PMHNP Certification Exam with complete solution 2024/2025 VERIFIED 100% CORRECT ANSWERS , Exams of Nursing

Download PMHNP Certification Exam with complete solution 2024/2025 VERIFIED 100% CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity! 1 / 58 PMHNP Certification Exam with complete solution 2024/2025 VERIFIED 100% CORRECT ANSWERS GUARANTEED PASS 1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci- nations 2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months), Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +) 3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty things • This is NORMAL for children this age. 4. What do you do when a patient has an increased prolactin level?: • Stop prolactin (stop the agent that cause increase prolactin) 5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP to ONE MONTH - Less than 1 month. • If LONGER than 1 month = PTSD - Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder 6. What would you do if a 5-year-old tells you his brother sodomized him?: • Tell mom don't leave him alone with patient and call CPS implement crisis 7. If a child is playing with doll in a sexual way, what do you do first?: • You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you have to have something (assessment data) to report - 2 / 58 Assess = FIRST 8. If a 13-year-old tells you he want to smoke, what would be an appropriate response?: • Ask him of his plan to stop smoking 9. If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect?: • Cranial nerve V-Trigeminal nerve (FIVE) 10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis 11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7 12. What cranial nerves do you assess for papillary reaction to light and accommodation?: Nerves 3,4,& 6 13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc- ular movements?: Nerves 3, 4, & 6 5 / 58 - slow or clumsy movements - syncope - weight gain - fluid retention - muscle aches and stiffness - slowed reflexes - somatic discomfort including aching and joint stiffness - slowed speech and thinking - sensory disturbances including hearing - cerebellar ataxia (may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements) - loss of amplitude in ECG 39. What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic?: Bipolar affective disorders - motor restlessness - emotional lability - short attention span - compulsive movements - fatigue - tremor - insomnia - impotence - weight loss - increased appetite - abdominal pain - excessive sweating - flushing - elevated upper eyelid leading to decreased blinking, starring, and fine tremor - tachycardia - dysrhythmias 40. What does ADPIE stand for?: • Assessment • Diagnosis • Planning • Implementation • Evaluation 41. Recommend CBT for: Depression & Anxiety (keep a daily log) 42. pg 209 and every PB pages for each dx: all thing for each disorder 43. What medication is best for an aggressive patient?: IM Geodon 6 / 58 44. Medications to improve anxiety...: act directly or indirectly on GABA system - SSRIs - Benzodiazepines - Tricyclics (TCA) - Buspirone - Tiagabine (Gabitril) - gabapentin - propranolol in children: - alpha agonists : clonidine (catapres) & guanfacine (tenex) 45. advantages of Benzodiazepines with short have lives: - less daytime se- dation - less drug accumulation - quick onset - useful for tx of insomnia 46. disadvantages of Benzodiazepines with short have lives: increase risk of addiction 47. non-pharmacological Management for anxiety: - behavioral therapy - CBT - interpersonal therapies - community self help groups - alternate therapies as adjunct tx 48. SSRI's: - first line tx for anxiety - act on serotonin and indirectly on GABA - takes 3-4 weeks to reach symptom control - black box warning for kids is SI 49. Agoraphobia treatment: • BZs: Short term symptom relief • SSRIs: long term maintenance • Fluoxetine (Prozac) • Paroxetine (Paxil) • Sertraline (Zoloft) • SNRIs: long term maintenance • Venlafaxine (Effexor) TCAs: long term maintenance 7 / 58 • Beta blockers (off-label use) used for discrete episodes of social anxiety - contraindicated for clients with asthma 50. Alprostadil (PGE1): • Ductal-dependent Congenital Heart disease (all forms) • Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction. • 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO 51. Amygdala: • A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression 52. Anorexia nervosa: • Anorexia (SAFETY = KEY) • BMI less than 18.5 • BMI < 16 = AUTOMATIC ADMISSION • An eating disorder in which an irrational fear of weight gain leads people to starve themselves • Anorexia admission criteria for hospitalization - Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L). • Set up family therapy (especially adolescent pts since they have no control over food choices) 53. • ANOVA (analysis of variance): • 3 or more • An inferential statistical test for comparing the means of three or more groups 54. PROZAC Causes What?: • Increase Anxiety in Elderly 55. • Apoptosis: • Cell death in aging/elderly 56. • Appreciative inquiry: • An organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work • An organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements 10 / 58 76. TRICYCLIC ANTIDEPRESSANTS (TCAs): Not commonly used due to side effects and overdose toxicity risk; however, TCAs should be considered for appro- priate patients who do not respond to other antidepressants. There are nine TCAs approved by the FDA for depression (amitriptyline, amoxap- ine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trim- ipramine), and one approved for OCD - clomipramine (Anafranil). Tertiary TCAs (more sedating): Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg. Secondary TCAs (less sedating): Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5 mL oral solution. Side Effects: Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision. Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT prolongation, AV block. 