PMHNP Certification Exam Study Test Exam with 460questions and answers 100%Correctly verif, Exams of Nursing

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Pain and bloating after eating is caused by... - CORRECT ANSWERS delayed gastric emptying Medications that cause delayed gastric emptying? - CORRECT ANSWERS PPIs; ranitidine, famotidine, omeprazole What instructions should you give your patient if they are prescribed antacids/PPIs and psychotropics? - CORRECT ANSWERS Give medications at least 2 hours apart b/c antacids/PPIs decrease absorption of psychotropics Normal BMI range - CORRECT ANSWERS 18.5- Criteria for admission for ED bx: - CORRECT ANSWERS BMI <15; 25% total body weight loss in 3 months; severe dehydration, infection, bradycardia, hypothermia, hematemesis, hypokalemia What neurotransmitters are implicated in ADHD? - CORRECT ANSWERS DA, NE, 5HT - DNS What brain structures are involved in ADHD? - CORRECT ANSWERS Reticular activating system, basal ganglia, frontal cortex - RBF Abnormalities in this part of the brain cause inattentive ADHD: - CORRECT ANSWERS Prefrontal cortex Amphetamines are FDA approved for children beginning at _ years old - CORRECT ANSWERS 3 Methamphetamines are FDA approved for children beginning at _ years old - CORRECT ANSWERS 6 Alpha agonists clonidine and guanfacine are FDA approved to treat ADHD in patients ages ___ - CORRECT ANSWERS 6-

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Strattera is FDA approved to treat ADHD in patients ages ___ - CORRECT ANSWERS 6 and up (including adults) Adults diagnosed with both ADHD and depression would benefit from being prescribed: - CORRECT ANSWERS Wellbutrin Conduct disorder can be diagnosed in: - CORRECT ANSWERS Both children and adults Conduct disorder diagnostic criteria: - CORRECT ANSWERS Violating rights of others or societal norms; aggression towards people/animals; destruction of property; no remorse Treatment for conduct disorder: - CORRECT ANSWERS Targets aggression and mood; SGA, mood stabilizer, SSRI, alpha agonists ODD diagnostic criteria: - CORRECT ANSWERS Argumentative, defiant for at least 6 months and with 4 sx Treatment of ODD: - CORRECT ANSWERS Focused on family therapy, child management skills, teaching parents reinforcement/boundaries/problem solving DMDD diagnostic criteria: - CORRECT ANSWERS Childhood depressive d/o between ages 6-17; chronic dysregulated mood, frequent tantrums, severe irritability; typically DMDD rather than bipolar d/o in children Neurotransmitters implicated in ASD: - CORRECT ANSWERS Glutamate, GABA, 5HT - GGS Echolalia - CORRECT ANSWERS Meaningless repetition of words; often seen in ASD

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Broken mirror theory - CORRECT ANSWERS Dysfunction of the mirror neuron system results in poor social interaction and cognition in ASD patients Parallel play is developmentally appropriate at which ages? - CORRECT ANSWERS 1-3 years old Parallel play continuing beyond the age of 3 years old may be indicative of... - CORRECT ANSWERS ASD dx d/t social deficits M-CHAT - CORRECT ANSWERS Modified Checklist for Autism in Toddlers; ASD scale ADOS-G - CORRECT ANSWERS Autism Diagnostic Observation Schedule - Generic; ASD scale ASQ - CORRECT ANSWERS Ages and Stages Questionnaire; development and social/emotional screening Pharmacological treatment of ASD: - CORRECT ANSWERS Stimulants (increase DA to help with impulsivity, hyperactivity, inattention; Antipsychotics (target aggressive bx, tantrums, self-injury, stereotyped bx) Nightmares in children can be the result of: - CORRECT ANSWERS Genetic factors; assess family patterns of nightmares Features of children diagnosed with Fragile X - CORRECT ANSWERS LARGE features: large head, elongated face, hyperextensible joints, abnormally large testes, short stature Features of children diagnosed with fetal alcohol syndrome - CORRECT ANSWERS small features: small head, small eye opening, low nasal bridge, flat midface, smooth philtrum, thin upper lip

