PMHNP Last Minute Review LMR Exam: Psychiatric-Mental Health Nurse Practitioner Board Exam, Exams of Psychiatry

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Walden University

PMNHP Psychiatric-Mental Health Nurse

Practitioner PMHNP Last Minute Review LMR

Exam

Course Title and Number: PMHNP Last Minute Review LMR Exam Exam Title: Board Exam Exam Date: Exam 2024- 2025 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]

Examination

180 minutes

Instructions:

**1. Read each question carefully.

2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you** **have completed the Exam.
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7. This is Exam which will assess your knowledge on the course** Learning Resources.

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PMNHP Psychiatric-Mental Health Nurse Practitioner 2024- Last Minute Review LMR PMHNP Exam Final Review Questions with Correct Answers | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - · Stimulant abuse and ADHD= screen all kids (T/F) - Answer>> True Suicide risk factors - Answer>> ***Count risk factor -age 45 yrs of older if male -55 yrs or older is female -Male -Divorced/Single/Separated -White -Living alone -Psychiatric disorder -Substance abuse -Physical illness -Previous suicide -Family hx of suicide -Recent loss/death Highest Suicide risk - Answer>> -previous attempt -elderly -male -Plan

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Lithium (Li) - Answer>> Normal: 0.6-1. Lithium toxicity can occur at 1.5 or higher Gold standard for treating manic episodes Has anti-suicide effects in bipolar Neuroprotective tx of choice for Bipolar Before Rx, Check: TSH, Creatinine,BUN, UA (4+ protein = kidney disease), HCG for females of childbearing age (12-51 years) Lithium s/e: hypothyroidism, find hand tremors, maculopapular rash, GI upset, diabetes insipidus (polyuria, polydipsia), , T-wave inversions, leukocytosis (increased WBC's), Ebstein anomaly ----- Ebstein anomaly (congenital heart defect), Do a pregnancy test!! Dehydration can increase Li level Hyponatremia can increase Li level **Pt shows understanding if the say "I will take extra water with me on a hike" Lithium toxicity - Answer>> Lithium toxicity can occur at 1.5 or higher

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-severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart palpitations, coarse hand tremors, unsteady walking (ataxia) Intervention: -D/C Lithium and check Li levels Meds that increase lithium level by reducing renal clearance leading to toxicity: ---kidney disease, NSAIDS, thiazides, ACE inhibitors (used for cardiac failure) Women of childbearing should get what test before starting any AP - Answer>> HCG Clozaril reduces suicide risk in what disorder? - Answer>> -schizophrenia Neuroleptic Malignant Syndrome (NMS) - Answer>> Caused by antipsychotics -----such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and prochlorperazine -Extreme muscular rigidity -Mutism -Hyperthermia -Tachycardia increased CPK (creatinine phosphokinase) d/t muscle contraction/muscle destruction -myoglobinuria d/t breakdown of muscle cells (RHABDOMYOLYSIS)

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-INcreased WBC (leukocytosis) -Increased LFT (liver function test) Tx: D/C offending agent -Bromocriptine -(Dopamine 2 agonist -Dantrolene- muscle relaxant (for rigidity) Tx for NMS - Answer>> 1. Tx: D/C offending agent (AP)

-Bromocriptine -(Dopamine 2 agonist) ---if question wants a tx to be dopamine agonist -Dantrolene- muscle relaxant (for rigidity) ---if question wants tx for muscle rigidity Serotonin Syndrome causes - Answer>> What classes can increase serotonin levels -SSRI/SRNI/TCA/MAOI ..... ----don't give more than 1 drug in each class at any time ----when switching from one class to another, wait 2 weeks for drug to degenerate (completely clear from body) ---when switching ssri to a maoi wait 2 weeks ----when switching fluoxetine (prozac) to MAOI wait 5- weeks -----when switching MAOI to fluoxetine wait 2 weeks

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Washout period of 5 half lives between cessation of previous drug and introduction of new drug is the safest strategy to avoid drug interactions Triptans for migraines (i.e. Sumatriptan) increase serotonin levels, thus cannot be taken with SSRI/SRNI/TCA/MAOI = Serotonin Syndrome -----give NDRI St John Wort increase serotonin levels, thus cannot be taken with SSRI/SRNI/TCA/MAOI = Serotonin Syndrome What disorders increase thoughts of self harm... - Answer>> -Depression, bipolar, ETOH abuse, eating disorder, & schizophrenia Serotonin Syndrome - Answer>> -caused by antidepressants S/E -hyperreflexia -myoclonic jerks Tx: D/C offending agent -Cyproheptadine SSRIs is safe for.... - Answer>> -Ist line Tx for depression d/t low risk of overdose -has fewer drug-drug interaction-- safe for Cancer pt.