77. Clozaril (Clozapine): • DC Clozapine at - ANC < 1000 - WBC 2000-3000 ANC & WBC WEEKLY for 6 months: • When a patient is on Clozapine monitor for signs for agranulocytosis such as: • Sores in the mouth, throat, • Chronic infections of the gums, throat, or skin, • Fever • Chills 78. • Co-morbidities of bipolar: • Anxiety, alcohol and substance abuse 79. • Inducer; Pushes the substrate out of the exit pathways, < the serum level of other drugs, < therapeutic effect.: I'll Come See Pumpkin Pie Tomorrow or Monday And Chow 11 / 58 • Carbamazepine/Oxcarba (1A2, 2C19 and 3A4) • St. John's Wart (3A4) • Phenytoin • Phenobarbital • Tobacco (1A2) • OCP (1A4) (watch with use of Topamax/Tegretol) • Methadone (1A2) • Antiretroviral • Cyclosporine Or Bull Shit CRAPGPS • Barbiturates • St. Johns Wart • Carbamazepine • Rifampin • Alcohol (chronic use) • Phenytoin • Griseofulvin • Phenobarbital • Sulfonylureas 80. • Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion, Increase the serum level of other drugs, Increase toxic risk: Sickfaces.com • Sodium Valproate • Isoniazid • Cimetidine • Ketoconazole • Fluconazole • Alcohol • Chloramphenicol • Erythromycin • Sulfonamides • Ciprofloxacin • Omeprazole • Metronidazole Plus Grapefruit juice 81. • DBT (Dialectical behavior therapy): • Relaxation muscle prior to DBT • Borderline Patients - NO meds - DBT therapy 12 / 58 82. what therapy uses a diary log: • CBT 83. what medication is used for ENURESIS: • DDAVP (Desmopressin) Works in the SAME manner of ANTIDIEURTIC HORMONE • Makes less urine - Used for ENURESIS 84. what medications increase INR?: Depakote and Disulfiram 85. What medication causes Spina bifida?: Depakote, so check HCG level 86. • DIGFAST for Mania: • Distractibility • Indiscretion • Grandiosity • Flight of ideas • Activity increase • Sleep deficit • Talking increase 87. • Disseminated Encephalomyelitis: • Assess for asymmetry of extremities • Along with this pattern, the patient usually get neurological symptoms which may include • Confusion, drowsiness, and even coma • Unsteadiness and falling • Visual blurring or double vision (occasionally) • Trouble swallowing • Weakness of the arms or legs • Fever • Headache 88. Disulfiram: Disulfiram (sold under the trade name Antabuse) is a drug used to support the treatment of alcohol use disorder by producing an acute sensitivity to ethanol (drinking alcohol). Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption. • Increase Coumadin 89. • Does impaired judgement mean one is incompetent?: No 90. • Does the de facto rule of proxy apply in same sex marriages?: • No 91. Drug affects with Flonase: (just know that Flonase has interaction with Zan- tac & Tegretol) 15 / 58 109. lithium can cause: leukocytosis, hypothyroidism, maculopapular rash, t-wave inversion, tremors (fine hand Tremors), GI upset, - course hand tremors = can indicate toxicity 110. Signs of lithium toxicity: muscle weakness, confusion, incoordination, pal- pitations, severe GI upset, drowsiness, find hand tremors priority action - d/c lithium and check serum levels 111. NMS (neuroleptic malignant syndrome): Can be caused by antipsychotics - extra muscle rigidity that can lead to mutism - increase CPK levels - myoglobinuria (muscle contractions and muscle destruction which is what is responsible for increase CPK levels - increase WBC & LFT *If the patient goes to the gym a lot with a reddish/cherry color that would indicate myoglobinuria Tx: - stop med - give bromocriptine (dopamine agonsit) - give dantrolene (muscle relaxant) 112. Serotonin Syndrome: Caused by antidepressants - SSRIs, TCA, SNRIs, MAOIs - Triptans - migraine medications, also are risk for SS - hyperflexia (myoclonic jerks) TX: - stop med - give cyproheptadine *NDRIs (Wellbutrin) do not increase serotonin levels 113. How long should you wait to switch medications that are serotonin meds: 2 weeks (ex. SSRIs to MAOI) 16 / 58 wait 5-6 weeks for fluoxetine to MAOI *prozac has a long half life 114. Why are SSRIs first line?: They are safer and less potential for causing injury with potential overdose 115. depression + cancer, give what meds: Give a SSRI like citalopram or escitalopram because they have less potential for drug to drug interactions 116. depressed + neuropathic pain: SNRI - duloxetine (Cymbalta) TCAs Gabapentin 117. Schizophrenia: Age on onset: 18-25 in males 25-35 in females - the dx has the highest rate of dx's that increases risk for self harm - even more than depression or bipolar - can aggression, impulsivity, abstract thinking problems, - changes or abnormalities in the prefrontal cortex, amygdala, basal ganglia, hippocampus, and limbic regions of the brain can cause aggression & impulsivity - MRI/PET will show a decrease in size of the lobes of the brain, and an INCREASE is the ventricles d/t increased cerebral blood flow - Do not give stimulants - increased dopamine - positive symptoms of schizo is due to too much dopamine - Tx: - assertive community treatment - Long term non-compliance of meds then should refer to ACT team (ACT is a form or rehabilitation post hospitalization in the home) - social skills rehabilitation (is a tertiary level of prevention) 17 / 58 - refer to exercise program (aerobic exercises can help improve cognition and quality of life and long term health 118. what is the dx that increases HI the most: antisocial personality disorder 119. How do you calculate dose of monthly IM haldol: You multiply their daily dose by 20 ex. if a PT is taking 5mg BID, you would multiply 10X20= 200 but you can only give 100mg, so give 100mg and tell them to come back in two weeks for their other 100mg 120. What is a delusion?: Is the false belief firmly maintained despite the evi- dence to the contrary (ex. their family member is part of a cult) 121. Mini Mental Status Exam: Thought process - you want to assess your PT's thoughts if they are normal or abnormal - organization of thoughts 122. Tangential thinking- Thought process: the patient never gets to the point. they move from thought to thought with never getting to the point 123. Circumstantial thinking - thought process: a PT goes in circle and provide unnecessary details before getting to the point 124. What is another name for the MMSE: Folstein Scale 125. What areas of the brain does the clock function test target?: If cannot draw the clock it can indicate a problem with the right hemisphere/right parietal lobe 126. Hyperactivity of dopamine in the mesolimbic pathway mediates what type of psychotic symptoms: positive symptoms = mesolimbic pathway 127. decreased dopamine in the mesocortical projection to the dorsolateral prefrontal cortex is postulated to be responsible for what types of schizo- phrenia symtoms?: negative and depressive symptoms = mesocortical pathway 128. What are the positive symptoms of schizophrenia?: delusions, hallucina- tions, disorganized