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Clock drawing test assesses function of which brain lobe? - CORRECT ANSWERS Parietal What does the clock drawing test assess for? - CORRECT ANSWERS Executive/cognitive fx, impairments associated w/ damage to right parietal lobe, constructional apraxia (inability to draw or assemble objects) Important labs to draw for patients presenting with dementia? - CORRECT ANSWERS B12, folic acid Dementia presents with mental decline that is ___ - CORRECT ANSWERS Chronic; if acute sx, consider other dx Symptoms of subcortical dementia: - CORRECT ANSWERS Motor sx, lack of coordination, tremors, depression, irritability, apathy Example of subcortical dementia diagnosis - CORRECT ANSWERS Huntington's disease Symptoms of cortical dementia: - CORRECT ANSWERS Language and memory impairments (aphasia and amnesia) Example of cortical dementia diagnosis: - CORRECT ANSWERS Alzheimer's Presentation of dementia d/t HIV disease - CORRECT ANSWERS Subcortical effects; motor abnormalities, bx abnormalities, cognitive decline Presentation of dementia with Lewy bodies - CORRECT ANSWERS Visual hallucinations, Parkinsonian sx Presentation of frontal lobe dementia (e.g. Pick's disease) - CORRECT ANSWERS Personality/bx changes, language changes, inappropriate social bx, aggression

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Presentation of Huntington's disease - CORRECT ANSWERS Subcortical dementia; motor abnormalities, psychomotor slowing; high incidence of depression, psychosis; begins ages 30-45; affects males and females equally What is the most effective test to determine if someone will develop Huntington's disease? - CORRECT ANSWERS Direct genetic test (no risk) What is the likelihood a child of a parent with Huntington's will develop it? - CORRECT ANSWERS 50% chance Dementia etiology - CORRECT ANSWERS Cerebral atrophy, enlarged ventricles; decreased Ach and NE; genetic loading What neurotransmitters are implicated in dementia, and how? - CORRECT ANSWERS Decreased Ach and NE What is the first line treatment for psychosis and agitation in dementia? - CORRECT ANSWERS SGAs - but try nonpharmacological therapies first What is delirium? - CORRECT ANSWERS ACUTE disturbance of LOC, cognition, attention What pharmacological treatment do you use for delirium-induced agitation or psychosis? - CORRECT ANSWERS Low dose haldol What pharmacological treatment do you use for alcohol-induced delirium? - CORRECT ANSWERS BNZ Anytime a patient presents with delirium, what labs should you order? - CORRECT ANSWERS UA with culture and specificity d/t infx being a potential cause for delirium, esp in older adults

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What is pseudodementia? - CORRECT ANSWERS Cognitive sx r/t depression in older adults Dementia vs. pseudodementia - CORRECT ANSWERS Dementia: premorbid hx of slowly declining cognition Pseudodementia: acute onset of significant cognitive changes How would someone with dementia vs. pseudodementia answer a question? - CORRECT ANSWERS Dementia: confabulates, lacks answer Pseudodementia: "I don't know" How can depression present in older adults? - CORRECT ANSWERS Cognitive deficits - irritability, agitation, hallucinations, delusions What neurotransmitters are implicated in mood disorders? - CORRECT ANSWERS DA, NE, 5HT (DNS), GABA, glutamate What neurotransmitters are implicated in depression? - CORRECT ANSWERS DA, NE, 5HT - DNS How does depression present in children/adolescents? - CORRECT ANSWERS Irritability/anger What cerebral changes are noted in depression? - CORRECT ANSWERS Increased amygdala, decreased hippocampus/thalamus First line pharmacological tx of depression - CORRECT ANSWERS SSRIs What medication is best for a patient who is depressed and prescribed Tamoxifen for cancer treatment? - CORRECT ANSWERS SSRI (especially sertraline, citalopram, escitalopram)

