Download PMHNP certification Exam KM questions with verified answers 2023 and more Exams Nursing in PDF only on Docsity!
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 Answer s✅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 s✅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 s✅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
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 Answer s✅D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? - Correct Answer s✅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 s✅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 s✅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
with verified answers 2023
rae Hyperthyroid can mimic - Correct Answer s✅Mania Hypothyroid can mimic - Correct Answer s✅Depression A patient on depakote complains of RUQ pain and has reddish/brown urine - Correct Answer s✅Hepatoxicity -Check LFTs Signs of Depakote toxicity - Correct Answer s✅Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? - Correct Answer s✅Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? - Correct Answer s✅Kava Kava When taking Kava Kava in combinations with other medications you should caution about - Correct Answer s✅Risk of Hepatoxicity and Sedation
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rae TCAs carry a risk of - Correct Answer s✅Hepatotoxicity Signs of Stevens-Johnson Syndrome - Correct Answer s✅-fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome - Correct Answer s✅lamictal and tegretol What nationality is most suseptible of getting steven johnson? - Correct Answer s✅Asians When treating asians with tegretal screen for? - Correct Answer s✅HLAB-1502 Allele What two medications cause agranulocytosis? - Correct Answer s✅Clozaril & Tegretal Agranulocytosis when to discontinue medication - Correct Answer s✅Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? - Correct Answer s✅Infection
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rae Lithium Toxicity - Correct Answer s✅1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 - Correct Answer s✅Monitor for toxicity Labs before starting lithium - Correct Answer s✅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 s✅4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects - Correct Answer s✅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 s✅confusion, ataxia, GI upset, palpitation, tremor
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rae NMS - Correct Answer s✅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) Cherry colored urine in a patient that exercises a lot - Correct Answer s✅test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome - Correct Answer s✅With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Treatment for NMS - Correct Answer s✅Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer Treatment for Serotonin Syndrome - Correct Answer s✅Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine
with verified answers 2023
rae Patient with depression worries about sexual dysfunction what would be the medication of choice? - Correct Answer s✅Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? - Correct Answer s✅Wellbutrin Wellbutrin is contraindicated in patients with - Correct Answer s✅Seizures and anorexia Which medications are best for neuropathic pain? - Correct Answer s✅SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? - Correct Answer s✅Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome - Correct Answer s✅Those with short half lives such as zoloft
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rae Symptoms of serotonin withdrawal syndrome - Correct Answer s✅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 s✅-MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for - Correct Answer s✅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 s✅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)
with verified answers 2023
rae ACT is ideal for patients with a history of - Correct Answer s✅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 s✅Antisocial In the MMSE how do you test for abstraction? - Correct Answer s✅proverb interpretation (everyone that lives in glass houses shouldn't throw stones) Are they able to think abstractly Thought Process-Tangential - Correct Answer s✅means that their response has nothing to do with the question Circumstantial - Correct Answer s✅means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes - Correct Answer s✅SI/HI/AH/VH
with verified answers 2023
rae Another name for MMSE - Correct Answer s✅Folstein Scale How to assess concentration on MMSE - Correct Answer s✅Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material - Correct Answer s✅repeat 3 words after me Assess ability to recall - Correct Answer s✅repeat 3 words after 5 minutes Assess fund of knowledge - Correct Answer s✅Who is the president What is a quick and easy way to assess for neurological issues - Correct Answer s✅Clock drawing test If patient is unable to draw a clock this indicates - Correct Answer s✅Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway - Correct Answer s✅Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms
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 Answer s✅osteoporosis Normal Prolactin Level in Men - Correct Answer s✅level less than 20ng/ml Normal Prolactin Level in Women - Correct Answer s✅less than 25ng/ml Which medication is the highest offender for increasing prolactin - Correct Answer s✅Risperdal Acute Dystonia + Treatment - Correct Answer s✅neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days
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rae Akathisia + Treatment - Correct Answer s✅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 s✅-DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment - Correct Answer s✅A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment - Correct Answer s✅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
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rae Phenytoin Grisiofulvin Phenobarb Sulphonylureas Crap GPS Induces me to Madness! InhIbitors of CYP450 - Correct Answer s✅INCREASE Ciprofloxacin Ritonavir Amiodarone Cimetidine Ketoconazole Acute Etoh Macrolides INH Grapefruit Juice Omeprazole
with verified answers 2023
rae Crack Amigos Erythromycin and Clarithromycin can cause - Correct Answer s✅Increased tegretol levels Patient started on Clozaril or Zyprexa and two months later starts smoking - Correct Answer s✅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 Answer s✅as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania - Correct Answer s✅Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer
