PMHNP Certification Exam KM 2023 Review, Exams of Nursing

Download PMHNP Certification Exam KM 2023 Review and more Exams Nursing in PDF only on Docsity! PMHNP certification Exam KM 2023 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) - correct answer D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors.. When interview teenagers (16 y/o) that arrive with their parents what should you do? - correct answer interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. Which Ethnic group has the highest rate of suicide? - correct answer Native Americans 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 PMHNP certification Exam KM 2023 B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism C. Increased Lipids D. Metabolic Syndrome - correct answer D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? - correct answer 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 Which mood stabilizer have the least weight gain? - correct answer Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a - correct answer atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System PMHNP certification Exam KM 2023 two psychotropics known to cause steven johnson syndrome - correct answer lamictal and tegretol What nationality is most suseptible of getting steven johnson? - correct answer Asians When treating asians with tegretal screen for? - correct answer HLAB- 1502 Allele What two medications cause agranulocytosis? - correct answer Clozaril & Tegretal Agranulocytosis when to discontinue medication - correct answer Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? - correct answer Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? - correct answer HCG PMHNP certification Exam KM 2023 Which two medications may decrease the risk of suicide? - correct answer clozaril and lithium Medications that increase lithium level - correct answer NSAID- ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? - correct answer Heart Failure Certain medications are known to increase lithium level, but HOW? - correct answer by reducing renal clearance When educating a patient about lithium teach them about - correct answer Hyponatremia Dehydration-hot days, exercise Normal Lithium Level - correct answer 0.6-1.2 Lithium Toxicity - correct answer 1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 - correct answer Monitor for toxicity PMHNP certification Exam KM 2023 Labs before starting lithium - correct answer TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium - correct answer 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects - correct answer hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity Signs of lithium toxicity - correct answer confusion, ataxia, GI upset, palpitation, tremor NMS - correct answer 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) PMHNP certification Exam KM 2023 Wellbutrin is contraindicated in patients with - correct answer Seizures and anorexia Which medications are best for neuropathic pain? - correct answer SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? - correct answer Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome - correct answer Those with short half lives such as zoloft Symptoms of serotonin withdrawal syndrome - correct answer Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females - correct answer - MALES 18-25 years PMHNP certification Exam KM 2023 -FEMALE 25-35 years Schizophrenia increases the risk for - correct answer SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia - correct answer excessive 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) MRI or PET scan what is seen in schizophrenia - correct answer EVERYTHING DECREASES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter? - correct answer Dopamine which can worsen symptoms of schizophrenia PMHNP certification Exam KM 2023 Assertive Community Treatment (ACT) - correct answer a form of rehabilitation post hospitalization, in home treatment What level of prevention is ACT? - correct answer Tertiary What adjunctive treatment is important in schizophrenia - correct answer -social skills training -Exercise Exercise for mental health patients can promote - correct answer Cognition Quality of Life Long-term health ACT is ideal for patients with a history of - correct answer Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality - correct answer Antisocial PMHNP certification Exam KM 2023 Low Dopamine in the nigrostriatal pathway increases which neurotransmitter - correct answer -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to - correct answer tardrive dyskinesia Tuberoinfundibular pathway - correct answer -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 Long-term hyperprolactinemia can be associated with what condition - correct answer osteoporosis Normal Prolactin Level in Men - correct answer level less than 20ng/ml Normal Prolactin Level in Women - correct answer less than 25ng/ml Which medication is the highest offender for increasing prolactin - correct answer Risperdal PMHNP certification Exam KM 2023 Acute Dystonia + Treatment - correct answer neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment - correct answer 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 Beta-Blockers such as Inderal are contraindicated with what type of asthma medication - correct answer -DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment - correct answer A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment - correct answer caused by dopamine blockade, results in muscle rigidity, mask like facial PMHNP certification Exam KM 2023 expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN tardive dyskinesia + Treatment - correct answer abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT Does Cogentin Treat TD - correct answer COGENTIN MAKES TD WORSE Typical onset of TD - correct answer OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO What non-psych med can cause TD? - correct answer 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 discontinue reglan if TD develops InDucers CYP450 - correct answer DECREASE Carbamazepine PMHNP certification Exam KM 2023 Medications that cause depression - correct answer steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone -may need to increase antidepressant Accutane (isotretinoin) - correct answer Can cause depression and birth defects Flonase - correct answer 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 Flonase can trigger mood instability but it can also cause an increase in - correct answer 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 Neurotransmitters involved in Addiction - correct answer Dopamine and GABA PMHNP certification Exam KM 2023 Symptoms of Stimulant Abuse - correct answer 1. agitation/aggression 2. impaired judgment 3. euphoria 4. elevated BP 5. tachycardia 6. dilated pupils 7. hallucinations 8. TREMORS 9. IMSOMNIA If an anorexic patient complains of pain or bloating after eating this may indicate - correct answer delayed gastric emptying Medications that delay gastric emptying - correct answer Omeprazole, ranitidine, famotidine Proton Pump Inhibitors (omeprazole & Protonix) - correct answer Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI PMHNP certification Exam KM 2023 When initiating an SSRI on an elderly patient you should advise about - correct answer increased anxiety Paradoxical effect - correct answer when meds cause the opposite effect than expected Apoptosis - correct answer programmed cell death/neuronal loss At age 45 and above the patient displays mania for first time what should be ruled out - correct answer MEDICAL CONDITION Patient with bipolar disorder presents with depressed mood & emotional lability - correct answer Give Depakote Hallmark sx of Borderline Personality - correct answer Recurrent self harm Treatment for Borderline Personality - correct answer DBT Creator of DBT - correct answer Marsha Linehan What activity is helpful in making a diagnosis of borderline personality - correct answer Journaling or diary keeping PMHNP certification Exam KM 2023 Panic attack vs Panic disorder (treatment) - correct answer Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom Tourette's Syndrome - correct answer 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** Child presents with one tic and the parent is worried - correct answer **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Neurotransmitters involved in Tourettes - correct answer DNS: Dopamine, Norepinephrine, Serotonin PMHNP certification Exam KM 2023 Treatment for tourettes - correct answer Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them - correct answer Stimulants Neurotransmitters involved in mood disorders - correct answer DNS: Dopamine, Norepinephrine, Serotonin + GABA Neurotransmitters involved in ADHD - correct answer DNS: Dopamine, Norepinephrine, Serotonin part of brain implicated in ADHD - correct answer prefrontal cortex basal ganglia reticular activating system ADHD inattentive type is caused in what part of the brain - correct answer Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION dorsolateral prefrontal cortex - correct answer Attention Executive Function Cognition Processing PMHNP certification Exam KM 2023 Working Memory Problem Solving Deficit in the _____ can lead to ADHD inattentive type - correct answer Prefrontal Cortex Teacher reports that the stimulant only works for first few hours of class - correct answer medication has worn off too fast. Order multiple dosing throughout the day When does the aftercare plan start - correct answer on admission If parents become anxious while you are educating about a new diagnosis what should you do - correct answer -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 Neurotransmitters involved in OCD - correct answer serotonin, dopamine, glutamate & GABA A tic may also be a ___ - correct answer Compulsion PMHNP certification Exam KM 2023 Subcortical Dementia - correct answer Motor abnormalities/Mood issues like apathy, depression, irritability HIV Dementia is a type of subcortical dementia Early signs of HIV dementia - correct answer subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordination, unsteady gait Treatment for HIV dementia - correct answer Antivirals Pseudo Dementia - correct answer 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" Instruments to use to differentiate between dementia and pseudo dementia - correct answer -Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE PMHNP certification Exam KM 2023 -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 - correct answer hallmark of lewy body dementia - correct answer visual hallucinations Frontotemporal lobe Dementia - correct answer PICKs Disease -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes -May see slurred speech or difficulty getting words out What lobe is associated with ability to understand what others are saying (comprehending speech) - correct answer Temporal Lobe Neurotransmitters involved in Autism - correct answer GABA, Glutamate, Serotonin Autism - correct answer a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement When play they often like to line up their toys, stack them in tidy rows PMHNP certification Exam KM 2023 Broken Mirror Theory of Autism - correct answer Explains that the child's presentation is caused by the mirror neuron i.e dysfunction in the mirror neuron Risk Factors for Autism - correct answer Male gender, genetic loading, intellectual disability, parents ages, preterm Screening tools for Autism - correct answer ADOS-G (autism diagnostic observation schedule-genetic) ASQ (ages and stages questionnaire) M-CHAT (modified-checklist for autism-toddler) Where is Norepinephrine produced? - correct answer locus coeruleus and medullary reticular formation Where is serotonin produced? - correct answer raphe nuclei Where is dopamine produced? - correct answer substantia nigra, ventral tegmental area, nucleaus accumbens Where is acetylcholine synthesized? - correct answer Basal nucleus of Meynert PMHNP certification Exam KM 2023 If discharging a patient that is not following up with outpatient care, organize ways to help the patient get to the appointment REMEMBER STAY INVOLVED IN THE CARE - correct answer Assume you are doing group therapy and there is a patient that is not comfortable sharing but you are trying to promote interpersonal learning. What should you do? - correct answer Provide adjunctive individual session that will help facilitate group participation Cognitive Therapy - correct answer -Aaron Beck Replacing irrational or distortive thoughts with positive thoughts Behavioral Therapy - correct answer -Arnold Lazarus focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors -Exposure -Relaxation -Skills training -Role Playing Humanistic Therapy - correct answer -Carl Rogers person-centered therapy -Self-actualization -Self-Directive Growth PMHNP certification Exam KM 2023 -Everyone has the potential to actualize and find meaning in life Existential Therapy - correct answer Victor Frankl -an insight therapy that focuses on the elemental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices. -Emphasizes accepting freedom and making responsible choices -Focus on the present Why am I here, What is my purpose Interpersonal Therapy - correct answer Gerald Kierman & Myrna Weissman --Used for people who have trouble interacting with others, relationship distress -Marital conflict -12-16 weeks (3-4 months) EMDR Phases - correct answer Desensitization Phase: visualize the trauma, verbalize negative thoughts but remain attentive to physical sensations Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement PMHNP certification Exam KM 2023 Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within Group therapy: Installation of hope - correct answer participants develop hope for creating a different life; they gain hope from others Group therapy: Universality - correct answer people have similar problems, thoughts, and feelings and they are NOT ALONE Group Therapy: Altruism - correct answer sharing of oneself with another and helping another Group Therapy: Imitative Behavior - correct answer Patients can increase their skills by imitating the bx of others Group Therapy: Interpersonal learning - correct answer interacting with others increases adaptive interpersonal relationships Group Therapy: Group Cohesiveness - correct answer Patients develop an attraction to the group and other members as well as a sense of belonging PMHNP certification Exam KM 2023 USE OPEN ENDED QUESTIONS unless talking to a child or someone that is unable to construct a narrative then use CLOSED ENDED or YES/NO - correct answer PICOT - correct answer P: Population I: Intervention C: Comparison O: Outcome T: Time If a patient has rheumatoid arthritis check - correct answer ESR Therapy session with husband and wife & only one shows up - correct answer Reschedule A