NRNP 6675 Midterm Exam: Practice Questions and Answers - Prof. Somuah, Exams of Nursing

Download NRNP 6675 Midterm Exam: Practice Questions and Answers - Prof. Somuah and more Exams Nursing in PDF only on Docsity! 1 NRNP 6675 MIDTERM EXAM WITH ACTUAL 2024 NEWEST QUESTIONS AND VERIFIED CORRECT SOLUTIONS/GRADED A+ 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 qualify for social security disability payments and benefits C. adults who are disabled for one year or less and who qualify on the basis of poverty D. mothers and children who qualify on the basis of poverty - ANSWER A. Individuals 65 years and older who have enrolled and pay premiums B. disabled individuals who qualify for social security disability payments and benefits C. adults who are disabled for one year or less and who qualify on the basis of poverty D. mothers and children who qualify on the basis of poverty Which of the following neurotransmitters increases libidio? A. GABA B. serotonin C. oxytocin D. dopamine - ANSWER A. GABA B. serotonin C. oxytocin D. dopamine Which of the following factors are associated with poor prognosis for patients with OCD? A. Childhood Onset B. the presence of a precipitating event 2 C. Co-existing major depressive disorder D. A & C - ANSWER A. Childhood Onset B. the presence of a precipitating event C. Co-existing major depressive disorder D. A & C Which of the following is inconsistent with current knowledge about schizophrenia? A. schizophrenia is one of the most common of the serious mental disorders B. a diagnosis of schizophrenia is based entirely on the psychiatric history and mental status exam C. dopamine level is a laboratory test that assists in the Dx of Schizophrenia D. schizophrenia likely comprises a group of disorders with heterogeneous etiologies and variable presentations - ANSWER A. schizophrenia is one of the most common of the serious mental disorders B. a diagnosis of schizophrenia is based entirely on the psychiatric history and mental status exam C. dopamine level is a laboratory test that assists in the Dx of Schizophrenia D. schizophrenia likely comprises a group of disorders with heterogeneous etiologies and variable presentations A chronic disorder characterized by repetitive hair pulling leading to variable hair loss that may be noticeable to others is known as what? - ANSWER Trichotillomania A method of therapy used to treat individuals with substance abuse based on motivational incentives to recognize and reinforce positive behavior change is known as which of the following? A. exposure therapy B. contingency management C. motivational interviewing D. cognitive behavioral therapy - ANSWER A. exposure therapy B. contingency management C. motivational interviewing D. cognitive behavioral therapy 5 C. Borderline Personality Disorder D. Antisocial Personality Disorder 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? A. akathisia B. korsakoff's syndrome C. wernicke's encephalopathy D. idiosyncratic alcohol intoxication - ANSWER A. akathisia B. korsakoff's syndrome C. wernicke's encephalopathy D. idiosyncratic alcohol intoxication Cluster A personality disorders are more common in biological families of patients with which of the following disorders? A. depression B. OCD C. alcohol use disorder D. schizophrenia - ANSWER A. depression B. OCD C. alcohol use disorder D. schizophrenia NP core competencies for INDEPENDENT practice includes all of the following EXCEPT: A) Maintain a collaboration agreement with physician B) Demonstrates the highest level of accountability for professional practice 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 - ANSWER A) Maintain a collaboration agreement with physician B) Demonstrates the highest level of accountability for professional practice C) Practices independently managing previously diagnosed and under- diagnosed pts 6 D) Practices patient-centered care recognizing culture diversity and the pt or designee as a full practice in decision making Which personality disorders belong to Cluster A? - ANSWER Schizotypal, schizoid, and paranoid subtypes the ARNP recognizes which of the following as long term effects of sex trafficking on victims? A. severe depression B. spiritual questions C. trauma bonding D. all of the above - ANSWER A. severe depression B. spiritual questions C. trauma bonding D. all of the above 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 and how these values related to behaviors, using a structure derived from factor analysis. Cultural Dimensions Therapy was developed by which theorist? A. Hofstede B. Leininger C. Purcell D. Campinha-Bacote - ANSWER A. Hofstede B. Leininger C. Purcell D. Campinha-Bacote The treatment of choice for patients with paranoid PD includes which of the following? A.psychophramacology B. behavioral therapy C. psychotherapy D. B&C - ANSWER A.psychophramacology B. behavioral therapy 7 C. psychotherapy D. B&C The differences in quality of healthcare actions across individuals or groups regard to access, affordability, quality, and care coverage are called what? - ANSWER Health disparities The incidence of suicide is highest for which of the following populations? A. older Latino men B. older Caucasian men C. older Caucasian women D. older African American men - ANSWER A. older Latino men B. older Caucasian men C. older Caucasian women D. older African American men The pt on lithium with a hx of alcohol use disorder presents with dry mouth, ataxia, dizziness, abdominal pain, and slurred speech. The ARNP should do what? - ANSWER The ARNP recognizes the symptoms of moderate lithium toxicity, discontinues the lithium immediately, orders lithium level, serum electrolytes and renal function tests Which personality disorder is characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness, and inflexibility? - ANSWER Obsessive compulsive Personality Disorder Which of the following are consistent with current data related to the prevalence of drinking alcohol? A. men and women with higher education and income are less likely to drink alcohol B. men and women with higher education and income are more likely to drink alcohol C. men and women with lower education and higher income are more likely to drink alcohol D. Education and income are not a factor in prevalence of drinking alcohol - ANSWER A. men and women with higher education and income are less likely to drink alcohol 10 A. psychosexual is used to describe personality development and functioning B. psychosexual is synonymous with libido in the Freudian sense C. psychosexual basically refers only to sexual feelings and behavior D. none of the above - ANSWER A. psychosexual is used to describe personality development and functioning B. psychosexual is synonymous with libido in the Freudian sense C. psychosexual basically refers only to sexual feelings and behavior D. none of the above Bleuler identified 4 fundamental s//s of schizophrenia, known as the 4 A's, which include which symptoms? - ANSWER Associations, Affect, Autism, Ambivalence The fear/anxiety regarding places from which escape may be difficult is known as what: - ANSWER Agoraphobia All of the following are one of the 5 major categories of third-party payers EXCEPT: A) Medicare/Medicaid B) Managed care organizations (MCOs) C) indemnity insurance companies D) only A & B - ANSWER A) Medicare/Medicaid B) Managed care organizations (MCOs) C) indemnity insurance companies D) only A & B All of the following are risk factors for sexual assault EXCEPT: A. religion B. Serious mental illness C. substance use disorder D. family history of sexual abuse - ANSWER A. religion B. Serious mental illness C. substance use disorder D. family history of sexual abuse Which of the following is consistent with what is known about post-partum depression? 11 A. feelings of guilt/and inadequacy are often present and excessive B. thoughts of harming the baby are often present C. typical onset is within 3-6 months of delivery D. all of the above - ANSWER A. feelings of guilt/and inadequacy are often present and excessive B. thoughts of harming the baby are often present C. typical onset is within 3-6 months of delivery D. all of the above Which of the following is used for treating alcohol dependence individuals seeking to continue to remain alcohol free after they have stopped drinking? A. Tacrine B. Amantadine C. Galantamine D. Acamprosate - ANSWER A. Tacrine B. Amantadine C. Galantamine D. Acamprosate The NP can impact health policy and healthcare by doing which of the following? A. becomes an active member of local, state, and/or national NP B. becomes familiar with the resources available on NP organization website C. volunteer to serve on legislature committees within professional NP organizations D. all of the above - ANSWER A. becomes an active member of local, state, and/or national NP B. becomes familiar with the resources available on NP organization website C. volunteer to serve on legislature committees within professional NP organizations D. all of the above Which of the following would constitute negligence? Select all that apply A) Failure to give necessary care B) Failure to refer when necessary 12 C) Failure to follow up with a patient D) Failure to disclose necessary info to a patient - ANSWER 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? A. Florence Nightingale B Camipinha-Cacote C. Mary Breckenridge D. Loretta Ford - ANSWER A. Florence Nightingale B Camipinha-Cacote C. Mary Breckenridge D. Loretta Ford the ARNP recognizes which of the following as long-term effects of sex trafficking on victims? A. Severe depression B. Spiritual questions C. Trauma bonding D. all of the above - ANSWER A. Severe depression B. Spiritual questions C. Trauma bonding D. all of the above A patient appears odd, with a pervasive hx of magical thinking, ideas of reference, illusions or derealization. This is consistent with which personality disorder? - ANSWER Schizotypal PD Which of the following are criteria for a particular suicide to be considered inevitable? A. strong genetic history of suicide in one or more family members B. a strong genetic loading of mental illness in the family 15 D. all of the above Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue, and jaw is known as which of the following? A. akathisia B. dystonia C. tardive dyskinesia D. EPS - ANSWER A. akathisia B. dystonia C. tardive dyskinesia D. 