PMHNP certification Exam-with 100% verified solutions-2024.docx, Exams of Nursing

Download PMHNP certification Exam-with 100% verified solutions-2024.docx and more Exams Nursing in PDF only on Docsity! 1 / PMHNP certification Exam-with 100% verified solutions- 2024 1. Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank *2 risk factors D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors 2. When interview teenagers (16 y/o) that arrive with their parents whatshould you do?: interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confiden-tial. Parents may be upset but remember you are advocating for the child. 3. Which Ethnic group has the highest rate of suicide?: Native Americans 4. Example A patient is being treated for schizophrenia with olanzapine.Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an-tagonism C. Increased Lipids D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER) 5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY 6. Which mood stabilizer have the least weight gain?: Lamictal -But remember all mood stabilizers cause some weight gain 7. When presented with a question about typical vs atypical antipsychoticthe answer is usually to start of a: atypical 2 / 8. A client presents with complains of changes in appetite, feeling fatigued,problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical area of the brain that is responsible for the normal regulationof these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus: Hypothalamus A, B, & D are all part of the limbic system so you can rule that out 5 / 38 45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta-bility, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). 46. Treatment for NMS: Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for dopamine agonist vs musclerelaxer 47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI,TCA, MOAI) -Cyproheptadine 48. Triptans: Used for MIGRAINES -These meds increase serotoninexample SUMATRIPTAN 49. patient taking Prozac and started on sumatriptan: -call PCP to ask themto switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP 50. How long do you wait when switching between an SSRI to an MAOI?: 2weeks 51. How long do you wait when switching between Prozac and MAOI?: 5-6weeks wash out period 52. What is the first line treatment for depression and why?: SSRI-First linetreatment for depression due to less risk of injury from OVERDOSE 53. If a cancer patient has depression what should you consider?: Treatingwith a medication with minimal drug/drug side effects like Lexapro 54. Patient with depression worries about sexual dysfunction what would bethe medication of choice?: Wellbutrin 55. Primary symptoms of depression include fatigue and low energy whatmed would you chose?: Wellbutrin 56. Wellbutrin is contraindicated in patients with: Seizures and anorexia 57. Which medications are best for neuropathic pain?: SNRIGabapentin TCA 6 / 38 58. Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERYappointment 59. Which meds have the worse serotonin discontinuation syndrome: Thosewith short half lives such as zoloft 60. Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness,lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers 61. Ages of onset for schizophrenia in males vs females: -MALES 18-25 years -FEMALE 25-35 years 62. Schizophrenia increases the risk for: SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) 63. What increases the causes or increases the risk or schizophrenia: exces-sive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) 64. MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREAS-ES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT 65. Stimulants can potentiate the release of what neurotransmitter?: - Dopamine which can worsen symptoms of schizophrenia 66. Assertive Community Treatment (ACT): a form of rehabilitation post hospi-talization, in home treatment 67. What level of prevention is ACT?: Tertiary 68. What adjunctive treatment is important in schizophrenia: -social skillstraining -Exercise 7 / 38 69. Exercise for mental health patients can promote: CognitionQuality of Life Long-term health 70. ACT is ideal for patients with a history of: Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home 71. What diagnosis has the highest risk of Homicidality: Antisocial 72. In the MMSE how do you test for abstraction?: proverb interpretation (every-one that lives in glass houses shouldn't throw stones) Are they able to think abstractly 73. Thought Process-Tangential: means that their response has nothing to dowith the question 74. Circumstantial: means that their response goes in circles instead of gettingto the point of the question 75. Mental Status-Thought Content includes: SI/HI/AH/VH 76. Another name for MMSE: Folstein Scale 77. How to assess concentration on MMSE: Serial 7s or perform an activitybackwards i.e list the days of the week backwards 78. Assess ability to learn new material: repeat 3 words after me 79. Assess ability to recall: repeat 3 words after 5 minutes 80. Assess fund of knowledge: Who is the president 81. What is a quick and easy way to assess for neurological issues: Clockdrawing test 82. If patient is unable to draw a clock this indicates: Problem with the righthemisphere, cerebrum, or parietal lobe 83. mesolimbic pathway: Hyperactivity of dopamine in the this pathway mediatespositive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms 84. mesocortical pathway: -Decreased dopamine in the this projection to thedorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia 85. Nigrostriatal Pathway: -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels 10 / Macrolides INH Grapefruit Juice Omeprazole Crack Amigos 104. Erythromycin and Clarithromycin can cause: Increased tegretol levels 105. Patient started on Clozaril or Zyprexa and two months later starts smoking: as a provider you know that the smoking can decrease the medicationeffectiveness -Increase medication dose 106. Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey: as a provider you know thatyou must now decrease the dose of the antipyshcotic 107. Medications that cause mania: Steroids, Disulfiram (Antabuse), Isoniazid(INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer 108. Medications that cause depression: steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodi-azepines, progesterone -may need to increase antidepressant 109. Accutane (isotretinoin): Can cause depression and birth defects 110. Flonase: As a provider you know that flonase is a STEROID so it mayexacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression 111. Flonase can trigger mood instability but it can also cause an increasein: Psychosis patient is taking flonase while on antipsychotic but you find that the antipsychoticis ineffective it is likely because the flonase is exacerbating psychosis -increase the dose of antipsychotic 112. Neurotransmitters involved in Addiction: Dopamine and GABA 113. Symptoms of Stimulant Abuse: 1. agitation/aggression 2. impaired judgment 11 / 3.euphoria 4.elevated BP 5. tachycardia 6.dilated pupils 7.hallucinations 8.TREMORS 9. IMSOMNIA 114. If an anorexic patient complains of pain or bloating after eating this mayindicate: delayed gastric emptying 115. Medications that delay gastric emptying: Omeprazole, ranitidine, famoti-dine 116. Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption ofantipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI 117. When initiating an SSRI on an elderly patient you should advise about- : increased anxiety 118. Paradoxical effect: when meds cause the opposite effect than expected 119. Apoptosis: programmed cell death/neuronal loss 120. At age 45 and above the patient displays mania for first time what shouldbe ruled out: MEDICAL CONDITION 121. Patient with bipolar disorder presents with depressed mood & emotion-al lability: Give Depakote 122. Hallmark sx of Borderline Personality: Recurrent self harm 123. Treatment for Borderline Personality: DBT 124. Creator of DBT: Marsha Linehan 125. What activity is helpful in making a diagnosis of borderline personality- : Journaling or diary keeping 126. Conversion Disorder: STRESS leads to neurological symptoms such asseizures, paresthesia, blindness, mutism 127. Adjustment Disorder: adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is morecommon in children: insomnia, peer conflict, verbal altercations, truancy, crying) 12 / -Symptoms occur within 3 months of the stressor If question states recently moved, recent death. THINK ADJUSTMENT 128. factitious disorder: when patients introduce foreign substances into theirbody or contaminate their food -Faking illness but NO MOTIVE BEHIND IT 129. Malingering: Faking illness for financial gain 130. Reactive Attachment: common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver 131. ODD: They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting 132. Conduct Disorder: violence, criminal, fire setting, killing animals, gang activ-ity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsy- chotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacineand clonidine) -Monitor BP with guanfacine and clonidine 133. Acute Stress Disorder: similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH 134. PTSD: -OVER ONE MONTH -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoid- ance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT 135. Panic attack vs Panic disorder (treatment): Panic attack = BZPanic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom 15 / 160. Low levels of what labs may mimic dementia: Vit B12 and Folic Acid 161. Cortical Dementia: Language and memory (aphasia and amnesia) 162. Subcortical Dementia: Motor abnormalities/Mood issues like apathy, de-pression, irritability HIV Dementia is a type of subcortical dementia 163. Early signs of HIV dementia: subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordina-tion, unsteady gait 164. Treatment for HIV dementia: Antivirals 165. Pseudo Dementia: Depression causes the memory issues, common in olderadults -Also assess onset of symptoms, pseudo dementia is more acute onset -When asked questions they often say "I DON'T KNOW" 166. Instruments to use to differentiate between dementia and pseudo de-mentia: -Use instrument to further screen out cognitive issues such as SLUMS,MOCHA, MMSE 167. -Older individuals with depression may present with irritability andagitation If question is asking you to differentiate between depression and dementialook at the amount of time that the symptoms have been present: 168. hallmark of lewy body dementia: visual hallucinations 169. Frontotemporal lobe Dementia: PICKs Disease -Hallmark is personality changes, language difficulties, poor impulse control, andbehavioral changes -May see slurred speech or difficulty getting words out 170. What lobe is associated with ability to understand what others aresaying (comprehending speech): Temporal Lobe 171. Neurotransmitters involved in Autism: GABA, Glutamate, Serotonin 172. Autism: a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when youcall their name, Stereotypical movement When play they often like to line up their toys, stack them in tidy rows 16 / 173. Broken Mirror Theory of Autism: Explains that the child's presentation iscaused by the mirror neuron i.e dysfunction in the mirror neuron 174. Risk Factors for Autism: Male gender, genetic loading, intellectual disability,parents ages, preterm 175. Screening tools for Autism: ADOS-G (autism diagnostic observationschedule- genetic) ASQ (ages and stages questionnaire) M-CHAT (modified-checklist for autism-toddler) 176. Where is Norepinephrine produced?: locus coeruleus and medullary retic-ular formation 177. Where is serotonin produced?: raphe nuclei 178. Where is dopamine produced?: substantia nigra, ventral tegmental area,nucleaus accumbens 179. Where is acetylcholine synthesized?: Basal nucleus of Meynert 180. Hippocampus: a neural center located in the limbic system; helps processmemory and manage stress 181. Limbic System: The limbic system is the part of the brain involved in our behavioral and emotional responses, especially when it comes to behaviors we need for survival: feeding, reproduction and caring for our young, and fight or flightresponses. -Hippocampus -Amygdala -Hypothalamus -Thalamus 182. Amygdala function: Responsible for the response and memory of emotions,especially fear 183. Thalamus function: relay station for sensory impulses, pain 184. hypothalamus function: homeostasis, temperature, thirst, appetite, sex dri-ve, sleep cycle, emotions * believed to serve a regulatory role in aggression 185. anterior cingulate cortex: brain region that regulates cognitive function,decision making, empathy, impulse control, and emotions 186. Cerebellum: Balance and coordination 17 / 187. signs of lead toxicity: developmental delay, learning diff., irritability, loss of appetite, weight loss, sluggishness, fatigue, abdominal pain, vomiting, constipa-tion, hearing loss, seizures, eating non-food items PICA Hint home built before 1970's TEST FOR LEAD 188. When caring for an infant that is about to die?: GIVE THE BABY TO THE PARENTS and allow them to grieve 189. Risk factors for osteoporosis: Agesmoking caffeine lack of exercise diet lacking calcium and vit D *Provide Education* 190. If discharging a patient that is not following up with outpatient care, organize ways to help the patient get to the appointment REMEMBER STAYINVOLVED IN THE CARE: 191. 