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Best pharmacological treatment for comorbid depression and fibromyalgia - CORRECT ANSWERS SNRI (duloxetine), TCAs, alpha 2 delta ligand (gabapentin, pregabalin); always choose SNRI over TCA if possible d/t safety What major side effect of SNRIs should you monitor for? - CORRECT ANSWERS Increased blood pressure Which depression medications are least likely to cause sexual dysfx? - CORRECT ANSWERS Bupropion, mirtazapine Best treatment for depression with low energy and fatigue? - CORRECT ANSWERS Bupropion; contraindicated in those with seizures or ED hx If a patient has a suicide attempt while prescribed an antidepressant, what is your next step? - CORRECT ANSWERS Discontinue antidepressant, switch medication to SGA or mood stabilizer When should fluoxetine be dosed? - CORRECT ANSWERS AM because of potential to cause insomnia; if patient experiencing insomnia and taking at night, switch to AM dosing instead of adding addtl med to sleep Which antidepressants are helpful for insomnia? - CORRECT ANSWERS Trazodone, mirtazapine Why is there more evidence for efficacy of antidepressants with adults than children? - CORRECT ANSWERS Children have lower placebo rates What happens if you have a 5HT2C genetic dysfunction? - CORRECT ANSWERS Experience decreased medication efficacy Best medications for those with 5HT2C dysfunction - CORRECT ANSWERS SSRIs, mirtazapine, bupropion

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Greatest risk factor for bipolar d/o - CORRECT ANSWERS Family hx; no single gene, no way to genetically test for it Likely cause for manic sx if first incidence is >45 years old - CORRECT ANSWERS Medical diagnosis Pneumonic for mania - CORRECT ANSWERS DIGFAST (distractable, impulsive, grandiose, flight of ideas, activity increase, sleep disturbance, talkativeness) Bipolar I vs. bipolar II - CORRECT ANSWERS BP1: full mania at least 1 week, severe enough to interfere w/ fx, can require hospitalization BP2: hypomanic sx at least 4 days, less severe Gold standard for tx of bipolar d/o - CORRECT ANSWERS Lithium What medication is neuroprotective for the tx of bipolar d/o - CORRECT ANSWERS Lithium Medication to tx bipolar depression - CORRECT ANSWERS Lamotrigine; olanzapine-fluoxetine combo; latuda Neurotransmitters implicated in OCD - CORRECT ANSWERS 5HT, NE With sudden onset of OCD symptoms in children, what diagnosis should you consider? - CORRECT ANSWERS Strep infection; consider PANDAS dx OCD vs. Tourette's - CORRECT ANSWERS OCD: intrusive thoughts and possibly tics; Tourette's: tics only Time criteria for GAD - CORRECT ANSWERS 6 months

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Pharmacological tx of GAD - CORRECT ANSWERS SSRIs, buspirone, BNZ Pharmacological tx of panic attacks - CORRECT ANSWERS Beta-blockers (contraindicated in those w/ asthma, prescribed albuterol d/t causing bronchospasm); BNZ; hydroxyzine Sx of beta-blocker induced bronchospasm - CORRECT ANSWERS Pain, chest tightness, SOB, wheezing, coughing, dizziness Panic d/o - CORRECT ANSWERS Recurrent, unexpected panic attacks that appear out of nowhere; impacts ability to go places for fear of experiencing panic attack in place can't escape from Tx for panic d/o - CORRECT ANSWERS SSRIs, SNRIs Hallmark sx of schizophrenia - CORRECT ANSWERS Impaired proverb interpretation Why are stimulants contraindicated in those dx with schizophrenia? - CORRECT ANSWERS Increase DA release -> increased psychotic sx What metabolic effects are associated with schizophrenia? - CORRECT ANSWERS Low HDL, increased triglycerides What medications do individuals with schizophrenia have a low tolerability to? - CORRECT ANSWERS Alpha 2 adrenergic agonists What level of prevention is social skills training? - CORRECT ANSWERS Tertiary

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Benefits of referring those with schizophrenia to an exercise program - CORRECT ANSWERS Metabolic benefits; improves cognition, brain fx, quality of life Average age of onset for schizophrenia in men and women - CORRECT ANSWERS Men: 18- Women: 25- Neurobiological changes in schizophrenia - CORRECT ANSWERS Enlarged ventricles; decreased: cerebral cortex, frontal/temporal lobes, symmetry between lobes, cerebral blood flow, hippocampus, amygdala What sx of schizophrenia is indicative of cerebral cortex abnormalities? - CORRECT ANSWERS Aggression What is the formula for switching from PO to IM haldol? - CORRECT ANSWERS 20 * total daily oral dose = IM dose; give no more than 100 mg at a time, give rest 7 days later ACT treatment - CORRECT ANSWERS Assertive community treatment for patients with SMI; intensive integrated approach to community mental health services; post-hospitalization, less restrictive than residential; holistic approach to improve all aspects of patient life Schizophreniform - CORRECT ANSWERS Similar sx to schizophrenia but last between 1-6 months; if sx last longer than 6 months, consider schizophrenia Cluster A personality d/o - CORRECT ANSWERS Schizoid, schizotypal, paranoid Schizoid personality d/o - CORRECT ANSWERS Voluntary social isolation; cold, detached, no interest in social support