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? A. schizophrenia B. delusional disorder C. brief psychotic disorder D. schizophreniform disorder - ANSWER A. schizophrenia B. delusional disorder C. brief psychotic disorder D. schizophreniform 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 B. consistent with transvestic disorder C. other specified paraphilic disorder D. sexual masochism disorder - ANSWER A. this can be serious and life- threatening if castration is carried out without medical supervision B. consistent with transvestic disorder C. other specified paraphilic disorder D. sexual masochism disorder 16 Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostics services rendered by clinicians? A. HIPPA B. CPT C. DSM-5 D. DRG - ANSWER A. HIPPA B. CPT C. DSM-5 D. 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 B. this is abnormal and needs to be evaluated by a specialist C. it is critical to stop the Chlorpromazine immediately D. this has nothing to do with the Chlorpromazine. Refer patient to PCP for follow-up - ANSWER A. this is likely a harmless response to the Chlorpromazine B. this is abnormal and needs to be evaluated by a specialist C. it is critical to stop the Chlorpromazine immediately D. this has nothing to do with the Chlorpromazine. Refer patient to PCP for follow-up A condition that results from the absence of a second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus, and infertility is known as what? A. Hermaphroditism B. Turner's Syndrome C. Andrenogenital Syndrome D. Androgen Insensitivity Syndrome - ANSWER A. Hermaphroditism B. Turner's Syndrome C. Andrenogenital Syndrome D. Androgen Insensitivity Syndrome 17 Which of the following would be characterized as a negative symptom of schizophrenia? A. Hallucinations B. impaired social and occupational functioning C. isolation and impaired self-care D. B & C only - ANSWER A. Hallucinations B. impaired social and occupational functioning C. isolation and impaired self-care D. B & C only Which of the following are keys to distinguishing OCD from psychosis? A. patients with OCD can almost always acknowledge the unreasonable nature of their symptoms B. patient with OCD are better able to control their compulsions C. patient with psychosis will have more obsessive thoughts D. patients with OCD have less bizarre obsessions - ANSWER A. patients with OCD can almost always acknowledge the unreasonable nature of their symptoms B. patient with OCD are better able to control their compulsions C. patient with psychosis will have more obsessive thoughts D. patients with OCD have less bizarre obsessions A federal program administered nationally and locally that covers enrolled individuals 65 who pay premiums and disabled individuals... A. Medicare B. Medicaid C. both A & B D. none of the above - ANSWER A. Medicare B. Medicaid C. both A & B D. none of the above Having an adequate legal description of the nurse practitioner's (NP) scope of practice according to state law is important for which of the following reasons? 20 C. brief psychotic disorder D. delusional disorder Major neurotransmitters possibly involved in developing substance abuse and substance dependence are which of the following? A. dopamine B. GABA C. serotonin D. A&B only - ANSWER A. dopamine B. GABA C. serotonin D. A&B only The dopamine hypothesis of schizophrenia states what? A. schizophrenia results from too much dopaminergic activity B. schizophrenia results from a deprivation of dopamine C. schizophrenia is not related to dopamine activity D. none of the above - ANSWER A. schizophrenia results from too much dopaminergic activity B. schizophrenia results from a deprivation of dopamine C. schizophrenia is not related to dopamine activity D. none of the above A patient reports a panic attack several years ago in an elevator and since then has avoided elevators. The patient meets the criteria for which of the following: A. social phobia B. specific phobia C. generalized anxiety disorder unspecified D. obsessive-compulsive disorder - ANSWER A. social phobia B. specific phobia C. generalized anxiety disorder unspecified D. obsessive-compulsive disorder 21 Treatment options for 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/are A. residential treatment B. partial hospitalization C. outpatient treatment D. all of the above - ANSWER A. residential treatment B. partial hospitalization C. outpatient treatment D. all of the above Obscene phone calling to an unsuspecting partner for sexual arousal is known as? A. telephilia b. partialism c. telephone scatologia d. normal adolescent prank - ANSWER A. telephilia b. partialism c. telephone scatologia d. normal adolescent prank The main psychological difference between fear and anxiety is best described by which of the following? A. fear is insidious; anxiety is sudden B. anxiety is insidious; fear is sudden C. there is no difference between fear and anxiety D. bother anxiety and fear are alerting signals - ANSWER A. fear is insidious; anxiety is sudden B. anxiety is insidious; fear is sudden C. there is no difference between fear and anxiety D. bother anxiety and fear are alerting signals A diffuse, unpleasant, vague sense of apprehension often accompanied by autonomic symptoms varies upon persons is commonly known as which of the following? 22 A. fear B. stress C. normal anxiety D. pathological anxiety - ANSWER A. fear B. stress C. normal anxiety D. pathological anxiety If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired, during which trimester is the least hazardous? A. first trimester B. second trimester C. third trimester D. withdrawal from methadone should never be done while the woman is pregnant - ANSWER A. first trimester B. second trimester C. third trimester D. withdrawal from methadone should never be done while the woman is pregnant Neurochemical or neurophysiological changes in the body that results from the repeated administration of a drug is known as which of the following? A. cross-tolerance B. neurotransformation C. neuroadapation D. neurocognitive adjustment - ANSWER A. cross-tolerance B. neurotransformation C. neuroadapation D. neurocognitive adjustment The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following? A. frotteurism B. voyeurism C. sexual sadism D. sexual masochism - ANSWER A. frotteurism 25 c. histrionic d. narcissistic which personality disorder is characterized by inner emptiness, unstable relationships and emotional dysregulation? - ANSWER BPD which personality disorder is characterized by Attention seeking and excessive emotionability? - ANSWER Histrionic which personality disorder is characterized by Social irresponsibility, diregard for others, deceitfulness, and manipulation of others for personal gain - ANSWER Antisocial which personality disorder is characterized by Self-grandiosity, need for admiration and lack of empathy - ANSWER Narcissistic PD which personality disorder is characterized by Eccentric ideas and behaviors? - ANSWER Schizotypal PD which personality disorder is characterized by Disinterest in others? - ANSWER Schizoid which personality disorder is characterized by Mistrust and suspicion? - ANSWER Paranoid PD Which personality cluster is characterized by appearing anxious or fearful? - ANSWER Cluster C a. avoidant PD b. dependent PD c. obsessive compulsive PD which personality disorder is characterized by Perfectionism, rigidity, and obstinacy traits? - ANSWER OCD Personality Disorder which personality disorder is characterized by Avoidance of interpersonal contact due not rejection sensitivity? - ANSWER `Avoidant 26 which personality disorder is characterized by Submissiveness and a need to be taken care of? - ANSWER Dependent PD Low health literacy has been linked with which of the following? A. poor health outcomes B. lower rates of hospitalization C. less frequent use of preventative services D. all of the above - ANSWER A. poor health outcomes B. lower rates of hospitalization C. less frequent use of preventative services D. all of the above 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 to care B) behavior below the appropriate standard of care for professionals dealing in like circumstances C) a causal link between the provider's failure to conform to treatment standards and harm to the patient D) Actual injury to the patient - ANSWER A) The existence of a client- professional relationship--duty to care B) behavior below the appropriate standard of care for professionals dealing in like circumstances C) a causal link between the provider's failure to conform to treatment standards and harm to the patient D) Actual injury to the patient According to USDHHS and the Federal Bureau of Primary Health Care, which of the following individuals would be considered homeless? A.an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations B. an individual who is a resident in transitional housing C. a person who is living with a friend` D. all of the above - ANSWER A. an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations 27 B. an individual who is a resident in transitional housing C. a person who is living with a friend` D. all of the above 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 B) mentalization based treatment C) transference focused psychotherapy D) exposure therapy - ANSWER A) DBT B) mentalization based treatment C) transference focused psychotherapy D) 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? A. avoid alcohol and caffeine B. set a cool room temp C. set TV to turn off within 1 hr of falling asleep D. go to bed at the same time each night - ANSWER A. avoid alcohol and caffeine B. set a cool room temp C. set TV to turn