olanzapine, quetiapine Antidepressants- mirtazepine, TCAs, Paxil Mood stabilizers- Lithium, Valproic Acid meds that cause moderate weight gain? - risperidone and invega meds that cause less weight gain? - ability, haldol, geodon, lurasidone First line tx for weight gain for psych meds? - A. Topamax ----se: cognitive dulling B. Metformin ER C. Olanzapine/Samidorphan (Lybalvi)--used as an alternative to zyprexa to help reduce weight gain D. Orlistat (Xenical). ---se: diarrhea E. Abilify--may be useful for olanzapine induced weight gain as an adjunct Second line tx for weight loss? - A. Wellburin SR B. Any stimulant C. Naltrexone/Bupropion (Contrave). --*antiobesity drug D. Phentermine (Suprenza)-*antiobesity drug E. Phentermine/topimate (Qsymia). ---*antiobesity drug F. Glucagon like peptide agonists---such as Liraglutide or Ozempic (Semaglutide) G. Nizatidine (Axid) ---antacid OTC H. Amantadine (symmetrel) Tx of akathisia? - First line: propanolol, inderal LA, benzos second line: cogentin, amandtadine, clonidine, gabapentin, trazodone, mirtazepine, Cyproheptadine Blocks D2 blockade? - decreases akathisia high potency antipsychotics increase risk of? - Akathisia ex. Haldol, Abilify, Invega, Risperidone, Brexipiprazole Akathisia typically has an onset of? - can be within a few hours, but normally takes days to weeks to appear ______ invol grinding of teeth - Bruxism How to tx Bruxism? - 1st line= Buspar 2nd line= benzos, gabapentin Botox is another tx option that is effective (in the masseter) Xerostomia? - Dry mouth caused by antipsychotics, antidepressants, lithium, stimulants, and meds used to tx EPS (cogentin, Artane, ect) first line tx of Xerostomia? - A) Biotene line prouces 2nd line= Procholinergic drugs ex. Pilocarpine (Salagen) ______ can worsen dry mouth? - Caffeine products, so recommendation is to decrease caffeine dose Another common cause of dry mouth? - old age Involuntary contractions of muscles due to antipsychotics - Dystonia D2 blockade First line tx= cogentin, benadryl second line= benzos, Amantadine, Artane 90% of what reactions in EPS? - occur within the first 5 days, although can occur hours to days after an antipsychotic is started Hyperhidrosis? - excessive sweating caused by antidepressants, espcially SNRIs (venlafaxine, duloxetine, and levomilnacipran) and bupropion tx for hyperhidrosis? - 1st line= A) Terazosin (Hytrin) alpha1 blocker B) Clonidine C) Cogentin D) Glycopyyrolate (Robinul) 2nd line= A) Oxybutrin B) Mirtazepine C) Cyproheptadine D) Abilify Antipsychotics rarely cause Nausea-- T or F - True , most are antiemetic options for nausea How to decrease prolactinemia? - Reduce dosage DC offending med (Prolactin doses tend to normalize after 2-4 days) If stopping the causation agent is NOT possible? - first line= add abilify. 5-20 mg daily 2nd line= add oral contraceptives First line tx of serotonin syndrome? - benzos second line= cyproheptadine Fun fact: MNDA in combination with any SSRI - can cause serotonin syndrome Sialorrhea? - Hypersalivation What drug causes the most sialorrhea? - Clozapine is the most common cause (30- 80%) other causes: zyrepxa, risperidone or quetiapine First line tx of Sialorrhea? - 1= glycopyrrolate (Robinul). --unlike other anticholinergics, glycopyrrloate does not cross the BBB, so ferwer central anticholinergic SE 2nd= Atrovent, Oxybutrin, Cogentin, Clonidine, Atropine, Artane Reducing the dose of Clozapine normally does what to hypersalivation? - not helpful in diminishing symptoms epidemology characterstics? - observe in age <50 Greatest abnormalities occurs in schizophrenia are related to what structures (2) - A. Basal ganglia B. Cerebellum *involved in the control of movement A patient on Chlorpromazine states his orgasm is dry and afterwards he will commonly have milky urine. The APRN realizes this is which of the following? - A) This is likely a harmless response to the Chlorpromazine "Thorazine" A condition which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus and infertility is known as which of the following? - B) Turners Syndrome Turners syndrome: tx involves hormone therapy; fertility treatments for women when they decide to have a baby Which of the following would be characterized as a negative s/s of schizophrenia? - B & C only B) impaired social and occupational functioning C) isolation and impaired self-care Which of the following are keys to distinguishing OCD from psychosis? - Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms A federal program administered nationally and locally which covers enrolled individuals 65+ who pays premiums and disabled individuals - Both A& B (Medicare and Medicaid) Having an adequate legal description of nurse practitioner (NP) scope of practice according to state law is important for which of the following reasons? - All of the above (to avoid any charges of practicing medicine without a license, to place accountability for both benefits and harm to patients squarely on the NP, to get reimbursed for physician services when provided by a NP Which of the following is the most widely consumed psychoactive substance? - B) Caffeine Incorrect: alcohol, heroin, cannabis