PMHNP certification Exam KM questions with verified answers 2023, Exams of Nursing

Download PMHNP certification Exam KM questions with verified answers 2023 and more Exams Nursing in PDF only on Docsity! PMHNP certification Exam KM questions with verified answers 2023 rae 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 Answers✅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 Answers✅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 Answers✅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 questions with verified answers 2023 rae B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism C. Increased Lipids D. Metabolic Syndrome - Correct Answers✅D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? - Correct Answers✅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 Answers✅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 Answers✅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 PMHNP certification Exam KM questions with verified answers 2023 rae TCAs carry a risk of - Correct Answers✅Hepatotoxicity Signs of Stevens-Johnson Syndrome - Correct Answers✅-fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome - Correct Answers✅lamictal and tegretol What nationality is most suseptible of getting steven johnson? - Correct Answers✅Asians When treating asians with tegretal screen for? - Correct Answers✅HLAB-1502 Allele What two medications cause agranulocytosis? - Correct Answers✅Clozaril & Tegretal Agranulocytosis when to discontinue medication - Correct Answers✅Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? - Correct Answers✅Infection -Fever, sore throat, fatigue, chills PMHNP certification Exam KM questions with verified answers 2023 rae Before starting any mood stabilizer in a female of childbearing age be sure to check? - Correct Answers✅HCG Which two medications may decrease the risk of suicide? - Correct Answers✅clozaril and lithium Medications that increase lithium level - Correct Answers✅NSAID- ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? - Correct Answers✅Heart Failure Certain medications are known to increase lithium level, but HOW? - Correct Answers✅by reducing renal clearance When educating a patient about lithium teach them about - Correct Answers✅Hyponatremia Dehydration-hot days, exercise Normal Lithium Level - Correct Answers✅0.6-1.2 PMHNP certification Exam KM questions with verified answers 2023 rae Lithium Toxicity - Correct Answers✅1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 - Correct Answers✅Monitor for toxicity Labs before starting lithium - Correct Answers✅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 Answers✅4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects - Correct Answers✅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 Answers✅confusion, ataxia, GI upset, palpitation, tremor PMHNP certification Exam KM questions with verified answers 2023 rae Patient with depression worries about sexual dysfunction what would be the medication of choice? - Correct Answers✅Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? - Correct Answers✅Wellbutrin Wellbutrin is contraindicated in patients with - Correct Answers✅Seizures and anorexia Which medications are best for neuropathic pain? - Correct Answers✅SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? - Correct Answers✅Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome - Correct Answers✅Those with short half lives such as zoloft PMHNP certification Exam KM questions with verified answers 2023 rae Symptoms of serotonin withdrawal syndrome - Correct Answers✅Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females - Correct Answers✅- MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for - Correct Answers✅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 Answers✅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) PMHNP certification Exam KM questions with verified answers 2023 rae MRI or PET scan what is seen in schizophrenia - Correct Answers✅EVERYTHING DECREASES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter? - Correct Answers✅Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) - Correct Answers✅a form of rehabilitation post hospitalization, in home treatment What level of prevention is ACT? - Correct Answers✅Tertiary What adjunctive treatment is important in schizophrenia - Correct Answers✅-social skills training -Exercise Exercise for mental health patients can promote - Correct Answers✅Cognition Quality of Life Long-term health PMHNP certification Exam KM questions with verified answers 2023 rae -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway - Correct Answers✅-Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia Nigrostriatal Pathway - Correct Answers✅-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 dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter - Correct Answers✅-Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to - Correct Answers✅tardrive dyskinesia Tuberoinfundibular pathway - Correct Answers✅-Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to PMHNP certification Exam KM questions with verified answers 2023 rae 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 Answers✅osteoporosis Normal Prolactin Level in Men - Correct Answers✅level less than 20ng/ml Normal Prolactin Level in Women - Correct Answers✅less than 25ng/ml Which medication is the highest offender for increasing prolactin - Correct Answers✅Risperdal Acute Dystonia + Treatment - Correct Answers✅neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment - Correct Answers✅may mimic anxiety, restlessness, can't sit still, rocking, pacing PMHNP certification Exam KM questions with verified answers 2023 rae -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 Answers✅-DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment - Correct Answers✅A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment - Correct Answers✅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 tardive dyskinesia + Treatment - Correct Answers✅abnormal facial movements, grinding teeth, lip smacking, protruding tongue PMHNP certification Exam KM questions with verified answers 2023 rae Erythromycin and Clarithromycin can cause - Correct Answers✅Increased tegretol levels Patient started on Clozaril or Zyprexa and two months later starts smoking - Correct Answers✅as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey - Correct Answers✅as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania - Correct Answers✅Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer Medications that cause depression - Correct Answers✅steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone -may need to increase antidepressant PMHNP certification Exam KM questions with verified answers 2023 rae Accutane (isotretinoin) - Correct Answers✅Can cause depression and birth defects Flonase - Correct Answers✅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 Answers✅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 Answers✅Dopamine and GABA Symptoms of Stimulant Abuse - Correct Answers✅1. agitation/aggression 2. impaired judgment PMHNP certification Exam KM questions with verified answers 2023 rae 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 Answers✅delayed gastric emptying Medications that delay gastric emptying - Correct Answers✅Omeprazole, ranitidine, famotidine Proton Pump Inhibitors (omeprazole & Protonix) - Correct Answers✅Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI When initiating an SSRI on an elderly patient you should advise about - Correct Answers✅increased anxiety PMHNP certification Exam KM questions with verified answers 2023 rae -Positive reinforcement -Boundary Setting Conduct Disorder - Correct Answers✅violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine Acute Stress Disorder - Correct Answers✅similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH PTSD - Correct Answers✅-OVER ONE MONTH -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT PMHNP certification Exam KM questions with verified answers 2023 rae Panic attack vs Panic disorder (treatment) - Correct Answers✅Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom Tourette's Syndrome - Correct Answers✅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 Answers✅**CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Neurotransmitters involved in Tourettes - Correct Answers✅DNS: Dopamine, Norepinephrine, Serotonin PMHNP certification Exam KM questions with verified answers 2023 rae Treatment for tourettes - Correct Answers✅Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them - Correct Answers✅Stimulants Neurotransmitters involved in mood disorders - Correct Answers✅DNS: Dopamine, Norepinephrine, Serotonin + GABA Neurotransmitters involved in ADHD - Correct Answers✅DNS: Dopamine, Norepinephrine, Serotonin part of brain implicated in ADHD - Correct Answers✅prefrontal cortex basal ganglia reticular activating system ADHD inattentive type is caused in what part of the brain - Correct Answers✅Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION dorsolateral prefrontal cortex - Correct Answers✅Attention Executive Function PMHNP certification Exam KM questions with verified answers 2023 rae Sleep Disorders are often _____ So what should you assess if a parent reports that a child is having nightmares - Correct Answers✅GENETIC ask if someone in the family has a similar issue with sleep...look for family patterns of sleep problems GAD - Correct Answers✅Worry, apprehension, fear must LAST ATLEAST 6 MONTHS Delirium - Correct Answers✅-ACUTE (within hours to days) onset of disturbance of LOC, COGNITION, inattention -Urinary Tract Infections are common cause for DELIRIUM always check UA -Treatment is antipsychotics like HALDOL Dementia - Correct Answers✅-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 (confabulate) PMHNP certification Exam KM questions with verified answers 2023 rae Low levels of what labs may mimic dementia - Correct Answers✅Vit B12 and Folic Acid Cortical Dementia - Correct Answers✅Language and memory (aphasia and amnesia) Subcortical Dementia - Correct Answers✅Motor abnormalities/Mood issues like apathy, depression, irritability HIV Dementia is a type of subcortical dementia Early signs of HIV dementia - Correct Answers✅subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordination, unsteady gait Treatment for HIV dementia - Correct Answers✅Antivirals Pseudo Dementia - Correct Answers✅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" PMHNP certification Exam KM questions with verified answers 2023 rae Instruments to use to differentiate between dementia and pseudo dementia - Correct Answers✅-Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE -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 Answers✅ hallmark of lewy body dementia - Correct Answers✅visual hallucinations Frontotemporal lobe Dementia - Correct Answers✅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 Answers✅Temporal Lobe PMHNP certification Exam KM questions with verified answers 2023 rae Thalamus function - Correct Answers✅relay station for sensory impulses, pain hypothalamus function - Correct Answers✅homeostasis, temperature, thirst, appetite, sex drive, sleep cycle, emotions * believed to serve a regulatory role in aggression anterior cingulate cortex - Correct Answers✅brain region that regulates cognitive function, decision making, empathy, impulse control, and emotions Cerebellum - Correct Answers✅Balance and coordination signs of lead toxicity - Correct Answers✅developmental delay, learning diff., irritability, loss of appetite, weight loss, sluggishness, fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, eating non-food items PICA Hint home built before 1970's TEST FOR LEAD When caring for an infant that is about to die? - Correct Answers✅GIVE THE BABY TO THE PARENTS and allow them to grieve PMHNP certification Exam KM questions with verified answers 2023 rae Risk factors for osteoporosis - Correct Answers✅Age smoking caffeine lack of exercise diet lacking calcium and vit D *Provide Education* 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 Answers✅ 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 Answers✅Provide adjunctive individual session that will help facilitate group participation Cognitive Therapy - Correct Answers✅-Aaron Beck Replacing irrational or distortive thoughts with positive thoughts Behavioral Therapy - Correct Answers✅-Arnold Lazarus PMHNP certification Exam KM questions with verified answers 2023 rae focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors -Exposure -Relaxation -Skills training -Role Playing Humanistic Therapy - Correct Answers✅-Carl Rogers person-centered therapy -Self-actualization -Self-Directive Growth -Everyone has the potential to actualize and find meaning in life Existential Therapy - Correct Answers✅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 PMHNP certification Exam KM questions with verified answers 2023 rae Group Phases - Correct Answers✅forming, storming, norming, performing, adjourning Family Systems Therapy - Correct Answers✅Murray Bowen -a person's problematic bx may serve a function for the family or be a symptoms of dysfunctional patterns KEY WORDS* Self-Differentiation, Triangulation, Triangles Structural Family Therapy - Correct Answers✅Salvador Minuchin -How, when, and who whom family members relate KEY WORDS* Mapping Hierarchies Boundaries Strategic Therapy - Correct Answers✅Jay Haley -Symptoms are a way to communicate metaphorically in a family -Symptom focused KEY WORDS* Straightforward directive PMHNP certification Exam KM questions with verified answers 2023 rae Paradoxical directive (reverse psychology) Reframing (you are not jealous of your sister you just care for her so much) Solution Focused Therapy - Correct Answers✅-MIRACLE QUESTIONS -EXCEPTION-BASED FINDING -SCALING QUESTIONS Meditation - Correct Answers✅if teaching about meditation must tell them about MUSCLE RELAXATION If patient tells you something BEFORE you ASSESS- EXPRESS EMPATHY "I'm sorry this happened to you." - Correct Answers✅ 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 Answers✅ PICOT - Correct Answers✅P: Population I: Intervention C: Comparison O: Outcome T: Time PMHNP certification Exam KM questions with verified answers 2023 rae If a patient has rheumatoid arthritis check - Correct Answers✅ESR Therapy session with husband and wife & only one shows up - Correct Answers✅Reschedule A patient's mother calls and tells you that her son has been sodomized by their 15 year old brother - Correct Answers✅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 Answers✅if there is no imminent danger then provide enough medication for them to establish a new provider Level 1 evidence - Correct Answers✅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 Answers✅systematic reviews of cohort studies PMHNP certification Exam KM questions with verified answers 2023 rae Babinski reflex - Correct Answers✅Normal up to 2 years If present past normal range->refer to specialist PDE-5 inhibitors - Correct Answers✅Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) RAPIDLY ABSORBED Used for erectile disfunction Difference between BMI in anorexia vs Bulemia - Correct Answers✅Anorexia-Low BMI Bulemia-Normal BMI Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and you determine the patient needs to be sent for medical evaluation but the parents refuse - Correct Answers✅Contact CPS You read and article that says that most children with ADHD abuse substances... PMHNP certification Exam KM questions with verified answers 2023 rae -To translate this information into practice what should you do? - Correct Answers✅-Screen ALL children for ADHD for SUBSTANCE USE -OR Screen ALL children with SUBSTANCE USE for ADHD accupuncture - Correct Answers✅used for pain and depression Habeas Corpus - Correct Answers✅legal concept that protects patients from unlawful hospitalization -May be a reason to leave AMA Disseminated Encephalomyelitis - Correct Answers✅inflammation of nervous system -MUST DO NEURO EXAM -EXAM: May present with ASSYMETRICAL BODY MOVEMENTS Assume you are interviewing a patient and you want them to provide information in a specific timeline, but they are unable - Correct Answers✅TO help ask them specific questions which helps to ANCHOR their memory Before you administer a medication, you must educate them about the medication but first you should assess - Correct Answers✅BUT FIRST PMHNP certification Exam KM questions with verified answers 2023 rae ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION Patient presents with iatrogenic effect - Correct Answers✅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 Answers✅educate them on how the policy will benefit patient care To promote a policy how do you get the word out there - Correct Answers✅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 Answers✅-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 Answers✅Cytokine level If a child is urinating the bed - Correct Answers✅-Teach parents to use alarm clock to wake up to urinate (NON PHARM FIRST) PMHNP certification Exam KM questions with verified answers 2023 rae >15 Severe Anxiety Max score 21 COWS - Correct Answers✅Medicate with PRNS at score of 7 or above Consider Subutex or Suboxone at 13 or above Remember Methadone is the LEAST safe option due to cardiac issues CIWA - Correct Answers✅Begin PRN medication at 8 or above Scores of 15 or above consider scheduled medications Patient in alcohol withdrawal and you are choosing medication for CIWA, check what? - Correct Answers✅LFT if liver disease use ATIVAN because of short half life over VALIUM *REMEMBER DETOX SHOULD NOT OCCUR OUTPATIENT-->residential or inpatient is needed* especially if pregnant. REMEMBER SAFETY FIRST - Correct Answers✅ PMHNP certification Exam KM questions with verified answers 2023 rae Idealization - Correct Answers✅Seeing someone else as perfect, ideal, or more worthy than everyone else This is often seen in grieving before acceptance of the loss Appreciative Inquiry - Correct Answers✅is an approach to organizational change which focuses on strengths rather than on weakness Example do not focus on what the employee does wrong focus on what they do well Reflective Practice - Correct Answers✅Links theory to practice with a goal of correcting practices that are incorrect. Example Debriefing after a restraint to find out what went wrong or what went right DEBFRIEFING MAY BE A KEY WORD -After an incident--> Debrief Assume you started the patient on an antidepressant and now they complain of insomnia - Correct Answers✅1. Before changing medication, CHANGE THE TIME OF DAY THEY ARE TAKING THE MED Conflict of interest between pharmaceutical companies and Nurse Practitioners i.e promises to sponsor NP loan forgiveness. You want to create a policy to address this. First you must examine... - Correct PMHNP certification Exam KM questions with verified answers 2023 rae Answers✅study the relationship