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Schizotypal personality d/o - CORRECT ANSWERS Similar to schizophrenia but no hallucinations/delusions; social difficulties, few/no friends; ideas of reference, magical thinking, "off beliefs"; bx overtly odd, inappropriate affect Paranoid personality d/o - CORRECT ANSWERS Longtime distrust, suspiciousness of others; thinks everyone is out to get them Cluster B personality d/o - CORRECT ANSWERS BPD, histrionic, narcissistic, antisocial Cluster C personality d/o - CORRECT ANSWERS Avoidant, dependent, obsessive compulsive Avoidant personality d/o - CORRECT ANSWERS Want to socialize but feel they can't d/t inadequacy; fear of criticism, rejection, disapproval; reluctant to engage in new activities Age to dx personality d/o - CORRECT ANSWERS 18 years old Important taks for patients with BPD - CORRECT ANSWERS Keep a journal of sx Psychopharm tx of BPD for irritability, anger, self-harm - CORRECT ANSWERS Lithium Psychopharm tx of BPD for depressed mood, emotional lability, rejection sensitivity, interpersonal problems, aggression, hostility - CORRECT ANSWERS Depakote Conversion d/o - CORRECT ANSWERS Blindness, mutism, paralysis, paresthesias (often wearing gloves), other neuro sx that can't be explained by medical eval and begin suddenly after stressful experience Treatment for conversion d/o - CORRECT ANSWERS CBT, physical therapy

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Adjustment d/o - CORRECT ANSWERS Emotional, bx rxn to a stressful event within 3 months of it happening; depressed mood, anxiety, mixed anx/dep, conduct, mixed emotions/conduct If test question pinpoints depressive sx to a specific event (rather than an unknown cause for sx) what is the likely dx? - CORRECT ANSWERS Adjustment d/o Which psychotropic has a potential side effect of cataracts? - CORRECT ANSWERS Quetiapine Tourette's dx criteria - CORRECT ANSWERS At lest 2 motor tics, 1 vocal tic; don't have to occur at the same time; sx occur at lest 1 year and appear before age

18. Tics not cause of other medical or substance d/o Neurotransmitters implicated in Tourette's d/o - CORRECT ANSWERS DA, NE, 5HT - DNS Pharmacological tx of Tourette's - CORRECT ANSWERS SGAs: Haldol, Pimozide, Aripiprazole Alpha agonists: control bx sx, impulse control, rage attacks Acute stress d/o sx - CORRECT ANSWERS Stress response within 4 weeks of traumatic event, lasts less than 1 month. If lasts greater than 1 month likely PTSD. Sx: anxiety, insomnia, poor concentration, helplessness, fear Hallmark of PTSD - CORRECT ANSWERS Re-experiencing of trauma PTSD dx criteria - CORRECT ANSWERS Intrusive re-experiencing of trauma, increased arousal, avoidance of stimuli associated w/ trauma Pharmacologic tx for PTSD - CORRECT ANSWERS SSRIs, TCAs, prazosin for nightmares

