PMHNP Exam Reported Questions with Accurate Answers, Exams of Nursing

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PMHNP Exam Reported Questions -with accurate answers

1. What is dissemination?: 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
2. What does a 17 on MMSE mean?: Moderate cognitive impairment
3. What is Tegretol in the CYP450 system?: Inducer -->will lower dose of Lamictal and BCP's
4. What do BCP's do to Lamictal?: Inducer - will lower dose of Lamictal
5. What is a Type I research error?: There IS a difference but you say there isn't a difference.
6. What is a Type II research error?: There is NO difference but you say there is a difference.
7. What is pseudo-dementia?: Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve.
8. Is it normal for a 1 month old to have a palmar grasp?: Yes.
9. What is a drug 1/2 life?: The time it takes for 50% of a drug to be eliminated from the body.
10. What 3 atypicals can be used with teens?: Zyprexa, Abilify, Seroquel - low doses
11. What is a risk of using Tramadol?: Serotonin Syndrome as it is very seroton- ergic.
12. What is the allele seen in Asians that increase the risk of SJS?: HLAB-
13. When might you see toxic epidermal necrolysis?: With worsening of SJS
14. How many generations do you include for a genogram?: 1st degree - moth- er, father, siblings 2nd degree - grandparents & cousins 3rd degree -
15. What does messenger RNA code for?: Amino Acids
16. What is epigenetics?: Factors that affect genes - environmental, smoking, stress, etc...
17. What part of the brain is involved with OCD?: Basal Ganglia Occipito- Frontal
18. What happens to the brain during adolescence?: Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well
19. When do males typically present with schizophrenia?: 10-25 yo

20. When do females typically present with schizophrenia?: 25-35 yo
21. What does Erythromycin to trileptal?: You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor
22. ACE Inhibitors are the drug of choice for what?: Heart Failure HTN
23. What are some psychiatric side effects seen with some asthma drugs: - Leukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor
24. What should you watch for with Tegretol?: Agranulocytosis and Hyponatrem- ia
25. What are the 3 CK muscle enzyme tests?: CKBB, CKMM, CKMB
26. Which one of the 3 muscle enzymes are related to cardiac muscle dam- age?: CKMB
27. What is the risk of a seriously elevated CKMB?: Polymyositis Rhabdo
28. What is a normal CKMB?: 0.3 mcg/L
29. What psychoactives does Detrol interact with?: Topamax KCL Zonegran
30. What CN are you assessing when you have the patient shrug their shoul- ders?: CN XI - Spinal Accessory
31. What do you see in labs with HIV & Dementia?: CD4 <200 Viral Load is high <20% get it with antiretroviral treatment
32. What is the scoring with the Beck Depression Inventory?: Self-Report - 0-63 0-13 - minimal 14-19 - mild 20-28 - moderate 29-63 - severe
33. What is sensitivity?: Helps rule-out disease = True Positive = Snout
34. What is specificity?: Helps rule-in disease = True Negative = Spin
35. What does a sed rate measure?: Inflammation (ESR - Erythrocyte Sedimen- tation Rate) = distance in mm RBC's have descended in 1 hour.
36. What is a normal sed rate or ESR?: 0-22 males 0- females
37. What is a retic count?: Measures % of reticulocytes in blood (immature RBC's) Indicates whether enough RBC's are being produced by bone marrow.
38. What does a decreased retic count indicate?: Anemia - acute or chronic bleeding

61. What is a claims made/based liability insurance?: provides coverage for a claim that is brought within the policy period, no matter when the loss occurred.
62. Who sets the minimum requirements for NP's?: Board of Nursing State
63. What are the various controlled substance classes?: 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
64. What classes of CS's is the NP approved to prescribe?: Schedules III-V ONLY.
65. Where does 50% of healthcare funds come from?: The government
66. Who is eligible for Medicare?: >65 or under 65 with diability, ANY age with renal disease.
67. What is incident to billing?: 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%.
68. 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.
69. Can you have Medicare and Medicaid?: Yes, impoverished elderly but Medic- aid is always payor of last resort.
70. Is dental care included in Medicaid?: Yes, <21 gets basic dental as part of the Medicaid plan.
71. What is the purpose of HIPAA?: National standards for electronic HC transac- tions National ID for providers, health plans and employers. Not SIMPLY Confidentiality.