speech, disorganized or catatonic behavior 129. What are the negative symptoms of schizophrenia?: flat affect, social withdrawal, lack of motivation, lack of speech or thought, anhedonia 130. Nigrostraital Pathway: - mediates motor movements - when dopamine is blocked in this pathway it can lead to increased acetylcholine levels - blocked dopamine can lead to EPS -long standing D2 blockade in this pathway can lead to tar dive dyskinesia 20 / 58 140. Reglan (metoclopramide) or Compazine can cause what?: Tardive dysk- inesia, don't take with antipsychotics 141. Inducers do what?: Decrease - in"D"ucers = Decrease - smoking (not nicotine lozenges or gum, the actually smoking) - (ex. If you have a PT started on X dose of antipsychotic, and then come back to the follow up and says they start smoking, you should increase the dose of X because smoking decreases the serum levels. If they stop smoking, then decrease the dose the again) 142. Inhibitors do what?: Increase - in"H"ibitors = High 143. what do you need to consider with Tegretol?: There is a warning if you are giving it with erithromycin or clarithromycin because they are an inHibitor so it will make the Tegtrol have higher serum levels, so you must decrease the dose of tegretol - High levels of tegretol can cause mania and psychosis 144. what medications can cause mania: - steroids (steroids can also cause psychosis) - disulfiram (Antabuse) - isoniazid (INH) - antidepressants in persons with bipolar disorder 145. what medications can cause depression: - steroids (steroids can also cause psychosis) - beta blockers - interferon - isotretinoin (accurate) - some retroviral drugs - antineoplastic drugs - benzodiazepines - progesterone 146. What should you consider if your patient is on a mood stabilizer like depakote, oxcarbazepine, or lithium and the PCP starts them on Flonase or prednisone?: The Flonase or prednisone has steroids so they can be worsening the mood symptoms, so you must make adjustments on the mood stabilizers. The steroids are making the symptoms worse, you must increase the psychotropic medication 21 / 58 147. what are the two neurotransmitters in addiction: Dopamine & Gaba 148. what symptoms indicate stimulant abuse: mood swings, irritability, tremors, and insomnia 149. If your patient with anorexia starts complaining of pain after eating, bloating, or feel very fullness: That can be caused by delayed gastric emptying (DGE) - famotidine, rantidine, and omeprezole can cause DGE 150. what medications can decrease absorption of psychotropic medica- tions: Proton Pump Inhibitors (PPIs) - protonix - omeprazole - antacids You must take them 2hrs apart from the psychotropic so the psychotropic can still be effective 151. what can SSRI's cause in older adults: increased anxiety 152. paradoxical effective: The medication is causing the opposite effect of what it is intended to do 153. apoptosis: means neuronal loss or cell death 154. Bipolar disorder - mania symptoms: DIG FAST - distractibility and easy frustration - irresponsibility, indiscrete, impulsitivty, irritable - grandiosity (exaggerated self-esteem) - flight of ideas - activity increased - sleep decreased (still not tired) - talkativeness, pressured and rapid speech 155. what is the highest risk factor of bipolar: family history - hereditary 156. If a PT is 45 or older and presents with their first symptoms of bipolar disorder, what is most likely: a medical disorder (ex. cardiovascular or stroke) 157. borderline personality disorder: - self harming and suicidal behaviors - Use DBT to decrease thoughts of self harm 158. Who originated DBT?: DBT is originated by Marsha Linehan 22 / 58 159. What medication should you give to a PT with depressed mood and emotional instability that has borderline PD?: Depakote 160. What do you need to dx a PT with borderline: Journaling, diary of their behaviors 161. conversion disorder: When a PT has a stressful experience in their life (ex. loss of a loved one) sudden onset of neurological symptoms - paralysis - mustism - blindness - paresthesia (numbness and tingling) - 162. adjustment disorder: The PT is unable to adjust to a change. (dx of medical condition, child dx with illness, loss of job) - If they develop depression (adjustment dx with depression) - if they have anxiety (adjustment disorder with anxiety) 163. How long does adjustment disorder take to develop: Within 3 months 164. difference between adjustment disorder and MDD: If your PT presents with depressed mood, and the questions identifies a reason for the depressed mood (identifiable stressor), its likely adjustment disorder 165. adjustment dx with mixed disturbance of emotions and conduct: Com- mon with children, maybe the child lost a loved one or their parents got divorced - child cries alot - unable to sleep - peer conflict - verbal altercations - truancy 166. factitious disorder: Caused when PT or people introduce toxic things to their body to make themselves sick (drinking urine) 167. malingering: When someone is faking illness for gain (will not be on the test, no longer in the DSM but may be used as a distractor) 25 / 58 179. OCD (Obsessive Compulsive Disorder) neurotransmitters?: Serotonin & norepinephrine OCD = intrusive thoughts 180. what infections can cause OCD in children: Streptococcal & PANDAS 181. OCD Tx: Children = SSRIs - prozac Adults = - SSRIs or TCAs 182. DMDD (disruptive mood dysregulation disorder): Disorder in children from 6-17 years old will present with = - irritability - depressed or sad for no reason - anger outbursts / tantrums - moody/mad 183. If PT presents with irritable mood, depressed mood, or labile mood: - administer a mood questionnaire 184. Nightmares in children can be from what: - can be psychological or genetic - do not assume abuse or they watched something scary - you must assess first 185. GAD: Symptoms must last at least 6 months - excessive worry - anxiety 186. What are neurotransmitters in austims ?: - glutamate - gaba - serotonin 187. Autism Spectrum Disorder: - deficits in social interaction and communica- tion skills - lack of eye contact - may not respond when called by name - line up their toys in long tidy rows 26 / 58 188. The broken mirror theory of autism: claims that a dysfunction of the mirror neuron system may be a cause of poor social interaction & cognition in individuals with autism - tries to explain why the child presents in this way 