patient's mother calls and tells you that her son has been sodomized by their 15 year old brother - correct answer tell mother DO NOT LEAVE THE CHILD ALONE WITH THE BROTHER -Provider calls CPS -Arrange crisis therapy for family Patient is moving out of state - correct answer if there is no imminent danger then provide enough medication for them to establish a new provider PMHNP certification Exam KM 2023 Level 1 evidence - correct answer systematic reviews of random control trials (RCTs) or Meta-analysis or RCT-highest internal validity due to randomizations At least (2) Level 2 Evidence - correct answer systematic reviews of cohort studies -little bias because the subjects are identified prior to outcome - randomization is lost Shrill Cry - correct answer Intracranial pressure Child between the ages of 3-6 masterbating - correct answer Normal to play with genitals (PHALLIC STAGE) NORMAL do not assume they have been abused* Mom is concerned that her son age 10 has swelling in his chest and she is concerned he is developing breasts - correct answer Young boys ages 9-16 years old often have NORMAL BREAST ENLARGEMENT which disappears within 6 months *reassure them that this is normal Elderly female presents with decreased sex drive - correct answer Check Testosterone level PMHNP certification Exam KM 2023 Sex Hormone-Testosterone is involved in sex drive -MUST KNOW THAT WOMAN have TESTOSTERONE TOO alcohol dehydrogenase - correct answer an enzyme active in the stomach and the liver that metabolizes alcohol -WOMAN HAVE LOWER ALCOHOL DEHYDROGENASE (metabolizes alcohol) -This is why woman get drunk faster -Lower levels of this enzyme may also cause a higher propensity to develop LIVER DISEASE When OB wants to hire psych providers - correct answer they want to increase mental health access to those that need it the most Normalizing grief and loss in children - correct answer Don't tell them what to do because grief responses vary -i.e Don't tell them to stop working that is prescriptive advise -With children the most important thing is to reinforce FAMILY support an supportive therapy such as group therapy so they can learn from other children who have experienced similar events palmar grasp reflex - correct answer normal up to 5-6 months If older baby still has this reflex->refer to specialist PMHNP certification Exam KM 2023 ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION Patient presents with iatrogenic effect - correct answer assess ALL the medications that the patient is taking -Don't assume that it is from the medication you prescribed When trying to pass a policy and your co-workers are against it what should you do - correct answer educate them on how the policy will benefit patient care To promote a policy how do you get the word out there - correct answer Think most FEASIBLE option with WIDE net or audiance Working in outpatient setting and you want to ensure continuous improvement in quality of care. - correct answer -Create an instrument to monitor clinical outcomes (this helps to identify what you are doing right or wrong) Autoimmune disease can lead to increased - correct answer Cytokine level If a child is urinating the bed - correct answer -Teach parents to use alarm clock to wake up to urinate (NON PHARM FIRST) -If that doesn't work try DESMOSPRESSIN (decreased enuresis) PMHNP certification Exam KM 2023 Are you allowed to look up a patient on social media? - correct answer No it violates their trust Assume you started a patient on a medication and they go home and find out that there is a black box warning on the medication that you were unaware of. They call with concerns... - correct answer -First, go online and do your own research -Research the RISK vs BENEFIT before you tell the patient to stop the medication Risk factors for sleep apnea - correct answer excessive weight, obesity, diabetes, smoking Tolerance - correct answer you need higher doses of the medication in order for the medication to be effective PHQ-9 - correct answer > 5 mild depression > 10 moderate > 15 moderately severe > 20 severe Max score 27 PMHNP certification Exam KM 2023 HAM-D - correct answer >10 Mild >14 Moderate >17 Severe HAM-A - correct answer >8 Mild >15 Moderate >24 Severe Beck Depression Inventory (BDI) - correct answer 0-13 Subclinical >14 Mild >20 Moderate >29 Severe >40 EXTREME Max score 63 GAD-7 Scoring - correct answer 0-4: Minimal Anxiety >5 Mild Anxiety >10 Moderate Anxiety >15 Severe Anxiety Max score 21 PMHNP certification Exam KM 2023 Scope of practice is determined by - correct answer State board of Nursing Scope of practice defines - correct answer NP roles and actions -Varies broadly state to state If you would like to perform ECT as an NP what should you review - correct answer The state scope of practice standards to see if it is allowed and what certification is needed Standard of practice is determined by - correct answer ANA -Provides a way to judge nature of the care provided