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?: Provide adjunctive individual session that will help facilitategroup participation 192. Cognitive Therapy: -Aaron Beck Replacing irrational or distortive thoughts with positive thoughts 193. Behavioral Therapy: -Arnold Lazarus focuses on changing behavior by identifying problem behaviors, replacing themwith appropriate behaviors -Exposure -Relaxation -Skills training -Role Playing 194. Humanistic Therapy: -Carl Rogersperson- centered therapy -Self-actualization -Self-Directive Growth -Everyone has the potential to actualize and find meaning in life 20 / 216. If a patient has rheumatoid arthritis check: ESR 217. Therapy session with husband and wife & only one shows up: Resched-ule 218. A patient's mother calls and tells you that her son has been sodomizedby their 15 year old brother: tell mother DO NOT LEAVE THE CHILD ALONE WITH THE BROTHER -Provider calls CPS -Arrange crisis therapy for family 219. Patient is moving out of state: if there is no imminent danger then provideenough medication for them to establish a new provider 220. Level 1 evidence: systematic reviews of random control trials (RCTs) orMeta-analysis or RCT-highest internal validity due to randomizations At least (2) 221. Level 2 Evidence: systematic reviews of cohort studies -little bias because the subjects are identified prior to outcome - randomization islost 222. Shrill Cry: Intracranial pressure 223. Child between the ages of 3-6 masterbating: Normal to play with genitals(PHALLIC STAGE) NORMAL do not assume they have been abused* 224. Mom is concerned that her son age 10 has swelling in his chest and she is concerned he is developing breasts: Young boys ages 9-16 years old often have NORMAL BREAST ENLARGEMENT which disappears within 6 months *reassure them that this is normal 225. Elderly female presents with decreased sex drive: Check Testosteronelevel Sex Hormone-Testosterone is involved in sex drive -MUST KNOW THAT WOMAN have TESTOSTERONE TOO 226. alcohol dehydrogenase: an enzyme active in the stomach and the liver thatmetabolizes 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 LIVERDISEASE 227. When OB wants to hire psych providers: they want to increase mentalhealth access to those that need it the most 21 / 228. Normalizing grief and loss in children: Don't tell them what to do becausegrief 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 support-ive therapy such as group therapy so they can learn from other children who haveexperienced similar events 229. palmar grasp reflex: normal up to 5-6 monthsIf older baby still has this reflex->refer to specialist 230. Moro (startle) reflex: Normal till 5-6 monthsIf present past normal range->refer to specialist If not present within the normal age->Xray may be a sign of a broken bone, nerveinjury, or spinal injury 231. Babinski reflex: Normal up to 2 years If present past normal range->refer to specialist 232. PDE-5 inhibitors: Sildenafil (Viagra)Vardenafil (Levitra) Tadalafil (Cialis) RAPIDLY ABSORBED Used for erectile disfunction 233. Difference between BMI in anorexia vs Bulemia: Anorexia-Low BMIBulemia-Normal BMI 234. Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and youdetermine the patient needs to be sent for medical evaluation but the parents refuse: Contact CPS 235. You read and article that says that most children with ADHD abusesubstances... -To translate this information into practice what should you do?: -Screen ALLchildren for ADHD for SUBSTANCE USE -OR Screen ALL children with SUBSTANCE USE for ADHD 236. accupuncture: used for pain and depression 237. Habeas Corpus: legal concept that protects patients from unlawful hospital-ization -May be a reason to leave AMA 22 / 238. Disseminated Encephalomyelitis: inflammation of nervous system -MUST DO NEURO EXAM -EXAM: May present with ASSYMETRICAL BODY MOVEMENTS 239. Assume you are interviewing a patient and you want them to provideinformation in a specific timeline, but they are unable: TO help ask them specific questions which helps to ANCHOR their memory 240. Before you administer a medication, you must educate them about themedication but first you should assess: BUT FIRST ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION 241. Patient presents with iatrogenic effect: assess ALL