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PMHNP Comprehensive Exam Questions
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AIMS Answer- Abnormal Involuntary Movement Scale for 8 and older 12 item tool to assess symptoms of tardive dyskinesia for patients taking antipsychotics Rating 0-4, >2 to diagnose TD and reduce dose BARS Answer- Barnes Akathisia Rating Scale for 8 and older 4 item tool to assess objective and subjective symptoms of akathisia with antipsychotics and/or SSRIs CRS-R Answer- Connors Rating Scales - Revised for 3- 17 ADHD Parent (80 items) and Teacher Scales (59 items) Low T-score of 61= mildly atypical; >70 = markedly atypical Subscales for Oppositional Behaviors, Cognitive Problems, Hyperactivity, ADHD Index, Anxious-Shy, Perfectionism, Social Problems, DSM-IV Subscales and Connors' Global Index Vanderbilt ADHD Parent and Teacher Answer- 55 parent, 43 teacher items for 6- 12 Initial assessment rates symptoms and impairment in academic and behavioral performance ASRS-1 Answer- Adult ADHD Self-Report Scale, 16 and older Two-part Screening Part A: 6 questions, 4 symptoms suggest ADHD Part B: 12 questions to clarify and quantify AUDIT-C Answer- Alcohol Use Disorders Identification Test - Consumption, > 13 Documents use and frequency in prior year 0 - 4, F >3 = positive, M >4 = positive, >8 = hazardous drinking CAGE-AID Answer- IDs problem drinking or druging, 13 and older (C=cut down, A=annoy, G=guilty, E=Eye-opener, AID=altered to include drugs CRAFFT Answer- 6 - item screen for alcohol or drugs in adolescents, 14- 18 (C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble) BAI Answer- Beck Anxiety Inventory, 17 and older Assesses 21 symptoms of anxiety, 0-36 scores HAM-A Answer- Hamilton Anxiety Scale, most commonly used
14 domains, 14=mild, 18-24= moderate, 25-30=severe LSAS-CA Answer- Liebowitz Social Anxiety Scale-Child/Adolescent Version, 7 and older 24 items, social and performance 55 - 65=moderate social phobia, 65-80=marked, 80-95=severe, >95=very severe MMSE Answer- Mini Mental Status Exam 30 items, 24-30= no cognitive impairment; 18-23=mild cognitive impairment; 0- 1 7= severe cognitive impairment MOCA Answer- Montreal Cognitive Assessment
26=normal, add point for <12th grade education SPMSQ Answer- Short Portable Mental Status Questionnaire 10 items, more than 3 incorrect indicates dementia BDI-2 Answer- Beck Depression inventory, 13 and older presence and impact of depressive symptoms 21 items, <10=normal; 11-17=mild depression; 18-23=moderate; 24+=severe CCSD Answer- Cornell Scale for Depression in Dementia 19 items, <6=no significant depression; 8-17=probable major depression; >18=definite depression MDQ Answer- Mood Disorder Questionnaire Screen for mania or hypomania positive if 7 or more of 13 items in question #1 present and #2 is yes and #3 gets moderate or serious problem response YMRS Answer- Young Mania Rating Scale, 11 items (adult) Range 0-60; adults with 12 or more=mania CY-BOCS Answer- ... YBOCS Answer- Yale-Brown Obsessive Compulsive Scale 10 items; age 14 and older gold standard for OC symptoms score indicates level of severity BPRS Answer- Brief Psychiatric Rating Scale, 18 and older Assesses psychopathology (+, - and affective) with schizophrenia, not for screening or DX
PANSS Answer- Positive and Negative Syndrome Scale, 18 and older measures changes in symptom intensity in psychosis and schizophrenia
hypermagnesemia Answer- N/V, respiratory depression, hypotension, depressed skeletal muscle contraction and nerve function, bradycardia Potassium, K+ Answer- 3.5-5.1 mEq/L hyperkalemia Answer- chronic marijuana use can elevate potassium Chloride, Cl Answer- 98 - 106 passive transport through sodium major anion in the extracellular fluid Liver - ALT Answer- 5 - 35 U/L - depakote can increase, safe to use up to 2 times normal limit Liver - AST Answer- 5 - 40 U/L slight elevation can occur in DT's depakote can increase, safe to use up to 2 times normal limit Liver - GGT Answer- 10 - 38 IU/L Thrombocytopenia Answer- Platelet count normal = 150,000-450, if below - bone marrow doesn't make enough platelets. or bone marrow makes enough platelets, but the body destroys them or uses them up. or - The spleen holds on to too many platelets. The spleen is an organ that normally stores about one-third of the body's platelets. It also helps your body fight infection and remove unwanted cell material. can be caused by Valproate Neutropenia Answer- A normal ANC is above 1,500 cells per microliter. An ANC less than 500 cells/μL is defined as neutropenia and significantly increases the risk of infection. Neutropenia is the condition of a low ANC, Clozapine - WBC => 3500 to initiate therapy, ANC MUST BE =>2000/mm, ck wbc/anc weekly x 6 months, then Q other week for 6 months; if stable then Q 4 weeks. after therapy test for at least 4 weeks, LIVER PANEL Answer- ALP, AST, ASP, BILIRUBIN, ALBUMIN, TTL PROTEIN, CBC with WBC DIFFERENTIAL, PLATELET COUNT. FOR VALPROATE THERAPY - CK BASELINE AND MONTHLY FOR SEVERAL MONTHS CREATININE Answer- 0.5-1.2 normal, kidney damage if elevated , athletes may be higher BUN Answer- 10 - 20 mg/dL
LITHIUM THERAPY Answer- CREATININE/BUN, SERUM ELECTROLYTES, CBC W/WBC & DIFF, URINALYSIS, EKG, ck levels (post dose 12 hrs trough), after 4 days on med, then q 4-5 days during initial therapy lithium levels during acute tx Answer- 0.8 - 1.2, during maintenance 0.6 - 1. ALP Answer- 44 - 147 CK, creatine kinase Answer- <240, indicates muscle injury of heart, brain, skeletal muscle, elevated in MI, myositis, rhabdomysitis BUN Answer- 10 - 20, increased in impaired kidney function, significant dehydration, measure with lithium Creatinine Answer- 0.4-0.8, may vary with age gender, ethnicity, more sensitive then bun, GFR Answer- >90, best measurement of kidney function, no need to adjust dose depakote if GFR > 60 SIGNS OF LITHIUM TOXICITY Answer- nystagmus, ataxia, increased deep tendon reflexes, altered mental status, cardiac arrhythmias what meds do to lithium Answer- ACE inhibitors, ARB's, nsaid, tetracyclines, metronidazole can INCREASE LITHIUM DECREASES LITHIUM LEVELS Answer- potassium-sparing diuretics, thiazide diuretics, theophyline decreases lithium Examples of ARB's Answer- ALL INCREASE LITHIUM Valsartan Telmisartan Losartan Irbesartan Irbesartan Azilsartan Olmesartan Olmesartan Examples of Ace Inhibitors Answer- ALL INCREASE LITHIUM Enalapril (Vasotec/Renitec) Ramipril (Altace/Prilace/Ramace/Ramiwin/Triatec/Tritace) Quinapril (Accupril) Perindopril (Coversyl/Aceon/Perindo) Lisinopril (Listril/Lopril/Novatec/Prinivil/Zestril)
Certification Answer- Credential that provides title protection Determines scope of practice Is the process by which a professional organization/association certifies that an individual licensed to practice as a professional has met certain predetermined standards Assures the public that an individual has mastery of a body of knowledge Assures that the individual has acquired the skills necessary to function in a particular specialty ANCC only one for psych Scope of practice Answer- Defines NP roles and actions Identifies competencies assumed to be held by all NPs who function in a particular role Has broad variations from state to state Standards of Practice Answer- Gives authoritative statements regarding the quality and type of practice that should be provided Provides a way to judge the nature of care provided Reflects the expectation for the care that should be provided to patients with various illnesses Reflects professional agreement focused on the minimum levels of acceptable performance Can be used to legally describe the standard of care that must be met by a provider May be precise protocols that must be followed or more general guidelines that recommend actions Four Rights of HIPAA Answer- 1. To be educated about HIPAA privacy protection
- To have access to their own medical records
- To request amendment of their health information to which they object
- To require their permission for disclosure of their personal information HITECH Answer- Incentive payments for sharing specific EHR data Meaningful use incentives Improves outcomes Exceptions to confidentiality Answer- Intent to harm self or others Attorneys involved in litigation When records are released to insurance companies Answering court orders, subpoenas, summons Mandatory reporting of disease and conditions Tarasoff principle: Duty to warn potential victims of imminent danger of homicidal patients Child/elder abuse Justice Answer- Doing what is fair, fairness in all aspects of care
Beneficience Answer- Promoting well being and doing good Nonmalfeasance Answer- Doing no harm Fidelity Answer- Being true and loyal Autonomy Answer- Doing for self Veracity Answer- Telling the truth Respect Answer- Treating everyone with equal respect Deontological Theory Answer- An action is judged as good or bad based on the act itself regardless of the consequences Teleological Theory Answer- An action is judged as good or bad based on the consequence or outcome Virtue Ethics Answer- Actions are chosen based on the moral virtues (honesty, courage, compassion, wisdom, gratitude, self respect) or the character of the person making the decision Four elements of negligence to prove malpractice Answer- Duty: NP had a duty to exercise reasonable care when undertaking and providing treatment to the patient Breach of duty: NP violated the applicable standard of care in treating the patient's condition Proximate cause: causal relationship between the breach in the standard of care and the patient's injuries Damages:there are permanent and substantial damages to the patient as a result of the breach in the standard of care Commitment Criteria Answer- Person has a diagnosed psychiatric disorder Person is harmful to self or others as a consequence of the disorder Person is unaware or unwilling to accept the nature and severity of the disorder Treatment is likely to improve functioning Primary Prevention Answer- Aimed at decreasing the incidence (number of new cases) of mental disorders (prevention) Secondary Prevention Answer- Aimed at decreasing prevalence (number of existing cases) of mental disorders (screening) Tertiary Prevention Answer- Aimed at decreasing the disability and severity of a mental disorder (rehab)
How is countertransference usually dealt with Answer- Supervisory process and in talking to coworkers about the issues Erikson: Infancy Answer- 0 - 1 Trust vs Mistrust Erikson: Early childhood Answer- 1 - 3 Autonomy vs Shame and Doubt Erikson: Late childhood Answer- 3 - 6 Initiative vs Guilt Erikson: School age Answer- 6 - 12 Industry vs Inferiority Erikson: Adolescence Answer- 12 - 20 Identity vs Role Confusion Erikson: Early adulthood Answer- 20 - 35 Intimacy vs Isolation Erikson: Middle adulthood Answer- 35 - 65 Generativity vs Self Absorption or Stagnation Erikson: Late adulthood Answer- over 65 Integrity vs Despair Principle of Psychic Determinism Answer- Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content Freud Oral Stage Answer- 0 - 18 mths; sucking, chewing, feeding, crying (schizophrenia, substance abuse, paranoia) Freud Anal Stage Answer- 18 mths-3 years; sphincter control, activities of expulsion and retention (Depressive) Freud Phallic stage Answer- 3 - 6; Exhibitionism, masturbation, oedipal, castration anxiety, female fear of lost maternal love (sexual identity disorders) Freud Latency stage Answer- 6 - puberty; peer relationships, learning, motor skills development, socialization (inability to form social relationships) Freud genital stage Answer- puberty forward; integration and synthesis of behaviors from early stages, primary genital based sexuality (Sexual perversion disorders) Id Answer- primary drives or instincts, urges (hunger, sex, aggression) largely unconscious pleasure principle, immediate satisfaction present at birth "I want" Ego Answer- external reality rational mind; responsible for logical and abstract thinking adaptation
reality principle defense mechanisms "I think, I evaluate" Superego Answer- ego ideal sense of conscience or right vs wrong aspirations, ideals, moral values guilt and shame "I should or ought" Denial Answer- Avoidance of unpleasant realities by unconsciously ignoring their existence Projection Answer- unconscious rejection of emotionally unacceptable personal attributes, beliefs, or actions by attributing them to other people, situations, or events Regression Answer- return to more comfortable thoughts, behaviors, or feelings used in earlier stages of development in response to current conflict, stress, or threat Reaction formation Answer- often called overcompensation; unacceptable feelings, thoughts, or behaviors are pushed from conscious awareness by displaying and acting on the opposite feeling, thought or behavior Rationalization Answer- justification of illogical, unreasonable ideas, feelings, or actions by developing an acceptable explanation that satisfies the person Undoing Answer- behaviors that attempt to make up for or undo an unacceptable action, feeling, or impulse Intellectualization Answer- attempts to master current stressor or conflict by expansion of knowledge, explanation, or understanding Suppression Answer- conscious analog of repression; conscious denial of a disturbing situation, feeling, or event Sublimation Answer- unconscious process of substitution of socially acceptable, constructive activity for strong unacceptable impulse Altruism Answer- meeting the needs of others in order to discharge drives, conflicts or stressors Piaget Sensorimotor Answer- birth-2; object permanence Piaget Preoperational Answer- 2 - 7; more extensive use of language and symbolism; magical thinking
Frontal lobe functions Answer- Motor function (controlling voluntary motor activity) Premotor (coordinates movement of multiple muscles) Association Cortex (allows for multimodal sensory input to trigger memory and lead to decision making) Seat of executive functions (working memory, reasoning, planning, prioritizing, sequencing behavior, insight, flexibility, judgment, impulse control, behavioral cueing, intelligence, abstraction) Language (broca's area) expressive speech Personality variables Temporal lobe: Wernicke's Area Answer- Receptive speech or language comprehension (primary auditory area) What lobe function includes memory, emotion, integration of vision with sensory information Answer- Temporal lobe (issues can lead to visual or auditory hallucinations, aphasia, amnesia) Primary function of occipital lobe Answer- Primary visual cortex Integration area: Integrates vision with other sensory information (Problems can lead to visual field defects, blindness, visual hallucinations) Primary functions of parietal lobe Answer- Primary sensory area Taste Reading and writing (Problems can lead to sensory-perceptual disturbances and agnosia) What is included in the cerebrum Answer- Cerebral cortex Limbic system Thalamus Hypothalamus Basal Ganglia Cerebral cortex controls the... Answer- Contralateral side of the body (opposite) Speech, cognition, judgment, perception, motor function Limbic system regulates... Answer- Emotions and memory Limbic system is composed of... Answer- hypothalamus, thalamus, hippocampus, amygdala The hypothalamus.... Answer- Plays key roles in various regulatory functions such as appetite, sensations of Hunger and thirst, water balance, circadian rhythms, body temp, libido, and Hormonal regulation
Thalamus... Answer- Sensory relay station except for smell, modulates flow of sensory information to prevent overwhelming the cortex; regulates emotions, memory, and related affective behaviors The hippocampus... Answer- Regulates memory and converts shot term memory into long term memory Hippos never forget The amygdala... Answer- responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions The basal ganglia is also known as the Answer- corpus striatum What does the basal ganglia do Answer- modulate and stabilize somatic motor activity (info from CNS to skeletal muscles) Movement initiation Learning and automatic actions like walking/driving extrapyramidal motor system or nerve track involuntary motor activities Psychotropic meds affect this track and cause involuntary movements Contains caudate and putamen (Problems here can lead to bradykinesia, hyperkinesia, and dystonia) What does the brainstem include Answer- midbrain, pons, cerebellum, medulla, cerebellum, reticular formation The midbrain... Answer- houses the ventral tegmental area and the substantia nigra (dopamine synthesis) The middle of the brain and the nigras are dope The pons.... Answer- Houses the locus ceruleus (norepinephrine synthesis) Ponies circle up around norris newton Medulla... Answer- with the pons, contains autonomic control centers that regulate internal body functions The cerebellum is responsible for.. Answer- maintaining the equilibrium, acts as a gross movement control center (movement balance posture) Each hemisphere of the cerebellum has.....control Answer- ipsilateral (same side of body) Problems with the cerebellum can lead to.. Answer- ataxia (uncoordinated and inaccurate movements)
Produced in locus ceruleus of the pons Major neurotransmitter implicated in mood, anxiety, and concentration disorders Epinephrine also known as Answer- Catecholamine Produced by the adrenal glands Also referred to as the adrenergic system Serotonin is known as Answer- Indole Produced in raphe nuclei Precursor is trytophan Major transmitter implicated in mood and anxiety Amino acids include... Answer- glutamate GABA glycine aspartate Glutamate Answer- Universal excitatory neurotransmitter Involved in kindling (seizure d/o and bipolar) Mood disorders and schizophrenia if imbalanced Aspartate Answer- Excitatory neurotransmitter that works with glutamate GABA Answer- Universal inhibitory neurotransmitter Site of action of benzodiazepines, alcohol, barbiturates, and other CNS depressants Glycine Answer- Inhibitory neurotransmitter that works with GABA Cholinergics Answer- Acetylcholine Acetylcholine Answer- synthesized by the basal nucleus of Meynert Precursors are aceylcoenzyme A and choline Neuropeptides Answer- Nonopiod type: Substance P, somatostatin Opioid type: endorphins, enkephalins, dynorphins Modulate pain, decreased amount is thought to cuase substance abuse Acetylcholine decrease thought to cause.... Answer- Alzheimers and Impaired memory Acetylcholine increase thought to cause... Answer- Parkinsoian symptoms Dopamine increase thought to cause... Answer- Schizophrenia/psychosis Dopamine decrease thought to cause... Answer- Substance abuse, anhedonia, Parkinson's
Norepinephrine decrease thought to cause... Answer- depression Norepinephrine increase thought to cause... Answer- Anxiety Serotonin decrease thought to cause... Answer- Depression, OCD, anxiety, schizophrenia GABA decrease thought to cause... Answer- anxiety Glutamate increase thought to cause... Answer- Bipolar affective disorder, psychosis from ischemic neurotoxicity/excessive pruning Glutamate decrease thought to cause... Answer- Memory and learning difficulty or negative sx of schizophrenia Opioid neuropeptides decrease thought to cause... Answer- substance abuse 2 most common types of structural imaging Answer- CT: 3D view of brain structures; density; inexpensive; cannot differentiate gray and white matter MRI: Series of 2D images that represent the brain; separates white and gray matter; expensive and many contraindications Functional imaging tests Answer- EEG MED SPECT PET Autosomal dominant conditions... Answer- May be present in more than one generation and in up to 50% of offspring when one parent is affected Recessive conditions... Answer- Appear in only one generation affect individuals who have two copies of a faulty gene, one from each unaffected parent X linked disorders... Answer- Caused by faulty genes on an X chromosome What is required testing for people of Asian decent prior to prescribing carbamazepine Answer- HLA B*1502 allele Epidemiology Answer- Study of the distribution, incidence, prevalence, and duration of a disease Incidence Answer- Number of new cases occurring over a specified time Prevalence Answer- Number of existing cases of a disorder at a specified time
Cranial nerve 5--Motor Answer- Trigeminal Palpate masseter muscles while pt clenches teeth Look for tremor in lips, involuntary chewing movements, spasms Cranial Nerve 5--Sensory Answer- Trigeminal Tactile perception of the facial skin by touching w/cotton Corneal reflex Superficial pain with pinpricks Touch in oral mucosa Cranial nerve 6 Answer- Abducens Same as for 3 and 4 Cranial nerve 7--Motor Answer- Facial Elevate eyebrows wrinkle forehead, close eyes, frown, smile, puff cheeks Cranial nerve 7--Sensory Answer- Facial Test taste for sugar, vinegar, salt Cranial nerve 8 Answer- Acoustic Whisper test Weber and Rinne tests Cranial nerve 9 Answer- Glossopharyngeal Test with 10 Cranial nerve 10 Answer- Vagus Say ah Gag reflex with tongue blade Cranial nerve 11 Answer- Accessory spinal Shrug shoulders against resistance Cranial nerve 12 Answer- Hypoglossal Look for tremors and other movement when sticking out tongue Diadochokinesia Answer- Rapid alternating movements Thumb to finger or patting knees with palms and backs of hands Dyssynergia Answer- Finger to nsoe and heel to knee What makes up the MSE Answer- Appearance Behavior Mood Affect Thought processes
Thought content Flight of ideas Answer- Speech pattern characterized by accelerated speech and rapid shifts in topic Disorganized, difficult to follow, but syntax and vocabulary remain intact Loose association Answer- Shift in thinking in which ideas move from one apparently unrelated topic to another Poverty of content Answer- Vague, repetitive, and abstractive form of speech that contains many words but little information Neologisms Answer- Word inventions or unusual application of current words that while having personal significance to the person, have no apparent meaning for the listener Circumstantiality Answer- Inclusion of unnecessary detail and parenthetical information into the conversation Tangentiality Answer- Shifts in topics that often start as related shifts but progressively move farther and farther away from the original topic Clanging Answer- Form of loose association in which topics change on the basis of sounds of words rather than meaning of words Word salad Answer- Form of very disorganized speech in which syntax is lost and word use is random and idiosyncratic Perseveration Answer- Persistent repetition of words or phrases Confabulation Answer- Fabrication of facts and details to fill gaps in memory Blocking Answer- Sudden stopage of speech attributed to losing though or forgetting what was being talked about Echolalia Answer- Echoing of words or phrases just spoken by another Structured Date of the MSE Answer- Orientation: Person, place, time Concentration: digit span, serial number, backward spell Memory: long term, president, event, short term, three object, immediate recall, number string Abstraction: proverb, similarity Insight Judgment Mini mental status exam Answer- Orientation Registration: 3 objects, repeat, 5 minutes later
