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increase prolactin - - # CORRECT ANSWER® - Stop prolactin (stop the agent that cause increase prolactin) 3-year-old masturbates, play with self, says naughty things - - # CORRECT ANSWER Normal for Piaget 5-year-old tells you his brother sodomized him - - ## CORRECT ANSWER® - Tell mom don't leave him alone with patient and call CPS implement crisis 13-year-old want to smoke - - # CORRECT ANSWER - Ask him of his plan to stop smoking 14-year-old girl clenching her teeth - - # CORRECT ANSWER® - Cranial nerve V-Trigeminal nerve 16-year-old falls with the wrong crowd - - # CORRECT ANSWER - Conduct disorder 16-year-old refuse treatment - - # CORRECT ANSWER - Send to psych specialist for acting out kids 16-year-old shows up with mother for first therapy - - # CORRECT ANSWER - Confidential (mom sits in lobby) ACE inhibitors - - # CORRECT ANSWERW - HTN ACE inhibitors are the drug of choice for what? - - # CORRECT ANSWER - Heart failure/HTN Acute stress disorder (ASD) - - # CORRECT ANSWER® - Can be 2 to 4 weeks (less than a month) ADPIE - - *# CORRECT ANSWER © Assessment: 1st step, subjective and objective data ¢ Diagnosis: analysis, formulation of nursing diagnosis * Planning: prioritizing problems, determining goals, plan of care ¢ Implementation: nursing action (rather than medical action) * Evaluating: comparing outcomes, communicate and document findings Adult panic disorder - - # CORRECT ANSWER - Buspar Lithium level 1.2 what are you concerned with - - # CORRECT ANSWER® - 4+ Ketones Labs for Kidney compromised it is wrong Urine kidney problem 1. NSAID, dehydration and Thiazides increases risk of Lithium toxicity - - # CORRECT ANSWER*®Y Lithium toxicity Ibuprofen and lithium - - # CORRECT ANSWER® INCREASES the serum level up to double Lab Values concerning for patient on Lithium: - - # CORRECT ANSWER 0 Leukocytosis 0 Creatinine o BUN o NA+ In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until the surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction . Amygdala: - - # CORRECT ANSWER# - Fear, anxiety, and aggression Amygdala - - # CORRECT ANSWER® - A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression Anorexia (SAFETY = KEY) - - # CORRECT ANSWER - Set up family therapy (especially adolescent pts since they have no control over food choices) Anorexia admission criteria for hospitalization - - # CORRECT ANSWER - Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L). anorexia nervosa - - # CORRECT ANSWER - BMI less than 18.5 - BMI < 16 = AUTOMATIC ADMISSION - An eating disorder in which an irrational fear of weight gain leads people to starve themselves ANOVA (analysis of variance) - - # CORRECT ANSWER an inferential statistical test for comparing the means of three or more groups Antidepressant takes - - # CORRECT ANSWER® 4 to 6 weeks Prozac causes what? - - # CORRECT ANSWER‘ increase anxiety in elderly Apoptosis - - # CORRECT ANSWER programmed cell death in aging/elderly Appreciative Inquiry - - # CORRECT ANSWER - Dream (wishes or dreams of organization) - Design (decide what you want to change) - Destiny (make it happen, implanting change) Appreciative Inquiry - - ## CORRECT ANSWER an organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements Appreciative Inquiry - - # CORRECT ANSWER an organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work Appreciative Inquiry - - # CORRECT ANSWER® - Identify the problem - Analyze the problem - Generate solutions - Implement best solution Assertive Community Treatment (ACT) - - # CORRECT ANSWER*# community-based programs that provide many of the services that are necessary for successful community living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basis Assertive questions - - # CORRECT ANSWER - Use "I want", "I need", or"! feel" to convey basic assertions and get your point across firmly. For example "I feel strongly that we need to bring in a third party to medicate this disagreement" another example "Dave, your request has caught me off guard. I'll get back to you within the half hour". - Those are strong inhibitors of 2D6 Big concern with HER - - # CORRECT ANSWER - Confidentiality Borderline personality disorder treatment - - # CORRECT ANSWER® dialectical behavior therapy Boy states that he wishes to be a girl and tells you not to tell his parent - - # CORRECT ANSWER® - Don't tell Bruise on the padded part of patient's arm - - # CORRECT ANSWER - Say I see you have bruises on your arm - Ask what happened Can an advanced directive ever be revoked? - - # CORRECT ANSWER® - Yes, at any time Can asthma medications cause depression? - - # CORRECT ANSWER® yes , - Examples: INTERFERON - ACCUTANE (Acne Tx) (Vit A) o Can cause depression & birth defect Can you have Medicare and Medicaid? - - # CORRECT ANSWER® - Yes, impoverished elderly but Medicaid is always payer of last resort Can you take Buspar during pregnancy? - - # CORRECT ANSWER - Category B: OK if really needed 1Can you take Klonopin during pregnancy? - - # CORRECT ANSWER - Category C: Avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms - Floppy baby Carb and Barb (Carbamazepine and Phenobarbital is a barbiturates) - - # CORRECT ANSWER® - Strong inducers of 3A4 - Decrease INR CBT - - &# CORRECT ANSWER - Anxiety - Popular integrative therapy that combines cognitive (thinking) and behavior therapy 1. Change agent - - ~# CORRECT ANSWER - The person formally in charge of guiding a change effort - Administrator - Usually the person on top in the facility is responsible for being the change agent. Charge of DEA (Drug Enforcement Administration) - - # CORRECT ANSWER. - State and federal Child in foster home 5 years poor eye contact, isolated self, eat without difficulty - - # CORRECT ANSWER - Autism VS - Child in foster home since birth, eats without interest, shows little emotion = REACTIVE ATTACHMENT DISORDER -REACTIVE ATTACHMENT DISORDER = Look for NO Emotion . Child reports Sexual abuse - - ~# CORRECT ANSWER - Interview the young child and infants with parent . Culture questions : A man injects himself - - # CORRECT ANSWER -'"Tell me more about the medications" Cytochrome P-450 inhibitors - - # CORRECT ANSWER - Inducer; Pushes the substrate out of the exit pathways, < the serum level of other drugs, < therapeutic effect. Bull Shit CRAPGPS - Barbiturates + St. Johns Wart - Carbamazepine + Rifampin + Alcohol (chronic use) - Phenytoin - Griseofulvin + Phenobarbital - Sulfonylureas ( smoking) storoid ( sone Prednisone) Dairy log- - ~# CORRECT ANSWER CBT DBT (dialectical behavior therapy) - - # CORRECT ANSWER - Relaxation muscle prior to DBT - Borderline Patients - NO meds - DBT therapy DDAVP (Desmopressin) acts in much the same manner as antidiuretic hormone - - #4 CORRECT ANSWER - Makes less urine - Used for ENURESIS Depakote and Disulfiram - - # CORRECT ANSWER® - Increase INR Depakote causes - - # CORRECT ANSWER - Spina bifida Depakote check - - #” CORRECT ANSWER® check HCG levels DIGFAST for Mania - - #7 CORRECT ANSWER. - Distractibility - Indiscretion - Grandiosity - Flight of ideas - Activity increase - Sleep deficit - Talking increase dilated pupils - - # CORRECT ANSWER® - Stimulant intoxication (Cocaine) DISSEMINATED ENCEPHALOMYELITIS - - # CORRECT ANSWER® - Assess for asymmetry of extremities - Along with this pattern, the patient usually get neurological symptoms which may include - Confusion, drowsiness, and even coma - Unsteadiness and falling - Visual blurring or double vision (occasionally) + Trouble swallowing - Weakness of the arms or legs - Fever - Headache- do a neuro check? Disulfiram ( antiabuse) - - # CORRECT ANSWER increase coumadin - Interpersonal therapy - Interpersonal conflict - Klerman and Weismann - CBT - if nothing fits CBT works for most. Encopresis Treatment - - ~# CORRECT ANSWER Behavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation Counseling EPS - - ## CORRECT ANSWER® - Clients who experience any form of EPS are at increased risk of TD Erythromycin - - # CORRECT ANSWER® - Increases Xanax level because Erythromycin is an INHIBITOR Females more likely to become an alcoholic than man - - # CORRECT ANSWER® - Due to hormones - Alcohol dehydrogenase is an enzyme that is found mostly in the liver and stomach - Women have a much LOWER amount of this enzyme than men - Know the name First sign of temporal frontal dementia - - # CORRECT ANSWER® - Behavior and personality changes For there to be a duty to a patient what must exist? - - ~# CORRECT ANSWER® Relationship For there to be damages, what must exist first? - - # CORRECT ANSWER Negligence GAL- renal metabolized - - # CORRECT ANSWER® - Gabapentin - Acamprostate (Campral) - Lithium Give Ativan - - # CORRECT ANSWER - For alcoholic with liver problems, because it is a short-acting benzo. Grape-fruit juice and grapefruit are Inhibitors - - # CORRECT ANSWER - One glass can reduce absorption (metabolism of the drug) by 47% - Blood level of drug will be increased Grape fruit juice or grapefruit - - # CORRECT ANSWER - Will cause Increase trazodone levels because it is an INHIBITOR - see above - you would need to DECREASE the Trazodone dose in this case. Grasp reflex - - ## CORRECT ANSWER® - An infantile reflex in which an infant closes hand into a fist when palm is touched - Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until about 5 to 6 months of age Greatest patient at risk for violence - - # CORRECT ANSWER® - Substance abuse Hamilton anxiety rating scale (HAP-A) - - # CORRECT ANSWER - 14-17 Mild anxiety - 18-24 Moderated anxiety - 25-30 severe anxiety Hamilton Depression Rating Scale - - # CORRECT ANSWER - 0-7 normal - 14-18 moderated How do Asians see HC providers? - - # CORRECT ANSWER® - AS ina position of authority - Expect to give instructions and help make decisions How do you assess the competency of a medical procedure? - - #” CORRECT