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PMHNP Comprehensive Assessment Exam Latest
Reported Questions and Answers Uploaded 2025.
What is dissemination? -Answers- Getting the research information out to those who need to know it! Publication - highest level Presenting at National Conference Presenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? -Answers- Moderate cognitive impairment What is Tegretol in the CYP450 system? -Answers- Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? -Answers- Inducer - will lower dose of Lamictal What is a Type I research error? -Answers- There IS a difference but you say there isn't a difference. What is a Type II research error? -Answers- There is NO difference but you say there is a difference. What is pseudo-dementia? -Answers- Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve. Is it normal for a 1 month old to have a palmar grasp? -Answers- Yes. What is a drug 1/2 life? -Answers- The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? -Answers- Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? -Answers- Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? -Answers- HLAB- When might you see toxic epidermal necrolysis? -Answers- With worsening of SJS How many generations do you include for a genogram? -Answers- 1st degree - mother, father, siblings 2nd degree - grandparents & cousins
3rd degree - What does messenger RNA code for? -Answers- Amino Acids What is epigenetics? -Answers- Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? -Answers- Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? -Answers- Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? -Answers- 10-25 yo When do females typically present with schizophrenia? -Answers- 25-35 yo What does Erythromycin to trileptal? -Answers- You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? -Answers- Heart Failure HTN What are some psychiatric side effects seen with some asthma drugs -Answers- Leukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol? -Answers- Agranulocytosis and Hyponatremia What are the 3 CK muscle enzyme tests? -Answers- CKBB, CKMM, CKMB Which one of the 3 muscle enzymes are related to cardiac muscle damage? -Answers- CKMB What is the risk of a seriously elevated CKMB? -Answers- Polymyositis Rhabdo What is a normal CKMB? -Answers- 0.3 mcg/L What psychoactives does Detrol interact with? -Answers- Topamax KCL Zonegran What CN are you assessing when you have the patient shrug their shoulders? - Answers- CN XI - Spinal Accessory
Life Threatening Situation What are the legal ramifications of treating w/o informed consent? -Answers- Same as with informed consent Who can declare a patient incompetent and appoint a guardian? -Answers- Only a court Does impaired judgment mean one is incompetent? -Answers- No. Can an advanced directive ever be revoked? -Answers- Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? -Answers- Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? -Answers- No. How do Asians see HC providers? -Answers- As in a position of authority. Expect to give instructions and help make decisions What does it mean when an Asian patient does not make eye contact with the NP? - Answers- SIgn of respect What is the evil eye? -Answers- 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 HA, fever, diarrhea, disturbed sleep, increased fussiness. How do you protect from the evil eye? -Answers- Red ribbon on an infant Amulet for adults How do you treat for evil eye? -Answers- Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? -Answers- Relationship What is a proximate cause? -Answers- Connection between A + B. For there to be damages, what must exist first? -Answers- Negligence What is an occurrence basis liability insurance? -Answers- "occurred" during the policy period, no matter when the claim is brought against the insured What is a claims made/based liability insurance? -Answers- provides coverage for a claim that is brought within the policy period, no matter when the loss occurred. Who sets the minimum requirements for NP's? -Answers- Board of Nursing State
What are the various controlled substance classes? -Answers- Schedule I - nobody has these - not good for health - heroin, PCP, MDMA, researchers can get it sometimes. Schedule II - Significant Abuse Potential - morphine, methadone, methyphenidate Schedule III - Moderate Abuse Potential - hydrocodone, codeine Schedule IV - Low Abuse Potential - benzo's, ambien, phentermine Schedule V - Very low abuse potential - anti-tussives, lomotil What classes of CS's is the NP approved to prescribe? -Answers- Schedules III-V ONLY. Where does 50% of healthcare funds come from? -Answers- The government Who is eligible for Medicare? -Answers- >65 or under 65 with diability, ANY age with renal disease. What is incident to billing? -Answers- Means MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD. Allows NP to get reimbursed at 100% rather than 85%. How are Medicaid benefits determined? -Answers- State determines qualification - Partnership between State and Fed Govt. Must be impoverished Must be US resident and low or very low income. Can you have Medicare and Medicaid? -Answers- Yes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? -Answers- Yes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? -Answers- National standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state -Answers- Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? -Answers- Can decline to treat
MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse. How do you test CN XII? -Answers- Stick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? -Answers- CN V - Trigeminal What are two important things to measure when using Zyprexa? -Answers- Lipid level and abdominal circumference What is included in the mini-cognitive exam? -Answers- Clock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? -Answers- Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? -Answers- Stop and repeat lab. Normal is 1500-8000 mm Can you take Buspar during pregnancy? -Answers- Category B - ok if really needed. Can you take Klonopin during pregnancy? -Answers- Category C - avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms. What is the concern when prescribing Lamictal with Depakote? -Answers- Both are CYP450 inducers of the other and therefore together will lower the level of both drugs. Can asthma medications cause depression? -Answers- Yes. If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? -Answers- Microalbumin? What is often common to patients with fibro? -Answers- Sexual abuse How is telepsychiatry evaluated? -Answers- Outcome based - measure at intervals. What happens with a patient taking Lithium and who gets dehydrated? -Answers- Levels increase What happens with a patient taking Lithium who decreases sodium intake? -Answers- Levels increase What happens with a patient taking Lithium and drinks a lot of water? -Answers- Levels decrease
If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? -Answers- Zyprexa What happens when taking Lithium and NSAIDS? -Answers- NSAIDS can cause Lithium levels to increase and for the patient to become toxic! What medications are at risk to cause SJS in the Asian population? -Answers- HLAB- 1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's. Amgdyla -Answers- Fear, Anxiety, and Aggression Neurotransmitter for Addiction -Answers- Dopamine and GABA Neurotransmitter for Mood Disorder -Answers- Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol -Answers- Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol Signs and Symptoms of stimulant abuse -Answers- insomnia and tremor Depakote check -Answers- HCG levels Depakote causes -Answers- Spinal bifida Grasp reflex. -Answers- an infantile reflex in which an infant closes her hand into a fist when her 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. Moro reflex. -Answers- 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 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. pincer grasp -Answers- 9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios. Pt has MI looses his job stable on psych medications -Answers- Provide brief supportive therapy Latida and Geodon -Answers- Take with food
Distinguishes between Human error (e.g. slips), At-risk behavior (e.g. taking shortcuts), Reckless behavior (e.g. ignoring required safety steps). In a just culture, the response to an error or near-miss is predicated on the type of behavior associated with the error, not the severity of the event. Child reports Sexual Abuse -Answers- Interview the young child and infants child with parent First sign of temprofrontal Dementia -Answers- Behavior and personalty changes Tow amines related to depression -Answers- Serotonin and norepinephrine Want to start an consulting firm what tool would be needed to show economic viability - Answers- Revenue and expenses Patient stopped smoking (Cessation) -Answers- Decreased Zyprexia Promote resilience in schizophrenia for a patient that lives alone and doing well - Answers- Refer to peer support Spirit stick -Answers- Teach staff about culture competence Problems in the parietal lobe can lead -Answers- Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) PDSA cycle -Answers- For Plan-Do-Study-Act. Describes how to test a change: by trying it, observing the consequences, and then learning from those consequences. Appreciative Inquiry -Answers- 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 Appreciative Inquiry -Answers- an organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work Appreciative Inquiry (AI) -Answers- Identify the problem Analyze the problem Generate Solutions
Implement Best Solutions Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) Appreciative Inquiry -Answers- Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) CIWA-Ar -Answers- Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do -Answers- Validate his experience and provide care in a culturally specific way to that patient Native American wants his healer present -Answers- Involve mother of the patient and healer, mom was cleared for you to involve her 16 year old shows up with mother for first therapy is -Answers- confidential mom sits in lobby Patient acts out due to missing session what do you do -Answers- You relate to childhood abandonment and talk about it with the patient How do you assess the competency of a medical procedure -Answers- Identify a pen and recall 3 words Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis -Answers- Delusional disorder Increase ICP (signs and symptoms) -Answers- Baby Neuro cry Menopausal woman -Answers- Hormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide -Answers- Stop medication immediately You want to decrease seclusion on your unit who considered the primary change agent -Answers- Unit staff You are a lead NP over other NPs in a rural setting how would you go about the change -Answers- Make online form and have them vote on it
Trazodone (Desyrel) -Answers- Get EKG. Trazodone (Desyrel) -Answers- Get an eye exam can cause Glaucoma Grapefruit juice or grapefruit -Answers- Increase trazodone PICOT -Answers- Patient population of interest Intervention of interest Comparison of interest Outcome Time limbic system -Answers- A doughnut-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. Amygdala -Answers- A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression. PANDAS -Answers- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD Mental Health Parity Act 1996 -Answers- ensure equal coverage for mental and physical illness equal life time and annual limits charge of DEA -Answers- state and federal Stereogenesis -Answers- identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object Sterogenesis abnormality in -Answers- parietal lobe Clozaril (Clozapine) -Answers- WBC- ANC LESS than 1000 (950) dc medication how treat child with depression -Answers- Zoloft and therapy 3 year old masturbates, plays with self, says naught things -Answers- normal for Piaget NMS treatment -Answers- Dantrolene: MUSCLE RELAXTION D2 agonists (e.g., bromocriptine). For NMS, think FEVER:
Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles mesolimbic system -Answers- POSITIVE symptoms of schizophrenia due to high dopamine negative symptoms of schizophrenia -Answers- the absence of appropriate behaviors (expressionless faces, rigid bodies) negative symptoms of schizophrenia -Answers- mesocorticol pathway mesocortical pathway -Answers- VTA to prefrontal cortex negative symptoms Nigrostriatal pathway -Answers- EPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA; used to initiate movement PDSA model -Answers- PLAN- Do-carry out Study -examine results Act-decide what action Tanner's stages -Answers- Tanner stages -Answers- MMSE (Mini Mental State Examination)- -Answers- Stage May be Normal 25- Mild/Early 21- Moderate 10- Severe 0- A pt states that she has been raped. What do you do -Answers- ensure safety Hamilton D score of 28 -Answers- Assess for Suicide Hamilton Depression Rating Scale -Answers- 17-21 questions 0-7 Normal 14-18 Moderate
20 Severe Depression
ODD what will you do to prevent it from becoming Conduct disorder -Answers- Therapy to target mood and aggression Herpes rooster 3 weeks later sleep difficulties and sad mood -Answers- Depression Schizophrenia in males -Answers- 18-25 years old Schizophrenia in Women -Answers- 25-35 years old signs of amphetamine intoxication -Answers- Tears, Runny nose, restlessness, HTN, Tremors, Insomnia Co-morbidities of bipolar -Answers- Anxiety, alcohol and substance abuse Big Freaking Problems -Answers- Bupropion Fluoxetine Paxil Medicare -Answers- A federal program of health insurance for persons 65 years of age and older Medicare Advantage -Answers- a program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrollee Medicare A, B, C, D -Answers- A: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs WATCHERS for GAD 3 of these *** for 6 months -Answers- worry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep trouble Transtheoretical Model of Change -Answers- 1. Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance Man working at the Gym and his urine is Cherry color -Answers- order myoglobinuria
Latino women wanting prenatal class -Answers- Consult with cultural group in community Anorexia -Answers- Set up family therapy quasi-experimental design -Answers- Research method similar to an experimental design except that it makes use of naturally occurring groups rather than randomly assigning subjects to groups. The ventricle enlargement observed in clients with -Answers- schizophrenia is most often accompanied by Encopresis Treatment -Answers- Behavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation Counseling Medication that contradicts albuterol -Answers- Adderall (amphetamine / dextroamphetamine) Advair Diskus (fluticasone / salmeterol) amoxicillin (Amoxil, Trimox, Apo-Amoxi, Moxatag, Amoxicot, DisperMox, Biomox, Moxilin, Wymox) Ativan (lorazepam) Atrovent (ipratropium) azithromycin (Zithromax, Azithromycin Dose Pack, Z-Pak, Zmax) Benadryl (diphenhydramine) caffeine Flonase (fluticasone nasal) ibuprofen ipratropium (Atrovent, Ipratropium Inhalation Solution, Atrovent HFA, Ipratropium Inhalation Aerosol) Lasix (furosemide) metoprolol (Metoprolol Succinate ER, Metoprolol Tartrate, Lopressor, Toprol-XL, Kapspargo Sprinkle) Mucinex (guaifenesin) oxycodone (OxyContin, Roxicodone, Xtampza ER, OxyIR, Oxaydo, Dazidox, Oxyfast, Oxecta, RoxyBond, Oxydose, Percolone, M-Oxy, ETH-Oxydose, Endocodone, Roxicodone Intensol) prednisone (Deltasone, Rayos, Sterapred, Prednicot, Sterapred DS, Liquid Pred, Meticorten, Orasone, Prednicen-M) Singulair (montelukast) Spiriva (tiotropium) Symbicort (budesonide / formoterol) Tylenol (acetaminophen) Vitamin B12 (cyanocobalamin)
Cohesiveness: Feelings of trust, belonging and togetherness experienced by the group members Existential factors: Members accept responsibility for life decisions Catharsis: Members release of strong feelings about past or present experiences Interpersonal learning- input Members gain personal insight about their interpersonal impact through feedback provided from other members Interpersonal learning- output Members provide an environment that allows members to interact in a more adaptive manner Self-understanding: m embers gain insight into psychological motivation underlying behavior and emotional reactions Metobolic syndrome -Answers- 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 NAMI -Answers- national alliance on mental illness help families of mentally ill: education, support groups health literacy -Answers- 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 health literacy -Answers- Man taking insulin asking him to read blood glucose level inferential statistics -Answers- numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population Mood Disorder Questionnaire (MDQ)-SCREENING -Answers- Mood Disorder Questionnaire Patient Name ______________________________________ Date of Visit ________________ Please answer each question to the best of your ability
- Has there ever been a period of time when you were not your usual self and... ...you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble? ...you were so irritable that you shouted at people or started fights or arguments? ...you felt much more self-confident than usual? ...you got much less sleep than usual and found that you didn't really miss it? ...you were more talkative or spoke much faster than usual? ...thoughts raced through your head or you couldn't slow your mind down? ...you were so easily distracted by things around you that you had trouble concentrating or staying on track?
...you had more energy than usual? ...you were much more active or did many more things than usual? ...you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? ...you were much more interested in sex than usual? ...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky? ...spending money got you or your family in trouble?
- If you checked YES to more than one of the above, have several of these ever happened during the same period of time?
- How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights? No problems Minor problem Moderate problem Serious problem This instrument is designed for screening purposes only and not to be used as a diagnostic tool. Permission for use granted by RMA Hirschfeld, MD YES NO Patient comes with vague symptoms depression irritability -Answers- BECK Depression scale DISSEMINATED ENCEPHALOMYELITIS -Answers- Assess for asymmetry of extremities Along with this pattern, the patients 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 HA CBT (cognitive behavioral therapy) -Answers- Anxiety popular integrative therapy that combines cognitive (thinking) and behavior therapy Impulsivity (ADHD) -Answers- Pre-Frontal Cortex Involves hasty actions taken without consideration of possible negative consequences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others. Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis - Answers- Hypogylcemia NSAIDS -Answers- Lithium toxicity