Which of the following is used to tx TD? - None of the above (cogentin, artane, catapress) The APRN consensus model did which of the following? - B & C B) adult and gerontology were merged and identified as PCP or acute care C) psychiatric mental health foci were stipulated as across the lifespan Which of the following behaviors are associated with an alcohol blood level of 0.05%? - B) Thought judgement and restraints are impaired According to HIPPA, which of the following must the NP share their NPI with? Check all the above - A) Health Plans B) Other providers C) Any entity that may need it for a billing purpose A patient presents with delusions, disorganized thoughts, and speech with poor self care all of which has persisted for the past 7 months. The APRN knowns this presentation means what diagnosis? - Schizophrenia Major neurotransmitters possibly involved in developing substance abuse and substance dependence are which of the following? - A) Dopamine Incorrect: GABA, serotonin, A& B only The dopamine hypothesis of schizophrenia, which of the following? - A) Schizophrenia results from too much dopaminergic activity incorrect: results from a deprivation of dopamine A patient reports a panic attack several years ago in an elevator and since then has avoided elevators. The pt meets the criteria for: - B) Specific phobia A patient with a substance use disorder who does not meet clinical criteria for hospitalization but lacks sufficient social and vocational skills and lack substance-free social supports is to - D) All of the above (Residential tx, partial hospitalization, outpt tx) Obscene phone calling to an unsuspecting partner for sexual arousal is known as? - C) Telephone Scatologia (not telephillia, partialism, normal adolescent prank) A chronic disorder characterized by repetitive hair pulling leading to variable hair loss that may be..to others known as? - C) Trichotillomania Which of the following are risk factors for neuroleptic malignant syndrome? - B) Rapid dose escalation C) Parental route of admin D) High potency typical antipsychotics A method of therapy used to tx individuals with substance use based on the fundamental principle of a psychology that reinforced behaviors are likely to be..is known as the following? - B) Contingency Management The conditions in which people are born, grow, work, live and age are known as? - Social determinants of health All of the following is consistent with the ANCCs rules regarding recertification EXCEPT: - A) You are required to have a maximum of 25 credit hours during each certification period Correct: B) you can start the recert process 1 year before your expiration date, but no later than 3 months before C) You must have 1000 clinical practice hours in a clinical speciality within the preceding 5 years D)you must have at least 25 contact hours in pharmacotherapy Risks factors for school violence include which of the following? Select all that apply - A) Bullying B) Being bullied C) Isolation Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas in the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics with which of the following personality disorders? - C) Dependent personality disorder Incorrect: avoid PD, passive PD, antisocial PD Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels? - D) >25 mEq/L (TOXICITY) A form of child abuse in which a patient or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought in an ER is known as which of the following? - D) Munchausen Syndrome by Proxy Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT? - D) plan to study for short periods over a longer period of time A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with..trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects that the pt likely has which of the following PDs? - B) Paranoid PD Incorrect: schizoid PD, BDP, Antisocial PD A pt will a hx of alcohol use presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. Symptoms are consistent with which of the following psychiatric emergencies? - C) Wernickes Encephalopathy Incorrect: akathisia, korsakoff's syndromes, idiosyncratic alcohol intoxication Cluster A personality disorders are more common in biological families of pts with which of the following disorders? - D) Schizophrenia Incorrect: depression, OCD, alcohol use disorder NP core competencies for INDEPENDENT practice includes all of the following EXCEPT: - B) Demonstrates the highest level of accountability for professional practice NP competencies for independent practice: - A) Maintain a collaboration agreement with physician C) Practices independently managing previously diagnosed and under-diagnosed pts D) Practices patient centered care recognizing culture diversity and the pt or designee as a full practice in decision making Cluster A personality traits consists of which of the following? - A) Schizotypal, schizoid, and paranoid subtypes The misuse of the charge's funds for personal gain is known as which of the following? - C) Financial abuse /exploitation the ARNP recognizes which of the following as long term effects of sex trafficking on victims? - D) All of the above Which