PMHNP certification Exam 2023(Questions With Answers 100% Tested And Verified A+), Exams of Nursing

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PMHNP certification Exam

2023(Questions With Answers 100%

Tested And Verified A+)

**1. Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank 2 risk factors D. 68 y/o single white male with depression 5 risk factors (age, male, white, depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors 2. When interview teenagers (16 y/o) that arrive with their parents what should you do?: interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confiden- tial. Parents may be upset but remember you are advocating for the child. 3. Which Ethnic group has the highest rate of suicide?: Native Americans 4. Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference

B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an- tagonism C. Increased Lipids D.Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)

5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY 6. Which mood stabilizer have the least weight gain?: Lamictal -But remember all mood stabilizers cause some weight gain 7. When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a: atypical 8. A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D.Hippocampus: Hypothalamus A, B, & D are all part of the limbic system so you can rule that out 9. When a patient is hesitant to participate in treatment you should encour- age?: Bring a support person like a husband 10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L

11. When T4 and T3 are high and TSH is low what is the diagnosis: HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE 12. Key symptoms of Heat Intolerance: Hyperthyroidism 13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE 14. Key symptoms of Cold Intolerance: Hypothyroidism 15. Hyperthyroid can mimic: Mania 16. Hypothyroid can mimic: Depression 17. A patient on depakote complains of RUQ pain and has reddish/brown urine: Hepatoxicity -Check LFTs 18. Signs of Depakote toxicity: Disorientation, confusion, lethargy 19. You suspect depakote toxicity what do you do?: Check -LFT -Ammonia -Depakote Level 20. What herbal supplement can cause hepatoxicity?: Kava Kava 21. When taking Kava Kava in combinations with other medications you should caution about: Risk of Hepatoxicity and Sedation 22. TCAs carry a risk of: Hepatotoxicity 23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling,

burning eyes, blisters, skin pain

24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol 25. What nationality is most suseptible of getting steven johnson?: Asians 26. When treating asians with tegretal screen for?: HLAB-1502 Allele 27. What two medications cause agranulocytosis?: Clozaril & Tegretal 28. Agranulocytosis when to discontinue medication: Less than 1000 29. When monitoring for agranulocytosis in patients look for s/s of what?: - Infection -Fever, sore throat, fatigue, chills 30. Before starting any mood stabilizer in a female of childbearing age be sure to check?: HCG 31. Which two medications may decrease the risk of suicide?: clozaril and lithium 32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS- lisinopril 33. Ace inhibitors are treatment of choice for?: Heart Failure 34. Certain medications are known to increase lithium level, but HOW?: by reducing renal clearance 35. When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise

36. Normal Lithium Level: 0.6-1. 37. Lithium Toxicity: 1.5 or above Discontinue and re-order lithium level 38. Lithium level of 1.4: Monitor for toxicity 39. Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY 40. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY 41. Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity 42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation, tremor 43. NMS: muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) 44. Cherry colored urine in a patient that exercises a lot: test for myoglobinuria may be a sign of rhabdo

45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta- bility, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). 46. Treatment for NMS: Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer 47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine 48. Triptans: Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN 49. patient taking Prozac and started on sumatriptan: -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP 50. How long do you wait when switching between an SSRI to an MAOI?: 2 weeks 51. How long do you wait when switching between Prozac and MAOI?: 5-6 weeks wash out period

52. What is the first line treatment for depression and why?: SSRI-First line treatment for depression due to less risk of injury from OVERDOSE 53. If a cancer patient has depression what should you consider?: Treating with a medication with minimal drug/drug side effects like Lexapro 54. Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin 55. Primary symptoms of depression include fatigue and low energy what med would you chose?: Wellbutrin 56. Wellbutrin is contraindicated in patients with: Seizures and anorexia 57. Which medications are best for neuropathic pain?: SNRI Gabapentin TCA 58. Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERY appointment 59. Which meds have the worse serotonin discontinuation syndrome: Those with short half lives such as zoloft 60. Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET

Shits and Shivers

61. Ages of onset for schizophrenia in males vs females: -MALES 18- years -FEMALE 25-35 years 62. Schizophrenia increases the risk for: SUICIDE HIGH RISK OF SI in SCHIZOPHRENIA Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) 63. What increases the causes or increases the risk or schizophrenia: exces- sive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) 64. MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREAS- ES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT 65. Stimulants can potentiate the release of what neurotransmitter?: - Dopamine which can worsen symptoms of schizophrenia 66. Assertive Community Treatment (ACT): a form of rehabilitation post