between the industry provided samples and industry sponsored education If a patient is involuntarily admitted can they still refuse medications? - Correct Answers✅they can still refuse medications, UNLESS it is an emergency or if the court determines they must take medications Scope of practice is determined by - Correct Answers✅State board of Nursing Scope of practice defines - Correct Answers✅NP roles and actions -Varies broadly state to state If you would like to perform ECT as an NP what should you review - Correct Answers✅The state scope of practice standards to see if it is allowed and what certification is needed Standard of practice is determined by - Correct Answers✅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 PMHNP certification Exam KM questions with verified answers 2023 rae 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 Answers✅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* If no history of substance use, then beneficence would be appropriate because the Xanax would help the anxiety Acute agitation and anxiety vs acute agitation and psychosis IM ordered - Correct Answers✅IM ativan for agit/anx IM antipsychotic for agit/psychosis Patients have the right to be treated in the Least - Correct Answers✅Restrictive Setting PMHNP certification Exam KM questions with verified answers 2023 rae The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP's next step is to: A. Create interdisciplinary teaching team B. Develop Outcome measures C. Market the educational plan D. Utilize a survey to assess the educational needs of the staff - Correct Answers✅D. Utilize a survey to assess the educational needs of the staff *3 Interventions vs 1 Assessment* FIRST YOU NEED TO ASSESS FIRST What is the best way to reduce stigma - Correct Answers✅THROUGH EDUCATION *THINK WIDEST AUDIENCE Just Culture - Correct Answers✅individuals are continually learning, designing safety systems, and managing behavioral choices The PMHNP is concerned about access-to-care issues in the local community and wants to help develop health care policy to help patients access care more effectively. PMHNP certification Exam KM questions with verified answers 2023 rae A. Asking the clinical manager to explore options for access B. Organizing a political protest C. Working with the local chapter of the nurses professional association D. Writing letters to the editor of the local newspaper - Correct Answers✅C. Working with the local chapter of the nurses professional association *Remember strength in numbers but STAY INVOLVED i.e asking the manager just passes off* If a patient from a specific culture is refusing to accept any diagnosis of mental health disorders because of shame what could be done to address this barrier? A. Educate the family B. Political advocacy C. Public Health Concern D. Community education programs - Correct Answers✅D. Community education programs *Narrow down to education A/D...then think WIDE NET =Community EDUCATION PMHNP certification Exam KM questions with verified answers 2023 rae 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 Answers✅ 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 Answers✅C. Plan Do Study Act SBIRT - Correct Answers✅Screening, Brief Intervention, and Referral to Treatment * Use to screen substance use disorders Erikson's stages of psychosocial development - Correct Answers✅1. trust vs. mistrust 2. autonomy vs. shame and doubt 3. initiative vs. guilt 4. industry vs. inferiority 5. identity vs. role confusion PMHNP certification Exam KM questions with verified answers 2023 rae 6. intimacy vs. isolation 7. generativity vs. stagnation 8. integrity vs. despair Piaget's stages of cognitive development - Correct Answers✅1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational Preoperational Stage includes - Correct Answers✅2-7 y.o- MAGICAL THINKING IS NORMAL, if they believe that monsters can fly this is NORMAL Egocentric Understand language formal operational stage - Correct Answers✅12+ y/o during which people begin to think logically about abstract concepts KEY WORD is LOGIC think like a scientist or do a science project you must be able to use logic ABSTRACT THINKING such as doing algebra PMHNP certification Exam KM questions with verified answers 2023 rae sensorimotor stage - Correct Answers✅in Piaget's theory, the stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities Object permanance concrete operational stage - Correct Answers✅in Piaget's theory, the stage of cognitive development (from about 6 or 7 to 11 years of age) during which children gain the mental operations that enable them to think logically about concrete events i.e finding similarities in objects, grouping things Risk factors for suicide - Correct Answers✅Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking. WHITE Women try more often. Men succeed more often. PMHNP certification Exam KM questions with verified answers 2023 rae 1. Lithium 2. Carbamazepine 3. Depakote 4. Benzo - Correct Answers✅1. Epstein Anomaly 2. Neural Tube 3. Neural Tube (specifically spina bifida, atrial septal defect, cleft palate) 4. Floppy Baby Primary prevention - Correct Answers✅Efforts to prevent an injury or illness from ever occurring. -Education -Safety Initiatives -Modifying environment Secondary Prevention - Correct Answers✅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 PMHNP certification Exam KM questions with verified answers 2023 rae Tertiary Prevention - Correct Answers✅-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -Rehab Services -Day treatment -Case management -Social Skills training Pharmacokinetics - Correct Answers✅what the body does to the drug Pharmacodynamics - Correct Answers✅what the drug does to the body messenger RNA codes for - Correct Answers✅amino acids Poor relationships, lack of future hope, suspicious of others indicates developmental failure of what stage - Correct Answers✅infancy, trust vs mistrust Poor self-esteem, low self control, self-doubt, lack of independence indicates failure of what stage - Correct Answers✅early childhood 1-3, autonomy vs shame and doubt PMHNP certification Exam KM questions with verified answers 2023 rae Lack of self-initiative, lack of goal orientation indicates failure of what stage - Correct Answers✅Late childhood 3-6 y/o initiative vs guilt sense of inferiority, difficulty with working/learning indicates a failure of what stage - Correct Answers✅school age 6-12 y/o industry vs inferiority identity confusion, poor self-identification in groups indicates failure of what stage - Correct Answers✅adolescence 12-20 y/o identity vs inferiority emotional isolation, egocentrism indicates a failure of what stage - Correct Answers✅early adulthood 20-35 y/o intimacy vs isolation self-absorption, inability to grow and change as a person, inability to care for others indicates a failure at what stage - Correct Answers✅middle adulthood 35-65 y/o generativity vs stagnation bitterness, sense of dissatisfaction with life, despair over impending death indicates failure of what stage - Correct Answers✅>65 y/o integrity vs despair agonist effect - Correct Answers✅Drug binds to receptors and activates a biological response PMHNP certification Exam KM questions with verified answers 2023 rae 14 y/o with no axillary hair and no period - Correct Answers✅Normal tanner stage, start by 16 Two classes of cardiac meds that should not be used together - Correct Answers✅ACES and ARBS (angiotensin receptor blocker) Together can cause renal dysfunction Abnormal Trendelenburg Test - Correct Answers✅Hip disease, refer child out, assessed during head to toe too little acetylcholine too much acetylcholine - Correct Answers✅Alzheimer's Parkinson's and EPS 4 D's Discover, Dream, Design, Destiny - Correct Answers✅Appreciative Inquiry Cranial Nerve V - Correct Answers✅Trigeminal Clenched Teeth WBC 1500-2000 - Correct Answers✅Biweekly labs Less than 1000 Stop PMHNP certification Exam KM questions with verified answers 2023 rae How can you assess cranial nerve XII? - Correct Answers✅Ask patient to stick out their tongue First sign of metabolic syndrome - Correct Answers✅large waist circumference Grade 2/5 hoarse systolic heart murmur - Correct Answers✅aortic stenosis Ibuprofen + lithium - Correct Answers✅increases the serum level of lithium up to double Kleinfelter's Syndrome - Correct Answers✅male with more than one X chromosome (XXY) -Decreased sperm, fertility issues Mental Health Parity Act - Correct Answers✅forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits what does nuchal rigidity indicate? - Correct Answers✅meningitis PMHNP certification Exam KM questions with verified answers 2023 rae Patient is on interferon and lexapro, as a provider you understand that - Correct Answers✅interferon can increase depression therefore you may have to increase the lexapro Patient complains of neuropathic pain and neurontin is not working - Correct Answers✅Try Lyrica (pregabalin) its absorbed quickly and the maximum rate of absorption is 3x of Neurontin Patient is in hospital with no family and is failing cognitive test what should you do? - Correct Answers✅MRI Tox Screen Phases of policy making - Correct Answers✅formulation, implementation, evaluation Rhett Syndrome - Correct Answers✅a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally until about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities Signs of fetal alcohol syndrome - Correct Answers✅small head, smooth palpebral fissure, inner epicanthal