the medications thatthe patient is taking -Don't assume that it is from the medication you prescribed 242. When trying to pass a policy and your co-workers are against it whatshould you do: educate them on how the policy will benefit patient care 243. To promote a policy how do you get the word out there: Think mostFEASIBLE option with WIDE net or audiance 244. Working in outpatient setting and you want to ensure continuous im- provement in quality of care.: - Create an instrument to monitor clinical outcomes(this helps to identify what you are doing right or wrong) 245. Autoimmune disease can lead to increased: Cytokine level 246. If a child is urinating the bed: -Teach parents to use alarm clock to wake upto urinate (NON PHARM FIRST) -If that doesn't work try DESMOSPRESSIN (decreased enuresis) 247. Are you allowed to look up a patient on social media?: No it violates theirtrust 248. 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 un-aware of. They call with concerns...: -First, go online and do your own research -Research the RISK vs BENEFIT before you tell the patient to stop the medication 249. Risk factors for sleep apnea: excessive weight, obesity, diabetes, smoking 250. Tolerance: you need higher doses of the medication in order for the medica-tion to be effective 251. PHQ-9: > 5 mild depression >10 moderate >15 moderately severe 25 / -Giving information to attorneys involved in litigation -Intent to harm self or others -Meeting state of federal requirements for reporting disease states -When the need for information outweighs the principle of confidentiality i.e uncon-scious patient and their life is at stake 271. Tarasoff principle: 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 maynot be your responsibility to notify 272. 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 tokill self: -Call the police, provide the address 273. informed consent: -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 274. If patient is able to reiterate the risks vs benefits of procedure or treat-ment, 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: assess need for involuntary treatment 275. Justice: doing what is fair, fairness in all aspects of care 276. Nonmaleficence: do no harm 277. Beneficence: doing good/promoting well-being 278. Fidelity: being true and loyal 279. Veracity: telling the truth, patients have the right to know the truth about theirtreatment 280. Autonomy: doing for self (right to self-determination) 281. 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: C. Non-Maleficence *Do no harm, giving Xanax would endanger him secondary to the high abusepotential and imminent danger if he were to overdose on Xanax* 26 / If no history of substance use, then beneficence would be appropriate because theXanax would help the anxiety 282. Acute agitation and anxiety vs acute agitation and psychosisIM ordered: IM ativan for agit/anx IM antipsychotic for agit/psychosis 283. Patients have the right to be treated in the Least: Restrictive Setting 284. The PMHNP is asked to consult with a local inpatient psychiatric facilityto provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP'snext 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: D. Utilize asurvey to assess the educational needs of the staff *3 Interventions vs 1 Assessment* FIRST YOU NEED TO ASSESS FIRST 285. What is the best way to reduce stigma: THROUGH EDUCATION *THINK WIDEST AUDIENCE 286. Just Culture: individuals are continually learning, designing safety systems,and managing behavioral choices 287. The PMHNP is concerned about access-to-care issues in the local com- munity and wants to help develop health care policy to help patients accesscare more effectively. 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: C. Working with the local chapter of the nurses professional association *Remember strength in numbers but STAY INVOLVED i.e asking the manager justpasses off* 288. If a patient from a specific culture is refusing to accept any diagnosis ofmental health disorders because of shame what could be done to address 27 / this barrier? A. Educate the family B. Political advocacy C. Public Health Concern D. Community education programs: D. Community education programs *Narrow down to education A/D...then think WIDE NET =Community EDUCATION 289. 