72. What must be signed prior to any healthcare in the state: Notice of Privacy Practices Statement
73. What happens if a patient refuses to sign an ROI?: Can decline to treat Health plan may condition enrollment on provision of consent
74. When is HIPAA not required?: Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment
75. Is it ok to announce a patient's name in a waiting room?: Yes, no other way to give care.
76. Is it ok to leave a message on a patient's vm?: Yes, but should be limited.
77. What is the impact of steroid inhalers on children?: Slows bone growth and may decrease ultimate height.
78. What is the long-term impact of using steroid inhalers?: Cataracts, glauco- ma, thinning of bones and skin
79. What is included in the treatment of fibromyalgia?: Sleeping meds Antidepressants Pain meds
80. What psychoactives are first line treatment for fibro?: Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's
81. What is the purpose of telepsychiatry?: Increase the ability to reach rural and underserved areas.
82. What is the purpose of Motivational Interviewing?: Explore ambiguity Maintain passive position
83. What is required for Medicare submission?: ICD 10 and narrative or CPT
84. What is the neurotransmitter problem in Schizophrenia?: Excess dopamine in mesolimbic pathway.
85. What is the neurotransmitter problem in ADHD?: Dopamine, norepinephrine and serotonergic dysfunction
86. What is the benefit of play therapy?: Don't have to confront emotions head on.
87. What neurotransmitters are involved in the bioamine hypothesis of depres- sion?: Noradrenaline Serotonin Dopamine MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse.
88. How do you test CN XII?: Stick out your tongue.

110. Which drug affects Carbamazepine/tegretol: Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol
111. Signs and Symptoms of stimulant abuse: insomnia and tremor
112. Depakote check: HCG levels
113. Depakote causes: Spinal bifida
114. Grasp reflex.: 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.
115. Moro reflex.: 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.
116. pincer grasp: 9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios.
117. Pt has MI looses his job stable on psych medications: Provide brief sup- portive therapy
118. Latida and Geodon: Take with food
119. Moro reflex absent: Do xray
120. Health Care Policy Model: Access, Cost, Quality
121. Pt wants to stop medications: explore reason for stopping Its their right
122. 16 year old falls with the wrong crowd: Conduct disorder
123. change agent: the person formally in charge of guiding a change effort Administrator
124. 14 year old girl clenching her teeth: Cranial Nerve V-Trigeminal nerve
125. Infant dying: Give child to parents and comfort parents
126. borderline personality disorder Treatment: dialectical behavior therapy
127. Aggressive patient give: IM geodon
128. SIGECAPS of Depression: Sleep Interest Guilt Energy Concentration Appetite

psychomotor retardation Suicide

129. DIGFAST for mania: Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase
130. 5 year old tells u his brother sodomized him: Tell mom don't leave him alone with patient and call CPS implement crisis
131. Just culture: "Just culture" model: proposed to reconcile the twin needs for no-blame and appropriate accountability The focus is on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors while maintaining individual accountability by establish- ing zero tolerance for reckless behavior. 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.
132. Child reports Sexual Abuse: Interview the young child and infants child with parent
133. First sign of temprofrontal Dementia: Behavior and personalty changes
134. Tow amines related to depression: Serotonin and norepinephrine
135. Want to start an consulting firm what tool would be needed to show economic viability: Revenue and expenses
136. Patient stopped smoking (Cessation): Decreased Zyprexia
137. Promote resilience in schizophrenia for a patient that lives alone and doing well: Refer to peer support
138. Spirit stick: Teach staff about culture competence

arba

149. Patient acts out due to missing session what do you do: You relate to childhood abandonment and talk about it with the patient
150. How do you assess the competency of a medical procedure: Identify a pen and recall 3 words
151. Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis: Delusional disorder
152. Increase ICP (signs and symptoms): Baby Neuro cry
153. Menopausal woman: Hormone therapy and replacement
154. Patient on antidepressants for 3 weeks and attempted Suicide: Stop med- ication immediately
155. You want to decrease seclusion on your unit who considered the primary change agent: Unit staff
156. You are a lead NP over other NPs in a rural setting how would you go about the change: Make online form and have them vote on it
157. 16 year old refuse treatment: Send to psych specialist for acting out kids
158. Positive Trendelenburg Sign: Refer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor.
159. Drug affects Flonase: Zantac (Histamine 2 Blocker) Antagonist
160. Little boy wet his sheets, What kind of therapy would you suggest: Behav- ior therapy
161. DDVAP acts in much the same manner as antidiuretic hormone.: Makes less urine
162. Lithium level 1.2u what are you concerned with: 4+ Ketones
163. What does depakote do to Lamictal: Increase laminate 200%
164. Inducers of Cytochrome P450 (CYP450): Barbiturates, phenytoin, c mazepine, rifampin, St. John's Wort A substance that speeds up a chemical reaction
165. Inhibitor: A substance that slows down or stops a chemical reaction
166. cytochrome p450 inhibitors: CRACK AMIGOS Cimetidine Ritonavir Acute Alcohol Ciprofloxacin Ketoconazole Amiodarone Macrolides