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Fluoxetine, paroxetine, sertraline, citalopram. SSRIs (selective serotonin reuptake inhibitors) - Answer>> citalopram [Celexa]; escitalopram [Lexapro] fluoxetine [Prozac]; paroxetine [Paxil] Use: depression, GAD, panic disorder, OCD, bulimia, social phobias, and PTSD SE: GI distress, SIADH (body retains too much H2O, SEXUAL DYSFUNCTION If pt complains of sexual dysfunction- give wellbutrin (NDRI) Takes 4-8 weeks to kick in Black Box Warning: All antidepressants - Answer>> - All antidepressants can increase the risk of suicide.. -Screen everyone that is Rx an antidepressants for SI ----Especially teens/young adults Disorders with high self harm (suicide) rates - Answer>> -Depression, bipolar, ETOH abuse, eating disorder personality disorders with highest HOMICIDAL ideation - Answer>> -antisocial personality disorder, -schizoaffective disorder,

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-borderline personality disorder Prozac (fluoxetine) when to tAKE AND WHY? - Answer>> -can cause insomnia ---take in AM ETOH & DEPRESSION - Answer>> alcohol is used to self medicate for depression which can be a barrier to Tx -Assess for alcohol use with every clinic visit SNRIs - Answer>> Venlafaxine (Effexor) Duloxetine (Cymbalta) Good for depression & chronic pain (fibromyalgia) Wellbutrin (bupropion). NDRI - Answer>> Tx depression, FATIGUE, LOW ENERGY SEXUAL DYSFUNCTION with the use of SSRI NEUROPATHIC PAIN Contraindicated: -SEIZURE (decreases seizure threshold=increase seizure risk) -EATING disorder alpha 2 delta ligands for neuropathic pain - Answer>> Gabapentin and Pregabalin (Lyrica) ♣ reduces anxiety/worry ♣ good for neuropathic pain

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Haldol dosing (PO to IM) - Answer>> 20 x daily dose EX. 5mg BID = 10 mg/day 20x10 mg= 200 mg **Don't give more than 100 mg starting dose. Next dose in 5-7 days Tangentiality - Answer>> moves from thought to thought that may not relate. --Never getting point across Circumstantial - Answer>> provide unnecessary detail but eventually get to the point Though process - Answer>> assess organization of pt's thoughts & ideas -Normal- logical, linear, coherent, goal oriented -Abnormal- associations are not clear, organized or coherent Ex: tangentiality and circumstantial Thought content - Answer>> ideas, beliefs, themes that occupy the thoughts and perceptual disturbances Ex: SI/HI ideations, SI/HI plan, visual/auditory hallucination Mini Mental Status Exam (Folstein scale) - Answer>> - Concentration/attention/calculation: count backward from 100 by 7's

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-Orientation: What is the year, season, date, day, month? -Registration/ability to learn new material: give three unrelated objects, then ask pt. to repeat the 3 objects -Recall (memory: ask pt to recall 3 words you previously asked -Fund of knowledge: who is the president/governor Clock drawing test: screen for neurological problems (Alzheimer's) ---Impairments on clock drawing test an be associated with damage to the right parietal lobe (right hemisphere) Constructional apraxia: inability to build objects Clock drawing test - Answer>> Clock drawing test: screen for neurological problems (Alzheimer's) Impairments on clock drawing test an be associated with damage to the right parietal lobe (right hemisphere) · Research process - Answer>> -Determine what problem exists, -review the literature, -develop a theoretical framework, -determine the research variables, -formulate a hypothesis,

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-select the appropriate tools, -collect data, -analyze data, -determine results, -develop a conclusion -communicate finding PICOT Research Questions (Population/Patient, Intervention, Comparison, Outcome, Time) - Answer>> - Helps summarize research questions