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 2months ago and is here to thank you for your care and tell you he no longerneeds appointments. Understanding ethical conflict, you use which of the following ethical principles? A. Autonomy B. Nonmaleficence C. Justice D. Beneficence: A. Autonomy *Patient's have the right to self-determination* 290. Recovery Model * RELAPSE IS A LEARNING OPPORTUNITY: -Treatmentapproach that does not focus on full symptom resolution but emphasizes on resilience and control over problems in life -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 continualgrowth, occasional setbacks, and learning from experience 291. 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: A. Respects themother's understanding of the child's illness 30 / 305. HALLMARKS FOR VASCULAR DEMENTIA: carotid bruits fundoscopic ab-normalities and enlarged cardiac chambers, 306. Patient comes to the office, and you score them on HAM-D a 23 and youstart an antidepressant on dose Xmg, 2 weeks later they score a 16 on the HAM-D. What would you do?: Leave the dose where it is 307. Patient is taking Zoloft 200mg and on the GAD 7 they score a 2, what doyou do: Leave the dose where it is 308. Zung Depression Scale Scoring: >50 Mild >60 Moderate >70 Severe 25-49 is NORMAL RANGE 100 is max score 309. MMSE scoring: 0-10 severe >10 moderate >20 mild >25 Normal Kids under 10 years old are severely challenging to teachHIGHER THE BETTER! 310. Teratogenic Effects 1. Lithium 2. Carbamazepine 3. Depakote 4. Benzo: 1. Epstein Anomaly 2.Neural Tube 3.Neural Tube (specifically spina bifida, atrial septal defect, cleft palate) 4.Floppy Baby 311. Primary prevention: Efforts to prevent an injury or illness from ever occur-ring. -Education -Safety Initiatives -Modifying environment 312. Secondary Prevention: Efforts to limit the effects of an injury or illness thatyou cannot completely prevent. -Early findings 31 / -Screening -Prompt and effective treatment Example: Crisis hotline, disaster response 313. Tertiary Prevention: -aims to prevent the long-term consequences of achronic illness or disability and to support optimal functioning -Rehab Services -Day treatment -Case management -Social Skills training 314. Pharmacokinetics: what the body does to the drug 315. Pharmacodynamics: what the drug does to the body 316. messenger RNA codes for: amino acids 317. Poor relationships, lack of future hope, suspicious of others indicatesdevelopmental failure of what stage: infancy, trust vs mistrust 318. Poor self-esteem, low self control, self-doubt, lack of independence indicates failure of what stage: early childhood 1-3, autonomy vs shame anddoubt 319. Lack of self-initiative, lack of goal orientation indicates failure of whatstage: Late childhood 3-6 y/o initiative vs guilt 320. sense of inferiority, difficulty with working/learning indicates a failure ofwhat stage: school age 6-12 y/o industry vs inferiority 321. identity confusion, poor self-identification in groups indicates failure ofwhat stage: adolescence 12-20 y/o identity vs inferiority 322. emotional isolation, egocentrism indicates a failure of what stage: earlyadulthood 20-35 y/o intimacy vs isolation 323. self-absorption, inability to grow and change as a person, inability to care for others indicates a failure at what stage: middle adulthood 35-65 y/ogenerativity vs stagnation 324. bitterness, sense of dissatisfaction with life, despair over impending death indicates failure of what stage: >65 y/o integrity vs despair 325. agonist effect: Drug binds to receptors and activates a biological response 326. Inverse agonist effect: Drug causes the opposite effect of agonist 327. partial agonist effect: Drug does not fully activate the receptors 32 / 328. Antagonist effect: Drug binds to the receptor but does not activate a biolog-ical response 329. Herbals that interact with warfarin: Vitamin EOmega-3 330. Black Cohosh: herbal used for menopause 331. Bellandonna: herbal used for anxiety 332. chamomile: herbal used for sedation and anxiety 333. Ginko: Herbal used to treat memory, dementia, & sexual dysfunction fromSSRIs 334. Ginseng: Herbal product used for stress reduction, fatigue, and depression 335. Valerian: herbal used for sedation 336. Hypertensive crisis can occur when MAOI are taken with: MeperidineDecongestants TCAs Atypical AntipsychoticsSt.Johns wart L-Tryptophan Stimulants Asthma meds 337. Microcytic anemia: iron deficiency 338. macrocytic anemia: due to folate or vitamin B12 deficiency Labs: Folic Acid, B12, ESR/CRP, HGB, MCV 339. 