hospi- talization, in home treatment

67. What level of prevention is ACT?: Tertiary 68. What adjunctive treatment is important in schizophrenia: -social skills training -Exercise 69. Exercise for mental health patients can promote: Cognition Quality of Life Long-term health 70. ACT is ideal for patients with a history of: Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home 71. What diagnosis has the highest risk of Homicidality: Antisocial 72. In the MMSE how do you test for abstraction?: proverb interpretation (every- one that lives in glass houses shouldn't throw stones) Are they able to think abstractly 73. Thought Process-Tangential: means that their response has nothing to do with the question 74. Circumstantial: means that their response goes in circles instead of getting to the point of the question 75. Mental Status-Thought Content includes: SI/HI/AH/VH 76. Another name for MMSE: Folstein Scale 77. How to assess concentration on MMSE: Serial 7s or perform an

activity backwards i.e list the days of the week backwards

78. Assess ability to learn new material: repeat 3 words after me 79. Assess ability to recall: repeat 3 words after 5 minutes 80. Assess fund of knowledge: Who is the president 81. What is a quick and easy way to assess for neurological issues: Clock drawing test 82. If patient is unable to draw a clock this indicates: Problem with the right hemisphere, cerebrum, or parietal lobe 83. mesolimbic pathway: Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms 84. mesocortical pathway: -Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia 85. Nigrostriatal Pathway: -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dysto- nia, parkinsonian symptoms and akathisia 86. Low Dopamine in the nigrostriatal pathway increases which

neurotrans- mitter: -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach)

87. Long-standing D2 blockade in the nigrostriatal pathway can lead to: - tardrive dyskinesia 88. Tuberoinfundibular pathway: -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN 89. Long-term hyperprolactinemia can be associated with what condition: - osteoporosis 90. Normal Prolactin Level in Men: level less than 20ng/ml 91. Normal Prolactin Level in Women: less than 25ng/ml 92. Which medication is the highest offender for increasing prolactin: - Risperdal 93. Acute Dystonia + Treatment: neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days 94. Akathisia + Treatment: may mimic anxiety, restlessness, can't sit still, rocking, pacing -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal)

-Second line treatment is COGENTIN -Third line treatment is benzos

95. Beta-Blockers such as Inderal are contraindicated with what type of asthma medication: -DO NOT GIVE WITH BROCHODIALATOR such as AL- BUTERAL this combination can cause bronchospasm 96. akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness of movement -Treatment Cogentin 97. PSEUDOPARKINSON or PARKINSONIAN + Treatment: caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN 98. tardive dyskinesia + Treatment: abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT 99. Does Cogentin Treat TD: COGENTIN MAKES TD WORSE 100. Typical onset of TD: OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO 101. What non-psych med can cause TD?: REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD***

encourage them to discon- tinue reglan if TD develops

102. InDucers CYP450: DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylure as Crap GPS Induces me to Madness! 103. InhIbitors of CYP450: INCREASE Ciprofloxaci n Ritonavir Amiodaron e Cimetidine Ketoconazol e

Acute Etoh

Macrolide s INH Grapefruit Juice Omeprazole Crack Amigos

104. Erythromycin and Clarithromycin can cause: Increased tegretol levels 105. Patient started on Clozaril or Zyprexa and two months later starts smoking: as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose 106. Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey: as a provider you know that you must now decrease the dose of the antipyshcotic 107. Medications that cause mania: Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer 108. Medications that cause depression: steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodi- azepines, progesterone

-may need to increase antidepressant

109. Accutane (isotretinoin): Can cause depression and birth defects 110. Flonase: As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression 111. Flonase can trigger mood instability but it can also cause an increase in: Psychosis patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis -increase the dose of antipsychotic 112. Neurotransmitters involved in Addiction: Dopamine and GABA 113. Symptoms of Stimulant Abuse: 1. agitation/aggression 2.impaired judgment 3.euphoria 4.elevated BP 5.tachycardia 6.dilated pupils 7.hallucinations 8.TREMORS 9.IMSOMNIA

114. If an anorexic patient complains of pain or bloating after eating this may indicate: delayed gastric emptying
115. Medications that delay gastric emptying: Omeprazole, ranitidine, famoti- dine
116. Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI 117. When initiating an SSRI on an elderly patient you should advise about- : increased anxiety
117. Paradoxical effect: when meds cause the opposite effect than expected
118. Apoptosis: programmed cell death/neuronal loss
119. At age 45 and above the patient displays mania for first time what should be ruled out: MEDICAL CONDITION
120. Patient with bipolar disorder presents with depressed mood & emotion- al lability: Give Depakote
121. Hallmark sx of Borderline Personality: Recurrent self harm
122. Treatment for Borderline Personality: DBT
123. Creator of DBT: Marsha Linehan 125. What activity is helpful in making a diagnosis of borderline personality- : Journaling or diary keeping
124. Conversion Disorder: STRESS leads to neurological

symptoms such as seizures, paresthesia, blindness, mutism

127. Adjustment Disorder: adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying)

-Symptoms occur within 3 months of the stressor If question states recently moved, recent death....THINK ADJUSTMENT