• clinical questions are phrased in a manner that yields the most relevant information RCT (randomized controlled trial) - Answer>> - gold standard -Intervention is investigator controlled, -intervention given to one group and not the other -eliminates bias (randomness) -increases power · Cohort studies: - Answer>> -Follows people with certain risk factor/variable to determine the association with a particular outcome; -finds the true incidence rate and relative risk; -Compares a particular outcome (ex:lung cancer) in groups of indidivuals who are alike in many ways, but differ by certain characteristics (ex: female nurse who are smoking vs nonsmoking)

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· Cross Sectional: - Answer>> - find relationships between variables at specific points in TIME

• "surveys" · Meta-analysis: - Answer>> · averages results of two or more studies to see if the effect of an independent variable is reliable · Inferential statistics: - Answer>> · Numerical values to reach conclusions -generated by Quantitative research T-test: - Answer>> · Assess if the means of 2 groups are statistically different P-value - Answer>> · Level of significance -Probability of a result happening by chance alone
• p= +0.01 ( 1% probability of getting a result by chance) Probability - Answer>> -likelihood that a particular event will occur -lies between 0 and 1; impossible is 0, certain event is 1 · Descriptive statistics: - Answer>> · Describe basic features of the data in a study

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· How to implement policy/policy changing - Answer>> · Access needs, cost, and quality · Phases of policy making: Formulation, implementation, evaluation · Assess cranial nerve V (5); - Answer>> Trigeminal -CLENCH TEETH -Close eyes, swipe cotton ball across cheek How do you assess cranial nerve VII (7); - Answer>> · Facial movements -PUFF CHEEKS · Observe twitching of the eye; -have pt wrinkle forehead, close eyes, smile, pucker lips, show teeth, puff cheeks; check for symmetry Moro reflex (startle reflex) - Answer>> Extending arms when startled (noise/movement) -normal until 5-6 months Babinski/Plantar reflex - Answer>> -newborn fans out the toes when sole of foot is touched -Normal until 2 yrs. Palmer reflex - Answer>> -spontaneous grasping reflex when palm is touched -normal until 5-6 months PDSA Model: - Answer>> Plan, Do, Study, Act model -from the institute for Healthcare Improvement

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· Adverse effect of Depakote on the liver? - Answer>> · Can cause LIVER DAMAGE, especially in first 6 mons. .Sx: n/v, loss of appetite, abdominal pain, dark-colored urine, facial swelling, yellowing of the skin/eyes · AST can increase, safe to use up to two times the normal limit Tegretol (CARBAMAZEPINE) & pregnancy - Answer>> · Tegretol decreases oral contraceptives=pregnancy What happens when you take carbamazepine (Tegretol) and erythromycin or cipro - Answer>> -BLACK BOX WARNING -Antibx levels are Decreases -Carbamazepine levels are INCREASED -Erythromycin is an inhibitor = INCREASED level of carbamazepine = reduce the dose of carbamazepine · Side effects of carbamazepine (Tegretol) Tegretol is antiepileptic = reduces the action potential by GABA - Answer>> -Aplastic anemia, -agranulocytosis, -Steven Johnsons Syndrome (ASIANS) hyponatremia

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· Olanzapine (Zyprexa) and smoking - Answer>> · Nicotine is an inducer; -if pt starts smoking = INCREASE Olanzapine -if patient stops smoking DECREASE Olanzapine SMOKING CESSATION DECREASE ZYPREXA DOSE · Baby with neuro cry (shrill, high pitched and very grating on ears - Answer>> -D/T Increased cranial pressure SX: high pitched cry, irritability, restlessness, bulging fontanels, · Neuroleptic Malignant Syndrome (NMS) - Answer>> Caused by antipsychotics -----such as haloperidol, fluphenazine, chlorpromazine, trifluoperazine, and prochlorperazine -Extreme muscular rigidity -Mutism -Hyperthermia -Tachycardia increased CPK (creatinine phosphokinase) d/t muscle contraction/muscle destruction -myoglobinuria d/t breakdown of muscle cells (RHABDOMYOLYSIS) -INcreased WBC (leukocytosis) -Increased LFT (liver function test)

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Tx: D/C offending agent -Bromocriptine -(Dopamine 2 agonist -Dantrolene- muscle relaxant (for rigidity) · Amygdala - Answer>> ·-Aggression center -stimulation result in anger/violence, fear/anxiety -damage results in mellow, hyperorality, hypersexuality, disinhibited behavior Levels of Prevention - Answer>> PRIMARY Prevention (PROMOTE)

• PREVENT injury or illness from occurring -Ex: Stress management class for graduate students, -healthy diet, wearing seatbelts, NO tobacco, safety initiatives SECONDARY Prevention (SCREENING) -CAGE, Early Detection -Ex: Screening exams, hotlines, crisis intervention, regular exams EX: TERTIARY Prevention (REHAB) -decrease severity of a mental health disorder -Ex: `Providing a social skills education for a group of intellectually disabled teens

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Cardiac rehab after MIPhysical therapy after MVA MENTAL Disorder that is highly prevalent in pts with congestive heart failure - Answer>> Major depressive disorder · Lithium - Answer>> · Lithium level during treatment should by 0.6-1. Lithium s/e: hypothyroidism, find hand tremors, maculopapular rash, GI upset, diabetes insipidus (polyuria, polydipsia), , T-wave inversions, leukocytosis (increased WBC's), Ebstein anomaly ----- Ebstein anomaly (congenital heart defect), Do a pregnancy test!! -Monitor Creat/BUN, Serum electrolytes, CBC with WBC and Diff, Urinalysis, EKG, CK levels RENAL, THYROID · Kid is going on a hike, hows understanding IF he brings extra water · If pt is in hospital with N/V; lithium = 1.4, monitor for toxicity · UA (Protein) 4+ = kidney disease, so MONITOR CLOSELY · Lithium TOXICITY (1.5+) : SEVERE GI EFFECTS nystagmus, ataxia, increased deep tendon reflexes, altered mental status, cardiac arrhythmias

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· Greater than 2.5 SEIZURES AND DEATH · ACE, ARB, NSAID, Tetracycline, metronidazole can INCREASE LITHIUM thiazide diuretics, theophylline INCREASE LITHIUM · Use diuretics cautiously · Crisis Intervention - Answer>> o Five step problem- solving technique to promote adaptation and improve future coping o Ensure safety and boundaries, establish trust and rapport · Group Therapy - Answer>> o Irvin Yalom o Therapy conducted with groups promotes group interactions 2 neurotransmitter for addiction - Answer>> GABA and Dopamine · Borderline Personality Disorder - Answer>> o Impulsive actions, potential for self-harm, mood instability, chaotic relationships Tx: DBT · Eating Disorders - Answer>> -Bulimia= DEATH from HYPOKALEMIA due to vomiting, ----------esophageal tears

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-- prolonged QTC, -Avoidance of obesity: (laxative, exercise, vomiting, diuretic, **watch for rectal prolapse and Russel signs (bruised knuckles) Tx: SSRI and TCA decrease binging and purging ---§ Don't put patient on Wellbutrin! o Admit when <75% of ideal body weight and/or electrolyte imbalances o Keep them medically safe and don't control them in communication o Delayed gastric emptying in anorexic patients; -Anorexic patient with pain when eating is refeeding syndrome, bloating Sx: Bradycardia, hypotension, decreased temperature (hypothermia) o Treatment Correct dangerous eating patterns, Address psychological and situational factors Often requires family/friend participation

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· Just Culture - Answer>> o Culture where staff are willing to come forward with information about errors so everyone can learn from mistakes o Collaboration among state BON, professional organizations, patient safety centers, and health systems to develop initiatives o Goal of creating open and fair learning environment to design safe systems o Mindset that affects work environment to proactively look for system breakdowns and identify ways to improve systems · Geriatric Anemia - Answer>> o Lower than normal RBC that is common in seniors · PHQ- MOD-SEVERE= THERAPY & MEDS SEVERE= ASSESS FOR SUICIDE - Answer>> o "Over the last 2 weeks how often have you been bothered by the following".... o 1-4 minimal o 5-9 mild o 10-14 MODERATE- THERAPY & MEDS o 15-19 moderately severe