off within 1 hr of falling asleep D. go to bed at the same time each night The need for NPs to practice to the full extent of their education and training is necessary for which of the following reasons? A) The growth in number and proportion of older Americans B) The projected PCP shortages by 2025 C) increased number of individuals who have access to healthcare D) all of the above - ANSWER A) The growth in number and proportion of older Americans B) The projected PCP shortages by 2025 C) increased number of individuals who have access to healthcare 30 a PD characterized by extraordinarily unstable affect, mood, behavior, object relations and self-image is known as? - ANSWER BPD A particular form of psychotherapy based on Otto Kernbeg's object relations theory is known as which of the following? - ANSWER C) Transference- focused psychotherapy generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following Lithium levels? - ANSWER C) > 2.5 mEq/L nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, oliguria and renal failure - ANSWER Moderate Lithium toxicity: 2.0-2.5 Lithium therapeutic window - ANSWER 0.6-1.2 mEq/L first med approved for bipolar d/o - ANSWER lithium Common side effects of Lithium, - ANSWER tremor, nausea., fatigue, increased thirst, slowed thinking Important serious side effects of Lithium: - ANSWER hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity How do we decrease the risk of lithium toxicity? - ANSWER 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? - ANSWER Increase ACE inhibitors: lisinopril, catopril, enalapril Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline - ANSWER Decrease 31 concurrent use of lithium and antidepressants and/or antipsychotics can cause what? - ANSWER 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 B. someone who has attempted suicide but failed C. only those who have had a serious suicide attempt with a near-death experience D. this is an ambiguous term that should not be used - ANSWER 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 A. is the patient psychotic B. is the patient suicidal or homicidal? C. is the problem organic, functional, or a combination? D. is it safe for the patient to be in the emergency room? - ANSWER B, C 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? - ANSWER B) Paranoid PD The obligation to not inflict harm, or balancing unavoidable harm with the benefits of good achieved, is known as which of the following? A, fidelity B. beneficence C. non-maleficence D. respect for autonomy - ANSWER 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 courts expect related to inpatient psych unit suicide events? 32 A. courts expect suicides to occur in inpatient settings B. courts require zero suicide rates in inpatient settings C. periodic patient evaluation for suicide risk D. Evidence of formulation of a treatment plan with a high level of security - ANSWER 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? A. agree to disagree on differences in values B. solicit other options or points of view C. acknowledge and validate powerful emotions when expressed D. all of the above - ANSWER D) all of the above 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? A. Medicare B. the Joint Commission C. the Agency for Healthcare Research and Quality D. All of the above - ANSWER D) All of the above 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? A. Racism B. Health Disparities C. Vulnerable Populations D. Social Determinants of Health - ANSWER B)Health disparities Which of the following medical conditions can present with prominent mental status changes that mimic common psychiatric illnesses? Select all that apply A. Diabetes B. Thyroid Diseases C. Head Trauma 35 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? - ANSWER D) inform the pt about precautionary therapy that he or she should seek in the future Ethnocentrism results in which of the following? - ANSWER 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? - ANSWER 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? - ANSWER C) Base salary plus percentage Which of the following is NOT consistent with guidelines as a mentor? - ANSWER 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 - ANSWER Cluster A PD includes which 3 disorders? - ANSWER Schizotypal, schizoid, paranoid subtypes Cultural dimensions therapy: - ANSWER Hofstede describes the effects of a society's culture on the values of its members Tx of choice with a pt with paranoid PD? - ANSWER B&C -behavioral therapy -psychotherapy Which of the following is NOT a common physical effect of cannabis? - ANSWER B) Mild bradycardia s/.s of cannabis physical effects? - ANSWER Mild tachycardia, orthostatic hypotension, dilation of the conjunctival blood vessels 36 A conscious standard recurrent behavior such as counting, checking, avoiding that interferes with the person's normal routine and functioning is known as? - ANSWER A_ Compulsion Most everyone has a firm conviction that they are male or female by which age range? - ANSWER 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? - ANSWER D)_ Pseduo- parkinsonism What of the following is consistent with current epidemiology literature about gender and OCD? - ANSWER 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? - ANSWER B) Catatonic A pt who presents with the inability to remain still with motor restlessness, would be assessed to have? - ANSWER B) Akathisia method of therapy used to tx individuals with substance use disorders? - ANSWER B) Contingency Management Ethnocentrism results in which of the following? - ANSWER C) provides care givers the ability to care for pts of various cultures Which of following demographic characteristics is consistent with high suicide risk? - ANSWER 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? - ANSWER 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 37 -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? - ANSWER B) GABA, norepinephrine and serotonin What neurotransmitter increases libidio? - ANSWER D) Dopamine Concerns when treating geriatric pts with psychotherapeutic drugs includes all of the following EXCEPT? - ANSWER C) Elderly persons may metabolize psychotherapeutic drugs more rapidly Concerns when treating geriatric pts with psychotherapeutic drugs? - ANSWER 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? - ANSWER C) Dependent PD According to Sullivan, which of the following are consistent with a mentor/mentee relationship? - ANSWER 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 - ANSWER ALl of the above The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? - ANSWER A) Diet 40 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 - ANSWER B) Avoidant PD OCD PD, dependent PD and avoidance PD traits are associated with which class of PDs? - ANSWER C) Cluster C Therapeutic blood level range for lithium? - ANSWER 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? - ANSWER 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? - ANSWER D) Respect for autonomy Narcissistic, BPD, antisocial and histrionic subtypes are part of what cluster of PDs? - ANSWER B) Cluster B Being knowledgeable about one's own thoughts, feelings and sensations as well as the ability to reflect on how these can affect one's interactions with others is known as? - ANSWER A) Cultural awareness The NP recognizes which are the long-term effects of sex trafficking on victims? - ANSWER D) All of the above wernickles encephalopathy= considered a medical emergency or not? - ANSWER is a medical emergency Is a degenerative brain disorder caused by lack of vitamin B1 Aim of tx for wernickles encephalopathy - ANSWER Prompt and quick correction of the thiamine deficiency in the brain 41 Is wernickles encephalopathy reversible? - ANSWER it is considered reversible Wernickles encephalopathy is caused from? - ANSWER Alcohol abuse, dietary deficiencies, prolon ged vomiting, eating disorders, effects of chemotherapy =s/s mental confusion, vision problems, coma, hypothermia, low bp, lack of muscle coordination (ataxia) lack of muscle coordination? - ANSWER Ataxia Clinical triad of ophthalmoplegia, ataxia and confusion? - ANSWER Wernickles encephalopathy = acute neurological condition Korsakoff's Syndrome: - ANSWER neuropsychiatric disorder associated with confabulation and significant deficits in anterograde and retrograde memory This disorder is associated with pts fabricating stories in the setting of clear consciousness - ANSWER Korsakoff's A common inciting event that precepitates WE is? - ANSWER an acute infection other triggers include: prolonged carb or glucose loading in the presence of thiamine deficiency Hallmark sign of WE? - ANSWER is ocular abnormalities especially nystagmus 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? - ANSWER WE Can WE cause death? - ANSWER 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 42 Warning s/s of WE that could indicate coma or death? - ANSWER 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: - ANSWER A) eye signs B) Dietary deficiency in thiamine C) AMS D) Cerebellar dysfunction Normal brain imaging cannot rule out? - ANSWER WE -therefore not very beneficial What does thiamine do? - ANSWER help brain cells produce energy from sugar Korsakoff's syndrome is often, but not always, preceded by an episode of? - ANSWER WE however, it can occur in someone who has never had a prior episode of WE S/s of Korsakoff's syndrome? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER C) Tension building phase 45 A claim of malpractice requires a pt/plaintiff prove which of the following? select all that apply - ANSWER 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? - ANSWER 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: - ANSWER D) A&C only The US supreme court upheld the psychotherapist-pt privilege in which of the following cases? - ANSWER A) Jaffee vs Redmond Loyalty, fairness, truthfulness, advocacy and dedication in professional relationships is known as? - ANSWER B) Fidelity Which of the following is consistent with PDs? - ANSWER C) Involves impairment in at least 1 out of 4 areas of cognition, affectivity, interpersonal function or impulse control A late appearing adverse effect of neuroleptic drugs is known as? - ANSWER D) Neuroleptic induced tardive dyskinesia the failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession is known as? - ANSWER B) Malpractice a somatpsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about one week before the onset of menses characterized by irritability, emotional liability, HA, anxiety and depression is known as? - ANSWER D) Premenstrual psychosomatic disorder persons who exhibit impulsive traits also show high levels of which of the following hormones? select all that apply - ANSWER D) A& C only 46 in educating a pt beginning on lithium, the NP explains which of the following related to need for blood tests? - ANSWER D) A&B only the incidence of suicide is highest for which of the following populations? - ANSWER B) Older white men Which of the following defense mechanisms does the abuser use during the honeymoon phase? - ANSWER B) Projection SIB patients should be engaged in what type of therapy (BPD individuals who engage in SIB) - ANSWER A) DBT the _____stage begins at 18 months of age and lasts until the age of 3 - ANSWER Anal Stage Freud believed that the libidio source shifted from the mouth (in stage 1) to the anus in what stage of development? - ANSWER 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? - ANSWER 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: - ANSWER Stubborn, very neat, rigid and stingy Adults who are anal expulsive tend to be: - ANSWER 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 - ANSWER Phallic stage (stage 3) Phallic stage occurs at what age? - ANSWER lasting from the ages of 3-6 47 *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? - ANSWER Phallic stage According to Freud, those who do not exhibit gender appropriate behavior have not completed this stage of psychosexual development? - ANSWER Phallic stage Introjection - ANSWER learning right fro wrong -how children incorporate values from others into their value set Introjection occurs at what phase? - ANSWER Phallic stage The development of play is an important milestone to early childhood because:? - ANSWER great way for children to express their thoughts, emotions, fears and anxieties Erikson: Initiative vs Guilt - ANSWER 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? - ANSWER A) Johann is exploring his autonomy Stage 1: Trust vs Mistrust is associated with what age and virtue? - ANSWER infant -18 months, hope Stage 2: Autonomy vs Shame/doubt is associated with what age and virtue? - ANSWER 18 months to 3 years will 50 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? - ANSWER 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? - ANSWER A) Integrity Promoting the Welfare of children and adolescents addresses which of the following ethical issues? - ANSWER 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 - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER D) DBT Manic episodes are considered distinct when they are separated by what length of time without significant symptoms of mania or hypomania? - ANSWER C) 2 months Which of the following meds are NOT FDA approved to tx restless leg syndrome? - ANSWER B) Modafinil Persistant Depressive Disorder lasts at least? - ANSWER 2 years MDD episodes are separated by how long? - ANSWER at least 2 months 51 The clinician asks the adolescent how long they have been sad--greater than 1 year? - ANSWER 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? - ANSWER 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? - ANSWER 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 - ANSWER 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? - ANSWER D) Bipolar I disorder, hypomanic type Which of the following hormone levels is increased in anorexia nervosa? - ANSWER A) Corticotrophin-releasing hormone Hormone released in response to starvation? - ANSWER Corticotrophin- releasing hormone (CRH) Lithium toxicity? - ANSWER 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, 52 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? - ANSWER BUN, creatinine What are drugs that should not be taken with lithium? - ANSWER -ACE inhibitors -Angiotensin II receptor antagonists (statins) -Diuretics -NSAIDS Nightmares and night terrors are associated with disorganization and arousal during which stage of sleep? - ANSWER 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? - ANSWER 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? - ANSWER Attention-deficit/hyperactivity disorder A patient presents endorsing persistent low- grade (sub-acute) depression for the last several years, uncertain of when it started, thinks he has always been depressed but still goes through the motions. These symptoms are consistent with which of the following diagnoses? - ANSWER Dysthymia -persistent mild depression. 