of the following is true about the legal practice of the PMHNP? - D) A&B only A) all have some degrees of prescriptive privileges in all states and the district of columbia B) all are considered primary providers in all states and the district of columbia Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical features of PTSD? - A) Intrusion Symptom B) Symptom of Avoidance In which ways are NPs and PAs different? - D) A&B A) NPs differ from PAs in legal definition, scope of practice, licensure, and independence of practice B) NPs practice under their own license and independent of the physician, PAs always work under the supervision of a physician Which of the following initials would a PMHNP use to designate appropriate credentials? - PMHNP-BC Variations from norms in gender roles such as toy preferences, rough and tumble play, aggression, or playmate gender is known as which of the following? - B) Gender role behavior 3 major neurotransmitters associated with anxiety, based on animal studies and response to drug tx include? - B) GABA, norepinephrine and serotonin Which of the following is consistent with the epidemiology of schizophrenia in the US? - D) Onset of schizophrenia before the age of 25 is extremely rare Clinical findings that may indicate abuse include which of the following? Select all that apply - B) Explanation by the pt which is inconsistent with the type of injury C) Psychological distress such as depression, anxiety, SI, and/or sleep disorder D) Explanation by the parent that is inconsistent with the type of injury According to the APA, which of the following is consistent with the EBP for telepsych? - B) In populations with severe anxiety, tele psychiatry is preferred Which of the following is consistent with literature regarding the term psychosexual? - D) None of the above -psychosexual is used to describe personality development and functioning -psychosexual is synonymous with libidio in the Freudian sense -Psychosexual basically refers only to sexual feelings and behavior Bleuler identified 4 fundamental s//s of schizophrenia, known as the 4 A's, which include which symptoms? - A) Associations, Affect, Autism, Ambivalence The fear/anxiety regarding places from which escape may be difficult is known as which of the following: - C) Agoraphobia All of the following are one of the 5 major categories of third-party payers EXCEPT: - D) only A & B A) Medicare/medicaid B) Managed care organization (MCOs) Which of the following are risk factors for sexual assault EXCEPT: - A) Religion Incorrect: serious mental illness, substance use disorder, family hx of sexual abuse Which of the following is consistent with what is known about PP depression? - D) All of the above (feelings of guilt/ and inadequacy are often present and excessive; thoughts of harming the baby are often present; typical onset is within 3-06 months of delivery) Affirmatively acting to benefit another or others, going beyond what is required by law is known as which of the following?> - C) Beneficence Which of the following is used for treating alcohol dependence individuals seeking to continue to remain alcohol free after they have stopped drinking? - D) Acamprosate The NP can impact health policy and healthcare by doing which of the following? - D) All of the above -becomes an active member of local, state, and/or national NP -becomes familiar with the resources available on NP organization websites -Volunteer to serve on legislature committees within professional NP organizations The tx of others equitably and distribution of benefits/burdens fairly is known as? - B) Justice Which of the following is INCONSISTENT with current literature about victims of sexual abuse? - C) The pre-existing relationship and\ familiarity with the abuser may impeded the victim's ability to make rational decisions Narcissistic, borderline, antisocial, and histrionic subtypes are associated with which cluster of PDs? - B) Cluster B Odd, eccentric cluster of PDs? - Cluster A a. Paranoid PD b. Schizoid PD C. Schizotypal PD Characterized by appearing dramatic, emotional, or erratic PD? - Cluster B a., antisocial b. borderline c. histrionic d. narcissistic inner emptiness, unstable relationships and emotional dysregulation? - BPD Attention seeking and excessive emotionability? - Histrionic Social irresponsibility, diregard for others, deceitfulness, and manipulation of others for personal gain - Antisocial Self-grandiosity, need for admiration and lack of empathy - Narcissistic PD Eccentric ideas and behaviors PD? - Schizotypal PD Disinterest in others PD? - Schizoid Mistrust and suspicion PD? - Paranoid PD Characterized by appearing anxious or fearful. it includes which PDs? - Cluster C a. avoidant PD b. dependent PD c. obsessive compulsive PD Perfectionism, rigidity and obstinacy traits PD? - OCD PD Avoidance of interpersonal contact due not rejection sensitivity PD? - `Avoidant Submissiveness and a need to be taken care of PD? - Dependent PD Which of the following is NOT consistent with recommendations for psychiatric hx taking and the MSE of older adults? - B) Pt should be seen alone even in cases of clear evidence of impairment to persevere the privacy of a doctor/pt relationship Low health literacy has been linked with which of the following? - D_ All of the above -poor health outcomes -lower rates of hospitalization -less frequent use of preventative services A claim of malpractice requires that a patient/plaintiff prove which of the following? Select all that apply - A) The existence of a client-professional relationship--duty ti care C) a causal link b/t the provider's failure to confirm to tx standards and harm to the pt D) Actual injury to the pt According to USDHHS and the Federal Bureau of Primary Health Care, which of the following individuals would be considered homeless? - D) All of the above -an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations -an individual who is a resident in transitional housing -a person who is living w /a friend` A particular form of psychotherapy used for pts with BPD, especially those with parasuicidal behaviors, such as frequent cutting is known as which of the following? - A) DBT incorrect: mentalization based tx; transference focused psychotherapy and exposure therapy` As a pmhnp, one of the most common areas you will counsel your patients about is the importance of sleep hygiene. Which of the following is NOT consistent with common recommendations for good sleep hygiene? - B) Set a cool room temp True sleep hygiene tips: -avoid alcohol and caffeine -set TV to turn off within 1 hr of falling asleep A) ARNP B) Physician the ARNP is txing a 27 year old female who bipolar disorder who is obese and has renal; dysfunction. Which of the following is true? - C) An atypical antipsychotic such as olanzapine or risperidone should be used Pts with this PD are described as excitable, emotional and behave in a colorful, dramatic, extroverted, attention-seeking fashion, often with an inability to maintain deep long-lasting attachments - B) Histrionic PD a PD characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness and a pattern of perfectionism and inflexibility is known as which of the following? - D) OCD PD Which of the following core competencies are quality competencies? - D) A&C A) use best available evidence to continually improve quality of practice C) evaluates the relationship among access cost quality safety and their influence on health care Non-pharmacologic tx for abuse includes all of the following EXCEPT: - D) Involve the abuser in the tx planning Non-pharmacologic tx options for abuse victims? -CBT -build a community of support -assist pt to devise a safe escape plan a PD characterized by extraordinarily unstable affect, mood, behavior, object relations and self-image is known as? - BPD A particular form of psychotherapy based on Otto Kernbeg's object relations theory is known as which of the following?> - C) Transference-focused psychotherapy generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following Lithium levels? - C) > 2.5 mEq/L nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, oliguria and renal failure - Moderate Lithium toxicity: 2.0-2.5 Lithium therapeutic window - 0.6-1.2 mEq/L first med approved for bipolar d/o - lithium Common side effects of Lithium, - tremor, nausea., fatigue, increased thirst, slowed thinking Important serious side effects of Lithium: - hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity How do we decrease the risk of lithium toxicity? - Blood level monitoring therapeutic range: 0.6 - 1.2 Lithium levels are known to (increase/decrease) when used concurrently with diuretics, thiazides, ACE inhibitors and NSAIDs? - Increase ACE inhibitors: lisinopril, catopril, enalapril Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline - Decrease concurrent use of lithium and antidepressants and/or antipsychotics can cause what? - Serotonin syndrome & Neuroleptic malignant syndrome The term "suicide survivor" refers to which of the following? - A) those who have lost a loved one to suicide At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all the above - C) is the problem organic, functional or a combination? A pt presents with a formal, tense manner. He reluctantly responds a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the pt likely has which of the following PDs? - B) Paranoid PD The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following? - B) Beneficence `In about 1/2 the cases in which suicides occur while pts are in a psychiatric unit, a lawsuit occurs. Which of the following is NOT consistent with what court expects related to inpt psych unit suicide events? - D) Evidence of formulation of a tx plan with a high level of security curriculum content supports the NP scientific competency area includes which of the following? Select all that apply - A) Comparison of pt data sets with evidenced based standards to improve care B) Science from other disciplines relevant to heath care Self-injurious behaviors with a nonfatal outcome, accompanied by explicit or implicit evidence that the person intended to die, is most specifically known as what? - C) Suicide attempt The ARNP is working with a pt who has heightened sense of self-importance and grandiose feelings of uniqueness. The pt also lacks empathy for others, although is very sensitive to minor criticisms. The ARNP recognizes these s/s as consistent with which of the following PD? - C) Narcissistic PD The degree to which individuals have the cognitive and social capacity to access, process, and utilize basic health info and services to maintain good health, make appropriate health decisions and meet their goals is known as? - A) Health Literacy Risk factors for physical abuse includes all of the following EXCEPT: - A) Literacy Risk factors for physical abuse?: -pregnancy, serious mental illness, hx of victimization during the developmental years According to Freud, passive and dependent personality traits are associated with which stage of development? - B) Anal stage Sexual assault is most often which of the following? - C) family member incorrect: stranger, acquaintance, professional Which of the following is the tx of choice for pt's with depressive personality? - A) Exposure therapy incorrect: light exposure therapy, insight oriented psychotherapy, transmagnetic stimulation (TMS) Which of the following medications is associated with Ebstein's anomaly when gievn during pregnancy? - B) Lithium *Actually a very small risk to pregnancy-- should be used more In Canterbury v Spence in the US Court of Appeals for the District of Columbia Circuit listed physician responsibilities for disclosure. Which of the following is NOT listed as a responsibility? - D) inform the pt about precautionary therapy that he or she should seek in the future Ethnocentrism results in which of the following? - C) Provides caregivers with the ability to better care for pt's of various culture Which of the following demographic characteristics is consistent with high suicide risk? - D) Over 45 years of age An ARNP takes a position in which the ARNP is guaranteed a set salary but can make additional salary if he/or she generates practice income over some set amount; this is known as what type of pay structure? - C) Base salary plus percentage Which of the following is NOT consistent with guidelines as a mentor? - D) Be specific and kind when giving constructive feedback that ay not be what the mentee might want to hear Which stage of the cycle of DV is characterized by overt aggressive - Cluster A PD includes which 3 disorders? - Schizotypal, schizoid, paranoid subtypes Cultural dimensions therapy: - Hofstede describes the effects of a society's culture on the values of its members Tx of choice with a pt with paranoid PD? - B&C -behavioral therapy -psychotherapy Which of the following is NOT a common physical effect of cannabis? - B) Mild bradycardia s/.s of cannabis physical effects? - Mild tachycardia, orthostatic hypotension, dilation of the conjunctival blood vessels A conscious standard recurrent behavior such as counting, checking, avoiding that interferes with the person's normal routine and functioning is known as? - A_ Compulsion Most everyone has a firm conviction that they are male or female by which age range? - B) 2-3 years of age What are social determinants of health and lifestyle choices? - The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. In educating the pt about Lithium, the NP explains which of the following is related to diet and fluid intake? - D) All of the above The goal of psychotropic tx is to eliminate all manifestations of a disorder to below the syndromal threshold, which is defined as which of the following? - B) Remission The NP can impact health policy and healthcare by doing which of the following? - D) All of the above A term used to describe individuals and families who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following? - D) A& B Which of the following is consistent with current literature regarding the epidemiology of dependent PD? - C) Persons with chronic physical illness in childhood may be the most susceptible to this disorder Pts who injure themselves by self-mutalization but usually do not wish to die are said to have which of the following? - C) Parasuicidial behaviors The NP preceptor should have which of the following? - D) All of the above The tx choice of pts with histrionic PD include which of the following? - D) A & B The antipsychotics that are most likely to cause neuroleptic induced parkinsonism have which of the following effects? - C) High potency drugs with high levels of anticholinergic activity Tx aimed at reducing intimate partner violence and DV includes which of the following? - D) A&B only Pt presents with a formal, tense manner. He reluctantly reports a longstanding pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns that others are deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP; we suspect the pt most likely has the following PDs? - B) Paranoid PD Which of the following is consistent with current perspectives on NP competencies? - A) The National Organization of NPs Faculties have developed a list of core competencies that all students should have upon graduation from a master's program Which of the following core competencies are quality competencies? - D) A& C Which of the following are criteria for a