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o 20-27 SEVERE--- ASSESS FOR SI · Beck Depression Inventory MOD-SEVERE= THERAPY & MEDS SEVERE= ASSESS FOR SUICIDE - Answer>> o 0-9 Normal/Not depressed o 10-18 Mild depression-No meds, just therapy o 19-29 Moderate-sever depression o 30-63 Severe depression · HAM-D (Hamilton Depression Rating Scale) MOD-SEVERE= THERAPY & MEDS SEVERE= ASSESS FOR SUICIDE - Answer>> o Increased score indicates increase in number of symptoms of depression o 0-7 Normal/No depression o 8-13 Mild o 14-18 Moderate o 19-22 Severe o 23+ Very Severe- Monitor for SI · HAM-A (Hamilton Anxiety Rating Scale MOD-SEVERE= THERAPY & MEDS - Answer>> o 0- 17- Mild o 18-24 Mild/Moderate

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o 25+ Moderate/Severe GAD-7 (Generalized Anxiety Disorder Screening) MOD-SEVERE= THERAPY & MEDS - Answer>> · o 5-9 Mild o 10-14 MODERATE o 15-21 Severe Zung Self-Rating Depression Scale (SDS) SEVERE= ASSESS FOR SUICIDE - Answer>> -50-69 MODERATE depression, -70+ is severe depression = MOD - SEVERE =THERAPY & MEDS -SEVERE= ASSESS FOR SUICIDE · MMSE ASSESS FOR ALZHEIMER'S/DEMENTIA - Answer>> -HIGHER THE SCORE, THE BETTER -LOWER THE SCORE = DEMENTIA o 24-30 normal o 23-20 mild o 19-10 MODERATE ALZHEIMER'S o 9-0 Late Stage = SEVERE DEMENTIA · ALZHEIMERS/ Dementia - Answer>> o Chronic, irreversible

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o SLOW ONSET & progressive o Assessment for Alzheimer's ability to drive: functionality, visual acuity o Encourage RESPITE care for caregivers o Agnosia-can't recognize objects/people o Aphasia-language disturbance in expressing and understanding spoken words o Apraxia- inability to carry out motor activities Stages of dementia - Answer>> § Stage1- forgetfulness § Stage 2-Confusion and personality changes § Stage 3- wandering § Stage 4- end stage, cannot function, no cure vascular dementia risk - Answer>> -HTN -fundoscopic abnormalities -carotid bruit, -enlarged cardiac chambers- Delirium - Answer>> Acute, & Reversible -1ST sign = DISORIENTATION o Restlessness, illusions, incoherence of thought and speech -caused by other factors --TX UNDERLYING CAUSE EX:

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o Wandering person in the street disoriented for two days · Pediatric TX for depression - Answer>> -8yrs + fluoxetine (Prozac) SSRI -12yrs + escitalopram (Lexapro) SSRI · Pediatric TX for OCD - Answer>> o OCD medication 6 yrs + sertraline (Zoloft) SSRI 8yrs + fluoxetine (Prozac) ; fluvoxamine (Luvox) SSRI 10+ yrs. CLOMIPRAMINE (Anafranil) - TCA · Neurotransmitters - Answer>> o Serotonin

• Affects mood, hunger, sleep,
• decreased = depression o Dopamine
• Excitatory, regulates motor behavior, motivation, pleasure, and emotional arousal
• If increased= schizophrenia
• If decreased = tremors and decreased mobility; Parkinsons o Glutamate
• Excitatory
• decreased = disables learning and memory, causes muscle contraction o Norepinephrine

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• Excitatory, helps mood, attention, fatigue, anxiety disorders,
• decreased = depressed mood o GABA
• Inhibitory, sedate and calm
• decreased = BIPOLAR DISORDER (mania), seizures, tremors and insomnia o Acetylcholine -muscle control, learning, memory, and attention, involuntary muscle movement
• decreases = Alzheimer's · Neurotransmitters for mood - Answer>> -serotonin and norepinephrine · Neurotransmitters for addiction - Answer>> - dopamine and GABA · Child Abuse - Answer>> o Sx: Head injuries, bruises and welts in shapes of objects, burns, bits, rope burn, fractures in different stages of healing Ex: Brother sexually abusing sister then make sure that he is not left alone with her, call CPS, arranger crisis therapy Apoptosis - Answer>> Programmed NEURON DEATH, d/t SUFFOCATION

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