128. factitious disorder: when patients introduce foreign substances into their body or contaminate their food -Faking illness but NO MOTIVE BEHIND IT
129. Malingering: Faking illness for financial gain
130. Reactive Attachment: common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver
131. ODD: They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting
132. Conduct Disorder: violence, criminal, fire setting, killing animals, gang activ- ity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsy- chotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine
133. Acute Stress Disorder: similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks

-LESS THAN ONE MONTH

134. PTSD: -OVER ONE MONTH

-3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoid- ance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT

135. Panic attack vs Panic disorder (treatment): Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom
136. Tourette's Syndrome: Criteria for diagnosis -TWO moto tics and ONE vocal tics -LASTS more than ONE YEAR -By age 18 CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL
137. Child presents with one tic and the parent is worried: CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL
138. Neurotransmitters involved in Tourettes: DNS: Dopamine,

Norepineph- rine, Serotonin

139. Treatment for tourettes: Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine
140. What type of medication can cause tics or exacerbate them: Stimulants
141. Neurotransmitters involved in mood disorders: DNS: Dopamine, Norepi- nephrine, Serotonin + GABA
142. Neurotransmitters involved in ADHD: DNS: Dopamine, Norepinephrine, Serotonin
143. part of brain implicated in ADHD: prefrontal cortex basal ganglia reticular activating system
144. ADHD inattentive type is caused in what part of the brain: Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION
145. dorsolateral prefrontal cortex: Attention Executive Function Cognition Processing Working Memory Problem Solving
146. Deficit in the can lead to ADHD inattentive type:

Prefrontal Cortex

147. Teacher reports that the stimulant only works for first few hours of class: medication has worn off too fast. Order multiple dosing throughout the day
148. When does the aftercare plan start: on admission
149. If parents become anxious while you are educating about a new diag- nosis what should you do: -Provide patient and parents information immediately don't wait till discharge

-Parents may become anxious after a diagnosis of mental illness such as ADHD, stop teaching offer support because they will not absorb the education. Provide supportive therapy

150. Neurotransmitters involved in OCD: serotonin, dopamine, glutamate & GABA
151. A tic may also be a: Compulsion
152. Facts about OCD: Obsession/Compulsion -A tic may be a compulsion -If first order relative has OCD the child's risk of developing OCD is increased -Streptococcal infections increase risk of OCD -Treatment SSRI-prozac, Zoloft, if adult you may also use TCA such as clomipramine 153. If question asks if the patient has Tourette's vs OCD listen for mention of streptococcal treatment this will trigger you to think OCD:
153. DMDD: 6-17 years ONLY -Irritability for no reason, sad, depressed mood, tantrums, crying, moody, always mad
154. If patient presents with irritability or labile mood and you need help further delineating symptoms: Administer MOOD QUESTIONAIRE 7/13 Bipolar Diagnosis Likely 156. Sleep Disorders are often So what should you assess if a parent reports that a child is having night- mares: GENETIC

ask if someone in the family has a similar issue with sleep...look for family patterns of sleep problems

157. GAD: Worry, apprehension, fear must LAST ATLEAST 6 MONTHS
158. Delirium: -ACUTE (within hours to days) onset of disturbance of LOC, COG- NITION, inattention -Urinary Tract Infections are common cause for DELIRIUM always check UA -Treatment is antipsychotics like HALDOL
159. Dementia: -Chronic and slow onset (months to years to develop) -Mental decline in cognition, irritability, personality changes -When asked questions they may try to answer or MAKE UP ANSWERS (confab- ulate)
160. Low levels of what labs may mimic dementia: Vit B12 and Folic Acid
161. Cortical Dementia: Language and memory (aphasia and amnesia)
162. Subcortical Dementia: Motor abnormalities/Mood issues like apathy, de- pression, irritability HIV Dementia is a type of subcortical dementia
163. Early signs of HIV dementia: subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of

coordina- tion, unsteady gait

164. Treatment for HIV dementia: Antivirals
165. Pseudo Dementia: Depression causes the memory issues, common in older adults -Also assess onset of symptoms, pseudo dementia is more acute onset -When asked questions they often say "I DON'T KNOW"
166. Instruments to use to differentiate between dementia and pseudo de- mentia: -Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE 167. -Older individuals with depression may present with irritability and agitation If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present:
167. hallmark of lewy body dementia: visual hallucinations
168. Frontotemporal lobe Dementia: PICKs Disease -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes -May see slurred speech or difficulty getting words out
169. What lobe is associated with ability to understand what others are saying (comprehending speech): Temporal Lobe
170. Neurotransmitters involved in Autism: GABA, Glutamate, Serotonin