particular suicide to be considered inevitable? - D) All of the above According to Freud, passive and dependent personality traits are associated with what stage of development? - A) Oral stage SIB with a nonfatal outcome, accompanied by explicit or implicit evidence that the person intended to die, is known as?q - B) Suicide intent "Assumes complex and advanced leadership roles to initate and guide change" is a NP core competency for which area? - C) Leadership competencies At a minimal, a psych eval in an Emergency should include what? Select all that apply - A, B, C Which stage of the DV cycle is characterized by the abuser subconsciously implementing defense mechanisms and cognitive distortions to alleviate the ego dystonic implication of the abuse? - D) Defensive phase A pt with a hx of schizophrenia, currently prescribed Haldol, presents to the ED with hyperthermia, muscle rigidity, autonomic instability and elevated phosphokinase. The ARNP recognizes these symptoms are consistent with? - D) Neuroleptic malignant syndrome Pts with extreme sensitivity to rejection who are socially withdrawn because they consider themselves to be socially inept, although they are not antisocial, and show a great desire for companionship are demonstrating symptoms most consistent with which of the following PDs - B) Avoidant PD OCD PD, dependent PD and avoidance PD traits are associated with which class of PDs? - C) Cluster C Therapeutic blood level range for lithium? - 0.8 - 1.2 -can be as low as 0.6 for some and be therapeutic The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as? - C) Non-maleficence Acknowledging a person's right to make choices, to hold views and take actions based on personal value is known as which of the following? - D) Respect for autonomy other s/s include peripheral neuropathy--lower extremities are normally involved and the exam would reveal distal sensory los clinical dx of WE is present if the pt has two of the following features: - A) eye signs B) Dietary deficiency in thiamine C) AMS D) Cerebellar dysfunction Normal brain imaging cannot rule out? - WE -therefore not very beneficial What does thiamine do? - help brain cells produce energy from sugar Korsakoff's syndrome is often, but not always, preceded by an episode of? - WE however, it can occur in someone who has never had a prior episode of WE S/s of Korsakoff's syndrome? - problems learning new information, inabilty to remember recent events and long-term memory gaps. =confabulation -hallucinations may be present Cornerstone of effective long term tx of Korsakoffs /WEs? - Abstaining fro alcohol and maintaining a healthy diet pt on lithium with a hx of ETOH presents with dry mouth, ataxia, dizziness, abdominal pain and slurred speech-the NP should do what? - B) recognizes these are s/s of mild to moderate lithium toxicity--the NP decreases the lithium by half and encourages the pt to drink more fluids walking on eggshells, appeasement and avoidance behaviors by the victim is characteristic of what phase of DV? - C) Tension building phase what stage of the cycle of DV is characterized by overt aggressive behavior towards the victim? - B) Abusive incident inability to conform to the social norms that ordinarily govern many aspects of a person's behavior? (PD) - B) Antisocial PD Which of the following medical conditions can present with prominent mental health status changes that mimic common psych illnesses? select all that apply - A, B, D According to teh AANP Process of Care Standards, performing or ordering prevenatjve and diagnostic procedures based on the pt's age and hx is part of what component? - A) Assessment of health status A pt on lithium and quetiapine presents to the ED with anorexia, persistent nausea, persistent vomiting, blurred vision, choreoathetoid movements, muscle fasciculations and hyperactive deep tendon reflexes- the ARNP should do all of the following EXCEPT: - A) DC the lithium A pt on risperidone presents to the ED with increased agitation, restlessness, muscle discomfort, and dysphoria. The NP recognizes these symptoms of _____ and recommends which of the following? Select all that applies - D) B& C Only In order to qualify for ANCC BC testing you must have a minimal amount of supervised clinical hours in the specialty you are seeking certification in? - B) 500 supervised clinical hours in the judical system, 1 organization may publish one standard of care and an expert may testify to an alternative version of the standard of care. In this scenario who is the final arbiter of the standard of care? - A) The organization where the NP worked for at the time A pt appears odd with a pervasive hx of magical thinking, ideas of reference, illusions and derealization. This is consistent with which of the following? - C) Schizotypal PD Which of the following symptoms of BPD assist in differetianting BPD from schizophrenia? - D) A& C only pt is exhibiting being unapproachable, poor eye contact, reporting a lifetime pattern of isolation, uncomfortableness with human interaction and constricted affect. This presentation is consistent with which of the PDs? - A) Schizoid PD NP preceptors should have at least how much experience as a NP in the specialty prior to precepting? - D) Minimum of 2 years as an experienced NP in the specialty Heightened sense of self-importance, grandiose feelings of uniqueness, lacking empathy for others and is very sensitive to minor criticism? - C) Narcissistic PD the NP recognizes which of the following are short-term effects of sex trafficking on victims? - D) A&C only according to Freud, stubborn, parsimonious (frugal) and high conscientious traits are associated with what stage of development? - C) Phallic stage Which of the following is NOT consistent with common recommendations for good sleep? - B) Set up a cool room temp SIB patients should be engaged in what type of therapy (BPD individuals who engage in SIB) - A) DBT the _____stage begins at 18 months of age and lasts until the age of 3 - Anal Stage Freud believed that the libidio source shifted from the mouth (in stage 1) to the anus in what stage of development? - Anal stagen(stage 2) At what point does a child begin to understand that they have some degree of control over their lives, including when and where they defacate? - Anal stage this can lead to difficulties with potty training *primary erogenous zone is pleasure derived from controlling bladder and BMs Adults who are anal retentive tend to be: - Stubborn, very neat, rigid and stingy Adults who are anal expulsive tend to be: - messy, wasteful and harsh During the ____ stage, the child develops an attraction to the parent of a different sex to them, which is caused the Oedipus Complex for boys and the Electra Complex for girls - Phallic stage (stage 3) Phallic stage occurs at what age? - lasting from the ages of 3-6 *the libido centers upon the genitalia and children become aware of their bodies when a child recognizes that the parent of another sex is unavailable, the child learns to model their own behavior after the same-sex parent? - Phallic stage According to Freud, those who do not exhibit gender appropriate behavior have not completed this stage of psychosexual development? - Phallic stage Introjection - learning right fro wrong -how children incorporate values from others into their value set Introjection occurs at what phase? - Phallic stage The development of play is an important milestone to early childhood because:? - great way for children to express their thoughts, emotions, fears and anxieties Erikson: Initiative vs Guilt - influenced by Freud, Erikson believed that the relationships that people have, not psychosexual stages, are what influence personality development Johann is five years old and even though he really struggles with shoe tying, he protests when his parents try to help him. According to Erikson, Johann does this because? - A) Johann is exploring his autonomy Stage 1: Trust vs Mistrust is associated with what age and virtue? - infant -18 months, hope Stage 2: Autonomy vs Shame/doubt is associated with what age and virtue? - 18 months to 3 years will Stage 3: Initiative vs Guilt is associated with what age and virtue? - 3-5 years purpose Stage 4: Industry vs Inferiority is associated with what age and virtue? - ages 5-13 competency Stage 5: Identity vs Confusion is associated with what age and virtue? - 13-21 years fidelity Stage 6: Intimacy vs isolation is associated with what age and virtue? - 21-39 years love Stage 7: Generativity vs Stagnation is associated with what age and virtue? - 40-65 years care Stage 8: Integrity vs Dispair is associated with what age and virtue? - 65 + older Which of the following disorders is characterized by episodic bouts of intake of excessive amount of food without purging or similar compensatory behavior - C) Binge eating The ARNP working w a 5 year old child in a busy pediatric practice is seeking to use levl 1 and level 2 cross-cutting symptoms measures. Which of the following is true in this situation? - B) These level 1 and 2 assessments can help the NP identify the presenting problem for the kid Which of the following meds are approved by the FDA for treating OCD in children ages 6-17? - C) Zoloft (age 6+) A form of CBT that requires attending skills group in addition to individual therapy sessions are known as which of the following? - D) DBT Manic episodes are considered distinct when they are separated by what length of time without significant symptoms of mania or hypomania? - C) 2 months Which of the following meds are NOT FDA approved to tx restless leg syndrome? - B) Modafinil Persistant Depressive Disorder lasts at least? - 2 years MDD episodes are separated by how long? - at least 2 months The clinician asks the adolescent how long they have been sad--greater than 1 year? - C) MDD A dissociation between the pt's experience of sleeping and the objective polygraph measures of sleep is known as which of the following? - A) Sleep state misperception (now known as paradoxial insomnia) -disorder which causes people to feel awake even while they are asleep, leading them to underestimate how many hours they sleep at night Which of the following is NOT consistent with the code of ethics for the profession of nursign? - C) The code of ethics explicit the primary obligations of nursing profession Which of the following is approved by the FKA to tx OCD in children ages 10-17? Check all that apply - D) Clomipramine (Anafranil) -TCA (serotonin and norepinephrine reuptake inhibition) -more SE than SSRIs -considered a second-line med for OCD A variant of Bipolar I disorder characterized by episodes of MDD and hypomania is known as which of the following? - D) Bipolar I disorder, hypomanic type Which of the following hormone levels is increased in anorexia nervosa? - A) Corticotrophin-releasing hormone Hormone released in response to starvation? - Corticotrophin-releasing hormone (CRH) Lithium toxicity? - The chronic form of lithium toxicity can occur when you take lithium daily but your serum blood level has crept up into the toxic range. -Possible causes for this level increase?: A) a dosage increase, B) being dehydrated, C) interactions with other medications, and D) problems with kidney function In addition to elevated lithium levels, what other laboratory values are associated with lithium toxicity? - BUN, creatinine What are drugs that should not be taken with lithium? - -ACE inhibitors -Angiotensin II receptor antagonists (statins) -Diuretics -NSAIDS Nightmares and night terrors are associated with disorganization and arousal during which stage of sleep? - Stage 3 The right to assent of dissent from tx for a child or adolescent is reflected in which American Academy of Children & Adolescent ethical issues? - Autonomy A 10-year-old child presents with developmentally inappropriate and persistent difficulty with inattention with symptoms which are interfering with academic goals and in social settings. This is consistent with which of the following diagnoses? - Attention- deficit/hyperactivity disorder antipsychotic ATYPICAL Maximum IM dosage of Zipraisdone? - 40 mg/day Indicators for a good prognosis in MDDD includes which of the following? select all that apply - B & D During an initial interview with a 15 year old female, the PMHNP notes the presence of peripheral edema & Russell's sign; what do these indicate? - Anorexia Nervosa peripheral edema can be caused by a variety of conditions, but the presence of Russell's sign indicates possible anorexia. What is Russell's sign? - scarring or callouses on the dorsal surface of the hand caused by self-induced vomiting anorexia 82 year old woman arrives at the office with her son; over the past year, she has had trouble remembering once-familiar things, such as phone #s and friends names. She also does not recognize family members who visit often; she has become unusually moody and struggles with written tasks. What is the most likely dx? - A) Alzheimers Disease alzheimers can be associated with: deficits in language, motor function and recognition Dementia with Lewy Bodies typically is accompanied by? - EPS Huntington's disease is accompanied by? - spasmodic movement and incoordination Frontotemporal dementia is normally accompanied by? - extremely talkative and disinhibited ___ is one of the most usual symptoms of anxiety and a direct response to the activation of your sympathetic NS - shaking The comorbid psychiatric dx frequently associated with anorexia is? - OCD OCD-PD is also another comorbidity of those with anorexia Ethical questions about what we "ought" to do or be are addressed within which domain of ethics? - Normative ethics looks into the questions that arise regarding how one ought to act in a moral sense. It is also the study of ethical behavior Which of the following meds are approved by the FDA for tx of mania in children 12-17? - Lithium first FDA approved med for children ages 12-17 with mania Which of the following is important to realize when tx a child with an anxiety disorder? - B. Repeated exposures of a feared situation will always help the child to unlearn the fear response Developmental impairments and disruptive behavior problems are predominant issues during which of the age ranges? - A. 0-5 Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical fts of PTSD - A) Intrusive s/s AFAB - assigned female at birth AMAB - assigned male at birth _____is good for older adults with anxiety and depression? - Remeron the smaller the dose of Remeron, the more ________? - sedating What medication decreases psychotic s/s, & ruminating thoughts? - A) Seroquel What medication decreases psychotic s/s, decreases peservation, decreases ruminating thoughts while treating delusional/mixed beliefs and mood disorders/txs bipolar I disorder? - A) Zyprexa Drug used to tx NMS? - Dantrolene + Bromocriptine mesylate Bromocriptine is given to reverse the hypodopaminergic state and is administered orally (or via nasogastric tube), starting with 2.5 mg 2 or 3 times daily and increasing doses by 2.5 mg every 24 hours until a response or until reaching a maximum dose of 45 mg/d. Dantrolene sodium uncouples the heat-generating mechanism in muscle and is the drug of choice in treating malignant hyperthermia and neuroleptic malignant syndrome, which cause excessive muscular heat production. The potential benefit of this drug in treating heat stroke has been debated.