The PMHNP is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high-quality care consistent with established standards is critical Exceptions to Confidentiality - correct answer -Answering court orders, subpoenas, or summonses *high yield (if you don't release or lie about knowing this is PERJURY) -Insurance companies -Giving information to attorneys involved in litigation -Intent to harm self or others PMHNP certification Exam KM 2023 -Meeting state of federal requirements for reporting disease states -When the need for information outweighs the principle of confidentiality i.e unconscious patient and their life is at stake Tarasoff principle - correct answer 1976 - duty to warn victims of potential harm from client may vary by state so you must check with your state board of nursing first...it may not be your responsibility to notify If you are taking care of a patient and during the process of interview she tells you that her husband just texted her that her husband is going to kill self - correct answer -Call the police, provide the address informed consent - correct answer -Communication process between the provider and client that results in client's acceptance or rejection of proposed treatment -Ensure they understand the risks vs benefits If patient is able to reiterate the risks vs benefits of procedure or treatment, they are able to give consent* Example patient comes to the hospital, and they are unable to give consent i.e to sick to agree to treatment you must - correct answer assess need for involuntary treatment Justice - correct answer doing what is fair, fairness in all aspects of care PMHNP certification Exam KM 2023 Nonmaleficence - correct answer do no harm Beneficence - correct answer doing good/promoting well-being Fidelity - correct answer being true and loyal Veracity - correct answer telling the truth, patients have the right to know the truth about their treatment Autonomy - correct answer doing for self (right to self-determination) New male patient has a 10 year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward? A. Beneficence B. Fidelity C. Non-Maleficence D. Veracity - correct answer C. Non-Maleficence *Do no harm, giving Xanax would endanger him secondary to the high abuse potential and imminent danger if he were to overdose on Xanax* PMHNP certification Exam KM 2023 C. Public Health Concern D. Community education programs - correct answer D. Community education programs *Narrow down to education A/D...then think WIDE NET =Community EDUCATION A client with Biolar I disorder presents to your PMHNP office for a follow-up visit. During the visit the client informs you he no longer wants to be treated with medication. , and he does not have bipolar disorder, that was a misdiagnosis, He further informs you he stopped all his medications 2 months ago and is here to thank you for your care and tell you he no longer needs appointments. Understanding ethical conflict, you use which of the following ethical principles? A. Autonomy B. Nonmaleficence C. Justice D. Beneficence - correct answer A. Autonomy *Patient's have the right to self-determination* Recovery Model * RELAPSE IS A LEARNING OPPORTUNITY - correct answer -Treatment approach that does not focus on full symptom resolution but emphasizes on resilience and control over problems in life PMHNP certification Exam KM 2023 -Self-Direction (do not tell them what to do) -Individualized and Person-Centered -Non-Linear, Recovery is not a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience In counseling a 23 y/o married Hispanic mother who brought her 4 year old son to the clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting, and fever the PMHNO; A. Identifies what steps the mother has already tried in caring for the child B. Explain that the symptoms are viral infection C. Educates about importance of fluid electrolyte imbalance D. Respects the mother's understanding of the child's illness - correct answer A. Respects the mother's understanding of the child's illness *In cultural questions remember RESPECT FIRST! Even before assessment Quality Improvement - correct answer Projects designed to improve systems, decrease cost, and improve productivity PMHNP certification Exam KM 2023 What is an example of a quality improvement process? - correct answer Plan, Do, Study, Act Retrospective Chart Review is an example of a Quality Improvement Process If they ask HOW the NP would do a quality Improvement Process the answer may be Plan, Do, Study, Act - correct answer The NP is responsible for initiating quality improvement at a community clinic. The effective strategy for evaluating the clients services is to A. Chart review analysis B. A root cause analysis C. Plan DO Study Act D. Failure effect mode analysis - correct answer C. Plan Do Study Act SBIRT - correct answer Screening, Brief Intervention, and Referral to Treatment * Use to screen substance use disorders Erikson's stages of psychosocial development - correct answer 1. trust vs. mistrust 2. autonomy vs. shame and doubt 3. initiative vs. guilt 4. industry vs. inferiority PMHNP certification Exam KM 2023 A 72 year old female brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of HTN and is being treated with Lisinopril. The exam is normal and the MMSE provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the likely diagnosis? A. Alzheimer B. Vascular Dementia C. Depression D. Medication Toxicity - correct answer C. Depression *2 months=too soon for Alzheimer's, 24 is mild MMSE, HTN is not enough info to diagnose vascular dementia HALLMARKS FOR VASCULAR DEMENTIA are carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, remember PSEUDO dementia is DEPRESSION HALLMARKS FOR VASCULAR DEMENTIA - correct answer carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, Patient comes to the office, and you score them on HAM-D a 23 and you start an antidepressant on dose Xmg, 2 weeks later they score a 16 on the HAM-D. What would you do? - correct answer Leave the dose where it is PMHNP certification Exam KM 2023 Patient is taking Zoloft 200mg and on the GAD 7 they score a 2, what do you do - correct answer Leave the dose where it is Zung Depression Scale Scoring - correct answer >50 Mild >60 Moderate >70 Severe 25-49 is NORMAL RANGE 100 is max score MMSE scoring - correct answer 0-10 severe >10 moderate >20 mild >25 Normal Kids under 10 years old are severely challenging to teach HIGHER THE BETTER! Teratogenic Effects 1. Lithium 2. Carbamazepine PMHNP certification Exam KM 2023 3. Depakote 4. Benzo - correct answer 1. Epstein Anomaly 2. Neural Tube 3. Neural Tube (specifically spina bifida, atrial septal defect, cleft palate) 4. Floppy Baby Primary prevention - correct answer Efforts to prevent an injury or illness from ever occurring. -Education -Safety Initiatives -Modifying environment Secondary Prevention - correct answer Efforts to limit the effects of an injury or illness that you cannot completely prevent. -Early findings -Screening -Prompt and effective treatment Example: Crisis hotline, disaster response Tertiary Prevention - correct answer -aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -Rehab Services PMHNP certification Exam KM 2023 Antagonist effect - correct answer Drug binds to the receptor but does not activate a biological response Herbals that interact with warfarin - correct answer Vitamin E Omega-3 Black Cohosh - correct answer herbal used for menopause Bellandonna - correct answer herbal used for anxiety chamomile - correct answer herbal used for sedation and anxiety Ginko - correct answer Herbal used to treat memory, dementia, & sexual dysfunction from SSRIs Ginseng - correct answer Herbal product used for stress reduction, fatigue, and depression Valerian - correct answer herbal used for sedation Hypertensive crisis can occur when MAOI are taken with - correct answer Meperidine Decongestants PMHNP certification Exam KM 2023 TCAs Atypical Antipsychotics St.Johns wart L-Tryptophan Stimulants Asthma meds Microcytic anemia - correct answer iron deficiency macrocytic anemia - correct answer due to folate or vitamin B12 deficiency Labs: Folic Acid, B12, ESR/CRP, HGB, MCV 14 y/o with no axillary hair and no period - correct answer Normal tanner stage, start by 16 Two classes of cardiac meds that should not be used together - correct answer ACES and ARBS (angiotensin receptor blocker) Together can cause renal dysfunction Abnormal Trendelenburg Test - correct answer Hip disease, refer child out, assessed during head to toe PMHNP certification Exam KM 2023 too little acetylcholine too much acetylcholine - correct answer Alzheimer's Parkinson's and EPS 4 D's Discover, Dream, Design, Destiny - correct answer Appreciative Inquiry Cranial Nerve V - correct answer Trigeminal Clenched Teeth WBC 1500-2000 - correct answer Biweekly labs Less than 1000 Stop How can you assess cranial nerve XII? - correct answer Ask patient to stick out their tongue First sign of metabolic syndrome - correct answer large waist circumference Grade 2/5 hoarse systolic heart murmur - correct answer aortic stenosis PMHNP certification Exam KM 2023 Why? it is an H1 blocker but is also has serotonin receptor blocking activity. Specifically, it acts to block 5-HT1A and 5-HT2A receptors which are the ones responsible for serotonin syndrome When to assess a patient in restraints? - correct answer initially within 1 hour; then 8 hours Why would you be concerned with immature reticulocytes? - correct answer Reticulocytes are involved in conditions affecting RBCs such as anemia. -Low reticulocytes may be seen is iron def. anemia, pernicious anemia, folic acid deficiency, and aplastic anemia pharm treatment for agoraphobia - correct answer short term benzo, SSRI, SNRI, TCA, or beta-blocker off label Anorexia admission Criteria for hospitalization includes: - correct answer weight loss over 30% over 6 months severe hypothermia temp less than 96.8 HR less than 40 BP