14 y/o with no axillary hair and no period: Normal tanner stage, start by16 340. Two classes of cardiac meds that should not be used together: ACESand ARBS (angiotensin receptor blocker) Together can cause renal dysfunction 341. AbnormalTrendelenburgTest: Hip disease, refer child out, assessed duringhead to toe 342. too little acetylcholine too much acetylcholine: Alzheimer'sParkinson's and EPS 343. 4 D's Discover, Dream, Design, Destiny: Appreciative Inquiry 35 / 374. Boy tells you he wishes to be a girl and asks you not to tell the parents- : Don't tell 375. BRUISE on the padded part of his arms: Say I see you have bruises onyour arm may I Ask what happened 376. Can an advanced directive be revoked? How?: Yesat any time 377. Can you take Buspar during pregnancy?: Category B - ok if really needed. 378. Carb and barb + Coumadin: Strong Inducers of 3A4 can decrease INR 379. Who is in charge of the DEA?: State and Federal 380. Common comorbidities of bipolar: anxiety, alcohol, substance use 381. Conjunctival injection, munchies, psychomotor slowness?: Marijuanaintoxication 382. Diary Log: CBT 383. Depakote and Disulfiram: increases INR 384. What 3 atypicals can be used with teens?: Zyprexa, Abilify, Seroquel - lowdoses * also Risperdal 385. Np wants to implement a certain policy in nursing.: start with nursemanager 386. Phenycyclidine (PCP) can cause?: Nystagmus 387. Hildegard Peplau: Theory of Interpersonal RelationsNurse as therapeutic tool -Care for the person as well as the illness -Patients are PEOPLE not DIAGNOSES 388. Patient acting out due to missing session what do you do?: You relate tochildhood abandonment and talk about it with the patient 389. Patient on antidepressants for 3 weeks and attempted Suicide: stop themedication immediately 390. Patient shows symptoms of dizziness, tremors, sweating, What MedicalDiagnosis: hypoglycemia 36 / 391. Pearson's r: a statistic that measures the direction and strength of the linearrelation between two variables that have been measured on an interval or ratio scale 392. pincer grasp: 9 months 393. Problems in the parietal lobe can lead: Sensory-perceptual disturbancesand agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) 394. To promote resilience in a patient with schizophrenia that lives aloneconsider referral to: -ACT -Peer support 395. Patient on Lithium and Depakote and has temp, right flank pain, brownurine. What do you do FIRST?: Check LFT If fine then check creatinine 396. Pt states "god did this to me.": Assess spiritual needs first 397. Patient taking breathing treatment Albuterol/Proventil: Do not take MAOIor TCA 398. p-value: The probability of results of the experiment being attributed tochance. 399. Reliability: consistency of measurement 400. Stereogenesis: identify an object without sight i.e dice in hand 401. Tagamet (cimetidine): H2 receptor antagonist (antacid)Increases benzo Increases coumadin 402. Trazadone concerns: EKG-QT prolongationPriapism Glaucoma 403. Turner Syndrome: A chromosomal disorder in females in which either an Xchromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. -Delayed puberty -Amenorrhea 37 / -Web neck, osteoporosis, lymphedema -poor social skills 404. To start your own firm as an NP and need to examine economic viabili-ty: Show Revenue and expenses 405. 3 CK muscle enzyme tests?: CKMM, CKBB, CKMB (normal 0.3 mmcg/L) 406. What are the legal ramifications of treating someone without informedconsent?: The same as they are with informed consent -Respect -Beneficence -Justice 407. Two important things to measure when prescribing Zyprexa: Waist cir- cumference Lipids 408. What schedule of controlled substances are NPs allowed to prescribe?- : II-V 409. What crania nerve is affected when you ask the patient to shrug theirshoulders?: XI (11) Spinal Accessory 410. These medications are renally metabolized: GabapentinCampral Lithium 411. grapefruit juice: inhibitor that can reduce the absorption of the drug by 47%therefore the drug blood levels will be increased -Decrease dose of drug 412. How do Asians see HC providers?: As in a position of authority.Expect to give instructions and help make decisions 413. How do you protect from the evil eye?: Red ribbon on an infantAmulet for adults 414. T-test: assesses whether the means of two groups are statistically differentfrom each other 415. Treatment for children with panic disorder: clonidineguanfacine 416. What do BCP's do to Lamictal?: Inducer - will lower dose of Lamictal