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Nonpharm tx for PTSD - CORRECT ANSWERS EMDR, CBT, ERP, group therapy, relaxation Phases of EMDR - CORRECT ANSWERS DIB - desensitization, installation, body scan Desensitization: bilateral stimulation while thinking about event Installation: strengthen positive belief to associate with target event Body scan: hold target event and positive belief while scanning body and processing any disturbances Factitious d/o - CORRECT ANSWERS Px or mental sx induced purposely (drinking contaminated substances, injecting fecal material, etc.) in the absence of any obvious external rewards Malingering - CORRECT ANSWERS Similar to factitious d/o but motive is secondary gain (i.e. getting out of jail) Factitious d/o imposed on another - CORRECT ANSWERS Causing sx in another w/ the intention of deceiving others, in absence of any external reward; report to CPS if a child is involved What group may you need to use yes/no with rather than open ended questions? - CORRECT ANSWERS Those with intellectual/developmental disabilities; also use if patient unable to construct chronological narrative Enmeshment - CORRECT ANSWERS Relationship btwn 2+ people where personal boundaries are unclear Parentification - CORRECT ANSWERS Lack of healthy boundaries; unclear, diffuse, enmeshed

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Cognitive distortions - CORRECT ANSWERS Inaccurate and irrational automatic thoughts or ideas that lead to false assumptions and misinterpretations; usually generalized; ex: catastrophizing, all or nothing thinking, should statements, labeling Cognitive therapy - CORRECT ANSWERS Beck; focus to change irrational beliefs/cognitive distortions Behavioral therapy - CORRECT ANSWERS Change maladaptive bx; participate in active bx techniques: exposure, relaxation, skills training, problem-solving, role- playing, modeling CBT - CORRECT ANSWERS Replace irrational beliefs and change bx; journaling, cognitive restructuring, cognitive rehearsal What is the better option for patient tx: cognitive therapy or CBT? - CORRECT ANSWERS CBT Interpersonal therapy - CORRECT ANSWERS Focus on interpersonal issues; identify/modify interpersonal problems in context of relationships Psychodynamic therapy - CORRECT ANSWERS Focus on unconscious processes and how they manifest in present bx; goal: client-self awareness, understanding of influence of past on present bx Psychoanalytic therapy - CORRECT ANSWERS Focus on how unconscious mind influences thoughts/bx; looks at how childhood experiences shape current state Humanistic therapy - CORRECT ANSWERS Carl Rogers; person-centered, focuses on self-directed growth and self-actualization; everyone has the potential to find meaning

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Existential therapy - CORRECT ANSWERS Frankl; reflection on meaning/purpose in life; goal: focus on present, personal responsibility Logotherapy - CORRECT ANSWERS Form of existential therapy; freedom of will, free to achieve goals/purpose Trauma-focused CBT - CORRECT ANSWERS Focused on youth with PTSD and mood d/o resulting from sexual, physical abuse, violence, grief Multisystemic family therapy - CORRECT ANSWERS Targets youth 12-17 w/ serious antisocial, problematic, or criminal bx; empowers parents w/ resources and skills, reduces barriers that keep them from accessing services; home-based model; helps parents identify strengths, develop natural support systems and removes barriers Strategic therapy - CORRECT ANSWERS Problem and sx focused; reflect problems in the family system Strategic therapy techniques - CORRECT ANSWERS Paradoxical directive: use with caution; assign negative task when family member resistant to change and expected to be noncompliant (i.e. assign a couple to fight between sessions) Straightforward directive: task assigned in expectation of family member's compliance Reframing belief system: problematic bx relabeled to be more positive (e.g. jealousy reframed to caring) Solution focused therapy - CORRECT ANSWERS Rework solutions that have worked previously to apply to present situation; miracle questions "if a miracle happened and this was solved, what would be different?"; exception-finding questions "tell me about a time you didn't have this problem"; scaling questions "on a scale from 1-10, how anxious are you? (good for tracking progress)

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Family system therapy - CORRECT ANSWERS Focus on chronic anxiety w/in families; problematic bx serves as fx for family; goal: increase family awareness of each member's fx w/in the family, increase self-differentiation; includes sibling position, emotional cutoffs, multigenerational dysfx What therapy modality involves triangulation and what purpose does triangulation serve? - CORRECT ANSWERS Family system therapy; decreases stress Structural family therapy - CORRECT ANSWERS Clearly defined boundaries and hierarchies; genograms; enactment: family member asked to play out relationship patterns during session; map, track, modify family structure Key elements of mindfulness - CORRECT ANSWERS Awareness of breath, body sensations, thoughts How do self-esteem exercises benefit children? - CORRECT ANSWERS Promote resilience, improve relationships and social anxiety Benefits of body massage - CORRECT ANSWERS Decrease stress by lowering cortisol levels, reduce pain by improving circulation If you are conducting a joint session with multiple people and only 1 shows up, what is the priority action? - CORRECT ANSWERS Must reschedule for a time when all participants can be there If a child experiences sexual assault from a sibling, what are your next steps? - CORRECT ANSWERS 1. Insist mom not leave child with sibling