55 alzheimers can be associated with: deficits in language, motor function and recognition Dementia with Lewy Bodies typically is accompanied by? - ANSWER EPS Huntington's disease is accompanied by? - ANSWER spasmodic movement and incoordination Frontotemporal dementia is normally accompanied by? - ANSWER extremely talkative and disinhibited ___ is one of the most usual symptoms of anxiety and a direct response to the activation of your sympathetic NS - ANSWER shaking The comorbid psychiatric dx frequently associated with anorexia is? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER A. 0-5 56 Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical fts of PTSD - ANSWER A) Intrusive s/s AFAB - ANSWER assigned female at birth AMAB - ANSWER assigned male at birth _____is good for older adults with anxiety and depression? - ANSWER Remeron the smaller the dose of Remeron, the more ________? - ANSWER sedating What medication decreases psychotic s/s, & ruminating thoughts? - ANSWER 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? - ANSWER A) Zyprexa Drug used to tx NMS? - ANSWER 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? - ANSWER rapid onset of 24-72 hours "cis" - ANSWER matching "Trans" - ANSWER moving across the range Blockade of muscarinic M3 is linked to? - ANSWER cardio-metabolic risk 57 but is NOT linked to weight gain specifically Amantadine is a medication that is used to tx? - ANSWER 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 - ANSWER dopaminergic agent; also is a weak NMDA antagonist (similar to Namenda) Fewer anticholinergic SE of cognitive impairment, dry mouth & constipation? - ANSWER Amantadine Benztropine has increased amount of anticholinergic SE Amantadine (Symmetrel)'s dopaminergic effects can theoretically worsen? - ANSWER Psychosis however @ doses used to tx EPS, this is not a normal occurance An "analogue" of Amantadine? - ANSWER 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 - ANSWER ADJUST Benztropine (Cogentin) - ANSWER 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? - ANSWER Cogentin & Amantadine Common SE of cogentin? - ANSWER dry mouth, constipation, urinary retention, sedation, blurred vision 60 What causes TD? - ANSWER antipsychotics but other medications (nausea and reflux meds) can cause TD as well: reglan, compazine and other agents that block dopamine Medications used to tx TD? (3) - ANSWER FDA approved: Valbenazine (Ingrezza) + Deutrabenazine (Austedo) Not FDA approved for TD, but FDA approved for HD: tetrazbenazine (Xenazine) Meds that cause severe weight gain? - ANSWER Antipsychotics- especially clozapine, olanzapine, quetiapine Antidepressants- mirtazepine, TCAs, Paxil Mood stabilizers- Lithium, Valproic Acid meds that cause moderate weight gain? - ANSWER risperidone and invega meds that cause less weight gain? - ANSWER ability, haldol, geodon, lurasidone First line tx for weight gain for psych meds? - ANSWER 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? - ANSWER 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) 61 Tx of akathisia? - ANSWER First line: propanolol, inderal LA, benzos second line: cogentin, amandtadine, clonidine, gabapentin, trazodone, mirtazepine, Cyproheptadine Blocks D2 blockade? - ANSWER decreases akathisia high potency antipsychotics increase risk of? - ANSWER Akathisia ex. Haldol, Abilify, Invega, Risperidone, Brexipiprazole Akathisia typically has an onset of? - ANSWER can be within a few hours, but normally takes days to weeks to appear ______ invol grinding of teeth - ANSWER Bruxism How to tx Bruxism? - ANSWER 1st line= Buspar 2nd line= benzos, gabapentin Botox is another tx option that is effective (in the masseter) Xerostomia? - ANSWER Dry mouth caused by antipsychotics, antidepressants, lithium, stimulants, and meds used to tx EPS (cogentin, Artane, ect) first line tx of Xerostomia? - ANSWER A) Biotene line prouces 2nd line= Procholinergic drugs ex. Pilocarpine (Salagen) ______ can worsen dry mouth? - ANSWER Caffeine products, so recommendation is to decrease caffeine dose Another common cause of dry mouth? - ANSWER old age Involuntary contractions of muscles due to antipsychotics - ANSWER Dystonia D2 blockade First line tx= cogentin, benadryl 62 second line= benzos, Amantadine, Artane 90% of what reactions in EPS? - ANSWER occur within the first 5 days, although can occur hours to days after an antipsychotic is started Hyperhidrosis? - ANSWER excessive sweating caused by antidepressants, espcially SNRIs (venlafaxine, duloxetine, and levomilnacipran) and bupropion tx for hyperhidrosis? - ANSWER 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 - ANSWER True , most are antiemetic options for nausea How to decrease prolactinemia? - ANSWER Reduce dosage DC offending med (Prolactin doses tend to normalize after 2-4 days) If stopping the causation agent is NOT possible? - ANSWER first line= add abilify. 5-20 mg daily 2nd line= add oral contraceptives First line tx of serotonin syndrome? - ANSWER benzos second line= cyproheptadine