ANSWERW - Identify a pen and recall 3 words - Mental Status Exam - part of assessing competency How do you protect from the evil eye? - - ~ CORRECT ANSWER® - Red ribbon on an infant - Amulet for adults How do you test CN XIl- - ## CORRECT ANSWER stick out your tongue How do you treat for Evil eye? - - # CORRECT ANSWER - Access traditional healer + traditional care How is tele-psychiatry evaluated? - - ~# CORRECT ANSWER - Outcome based - Measure at intervals How many generations do you included for genogram? - - # CORRECT ANSWERW -3 generations How treat child with depression - - # CORRECT ANSWER - Zoloft and therapy - Of all the antidepressants, only fluoxetine (Prozac™) has been FDA approved to treat pediatric depression. For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (Prozac™), sertraline (Zolaft™), fluvoxamine, and clomipramine (Anafranil™) I don't know answers - - # CORRECT ANSWER® - Pseudo dementia - just treat depression, not the dementia - dementia will resolved with treatment of depression if it IS pseudodementia If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? - - # CORRECT ANSWER microalbumin ? ( the answer is rhabdomyolysis If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? - - e& CORRECT ANSWER® Zyprexa the answer is invega Impulsivity (ADHD) - - # CORRECT ANSWER® - Pre-frontal cortex - Involves hasty actions taken without consideration of possible negative consequences to self or others. It often shows up as a kind of social intrusiveness, such as excessively interrupting others. Increase ICP (signs and symptoms) - - # CORRECT ANSWER® - Baby neuro cry Infant dying - - ~# CORRECT ANSWER® - Give child to parents and comfort parents inferential statistics - - ~# CORRECT ANSWERY Numerical values that enable one to reach conclusions that extend beyond the immediate data alone; generated by quantitative research designs Examples include 1. t test: Assesses whether the means of two groups are statistically different from each other 2. Analysis of variance (ANOVA): Tests the differences among three or more groups 3. Pearson's r correlation: Tests the relationship between two variables 4. Probability: Likelihood of an event occurring; lies between 0 and 1; an impossible event has a probability of 0, and a certain event has a probability of 1 5. P value: Also known as level of significance; describes the probability of a particular result occurring by chance alone (if P = .01, there is a 1% probability of obtaining a result by chance alone) Is it OK to announce a patient's name ina waiting room? - - ~# CORRECT ANSWER - Yes, no other way to give care Is it OK to leave a message on a patient's Voicemail? - - # CORRECT ANSWER - Yes but should be limited Just Culture - - @## CORRECT ANSWER - OPPOSITE OF BLAME CULTURE - Proposed to reconcile the twin needs for no blame and appropriate accountability - The focus in on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors while maintaining individual accountability by establishing zero tolerance for reckless behavior - Distinguishes between Human error (ex. Slips) VS at risk behavior (eg. Taking shortcuts) VS Reckless behavior(eg. Ignoring required safety steps) - Ina just culture, the response to an error or near miss is predicated on the type of behavior associated with error, not the severity of the event Just Culture of Safety American Nurses Association Position Statement (ANA, 2010) PB 56 - Supports collaboration efforts among state boards of nursing, professional organizations, patient safety centers, and health systems to develop Just Culture initiatives - Holds people accountable for their behaviors and investigates errors - Goal of creating open and fair learning environment to design safe systems and manage choices - Mindset that affects work environment to proactively look for system breakdowns and identify ways to improve systems Kids panic disorder - - # CORRECT ANSWER® - Clonidine - Guanfacine Kids receive to many calories to staff letting him eat food - - # CORRECT ANSWER - Meet with dietician, discuss with manager Kid with nightmares creaming out does not remember the next morning what do you do? - - CORRECT ANSWER® - Ask about sleep disorder in family Latuda and Geodon - - # CORRECT ANSWER® - Take with food Latino women wanting prenatal class - - # CORRECT ANSWER - Consult with cultural group in community 1. Lesion in frontal cortex - - # CORRECT ANSWER - Impaired cognitive functions limbic system - - # CORRECT ANSWER®W - A donut shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus , amygdala, and hypothalamus Lithium level 1.2 what are you concerned with - - # CORRECT ANSWER® - 4+ Ketones Labs for Kidney compromised it is wrong Urine kidney problem Little boy wet his sheets, what kind of therapy would you suggest - - # CORRECT ANSWERW - Behavior therapy Man had apt, wife came and the patient didn't - - ~# CORRECT ANSWER - Tell wife reschedule appointment 