2. Report to CPS
3. Arrange crisis therapy for family Freud psychosexual stages of development - CORRECT ANSWERS Birth-1: oral - sucking, swallowing 1-3: Anal - witholding/expelling feces

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3-6: Phallic - penis or clitoris, masturbation 6-puberty: Latent - little/no sexual motivation Puberty to adulthood: Genital - penis or vagina, sexual intercourse A mother tells you her 3 year old child has been touching their genitals. What do you advise her to do? - CORRECT ANSWERS Nothing, this is normal for children this age; may explore genitals, ask questions, masturbate Yalom characteristics of group therapy - CORRECT ANSWERS -Instillation of hope: seeing others cope with similar problems and achieving goals can inspire peers -Universality: feel understood and similar to others -Information giving: increase knowledge/understanding -Altruism: selflessly helping other group members -Increased development of social skills: new skills learned, maladaptive bx corrected -Imitative bx: increase skills by imitating bx of others -Interpersonal learning: intxt with others increases adaptive interpersonal relationships -Group cohesiveness: participants develop attraction to group/other members, sense of belonging -Catharsis: catharsis experienced as members express feelings that were suppressed

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-Existential factors: deal w/ meaning of own existence -Corrective refocusing: reexperience family conflicts in group, recognize/change bx that may be problematic Yalom group phases - CORRECT ANSWERS -Pregroup: consider direction/framework of group including inclusion/exclusion criteria -Forming: orientation phase; leader most active; norms discussed (confidentiality, attendance, etc.); discuss time frame/termination of group -Storming: transition phase; anxiety, ambiguity, conflict; group acts out, test bx to define self/group -Norming: cohesive phase; develop cohesion and therapeutic alliance forms (i.e. disapproving late members) -Working: performing phase; individual growth/team productivity; experiment with new ideas/bx -Adjourning: termination phase; discuss/review outcomes, explore what worked/didn't; not time to introduce new concerns/initiatives Recovery model - CORRECT ANSWERS Tx doesn't focus on full sx resolution; ephasis on resilience, control over sx; goal: recognize, foster abilities/interests; individualized, person-centered, self-directed; non-linear; ongoing support crucial for recovery 4 dimensions of recovery - CORRECT ANSWERS Health, home, purpose, community (manage dz and be px/emotionally healthy; stable/safe place to live; meaningful daily activities -job, school, volunteer, etc.-; relationships/social networks that provide support, friendship, love)

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Mnemonic for remembering motivational interviewing steps - CORRECT ANSWERS FRAMES -Feedback (provide nonjudgmental feedback about use) -Responsibility (encourage pt to take responsibility for use/consequences) -Advice (offer personalized advice, benefits of change) -Menu (offer multiple strategies to choose from) -Empathy (show empathy, understanding) -Self-efficacy (build confidence in ability to make positive change) Transtheoretical Model of Change stages - CORRECT ANSWERS - Precontemplation: not aware of problem, no intention to change; DO: provide feedback to raise awareness -Contemplation: aware of problem, thinking about change but unsure; DO: help see benefits of change -Preparation: made decision to change, preparing to take action; setting goals, gathering info, seeking support; DO: help find realistic strategy -Action: specific steps taken to change; actively modify bx, routines, environment; DO: support/advocate, help accomplish goals -Maintenance: successfully changed bx, preventing relapse; DO: identify possibility of relapse/strategies to prevent Relapse - CORRECT ANSWERS Can occur at any stage of change; can return to earlier stage or cycle through all stages again; DO: help look holistically Projection - CORRECT ANSWERS Attribute own thoughts/feelings/motives to another person (e.g. person who is angry at colleague accuses colleague of being hostile towards them) Displacement - CORRECT ANSWERS Redirect impulse onto powerless target (e.g. someone frustrated by their boss goes home and takes it out on their kids)