less than 70 Hypokalemia less than 3mEq/L BMI<16 PMHNP certification Exam KM 2023 ANOVA - correct answer ANalysis Of VAriance - btwn means of 3 or more groups An inferential statistical test for comparing the means of three or more groups precontemplation stage - correct answer stage of change in which people are unwilling to change their behavior Contemplation stage - correct answer person is considering making a change, aware that there is a problem but is not quite committed to changing Preparation Stage - correct answer Person has made the decision to change, is ready for action Action Stage - correct answer Person is engaging in specific, overt actions to change Maintanence stage - correct answer The person is engaging in behaviors to prevent relapse These 3 meds cause BIG FREAKING PROBLEMS - correct answer Strong inhibitors of 2D6 PMHNP certification Exam KM 2023 Bupropion, Fluoxetine, Paxil Boy tells you he wishes to be a girl and asks you not to tell the parents - correct answer Don't tell BRUISE on the padded part of his arms - correct answer Say I see you have bruises on your arm may I Ask what happened Can an advanced directive be revoked? How? - correct answer Yes at any time Can you take Buspar during pregnancy? - correct answer Category B - ok if really needed. Carb and barb + Coumadin - correct answer Strong Inducers of 3A4 can decrease INR Who is in charge of the DEA? - correct answer State and Federal Common comorbidities of bipolar - correct answer anxiety, alcohol, substance use PMHNP certification Exam KM 2023 -Peer support Patient on Lithium and Depakote and has temp, right flank pain, brown urine. What do you do FIRST? - correct answer Check LFT If fine then check creatinine Pt states "god did this to me." - correct answer Assess spiritual needs first Patient taking breathing treatment Albuterol/Proventil - correct answer Do not take MAOI or TCA p-value - correct answer The probability of results of the experiment being attributed to chance. Reliability - correct answer consistency of measurement Stereogenesis - correct answer identify an object without sight i.e dice in hand Tagamet (cimetidine) - correct answer H2 receptor antagonist (antacid) Increases benzo Increases coumadin PMHNP certification Exam KM 2023 Trazadone concerns - correct answer EKG-QT prolongation Priapism Glaucoma Turner Syndrome - correct answer A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. -Delayed puberty -Amenorrhea -Web neck, osteoporosis, lymphedema -poor social skills To start your own firm as an NP and need to examine economic viability - correct answer Show Revenue and expenses 3 CK muscle enzyme tests? - correct answer CKMM, CKBB, CKMB (normal 0.3 mmcg/L) What are the legal ramifications of treating someone without informed consent? - correct answer The same as they are with informed consent -Respect -Beneficence PMHNP certification Exam KM 2023 -Justice Two important things to measure when prescribing Zyprexa - correct answer Waist circumference Lipids What schedule of controlled substances are NPs allowed to prescribe? - correct answer II-V What crania nerve is affected when you ask the patient to shrug their shoulders? - correct answer XI (11) Spinal Accessory These medications are renally metabolized - correct answer Gabapentin Campral Lithium grapefruit juice - correct answer inhibitor that can reduce the absorption of the drug by 47% therefore the drug blood levels will be increased -Decrease dose of drug How do Asians see HC providers? - correct answer As in a position of authority. Expect to give instructions and help make decisions PMHNP certification Exam KM 2023 What is the purpose of HIPAA? - correct answer National standards for electronic HC transactions -National ID for providers, health plans and employers. -Not SIMPLY Confidentiality. DETROL interactions - correct answer Topamax KCL Zonegran Yale-Brown Obsessive Compulsive Scale (Y-BOCS) - correct answer OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme If you want to decrease the use of seclusion who would be considered the primary change agent - correct answer Unit staff Rennie vs Klein - correct answer • right to refuse any treatment Until court orders it "due process" PMHNP certification Exam KM 2023 Roger vs. Oken - correct answer determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment. ROGERS GUARDIAN Donalson vs O'Connor - correct answer Confinement -It is unconstitutional to commit a person involuntarily who is not imminently dangerous to self or others Donalson was a patient hospitalized for 15 years Dusty vs United States - correct answer incompetent to stand trial Durham vs King - correct answer Insanity defense Riese vs St. Mary's Hospital - correct answer 7/8 8B ruling says that there should be court determination of incompetence for involuntary committed mental persons to receive antipsychotic medications Stark Law - correct answer Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment.