PMHNP Exam: Questions & Answers for Nurse Practitioners, Exams of Psychiatry

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Descriptive Vividness - ANSWER The researcher describes the data gathering process in sufficient detail that the reader can personally experience it. The data collected, often in the form of personal statements, should be quoted directly and extensively, because this is the raw data from the study. Methodological Congruence - ANSWER The researcher presents the philosophical and methodological approach used and cites references to support their approach. The subjects, sampling method, data- gathering and data-analysis strategies, and processes for informed consent are clearly and concisely described. Theoretical Conectedness - ANSWER Any theory developed from the study is clearly stated, logically consistent, reflective of the data, and in accord with other available knowledge. Analytical Precision - ANSWER Is not concerned with statistics and instruments. If refers to the decision- making process by which the researchers synthesize concrete data (words of the subjects) into an abstract that clarifies the meaning and the importance of the study. The last of the 5 criteria is Heuristic Relevance - The researcher clarifies the significance of the study, its applicability to public health or community nursing, and its likely influence o the future research. Phenelzine - ANSWER An MAOI that patients with atypical depression respond particularly well to. Atomoxetine - ANSWER A norepinephrine reuptake inhibitor approved for the treatment of ADHD. Loxapine - ANSWER A typical, tetracyclic antipsychotic with antidepressant properties. Its active metabolite is amoxapine, which is a secondary amine tricyclic antidepressant. HITECH - ANSWER Implementation of EHR for information exchanges and improving population health. This was done by Obama and the ARRA.

Suppression - ANSWER The intentional or conscious exclusion of painful or disturbing thoughts or emotions from awareness. A healthy defense mechanism because the client channels conflicting energies into growth-promoting activities. Medications that can induce depression - ANSWER beta blockers, steroids, interferon, Accutane, benzodiazepines, progesterone, some antivirals, and antineoplasmics. Medications that can induce mania - ANSWER Steroids, Isoniazid, antidepressants (in people who already have bipolar disorder), and Antabuse. Medigap Insurance Policies - ANSWER Private insurance policies purchased by elderly individuals to cover some or all of their medical expenses not paid for by Medicare. Medicare Advantage Plan - ANSWER Formerly Medicare + Choice, this created regional Preferred Provider Organizations (PPOs) and gave Medicare enrollees the option of enrolling in private insurance plans. Medicare + Choice - ANSWER Was a part of the Balanced Budget Act of 1997 that significantly increase the number of managed care insurance plans available to recipients. This was replaced with the Medicare Advantage Plan in 200. List of the Second Generation (atypical) Antipsychotics (9) - ANSWER Clozaril (clozapine), Zyprexa (olanzapine), Latuda (lurasidone), ziprasidone, Risperdal (risperidone), Invega Sustenna (palperidone), Fanapt (iloperidone), Seroquel (quetiapine), Saphris (asenapine), List of First Generation (typical) Antipsychotics (10) - ANSWER Haldol (haloperidol), Prolixin (fluphenazine), Navane (thiothixene), Thorazine (chlorpromazine), Loxitane (loxapine), Mellaril (thioridazine), Trilafon (perphenazine), Orap (pimozide), Solian amisulpride), Stellazine (trifluoperazine) List the 6 common benzodiazepines in order from shortest to longest half-life - ANSWER Xanax (alprazolam): 6-10 hrs Serax (oxazepam): 8 hrs

Ativan (lorazepam): 12-18 hrs Klonopin (clonazepam): 30-40 hrs Valium (diazepam): 100 hrs Librium (chlordiazepoxide): 36-200 hrs List of SNRIs (6) - ANSWER Cymbalta (duloxetine), Pristiq (desvenlafaxine), Effexor (venlafaxine), Fetzima (levomilnacipran), Savella (milnacipran), Strattera (atomoxetine) Action of Tricyclic Antidepressants (TCAs) - ANSWER They target serotonin, norepinephrine, and histamine-1 receptors List the Tricyclic Antidepressants (9) - ANSWER Pamelor (nortriptyline), Elavil (amitriptyline), amoxapine (no branded), Anafranil (clomipramine), Norpramin (desipramine), Tofranil (imipramine), Vivactil (protriptyline), Sinequan/Silenor (doxepin), Surmontil (trimipramine) FINISH acronym for SSRI withdrawal - ANSWER Flu-like symptoms Irritability Nausea Imbalance/instability/incoordination/dizzy (motor) Sensory disturbances Headache, hyperarousal (anxiety/agitation) Signs of NMS (Neuroleptic Malignant Syndrome) - ANSWER Initial Symptoms: altered sensorium, hyperreflexia, fever Then signs of autonomic instability: extreme muscle rigidity, hypotension, tachycardia, diaphoresis, tachypnea, hyperthermia, coma, death. Check for increased WBCs (leukocytosis)/LFTs/CPK Signs of Lithium toxicity - ANSWER Confusion, diplopia, nausea/diarrhea, ataxia, lethargy, fatigue, clumsiness, weakness, muscle cramping, severe tremor, blurred vision, nystagmus, increased DTRs, altered mental status, cardiac dysrhythmias

Signs of Serotonin Snydrome - ANSWER agitation, restlessness, rapid heart rate, blood pressure elevation, headache, sweating, shivering, goose bumps, myoclonic jerking and loss of coordination, confusion, fevers, unconsciousness, seizures Medications that can increase lithium level - ANSWER NSAIDs, ACE Inhibitors (-prils), ARBs (-sartans), tetracyclines, metronidazole Medications that can decrease lithium level - ANSWER potassium-sparing diuretics, thiazide diuretics, theophylline Clozaril - monitoring considerations - ANSWER Monitor ANC (absolute neutrophil count); pt needs an ANC of at least 1500 to start clozaril therapy; watch for Benign Ethnic Neutropenia (BED); Monitor ANC weekly x6 months, every 2 weeks x6 months, then monthly if ANC is at least 1500. Substances that can cause a false + drug test for PCP & methadone - ANSWER Niquil, OTC cough meds Substances that can cause a false + drug test for heroin & morphine - ANSWER rifampin, fluoroquniolones Substances that can cause a false + drug test for cocaine - ANSWER NSAIDs, amoxicillin, most antibiotics Substances that can cause a false + drug test for amphetamines - ANSWER Prozac, Wellbutrin, Trazodone, Nefazodone, Sudafed, OTC decongestants. Schizophrenia Prevalence: Non-twin siblings of a schizophrenic parent Dizygotic twins of a schizophrenic parent Monozygotic twins of a schizophrenic parent - ANSWER 8% 12% 47% Birth defects caused by benzodiazepines - ANSWER Cleft palate, floppy baby syndrome

Birth defects caused by carbamazepine - ANSWER Neural tube defects Birth defects caused by depakote - ANSWER Neural tube defects (spina bifida), cleft palate, atrial-septal defects, long-term developmental deficits CYP450 Inhibitors - ANSWER bupropion, clomipramine, cimetidine, clarithromycin, fluoroquinolone, grapefruit, ketoconazole, nefazodone, SSRIs CYP450 Inducers - ANSWER carbamazepine, nicotine, hypericum (St. John's wort), phenytoin, phenobarbital Normals lab value for AST (aspartate aminotransferase) - ANSWER 5- 40 Normal lab value for ALT (alanine aminotransferase) - ANSWER 5- 35 Normal lab value for Alkaline Phosphastase - ANSWER 44-147; male be increased in gallbladder disease & with bone injury /rapid bone growth Creatine Kinase (normal range) - ANSWER <240. Measures muscle injury (heart, brain, and skeletal). Increased in MI (CK-MO), myositis, NMS BUN (normal range) - ANSWER 10-20. Creatinine - ANSWER 0.4-0.8 or less than 1. Normal GFR - ANSWER >90 mL/min. If a patient is on psychotropics, as long as their GRF is >60, no dose adjustments need to be made. What is the best measure of kidney function? - ANSWER GFR (glomerular filtration rate)

Normal Plate Count - ANSWER 140,000-340, Normal hemoglobin value for males and females - ANSWER Males: 13.5- 18 Females: 12.5- 14 Normal MCV (mean corpuscular volume) value - ANSWER 78- 100 Normal TSH Range - ANSWER 0.4- 4 Normal Free T4 range - ANSWER 10- 27 Substances that can cause a false + drug test for codeine - ANSWER poppy seeds Substances that can cause a false + drug test for benzodiazepines - ANSWER Zoloft Gamma glutamyl transpeptidase (GGT) normal range - ANSWER 10- 38 Drug Category A and examples - ANSWER Controlled studies show no risk Vitamins within RDA, insulin, thyroxine Drug Category B and examples - ANSWER No evidence of risk in humans Buspirone, zolpidem, clozapine, lurasidone Beta-lactam antimicrobials (PCNs, cephalosporins, select macrocodes,azithromycin, erythromycin), acetaminophen, ibuprofen (1st & 2nd trimesters) Drug Category C and examples - ANSWER Risk cannot be ruled out bupropion, lamotrigine, SSRIs (except paroxetine), TCAs, duloxetine, mirtazapine, trazodone, venlafaxine, aripiprazole, Haldol, ziprasidone, risperidone

Drug Category D and examples - ANSWER Positive evidence of risk paroxetine, valproate, carbamazepine, lithium alprazolam, chlordiazepoxide, clonazepam, diazepam, lorazepam, oxazepam ACE Inhibitors (-prils), ARBs (-sartans), ibuprofen (3rd trimester), tetracyclines Drug Category X and examples - ANSWER Absolutely Contraindicated in pregnancy Accutane, misoprostol, thalidomide, flurazepam, temazepam, triazolam Types of inferential statistics - ANSWER p-value, Pearson's r correlation, t-test,ANOVA T-test - ANSWER Compares whether the means of two groups are statistically different ANOVA - ANSWER tests the differences of 3 or more groups Pearson's r correlation - ANSWER tests the relationship between 2 variables HLB-B*1502 - ANSWER Allele that some asian's have which makes them unable to metabolize carbamazepine, increasing their risk for Steven's-Johnson syndrome which can lead to toxic epithelial necrolysis. Asians must be tests for this gene prior to beginning therapy. TIGER - ANSWER technology competencies for NPs to improve access to quality & patient experience Who is covered by Medicare? - ANSWER Adults >65 who have worked at least 4 quarters and paid Medicare taxes End stage renal disease those who need a kidney transplant those with ALS Some younger people with disabilities Those receiving SSDI

Who is covered by Medicaid? - ANSWER Low-income children Low-income pregnant women Elderly & disable individuals who qualify for the supplemental security income program HAM-D (Hamilton Depression Scale) - ANSWER 17-21 questions. Each question with 3-5 possible responses that increase in severity. 0 - 7 normal

or = 20 moderately severe depression BDI (Beck Depression Inventory) - ANSWER 21 questions, scores range 0-63. 0 - 13: minimal depression 14 - 19: mild depression 20 - 28: moderate depression 29 - 63: severe depression Edinburgh Postnatal Depression Scale (EPDS) - ANSWER 10 questions. > or = possible depression SLUMS (St. Louis University Mental Status Exam) - ANSWER HS Education: Normal: 27- 30 MCI: 20- 27 Dementia: 1- 19 Less than HS education: Normal: 20- 30 MCI: 14- 19 Dementia: 1- 14 CIWA - ANSWER Very mild: 0- 9 Mild: 10- 15

Moderate: 16- 20 Severe: 21- 26 PHQ-9 (Patient Health Questionnaire 9) - ANSWER 9 questions 1 - 4 minimal depression 5 - 9 mild depression 10 - 14 moderate depression 15 - 19 moderately severe depression 20 - 27 severe depression MADRS (Montgomery Asberg Depression Rating Scale) - ANSWER 10 questions 44= very severe 31= severe 25= moderate 15= mild 7= recovered Mini-cog - ANSWER Screens for cognitive impairment. 3-item recall with a clock-drawing test (CDT). 0/3 word recall=cognitive impairment 1 - 2 word recall and abnormal CDT=cognitive impairment 1 - 2 word recall and normal CDT= no cognitive impairment 3/3 word recall= negative screen for dementia MMSE (Mini mental status exam) - ANSWER Screens for cognitive impairment and used to follow cognitive function over time. High education may score falsely high. 30-point questionnaire: Intact 25- 30 Mild 21- 24 Moderate 10- 20 Severe < or =

MoCA (Montreal Cognitive Assessment) - ANSWER Screens for mild cognitive decline. 30-point questionnaire. > or = 26 considered normal Which therapy uses straight-forward directives, paradoxical directives, and reframing-belief systems? - ANSWER Strategic Therapy Which therapy uses miracle questions, exception-finding questions, and scaling questions? - ANSWER Solutions-Focused Therapy Who with bipolar disorder is more likely to have a manic episode: men or women? - ANSWER Men Who with bipolar disorder is more likely to present with mixed episodes: men or women? - ANSWER Women Who with bipolar disorder is more likely to have rapid cycling: men or women? - ANSWER Women Who with bipolar disorder is more likely to have comorbid alcohol used disorder and eating disorders: men or women? - ANSWER Women Schedule II Drugs - ANSWER morphine, codeine, fentanyl, methadone, Percocet, oxycontin, Dilaudid, amphetamines, methylphenidate. Schedule III Drugs - ANSWER Appetite suppressants, butalbital, testosterone, suboxone Schedule IV Drugs - ANSWER benzodiazepines, Ambien, Lunesta, Provigil, Nuvigil, phenobarbital, dextropropoxyphene (Darvon), and pentazocine (Talwin) Schedule V Drugs - ANSWER buprenorphine, cheritussin (Robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil)

Role of hypothalamus - ANSWER homeostasis; basic needs (eating drinking, temperature regulation, sleep-wake cycle). Braine stem reponsibility and parts - ANSWER Pons, Midbrain, medulla oblongata Regulates BP, respirations, level of arousal, and digestions. Relays information to the cerebellum Thalamus - ANSWER transmits sensory information to the cerebrum. influences affect, mood, and body movements associated with strong emotions. Kohlberg - ANSWER Stages of Moral Development 6 Domains in Diagnosing Neurocognitive Disorders - ANSWER 1. Complex Attention

2. Executive Function
3. Learning Memory
4. Language
5. Perceptual Motor Ability
6. Social cognition Mesolimbic Pathway - ANSWER Responsible for POSITIVE symptoms of schizophrenia all antipsychotics block DA receptors (specifically D2) in this pathway Excess DA in this pathway leads to + symptoms (psychosis) Reward-oriented Associated with mood disorders, psychoses, and drug abuse Mesocortical Pathway - ANSWER Responsible for NEGATIVE symptoms of schizophrenia, cognition, planning and behavior. Nigrostriatal Pathways - ANSWER Responsible for voluntary and involuntary movements. Insufficient DA in this pathway is implicated in Parkinson's disease.

Tuberoinfundibular Pathway - ANSWER Responsible for prolactin production. Extends to the pituitary gland where prolactin is regulated. Otto Kernberg - ANSWER Psychoanalytic therapy with antisocial and borderline personality disorders. Carl Rogers - ANSWER Humanistic approach; unconditional positive regard; described the individual as an energy field existing within the universe 4 focuses of IPT (interpersonal therapy) - ANSWER 1. Complicated bereavement

2. Role Dispute
3. Role Transition
4. Interpersonal Deficits Maslow's Hierarchy - ANSWER 1. Physiologic Needs (food, water, warmth, rest) 2.Safety/security
5. Belongingness and love
6. Esteem
7. Self-actualization (achieving one's full potential)
8. Self-transcendence Erikson's Stages of Development - ANSWER 1. Trust vs Mistrust
9. Autonomy vs Shame/Doubt
10. Initiative vs Guilt
11. Industry vs. Inferiority
12. Identity vs Role Confusion
13. Intimacy vs Isolation
14. Generativity vs Stagnation
15. Integrity vs Despair

Trust vs Mistrust - ANSWER Age: infancy to 1 yr Mastery: Ability to form meaningful relationships, hope about the future, and trust in others Failure: Poor relationships, lack of future hope, suspicious of others Autonomy vs Shame/Doubt - ANSWER Age: 1- 3 Mastery: self-control, self-esteem, willpower Failure: Poor self-control, low self-esteem, self-doubt, lack of independence Initiative vs Guilt - ANSWER Age: 3- 6 Mastery: self-directed behavior, goal formation, sense of purpose Failure: lack of self-initiated behavior, lack of goal orientation Industry vs Inferiority - ANSWER Age: 7- 11 Mastery: Ability to work, sense of competence & achievement Failure: Sense of inferiority, difficulty working and learning Identity vs Role Confusion - ANSWER Age: 12- 19 Mastery: Personal sense of identity Failure: identity confusion, poor self-identification in group settings Intimacy vs Isolation - ANSWER Age: 20- 35 Mastery: committed relationships, capacity to love Failure: Emotional isolation, and egocentrism Generativity vs Stagnation - ANSWER Age: 35- 65 Mastery: ability to give time and talents to others and ability to care for others Failure: self-absorption, inability to grow-change as a person, inability to care for others Integrity vs Despair - ANSWER age 65+

Mastery: fulfillment and comfort with life, willingness to face heath, insight and balanced perspective on life's events Failure: biternes, sense of dissatisfaction with life, despair over impending death. Piaget Stages - ANSWER 1. Sensorimotor

2. Pre-operational
3. Concrete Operational
4. Formal Operational Sensorimotor Stage - ANSWER 0-2 years Infants develop object permanence (the realization that people exist even when they cannot be seen) Pre-operational - ANSWER 3-6 years Egocentrism prominent during this stage. Children develop language, symbolic thinking. Concrete Operational - ANSWER 7-11 years Development of logical thought, but it is still more concrete than abstract. Developing the understanding of the concept of conservation. Formal Operational - ANSWER 12+ years Development of hypothetical-deductive reasoning, may have an imaginary audience, personal fable, propositional thinking Freud Stages - ANSWER 1. Oral 0-18 months
5. Anal 18 mos-2 years
6. Phallic 3-6 years
7. Latency 7-11 years
8. Genital 12+ years Oral Stage - ANSWER Age: 0-18 mos

Activities: put everything in their mouth. sucking, chewing, feeding, crying Failure: schizophrenia, paranoia, substance abuse Anal Stage - ANSWER Age: 18 mos - 2 years Activities: fixated on toilet training and sphincter control, activities of expulsion and retention Failure: depressive disorders Phallic Stage - ANSWER Age: 3-6 years Activities: Exhibitionism, masturbation with focus on Oedipal Conflict, sexual fantasies about opposite sex parent, castration anxiety (males), hear of loss of maternal love (females) Failure: Sexual identity disorders Latency Stage - ANSWER Age: 7-11 years Activities: peer relationships, learning, motor skills development, socialization Failure: inability to form social relationships Genital Stage - ANSWER Age: 12+ years Activities: integration and synthesis of behaviors from early stages, primary genital-based sexuality Failure: Sexual perversion disorders Durham vs the United States (1954) - ANSWER Origin of the insanity defense. Determined than an individual is not criminally responsible if the unlawful act was the product of mental illness. O'connor vs Donaldson (1976) - ANSWER Ruled that harmless mentally ill patients cannot be conned against their will. Determined that the presence of a mental illness alone cannot justify involuntary hospitalization. Rennie vs Klein (1979) - ANSWER Determined that patients may have the right to refuse any treatment and use an appeal process.

Roger vs Oken (1981) - ANSWER Patient has a right to refuse treatment but a guardian can consent to treatment for them Ford vs Wainwright (1986) - ANSWER Established a person's competence to be executed. :

1. Person must understand retributive element of punishment
2. Person must be in the best place to make peace with his or her religion. Cranial Nerve I - ANSWER Olfactory Sensory Smell; tested by having patient smell common things like coffee ground through each nare while occluding the opposite nare (eyes must be closed) Cranial Nerve II - ANSWER Optic Sensory Sight; tested using Snellen chart. Also, examiner views optic disc with ophthalmoscope, peripheral vision with confrontation test Cranial Nerve III - ANSWER Oculomotor Motor Extraocular movements, tested with CNs IV and VII. Pupils and corneal light reflex. Check for PERRLA Cranial Nerve IV - ANSWER Trochlear Motor Extraocular movements, tested with CNs III and VII. Innervates superior oblique muscle, turns eyes down and laterally (out) Cranial Nerve V - ANSWER Trigeminal Both Sensation of touch and pain on the face. Movement of facial muscles (chewing). Specifically, have patient clench down and palpate the master muscle for tone. Cotton wisp test, and poke with pins with eyes closed on face.

Cranial Nerve VI - ANSWER Abducens Motor Extraocular movements, tested with CNs III and IV. Turns eyes laterally (outwards) Cranial Nerve VII - ANSWER Facial Both Facial expressions. Sensation on face. Saliva and tears secretion. Taste (identify sugar, vinegar, and salt with eyes closed). Movement of facial muscles: frown, smile, raise eyebrows, puff out cheeks Cranial Nerve VIII - ANSWER Acoustic (vestibulocochlear) Sensory Hearing: Weber and Rinne test, Whisper Test. Audiometer. Equilibrium, sensation. Cranial Nerve IX - ANSWER Glossopharyngeal Both Taste on anterior 2/3 tongue. Tongue movement. Test with vagus nerve. Cranial Nerve X - ANSWER Vagus Both Carotid blood pressure regulation, lower HR, gag reflex (put tongue depressor on back of tongue), taste, stimulated digestive organs. Test with glossopharyngeal nerve). Check for elevation of uvula by having pt open mouth, say "ahh". Cranial Nerve XI - ANSWER Spinal Accessory Motor Move face against examiners hand (test SCM), and shrug shoulders against examiner (trapezius muscle). Also controls swallowing. Have them sip water. Cranial Nerve XII - ANSWER Hypoglossal

Motor (tongue movement) Stick out tongue and wiggle side to side; protrude tongue and check for involuntary movements. Patient's Access to Responsible Care Alliance - ANSWER A coalition of organizations that represent the interests of millions of patients & non-phyisican healthcare providers. Pharmacodynamics - ANSWER What the drug does to the body (target sites for drug actions). Examples: receptors, ion channels, enzymes, carrier proteins. Transtheoretical Model Stages of Changes - ANSWER Precontemplation contemplation preparation action maintenance termination Excitatory Response - ANSWER Depolarization. Involves opening of sodium & calcium channels so these ion channels can enter the cell. Inhibitory Response - ANSWER Repolarization. Involved the opening of chloride channels so chloride can enter the cell & potassium can leave the cell. Schedule I Drugs - ANSWER Heroin, Marijuana Who developed motivational interview (MI)? - ANSWER William Miller and Stephen Rollnick Minuchen - ANSWER Developed Structural Family Therapy.vFamily is an organization/structure; learn each member's likes and goals to change the family structure. Bowen - ANSWER Develeped family systems therapy. Individuals problem behavior may serve a purpose as having a unique role in their family unit. The goal of this therapy is homeostasis.

Gonzalez-Jaimes and Turnbull Plaza developed what? - ANSWER "mirror psychotherapy" for patients with adjustment disorder and depressed moof secondary have having a myocardial infarction. Nightingale's view of the nurse's role - ANSWER The nurse is the provider of fresh-air, light, cleanliness, warmth, quiet, and nutrition. Who was interpersonal therapy (ITP) developed by? - ANSWER Myrna Weissman and Gerald Klerman Amoxapine - ANSWER The active metabolite of loxapine. What does Medicare Part A cover? - ANSWER hospitalizations (for up to 90 days) skilled nursing facility admission (up to 100 days) Hospice (up to 6 months for terminally ill patient) some home health care p-value - ANSWER level of significance. describes probability of a particular result occurring by chance alone. Third generation Antipsychotics list and mechanism of action - ANSWER MOA: partial dopamine receptor agonism and blocks 5HT2A. There are only 3: Rexulti, Vraylar, and Abilify Second generation antipsychotics mechanism of action - ANSWER Blocks dopamine everywhere, blocks 5HT2A, decreasing side effects of the dopamine blockade. valproic acid (normal/therapeutic level) - ANSWER 50-120 mcg/mL What does medicare part B cover? - ANSWER ambulatory practitioner services (outpatient); physical/occupational/speech therapies; medical equipment; diagnostic tests; some preventative care: pap smears, mammograms, influenza and pneumonia vaccines, screenings for diabetes/glaucoma/carviovascular disease/prostate and colorectal cancer.

What does medicare part 3 cover? - ANSWER optional coverage for beneficiaries who can choose to receive all of their health care services through one of the providers covered under the Medical Advantage Plan. What does medicare part D cover? - ANSWER Optional coverage for outpatient pharmaceuticals (think D for DRUG). Medical savings account - ANSWER a healthcare reform plan that allows individuals to establish tax-free savings funds to finance their medical care Pharmacokinetics - ANSWER What the body does to the drug. Types include: absorption, distribution, metabolism, excretion. Cerebellum - ANSWER coordinates balance, posture, movement, memory, impulse control, cognition, language Hippocampus - ANSWER involved in memory and converting short-term memory into long term memory; learning Amygdala - ANSWER regulates basic powerful emotions: fear, rage, sexual desire Bowlby - ANSWER attachment theory: kids who come from parents with highly expressed emotions and unresolved losses tend to develop disorganized attachment characterized by not feeling safe with their caregivers & an inability to feel soothing comfort antagonistic effect - ANSWER drug binds to receptors and activates a biological response inverse agonist - ANSWER drug causes the opposite effect of an agonist partial agonistic effect - ANSWER drug does not fully activate the receptors

antagonistic effect - ANSWER drug binds to the receptor but does not activate a biological response. carbamazepine and lamotrigine drug-drug interaction - ANSWER when taken together, carbamazepine will cause an increase in lamotrigine levels in the blood(up to 200% increase) First generation antipsychotics mechanism of action - ANSWER blocks dopamine everywhere. mesocortical pathway - ANSWER executive function: attention, focus, depression nigrostriatal pathway - ANSWER from substantia nigra (brainstem) to striatum (muscles): Parkinson's mesolimbic pathway - ANSWER projects to nucleus accumbens (part of limbic system). Pleasure, reward, positive symptoms of schizophrenia: Addiction, gambling Tuberoinfundibular pathway - ANSWER regulation of prolactin (acts on pituitary). Hypersexuality in mania Dopamine - ANSWER produced in substania nigra and VTA. D2 & D4 receptors most important. Elevated in the mesolimbic pathway associated with pleasure and psychosis. Antispychotics block dopamine. travels through mesocoritcal, mesolimbic, nigrostriatal, and tuberinfundibular pathways Serotonin - ANSWER 5-HT. produced in raphe nucleus. emotion, impulses, dreams. 5HT2A receptors = atypical antipsychotics. Norepinephrine - ANSWER produced in locus coeruleus. arousal and vigilance GABA - ANSWER inhibitory. produces calm in conjunction with benzodiazepines. ACTH - ANSWER motor control, learning, memory, sleep, and dreams. Helps with balance. Decrease in Alzheimer's disease

hypothalamus-pituitary-adrenal axis (HPA) - ANSWER CRH, ACTH, then cortisol. Worsens with stress and depression hypothalamus-pituitary-thyroid (HPT) - ANSWER TRH, TSH, T4. Hypothyroid causes depression, weight gain, slow metabolism. Hyperthyroid is opposite. hypothalamus-pituitary-gonadal (HPG) - ANSWER GnRH, FSH, LH. Malfunctions cause infertility problems. gray matter - ANSWER neurons are found frontal lobe - ANSWER executive function, voluntary movement, speech (Broca's area) Temporal lobe - ANSWER memory, cognition, speech, emotions (aka limbic area) parietal lobe - ANSWER receive and process sensory input Wernicke's area - ANSWER temporal and parietal lobes; speech amygdala - ANSWER fear response. hippocampus - ANSWER memory. Make up limbic system with amydgala HIPAA - ANSWER 1. education about privacy protection, 2. access to own medical records, 3. request amendment to health information to which they object, 4. require permission for disclosure of medical issues forensic nursing - ANSWER based on crime committed and investigational aspects correctional nursing - ANSWER offender's current mental health and medical condition

research utilization process - ANSWER critique, synthesize, apply, measure PICO question - ANSWER patient, intervention, comparison, outcome internal validity - ANSWER when the independent variable (treatment) caused a change in the dependent variable (outcome) external validity - ANSWER when the sample is representative of the population and the results can be generalized descriptive statistics - ANSWER used to describe the basic features of the data in the study standard deviation - ANSWER indication of the possible deviations from the mean variance - ANSWER how the values are dispersed around the mean - the larger the variance, the larger the dispersion of scores inferential statistics - ANSWER numerical value that enable one to reach conclusions that extend beyond immediate data alone - generated by quantitative research designs t-test - ANSWER assess whether means of 2 groups are statistically different from each other ANOVA - ANSWER analysis of variance - tests difference of 3 or more groups Pearson's r-correlation - ANSWER relationship between 2 variables probability - ANSWER 0-1: likelihood of an event occurring

p value - ANSWER level of significance: describes the probability of a particular result occurring by chance alone HOPE - ANSWER sources of hope, organized religion, personal spirituality, effects on medical care/end of life OLDCARTS for HPI - ANSWER onset, location, duration, character, alleviating/aggravating factors, radiation, time of occurrence, severity Cranial Nerves - ANSWER Olfactory, optic, ocular motor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, accessory spinal, hypoglossal dysdiadochokinesia - ANSWER inability to perform rapid alternating movements (finger to thumb), cerebellar lesion astereognosis - ANSWER inability to distinguish objects (such as paperclip) based on touch, parietal lesion Free T4 - ANSWER 0.8-2.8 TSH - ANSWER 0.4-0.5 - decreases when T3 & T4 are high, increases when T3 & T4 are low. Elevated in primary hypothyroidism. Values may decrease with aspirin, steroids, and heparin. Values may increase with lithium. calcium - ANSWER 8.8-10.5. 99% found in bone. major cation for bones and teeth. higher in kids because of bone growth. sodium - ANSWER 135- 148 magnesium - ANSWER 1.3-2.1. chloride - ANSWER 98- 106

potassium - ANSWER 3.5-5.1. value decrease with lithium, diuretics. marijuana use can elevate K ALT - ANSWER 5-35. AST - ANSWER 5- 40 GGT - ANSWER gamma glutamyl transpeptidase - 10 - 38. Used to evaluate alcohol abuse because levels rise after only a small ingestion of alcohol. teratogenic risks of benzodiazepines - ANSWER floppy baby, cleft palate teratogenic risks of tegretol - ANSWER neural tube defects teratogenic risks of lithium - ANSWER Epstein anomaly teratogenic risks of depakote - ANSWER neural tube defects such as spina bifida Rogers - ANSWER Humanistic theory: person centered therapy Beck - ANSWER CBT Lazarus - ANSWER Behavioral therapy Marsha Linehan - ANSWER DBT Frankle - ANSWER Existentialism: reflection on life and encouragement of self-confrontation. "Why am I here? What is my purpose?"