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Sublimation - CORRECT ANSWERS Displace unacceptable emotions into bx which are socially acceptable (i.e. mother of child killed in gun violence gets involved in change of gun laws) Intellectualization - CORRECT ANSWERS Avoid emotional aspects by concentrating on intellectual aspects Rationalization - CORRECT ANSWERS Attempt to logically justify unacceptable bx Reaction formation - CORRECT ANSWERS Unconsciously replace unacceptable thoughts with exact opposite; exaggerated bx opposite to true feelings (i.e. person who hates someone is overly nice to them) When does behavioral management begin? - CORRECT ANSWERS As soon as patient is admitted (not upon dc) Piaget Stages of Cognitive Development - CORRECT ANSWERS Birth-2 years: Sensorimotor (object permanence) 2-7: Preoperational (magical thinking, egocentric) 7-11: Concrete (conservation; concrete beliefs, rigid) 12+: Formal (abstract logic, reasoning; hypothesis testing) Erikson's Stages of Development - CORRECT ANSWERS +Trust vs. Mistrust: birth-1 yo (hope) +Autonomy vs. Shame: 1-3 yo (will) +Initiative vs. Guilt: 3-6 yo (purpose) +Industry vs. Inferiority: 6-12 yo (confidence) +Identity vs. Role Confusion: 12-20 yo (fidelity) +Intimacy vs. Isolation: 20-35 yo (love) +Generativity vs. Stagnation: 35-65 yo (care) +Ego Integrity vs. Despair: 65+ (wisdom)

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Children's understanding of illness - 2-7 yo - CORRECT ANSWERS Magical thinking, think immediate experiences are related to illness (e.g. if sunny, think sun made them sick); may think it's because of something they got in trouble for (e.g. hitting dog); experience guilt/shame - important to tell them it isn't their fault Children's understanding of illness - 8-12 yo - CORRECT ANSWERS Logical, understand factors that influence illness; good to discuss health dangers (i.e. consequences of smoking) Mnemonic for Erikson's stages - CORRECT ANSWERS TAG I RISE (trust, autonomy, guilt, inferiority, role confusion, intimacy, stagnation, ego integrity) Ages to remember for Erikson's stages - CORRECT ANSWERS 1, 3, 6, 12, 20, 35, 65 What birth defect can depakote cause? - CORRECT ANSWERS Spina bifida S/s hepatotoxicity - CORRECT ANSWERS RUQ pain, nausea, red urine, yellow skin/scleara, fatigue A patient is exhibiting signs of hepatotoxicity. What is your priority action? - CORRECT ANSWERS d/c offending agent, order LFTs Normal range for ALT/AST - CORRECT ANSWERS 5-40 Depakote therapeutic range - CORRECT ANSWERS 50-125 At what level is depakote toxic? - CORRECT ANSWERS >150 S/s depakote toxicity - CORRECT ANSWERS Disorientation, lethargy, respiratory depression, N/V

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Interventions for depakote toxicity - CORRECT ANSWERS d/c med; labs: VPA, LFT, ammonia What psychotropics are contraindicated for use in combination with metoprolol? - CORRECT ANSWERS Paroxetine, fluoxetine, bupropion because hypotension, bradycardia What psychotropic can cause pancreatitis? - CORRECT ANSWERS Depakote Which psychotropics can prolong QTc? - CORRECT ANSWERS Ziprasidone, haldol, citalopram - ZHC Which psychotropics should you not rx for those with cardiac hx d/t potential to prolong QTc? - CORRECT ANSWERS Ziprasidone, haldol, citalopram - ZHC What is the max dose of citalopram you can prescribe d/t QTc prolongation? - CORRECT ANSWERS 40 mg/day; 20 mg/day in older adults What side effect can SSRIs have in older adults? - CORRECT ANSWERS Increased anxiety Which SSRIs are safest for those with cardiac history? - CORRECT ANSWERS Sertraline, escitalopram What is the black box warning for lamotrigine? - CORRECT ANSWERS SJS What are s/s of SJS? - CORRECT ANSWERS Fever, body ache, red rash, peeling skin, facial/tongue swelling Which mood stabilizer is least likely to cause weight gain? - CORRECT ANSWERS Lamotrigine