189. delirium: ACUTE (occurs within hours or days) of sudden disturbances of - level of consciousness - cognition (memory problems) - inattention TX of psychosis and agitation: - Haldol - atypical antipsychotics *if an OLDER female PT (65 or older) presents with delirium, it is important to do an urinalysis with culture and sensitivity, b/c UTI can cause delirium 190. dementia: CHRONIC, progressive decline in cognitive status (takes months to years to dx) - irritability - personality changes IF you suspect this dx check folic acid levels and Vitamin b-12 191. types of dementia: HIV related dementia: subcortical dementia Early signs: - cognitive defect - behavioral and motor abnormalities - lack of coordination IF an IV drug user comes to your office with these early symptoms, test for HIV TX: - antiviral medications to target the primary cause of the cognitive problem 192. Pseudodementia: The primary dx is depression - when a PT is depressed, they can have memory problems caused by depression - Common in older PTs 27 / 58 - Do a cognitive screening when and older PT is depressed (MMSE to screen) *ask PT the onset of the memory problems - if it started months ago think depression - if started years ago think dementia Dementia = lack answers or make up answers Pseudo = answers questions with general responses like " I don't know" 193. Lewy's bodies dementia: It can cause visual hallucinations 194. Frontotemporal Dementia - Picks disease: The frontal lobes deals with expressive speech - the most focal area for personality development - slurred speech / language changes - social skills are affected - change in personality and behavior Temporal lobe = speech comprehension 195. Where is norepinephrine produced: in the locus ceruleus and medullary reticular formation 196. where is serotonin produced: in the raphe nuclei of the brainstem 197. dopamine: produced in the substania nigra (regulates motor movements) and the ventral tegmental area (VTA), and nucleus accumbens 198. where is acetylcholine produced: synthesized by the basal nucleus of Meynert 199. Symptoms of lead poisoning: developmental delay, learning difficulties, irritability, loss of appetite, weight loss, sluggishness and fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, pica 200. neurotransmitters in mood disorders: DNS (dopamine, norepinephrine, and serotonin + gaba) 201. Risk factors for osteoporosis: smoking, caffeine, lack of exercise, lack of Vit D in diet 202. Who made DBT: marsha linnenhan 203. what do you want CBT to do: - replace irrational thoughts with positive ones - cognitive restructuring - journaling PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 30 / 58 218. how should you prescribe meds to someone who is moving: if they are stable, give them 2 or 3 months worth until they can establish a new provider if there is no imminent risk 219. Rheumatoid arthriitis: check ESR level 220. PICOT question: P- patient population of interest I- intervention of interest C- comparison of interest O- outcome T- time provide evidenced based care by reading current journals 221. what does a shrill cry in infants mean: intracranial pressure 222. Is it normal to develop swelling on their genitals or Breast swelling in 9-16 y/o boys: yes 223. what can cause decreased sex drive in elderly female: - decreased testos- terone - decreased blood flow to the pelvic region 224. alcohol dehydrogenase: women have a decreased quanity of this enzyme that causes them to get drunk quicker women are more likely to develop liver problem than men lack of enzyme makes it more difficult for the alcohol to metabolize 225. how to normalize grief and loss in children: - grief responses vary (there is no standard guidelines on how someone is suppose to grieve, do not tell someone how to grieve - what is most important is an intact family system - encourage parents to take child to group therapy to learn coping skills from children who always experienced loss 226. grasp (palmar) reflex: normal 5-6 months 227. Babinski reflex: normal up to 2 years 228. PDE5 medications: these medications are rapidly absorbed after oral admin- istration PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 31 / 58 229. if a pt has normocytic microcytic anemia: check - folic acid - vit b 12 - iron levels 230. if a BMI is very low: think anorexia nervosa BMI within normal limits think bulimia 231. how would you apply the knowledge that you know ADHD adolescents have an increased risk of substance abuse: you can screen all ADHD kids for substances or screen all SUD kid for ADHD 232. acupuncture: can be used for pain or depression 233. habeas corpus: a legal concept that can protect a PT was unlawful hospital- ization They can use this concept to leave AMA 234. IF you are trying to create a MH policy: you can host an online forum / survey for PMHNP to enter their views - you can convince them the importance of the policy, you want to present how it will benefit patient care 235. Continuing improvement of quality of PT care: you ensure by creating an instrument to monitor patient clinical outcomes in quality of care 236. autimmune disease: can lead to increase cytokines levels 237. to help with child urinating while sleeping (enuresis): set an alarm clock to wake up to go to the bathroom pharm tx: - desmopressin = can decrease urine production 238. you cannot look up a PT on social media: violation of trust 239. DISSEMINATED ENCEPHALOMYELITIS: - need a neuro exam - PT may present with asymmetrical body movements, especially of the extremities PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 32 / 58 240. is education an intervention: yes - assess first what they know or believe about the medication 241. looking someone up on social media is: a violation of trust 242. If a medication has a black box warning, what do you do: do you own research of pros and cons 243. If you are prescribing a medication that is being used off-label, what is your best action: Give a full disclosure, you must document the pros and cons AS WELL AS the benefits of why you are prescribing the medication 244. Sleep apnea risk factors: smoking, excess weight, diabetes, narrowed air- ways 245. is your PT is scoring mild anxiety or depression: you can do therapy or nothing 246. If your PT is scoring moderate range: You can do therapy and medications 247. if your PT is scoring a severe range: You want to assess thoughts of self harm 248. COWS below a 13: you can give clonidine 249. COWS above a 13: start on scheduled medications such as buprenorphine - choose that over methadone as buprenorphine is safer 250. methadone can cause: cardiac arrhythmias 251. CIWA scores is 8 or above: prescribed symptoms triggered PRNS like zofran for n/v/d 252. CIWA >= 15: start scheduled meds and PRNs like diazepam, librium, or Ativan check for liver disease first - if they do give Ativan rather than diazepam d/t short life half of Ativan 253. If a PT is pregnant and presents with alcohol or opioid use, what is your priority action: priority action is to refer that PT to resident tx center & detox first action is NOT to call CPS 254. If a PT presents outpatient with anxiety that is in alcohol withdrawal what is your priority action: Do not give a benzodiazepine since they will start that in the ED when you refer them to detox, start on non-benzodiazepine PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 35 / 58 276. in a just culture, individuals are that are learning need to learn what: - safety systems 277. the PMHNP is concerned about access to care issues in the local community and wants to help health policy to health care policy , what is an effective avenue: working with the local chapter of the nurses's professional association (you want to get other nurses involved) 278. if a PT from a specific culture is refusing to accept any dx or MH dx because of shame, what can be done to address the barrier: Community education program (If the question is about stigma, you want to reach the widest audience) (writing a journal article would reach the widest audience) 279. a PT with Bipolar 1 presents for a follow-up. during the visit, the PT informs you that he no longer wants meds and does not have BP 1 dx b/c it was a missed dx. He said he stopped all his meds a few months ago. understanding the ethical conflict you use which following ethical principle- : autonomy (the question says nothing about it being court ordered tx, or he is in imminent danger. PT has the right to refuse) 280. The recovery model: - a tx approach which does not focus on full symptoms resolution but emphasizes resilience and control over problems of life - self direction - individual and person centered care - non-linear; recovery is not a step by step process, but one based on continual growth, occasional set backs, and LEARNING FROM EXPERIENCE ( you are not focusing on the illness, rather you are focusing on their skills) 281. In consulting a 23 y/o married Hispanic mother who brought her 4 y/o child to clinic for "Mal de ojo" with symptoms of fitful sleep, diarrhea, vomit- ting, and fever, the PMHNP should do what: respect the mother's understanding of the illness PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 36 / 58 (Hispanic is the key word, choose culture) 282. quality improvement: projects designed to improve systems, decrease cost, and improve productivity 283. process of quality improvement (: Plan, Do, Study, Act (PDSA) 284. the chief nursing officer of a large psych unit approached the PMHNP to discuss the new health effectiveness. she is asked to do a retrospective chart review. what is the PMHNP asked to do: qualitative improvement initiative (the retrospective chart review is a QI initiative) 285. the PMHNP is responsible for initiating QI at MH clinic, the effective strategy to evaluate the services is for: (effective strategy is the key word) - a plan to do study act process 286. 4 components of health care policy: - process: formulation, implementa- tion, anf evaluation (FIE) - policy reform: changes in programs and practice - policy environment: arena the process takes place in (government, media, public) - policy makers: key players and steak holders 287. before implementing evidence-based practice changes, an adult PHM- NP's initial action is to: (ASSESS FIRST) identify potential barriers and facilitators the reflect patient's values and experi- ences 288. you want to assess & address barriers: before you meet with the stake holders 289. Tarasoff v. Regents of the University of California (Tarasoffs Principle)- : Duty to warn potential victims of danger (HI) (DOES NOT APPLY IN EVERY STATE, must check with your state board of nursing) 290. Donalson vs O'Connor: (confinement) PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 37 / 58 it is unconstitutional to commit a person involuntary who is not imminently danger- ous to self or others 291. If your PT tells you that her husband just texted her that he wants to commit suicide, what is your priority action: Get address of the husband and call the police 292. Paiget's Preoperational stage: (2-7 y/o) Magical thinking is normal 293. Paiget's formal operational stage: (12 - adult) - use logic: science project or test hypothesis in science - abstract thinking: solve algebra 294. Which Patient is at the highest risk of suicide? A. 30 y/o married African American female with previous suicide attempt B. 35 y/o single asian male with a previous SA C. 38 y/o single African American male who is a manager of a bank D. 68 y/o single white male with depression: Count the risk factors: Previous SA is the highest risk factor A. 1 factor - previous SA B. 3 - single, male, SA C. 2 - single, male D. 5 - age, single, white, male, depression 295. A 72 y/o female is brought in by her husband with increasing forgetful- ness, decreased activity, and decreased appetite for 2 months. She has a hx of HTN and is being treated with Lisinopril. The exam I normal, and the MMSE is a 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely dx? A. Alzheimer disease B. Vascular dementia C. Depression D. Medication Toxicity: You can answer this in less than 15 seconds looking at the time frame. - Alzheimer can take up to a year to dx a PT with this - The MMSE is 24 which is mild cognitive impairment - 2 months is too sudden to develop or dx a PT with vascular dementia - no information indicated medication toxicity PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 40 / 58 PT must be admitted and if need to be transferred then use squad 311. If a PT comes in with psychosis, what is priority?: check urine/toxicology first before anything 312. What would it be called if a PT was not allowed to participate in med trial due to not having insurance?: Justice - you are violating justice (fairness in all aspect) 313. Which PT's score is most severe for an MMSE score? 