folds, thin upper lip PMHNP certification Exam KM questions with verified answers 2023 rae Contemplation stage - Correct Answers✅person is considering making a change, aware that there is a problem but is not quite committed to changing Preparation Stage - Correct Answers✅Person has made the decision to change, is ready for action Action Stage - Correct Answers✅Person is engaging in specific, overt actions to change Maintanence stage - Correct Answers✅The person is engaging in behaviors to prevent relapse These 3 meds cause BIG FREAKING PROBLEMS - Correct Answers✅Strong inhibitors of 2D6 Bupropion, Fluoxetine, Paxil Boy tells you he wishes to be a girl and asks you not to tell the parents - Correct Answers✅Don't tell BRUISE on the padded part of his arms - Correct Answers✅Say I see you have bruises on your arm may I Ask what happened PMHNP certification Exam KM questions with verified answers 2023 rae Can an advanced directive be revoked? How? - Correct Answers✅Yes at any time Can you take Buspar during pregnancy? - Correct Answers✅Category B - ok if really needed. Carb and barb + Coumadin - Correct Answers✅Strong Inducers of 3A4 can decrease INR Who is in charge of the DEA? - Correct Answers✅State and Federal Common comorbidities of bipolar - Correct Answers✅anxiety, alcohol, substance use Conjunctival injection, munchies, psychomotor slowness? - Correct Answers✅Marijuana intoxication Diary Log - Correct Answers✅CBT Depakote and Disulfiram - Correct Answers✅increases INR PMHNP certification Exam KM questions with verified answers 2023 rae What 3 atypicals can be used with teens? - Correct Answers✅Zyprexa, Abilify, Seroquel - low doses * also Risperdal Np wants to implement a certain policy in nursing. - Correct Answers✅start with nurse manager Phenycyclidine (PCP) can cause? - Correct Answers✅Nystagmus Hildegard Peplau - Correct Answers✅Theory of Interpersonal Relations Nurse as therapeutic tool -Care for the person as well as the illness -Patients are PEOPLE not DIAGNOSES Patient acting out due to missing session what do you do? - Correct Answers✅You relate to childhood abandonment and talk about it with the patient Patient on antidepressants for 3 weeks and attempted Suicide - Correct Answers✅stop the medication immediately PMHNP certification Exam KM questions with verified answers 2023 rae Turner Syndrome - Correct Answers✅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 Answers✅Show Revenue and expenses 3 CK muscle enzyme tests? - Correct Answers✅CKMM, CKBB, CKMB (normal 0.3 mmcg/L) What are the legal ramifications of treating someone without informed consent? - Correct Answers✅The same as they are with informed consent -Respect -Beneficence -Justice PMHNP certification Exam KM questions with verified answers 2023 rae Two important things to measure when prescribing Zyprexa - Correct Answers✅Waist circumference Lipids What schedule of controlled substances are NPs allowed to prescribe? - Correct Answers✅II-V What crania nerve is affected when you ask the patient to shrug their shoulders? - Correct Answers✅XI (11) Spinal Accessory These medications are renally metabolized - Correct Answers✅Gabapentin Campral Lithium grapefruit juice - Correct Answers✅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 Answers✅As in a position of authority. Expect to give instructions and help make decisions PMHNP certification Exam KM questions with verified answers 2023 rae How do you protect from the evil eye? - Correct Answers✅Red ribbon on an infant Amulet for adults T-test - Correct Answers✅assesses whether the means of two groups are statistically different from each other Treatment for children with panic disorder - Correct Answers✅clonidine guanfacine What do BCP's do to Lamictal? - Correct Answers✅Inducer - will lower dose of Lamictal What does an increased retic count indicate - Correct Answers✅Bone marrow disorder or Vitamin Deficiency Normal Range 0.5-1.5 What do you see in Labs with HIV dementia - Correct Answers✅CD4 <200 Viral Load is high <20% get it with antiretroviral treatment PMHNP certification Exam KM questions with verified answers 2023 rae Rennie vs Klein - Correct Answers✅• right to refuse any treatment Until court orders it "due process" Roger vs. Oken - Correct Answers✅determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment. ROGERS GUARDIAN Donalson vs O'Connor - Correct Answers✅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 Answers✅incompetent to stand trial Durham vs King - Correct Answers✅Insanity defense PMHNP certification Exam KM questions with verified answers 2023 rae Riese vs St. Mary's Hospital - Correct Answers✅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 Answers✅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.