Isoniazid Grapefruit juice Omeprazol Sulfonamides

167. Carb and Barb: decrease INR
168. Deapkote and Disulfruram: Increase INR
169. GAL-Renall metabolized: Gabapentin Acamprostate Lithium
170. Grapefruit juice: One glass can reduce absorption by 47% Blood levels will be Increased
171. Trazodone (Desyrel): Get EKG.
172. Trazodone (Desyrel): Get an eye exam can cause Glaucoma
173. Grapefruit juice or grapefruit: Increase trazodone
174. PICOT: Patient population of interest Intervention of interest Comparison of interest Outcome Time
175. limbic system: 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 hippocam- pus, amygdala, and hypothalamus.
176. Amygdala: A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression.
177. PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD
178. Mental Health Parity Act 1996: ensure equal coverage for mental and physical illness equal life time and annual limits
179. charge of DEA: state and federal
180. Stereogenesis: identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object
181. Sterogenesis abnormality in: parietal lobe
182. Clozaril (Clozapine): WBC-2500 ANC LESS than 1000 (950) dc medication
183. how treat child with depression: Zoloft and therapy
184. 3 year old masturbates, plays with self, says naught things: normal for Piaget

195. A pt states that she has been raped. What do you do: ensure safety
196. Hamilton D score of 28: Assess for Suicide
197. Hamilton Depression Rating Scale: 17-21 questions 0- Normal 14-18 Moderate

20 Severe Depression

198. Beck Depression Inventory (BDI): 0-13 Minimal depression 14- Mild Depression 20-28 Moderate Depression 29-63 Severe Depression
199. Patient Health Questionnaire (PHQ-9): 1-4 minimal 5- Mild depression 10-14 Moderate Depression 15-19 Moderate Severe Depression 20- Severe Depression A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression.
200. Hamilton Anxiety Rating Scale (HAM-A): 14-17 Mild Anxiety 18- Moderate Anxiety 25-30 Severe Anxiety
201. Yale-Brown Obsessive Compulsive Scale (Y-BOCS): OCD 0- subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme
202. PTSD (Post Traumatic Stress Disorder): EMDR
203. EMDR (eye movement desensitization and reprocessing): eye movement desensitization and reprocessing
204. Dilated pupils: Stimulant intoxication
205. constricted (pinpoint) pupils: Opiods

206. nystagmus: Phencyclidine 207. conjuctival injection, muchies (super hungry), psychomotor slowness?- : Marijuana
207. Marijuana: a drug, often smoked, whose effects include euphoria, impairment of judgment and concentration and occasionally hallucinations; rarely reported as addictive
208. Boy states that he wishes to be a girl and tells you not to tell his parent s: Don't tell 210. ODD what will you do to prevent it from becoming Conduct disorder: - Therapy to target mood and aggression
209. Herpes rooster 3 weeks later sleep difficulties and sad mood: Depression
210. Schizophrenia in males: 18-25 years old
211. Schizophrenia in Women: 25-35 years old
212. signs of amphetamine intoxication: Tears, Runny nose, restlessness, HTN, Tremors, Insomnia
213. Co-morbidities of bipolar: Anxiety, alcohol and substance abuse
214. Big Freaking Problems: Bupropion Fluoxetine Paxil
215. Medicare: A federal program of health insurance for persons 65 years of age and older
216. Medicare Advantage: 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
217. Medicare A, B, C, D: A: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs 220. WATCHERS for GAD 3 of these *** for 6 months: worry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep trouble
218. Transtheoretical Model of Change: 1. Precontemplation 2.Contemplation 3.Preparation

Singulair (montelukast) Spiriva (tiotropium) Symbicort (budesonide / formoterol) Tylenol (acetaminophen) Vitamin B12 (cyanocobalamin) Vitamin D3 (cholecalciferol) Zyrtec (cetirizine)

229. t-tests: statistical measure: test means of 2 independent samples, significantly different?
230. ANOVA (analysis of variance): 3 OR MORE an inferential statistical test for comparing the means of three or more groups
231. Pearson's r: a statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scale
232. p-value: The probability of results of the experiment being attributed to chance. LEVEL OF SIGNGNIFICANCE
233. Early onset of HIV dementia: Apathy Lack of Interest Abnormal of MRI-SLow But cognitive," functions such as memory, reasoning, judgment, concentration, and problem solving. Other common symptoms are changes in personality and behavior, speech prob- lems, and motor (movement) problems such as clumsiness and poor balance. show brain atrophy (shrinkage)
234. Yalom: Universality: Members recognize that other members share similar feelings, thoughts and problems Altruism: Members gain a boost to self concept through extending help to other group members Instillation of hope: Member recognizes that other members' success can be helpful and they develop optimism for their own improvement Imparting information: Education or advice provided by the therapist or group mem- bers Corrective:Opportunity to reenact critical family dynamics with group members in a corrective manner Development of socializing techniques: The group provides members with an envi-

ronment that fosters adaptive and effective communication Imitative behavior: Members expand their personal knowledge and skills through the observation of Group members' self-exploration, working through and personal development 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 interperson- al impact through feedback provided from other members Interpersonal learning- output Members provide an environment that allows mem- bers to interact in a more adaptive manner Self-understanding: m embers gain insight into psychological motivation underlying behavior and emotional reactions

235. Metobolic syndrome: group of signs and symptoms including insulin resis- tance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDL
236. NAMI: national alliance on mental illness help families of mentally ill: education, support groups
237. 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
238. health literacy: Man taking insulin asking him to read blood glucose level
239. inferential statistics: numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population
240. Mood Disorder Questionnaire (MDQ)-SCREENING: Mood Disorder Ques- tionnaire Patient Name Date of Visit Please answer each question to the best of your ability 1.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?

a score of hat a

243. CBT (cognitive behavioral therapy): Anxiety popular integrative therapy that combines cognitive (thinking) and behavior therapy
244. Impulsivity (ADHD): Pre-Frontal Cortex Involves hasty actions taken without consideration of possible negative conse- quences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others.
245. Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis: Hypogylcemia
246. NSAIDS: Lithium toxicity
247. Interferon: Causes depression
248. Beck Depression Inventory (BDI): Intimate therapy for a child with 10 a questionnaire useful for determining the level of depressive symptoms t person is reporting
249. Zantac (ranitidine): affects Flonase
250. Greatest patient at risk for Violence: Substance abuse
251. DBT (dialectical behavior therapy): relaxation muscle prior to DBT
252. Pt on Lithium: Prescribe Synthroid
253. Zantac (ranitidine): H2 antagonist H2 BLOCKER
254. Tegretol (carbamazepine): INDUCES Flonase
255. primary prevention: Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse.
256. Secondary prevention examples: - Implement blood pressure and choles- terol screening; give a treadmill stress test.

• Health screenings
• Skin screenings for cancer
• teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets.
• mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes
• Provide mental health interventions after stressful events.
• The public health nurse provides toxin screenings for migrant workers who may be

exposed to pesticides.

• Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center.
• Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care.
• Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health.
• Assess disaster victims and triage for care.
• Investigate an outbreak of flulike illness in a local school.
• Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems.
• Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the facility at which the skin test was administered.
• To prevent the spread of disease
• Notify partners and trace contacts (HIV)

257. Collab with OB NP questions: wants to establish a relationship so Mental Health can be reached by more people
258. anorexia nervosa: BMI less than 18. an eating disorder in which an irrational fear of weight gain leads people to starve themselves
259. Anorexia admission Criteria for hospitalization includes:: weight loss over 30% over 6 months, severe hypothermia (temperature 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).
260. Culture question: A man injects himself: "tell me more about the medica- tions"
261. Acute Stress Disorder (ASD): can be 2-4 weeks a disorder resulting from exposure to a major stressor, with symptoms of anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to "relive" the event in dreams and flashbacks for as long as 1 month following the event
262. Scope of Practice in Nursing: State
263. Standards of Practice: ANA
264. ADPIE - Nursing Process: Assessment Diagnosis Planning