17, 20, 30: 17 - lowest number is most severe 314. what should you do if your PT scores a 27 on the MMSE, and their PCP dx the PT with alzhiemers: rethink the PCP's dx 315. Can you give erythromycin and tegretol together?: Yes, but you need to decrease the tegretol level because erythromycin is an inhibitor and will cause a toxic level 316. A PT is treated for schizo with zyprexa, which of the following is most common side effect of zyprexa? A. increased waist circumference B. EPS C. metabolic syndrome D. increased lipids: C. metabolic syndrome * If a question has more than one correct answer, use the umbrella answer, meaning there may be more than one correct answer option - look for the answer that covers all the choice options 317. what differentiates atypical from typical? A. 5HT2a receptors antagonist properties B. 5HT2a receptor agonist properties C. specific dopamine receptor 3 and 5HT2a blockade D. dopamine receptor 2 antagonist properties: A. 5HT2a receptors antagonist properties Serotonin antagonism differentiates atypical from typical PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 41 / 58 318. *There is most of the time a trick for answering questions... if you have 2 answers that are the exact opposite of each other, then one is likely correct: 319. If a patient presents with the first psychotic episode, you want to place them on what kind of antipsychotic?: Atypical first such as geode, Invega, IM olanzapine if they are acting out with active psychosis, give IM geodon DO NOT GIVE ORAL, MUST GIVE IM with active psychosis 320. what medication should you give if a PT presents with a dx of delirium with psychosis including paranoid delusions, AH, VH: give haloperidol (low dose haldol) 321. what is the least weight gain causing atypical?: Geodon or Latuda 322. what atypical antipsychotic is the least sedating: Abilify 323. what mood stabilizer causes the least weight gain: lamictal 324. Erythromycin: • Increases Xanax level because Erythromycin is an IN- HIBITOR 325. • First sign of temporal frontal dementia: • Behavior and personality changes 326. • For there to be a duty to a patient what must exist?: A Relationship 327. • For there to be damages, what must exist first?: • Negligence 328. What medications are GAL- renal metabolized: • Gabapentin • Acamprostate (Campral) • Lithium 329. • Grape-fruit juice and grapefruit are Inhibitors: • One glass can reduce absorption (metabolism of the drug) by 47% • Blood level of drug will be increased 330. • Grasp reflex: • An infantile reflex in which an infant closes hand into a fist when palm is touched • Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until about 5 to 6 months of age 331. • Greatest patient at risk for violence: • Substance abuse PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 42 / 58 332. • Hamilton anxiety rating scale (HAP-A): • 0-7 normal • 14-18 moderated • > 20 Severe depression 333. • Hamilton D score of 28: • Assess for suicide 334. • Health care policy Model: • Access • Cost • Quality 335. • Health literacy: • A person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness • Man taking insulin - check literacy by asking him to read blood glucose level 336. • A client with Herpes Zoster - 3 weeks later experiences sleep difficul- ties and sad mood: • Adjustment Disorder WITH Depressed Mood (lasts less than 6 months requires only 2 symptoms of depression) • Adjustment D/O ONLY 2 Symptoms - Depression requires 5 + Sx. 337. • Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do?: Validate his experience and provide care in a culturally specific way to that patient 338. • How are Medicaid benefits determined?: • State determines qualification- partnership between state and fed govt • Must be impoverished • Must be US resident and low or very low income 339. • How do Asians see HC providers?: • AS in a position of authority - Expect to give instructions and help make decisions 340. • How do you assess the competency of a medical procedure?: • Identify a pen and recall 3 words - Mental Status Exam - part of assessing competency 341. • How do you protect from the evil eye?: • Red ribbon on an infant • Amulet for adults • How do you treat for Evil eye? • Access traditional healer + traditional care 342. • How is tele-psychiatry evaluated?: • Outcome based • Measure at intervals PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 45 / 58 • The question is pt. is on interferon, Wellbutrin and Lexapro. • Answer: increase Lexapro. • Rationale: interferon induces depression and to help with that you increase Lexapro cause if you increase Wellbutrin -> increases seizure risk 356. • Internal validity: • Was research done right? • Extent to which we can draw cause and effect inferences from a study • Concepts in interpreting research findings • Internal validity: The independent variable (the treatment) caused a change in the dependent variable (the outcome) • External validity: The sample is representative of the population and the results can be generalized 357. • Is dental care included in Medicaid?: • Yes, < 21 gets basic dental as part of the Medicaid plan 358. • Just Culture: • OPPOSITE OF BLAME CULTURE 359. • Kids panic disorder: • Kids panic disorder 360. • Kid with nightmares screaming out does not remember the next morn- ing what do you do?: • Ask about sleep disorder in family 361. • Latuda and Geodon: • Take with food 362. • Lesion in frontal cortex: • Impaired cognitive functions 363. • Limbic system: A donut shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus , amygdala, and hypothalamus 364. A man states his wife was so good if he could only be like her. - What is this: IDEALIZATION Intellectualization - is a defense mechanism by which reasoning is used to block confrontation with an unconscious conflict 365. • Man working at the Gym and his urine is cherry color: • Order Myoglo- binuria 366. • Medicare A, B, C, D: • A: inpatient services • B: Outpatient services • C: Private insurance can provide Medicare benefits • D: Drugs PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 46 / 58 367. • Medication that contradicts Albuterol: • Sertraline (Zoloft) is used to treat social anxiety disorder and the patient is on albuterol. Therefore the Non-selective Beta blocker Inderal is contraindicated with Albuterol due to the risk of increased CNS stimulation 368. • Mental health parity Act 1996: Ensures equal coverage for mental and physical illness equal life time and annual limits 369. • Mesocortical pathway: • VTA to prefrontal cortex • Reduced dopamine in this pathway cause NEGATIVE symptoms of Schizophre- nia 370. • Mesolimbic system: • Increased dopamine in this pathway causes POSI- TIVE symptoms of Schizophrenia 371. • Metabolic syndrome: • * First sign = Increased Waist Circumference • Group of signs and symptoms including insulin resistance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDL 372. • Mini-Cog: • Is another screening tool that can be administered in 5 minutes or less and requires minimal training: • 3 item recall • clock drawing test (CDT) 373. • MMSE (FOLSTEIN) - MEMORIZE THESE NUMBERS: • 25-30 May be normal • 21-24 Mild/Early • 10-21 Moderate • 0-9 Severe 374. • Mood disorder questionnaire screening: • Use mood questionnaire on any patient with mood lability - LABILE MOOD Positive Screen - All 3 of the following criteria must be met: • Question 1: 7 out of 13 positive (yes) responses • Question 2: Positive (yes) response • Question 3: "Moderate" or "Serious" response 375. • Moro reflex absent: • Do X-ray • The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement in response to the sound, the baby throws back his or her head, extends out the arms and legs, cries then pulls the PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 47 / 58 arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months • All reflexes should go away by 4-6 months EXCEPT for Babinski reflex that may persist until 24 months 376. • Motivational interviewing: • Focused, goal-directive therapy • Builds on the Trans-theoretical Model of Change • Motivation is elicited from the client • Non-confrontational, non-adversarial Examples • May we talk about • Your test shows • You are very courageous • You want to change but • Let's see if I got it • A collaborative • Person-centered form of guiding to elicit and strengthen motivation for change 377. NEUROTRANSMITTERS: • Alzheimer's - DECREASED ACH. - Impaired Memory • Parkinsonian SX - INCREASED ACH. • Bipolar - INCREASED GLUTAMATE • AUTISM - Glutamate, Serotonin, & GABA 378. Nigrostriatal pathways (basal ganglia): CAUSES EPS when Dopamine is DECREASED • EPS due to low dopamine in this area • * Communication from SNPC of the BASAL GANGLIA to the STRRIATUM • (Caudate + Putamen) of the BG via DPA? • * Clozaril can help NEGATIVE SX of Schizophrenia - Have to try TWO other medications and document BEFORE Clozaril. • WATCH Dirty Medicine • Communication from SNPC of the basal ganglia to the striatum (caudate+puta- men) of the BG via DA 379. ATYPICAL VS TYPICALS: Typical - ONLY TREAT POSITIVE SYMPTOMS and CAN CAUSE NEGATIVE SX. • Cheap • More harmful side effects PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 50 / 58 • Difficulty writing (agraphia) • Aphasia (difficulty of language) 396. • Promote resilience in schizophrenia for a patient that lives along and doing well: • Refer peer support • OR Case Manager OR ACT Team 397. • Pt on lithium and Depakote with temp, right flank pain, brown colored urine, what do you: • LFT • It does NOT matter which med the client is on, you want to check LIVER function • Hepatitis could be indicated by right flank pain (If patient complains of right upper quadrant pain at home - needs to go to ER) • Check LFT first - if fine, check CREATININE - due to dark colored urine 398. • Pt states that God did this to me: • Assess spiritual needs 399. • PT taking a breathing treatment Albuterol/Proventil: • Do not take MAOI or TCA 400. • Sensitivity: • True positive/ True positive + False negative 401. • Signs of amphetamine intoxication: • Tears, runny nose, restlessness, HTN, Tremors, Insomnia 402. • Social anxiety disorder: • Beta blocker • Propranolol 403. • Solution therapy: • Conducted through direct observation of clients' re- sponses to a series of precisely constructed questions 404. • Standard of practice: ANA 405. • Stereognosis: • Identify an object without sight • the mental perception of depth or three-dimensionality by the senses, usually in reference to the ability to perceive the form of solid objects by touch. • A sense that allows a person to recognize the size, shape, and texture of an object • Stereognosis abnormality in the Parietal lobe 406. • Tagamet (Cimetidine)_Antacid_H2 blocker: • Increase Benzo • Increase Coumadin • Prevents acid from backing up into the esophagus and causing heartburn 407. • Tegretol (Carbamazepine): • ANC/WBC: Tegretol is well know for Agranu- locytosis!!! PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 51 / 58 408. • Tourette Syndrome: • Involuntary, spasmodic, twitching movements; un- controllable vocal sounds; and inappropriate words • TICS for 1 year • Has to occur by 18 years old • Usually occurs by 3-9 years old 409. Trazodone (Desyrel): • Get EKG • The most severe reactions reported to have occurred with overdose of Trazodone have been priapism, respiratory arrest, seizures, and ECG changes, including QT prolongation. • Get an eye exam can cause Glaucoma 410. • Treating a 6 Y/O patient who has DX with Leukemia 1 month ago. What do you expect?: • He would think he is being punished for doing something wrong 411. • Turner Syndrome: • A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of the X chromosome is deleted • Delayed puberty, short id, 10-16 years old • Amenorrhea • Web neck, osteoporosis, lymphedema • Poor social skills 412. • WATCHERS for GAD_3 of these for 6 months: • Worry • Anxiety • Tension in muscles • Concentration • Hyperarousal • Energy loss, fatigue • Restlessness • Sleep trouble 413. • What 3 atypical can be used with teens?: • Seroquel • Abilify • Zyprexa 414. • What are the 3 CK muscle enzyme test?: • CKBB • CKMM • CKMB (normal 0.3 mmcg/L) 415. • What are the various controlled substance classes?: • Schedule I: Nobody has these (researchers sometimes) not good for health/heroin, PCP, MDMA PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 52 / 58 • Schedule II: Significant abuse potential Morphine, methadone, methylphenidate • Schedule III: Moderate abuse potential Hydrocodone, codeine • Schedule IV: Low abuse potential Benzos, Ambien, Phentermine • Schedule V: Very low abuse potential Anti-tussive, Lomotil 416. • What classes of Controlled Substances is the NP approved to pre- scribe?: • Schedules II-V only 417. • What do Birth control pills do to Lamictal?: • Inducer- will low level of Lamictal 418. • What does a 17 on MMSE mean?: • Moderate Cognitive impairment 419. • What does a decreased retic count indicate?: • Anemia: Acute or chronic bleeding • Normal range: 0.5 percent to 1.5 percent 420. • What does an increased retic count indicate?: • Bone marrow disorder or Vitamin deficiency • Normal range: 0.5 percent to 1.5 percent 421. • What does a sed rate measure?: • Inflammation (ESR: Erythrocyte Sedi- mentation Rate) = distance in mm RBC's have descended in 1 hour. • The sed rate test measures how fast red blood cells fall to the bottom of a tube. Inflammation creates proteins that make red blood cells fall more quickly. • Infection (including of the bones) • Cancer • Arteritis (inflammation of the blood vessels) • Lupus (an autoimmune disease that damages the skin, joints, and other parts of your body) • Polymyalgia rheumatica (causes stiff and painful muscles) • Rheumatoid arthritis (autoimmune disease in which the immune system attacks your joints) • Systematic vasculitis (inflammation in your blood vessels) 422. • What does Depakote do to Lamictal: • Depakote inhibit (note that it is not related to CYP) Lamictal metabolism and cause INCREASING Lamictal level • Lamictal is well known for Risk of Rash and Steven-Johnson Syndrome PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 55 / 58 442. • What is included in the treatment of fibromyalgia?: • Sleeping meds • Antidepressants • Pain meds • MEDICATION: Lyrica, Cymbalta, Gabapentin. 443. • What are Lyrica & Gabapentin Used for?: • Med Class: Alpha-2 delta Ligands (know class) • Lyrica & Gabapentin are FDA-approved for four PAIN uses: • Postherpetic Neuralgia (PHN) - pain that appears before, during, or after having shingles (Lyrica & Gabapentin) • FIBROMYALGIA - LYRICA ONLY • Neuropathic Pain associated with spinal cord injuries ( LYRICA) • Neuropathic pain associated with Diabetes (LYRICA ONLY) 444. • What is often common to patients with fibromyalgia?: • Sexual abuse 445. • What is pseudo-dementia?: • Cognitive impairment secondary to depres- sion that clears when treated in the elderly. Dementia won't improve 446. • What is Tegretol (Carbamazepine) in the CYP 450 system?: •INDUC- ER!!! Inducer: Will decrease level of Lamictal and birth control pills 447. • What is the benefit of play therapy?: • Don't have to confront emotions head on 448. • What is the concern when prescribing Lamictal with Depakote?: • divalproex added to lamotrigine will essentially double lamotrigine blood levels and can increase risk of a serious rash 449. • What is the different between a healthcare agent, proxy, surrogate, and attorney in fact?: • Nothing, they are all the same 450. • What is the evil eye? (CULTURAL): • When a stronger or more powerful person looks at a weaker person- often infant/child resulting in a hex which presents in illness such as headache, fever, diarrhea, disturbed sleep, increased fussiness 451. • What is the impact of steroid inhalers on children?: • Slows bone growth and may decrease ultimate height • Steroids CAN cause MANIA • If you have a client with Bipolar who has been stabilized on meds and becomes manic AFTER starting steroid inhaler - it is due to the med and the psych med will need to be adjusted accordingly. PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 56 / 58 452. • What is the long-term impact of using steroid inhalers?: • Cataracts, Glaucoma, thinning of bones and skin 453. • What is the neurotransmitter problem in ADHD (ADH anN D: N for NE D for DA)?: • Dopamine, Norepinephrine, and serotonergic dysfunction 454. • What is the neurotransmitter problem in schizophrenia?: • Excess dopamine in Mesolimbic pathway (positive symptoms) • Decreased dopamine in mesocortical pathway (negative symptoms) 455. • What is the purpose of HIPAA?: • National standards for electronic HC transactions • National ID for providers, health plans and employers • NOT simply confidentiality 456. • What is the purpose of Motivational interviewing?: • Explore ambiguity • Maintain passive position 457. • What is the purpose of telepsychiatry?: • Increase the ability to reach rural and underserved areas 458. • What is the risk of a seriously elevated CKMB?: • Polymyositis • Rhabdomyolysis 459. • What is the scoring with the Beck depression inventory?: • Self-report 0-63 • 0-13 minimal • 14-19 mild • 20-28 moderated • 29-63 severe 460. • What labs do you get for RA?: • Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP • CRP and ESR are both increased in AR but NOT in osteoarthritis 461. • What medications are at risk to cause SJS in Asian population?: • HLAB 1502 Allele increase risk of SJS • Trileptal • Tegretol • Other Anti-epileptic medications 462. • What neurotransmitters are involved in the bioamine hypothesis of depression?: • Serotonin • Norepinephrine • Dopamine PMHNP Certification Exam Study online at https://quizlet.com/_bnetcg 57 / 58 • MAOIs inhibit MSO's which break down neurotransmitters. So it allow increase it the amount in the synapse 463. • What part of the brain is involved with OCD?: • Occipitofrontal • Basal Ganglia 464. • What psycho medications are first line treatment for Fibromyalgia?: • Cymbalta • Effexor • Elavil • Pamelor • Lyrica • Gabapentin • Ultram • Benzos 465. • What psycho medications does Detrol (antimuscarinic med for relaxing the bladder muscles to treat overactive bladder) interact with?: • Topamax (anticonvulsant) • KCL (Potassium chloride) • Zonegran (anticonvulsant) 466. • What should you watch for with Tegretol?: • Agranulocytosis and Hy- ponatremia (Normal Sodium Level = 135-145 mEq) 467. • When do females typically present with schizophrenia?: • 25-35 years old (FEMALE) • If patient presents with psychotic symptoms at age 45, there is likely an underlying medical or other mental health diagnosis. 468. • When do you assume informed consent?: • Unconscious • Incompetent • Life threatening situation 469. • When is HIPAA not required?: • Emergency treatment • Substantial communication barriers and consent is inferred • Involuntary commitment 470. • When might you see toxic epidermal necrolysis?: • With worsening of SJS 471. • Which drug affects Carbamazepine (Tegretol)?: • Erythromycin (IN- HIBITOR) will cause toxic levels. You will need to decrease Tegretol 472. • Who can declare a patient incompetent and appoint a guardian?: • The court