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How long does it take SJS rash to disappear after discontinuing lamotrigine? - CORRECT ANSWERS 2-3 weeks Which antipsychotics cause the least amount of weight gain? - CORRECT ANSWERS Ziprasidone, aripiprazole, lurasidone - ZAL Which antipsychotic is least sedating? - CORRECT ANSWERS Aripiprazole What labs/assessments should you order when prescribing any antipsychotic? - CORRECT ANSWERS Weight/BMI, waist circumference, glucose, lipids If patient is gaining weight with an antipsychotic, what is your priority action? - CORRECT ANSWERS Encourage exercise and diet changes; if that doesn't work, switch to ZAL med What are the black box warnings for carbamezapine? - CORRECT ANSWERS Agranulocytosis and aplastic anemia (for both - fatigue, fever, nosebleeds, bleeding gums, frequent infx) What population is at risk for SJS with use of carbamezapine? What should you test for? - CORRECT ANSWERS Asians; test for HLAB-1502 allele Which class of medications can decrease the efficacy of oral contraceptives? - CORRECT ANSWERS Antiepileptics What is a sign that a patient prescribed carbamezapine or cloazaril is experiencing agranulocytosis? - CORRECT ANSWERS Sudden s/s infx (fever, chills, sore throat, etc.) In carbamazepine or clozaril, what ANC and WBC would you discontinue meds at> - CORRECT ANSWERS ANC <1000; WBC <3000

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What is the only know antipsychotic show to reduce risk of suicide in patients with schizophrenia? - CORRECT ANSWERS Clozaril Therapeutic range for lithium level - CORRECT ANSWERS 0.6-1.2 At what level is lithium toxic? - CORRECT ANSWERS 1.5 What is the neuroprotective psychotropic treatment of choice for bipolar d/o? - CORRECT ANSWERS Lithium What is the gold standard psychotropic tx for mania? - CORRECT ANSWERS Lithium Which psychotropic has been associated with decreased suicide in those with bipolar d/o? - CORRECT ANSWERS Lithium What labs should you order when prescribing lithium? - CORRECT ANSWERS TSH, BUN/Cr, UA (check proteins for kidney damage), Hcg Lithium side effects - CORRECT ANSWERS Hypothyroidism, fine hand tremors, rash, GI upset, diabetes insipidus (polyruia/polydipsia), t-wave inversion, leukocytosis, kidney disease Normal range for creatinine - CORRECT ANSWERS 0.6-1.2 Normal range for BUN - CORRECT ANSWERS 10-20 Lithium can cause which birth defect? - CORRECT ANSWERS Ebstein anomaly (congenital heart defect); avoid in pregnancy esp 1st trimester Which mood stabilizer is safest in pregnancy? - CORRECT ANSWERS Lamotrigine

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What should you do if patient has hx of thyroid issues or experiences hypothyroidism while rx'd lithium? - CORRECT ANSWERS Refer to endo - don't need to dc med S/s lithium toxicity - CORRECT ANSWERS Severe nausea/vomiting/diarrhea, confusion, muscle weakness, heart palpitations, ocarse hand tremors, unsteadiness What should you do if you suspect lithium toxicity? - CORRECT ANSWERS d/c med, check lithium levels What medications should you avoid in patients prescribed lithium and why? - CORRECT ANSWERS Those that reduce renal clearance because they will increase lithium levels; ex: NSAIDs, thiazides, ACE inhibitors, lisinopril Dehydration can cause _____ lithium levels - CORRECT ANSWERS Increased; encourage proper hydration Hyponatremia can cause _____ lithium levels - CORRECT ANSWERS Increased If a patient experiencing tics is diagnosed with ADHD, what psychotropic should you prescribe to tx the ADHD? - CORRECT ANSWERS Non-stimulants; avoid stimulants b/c worsen tics Which medications can precipitate mania sx? - CORRECT ANSWERS Steroids, disulfiram, isoniazid, antidepressants if bipolar d/o Which medications can precipitate depression sx? - CORRECT ANSWERS Steroids, beta blockers, interferon, isotretinoin, retrovirals, antineoplastics, benzos, progesterone Which psychiatric sx can result from steroid use? - CORRECT ANSWERS Mania, depression, psychosis