PMHNP LMR Questions and Answers 2025: A Review of Key Concepts and Medications, Exams of Nursing

Download PMHNP LMR Questions and Answers 2025: A Review of Key Concepts and Medications and more Exams Nursing in PDF only on Docsity! P a g e 1 | 88 1 GEORGETTE'S REVIEW PMHNP LMR Questions and Answers 2025 When many answers are remarkably similar, they are usually _____________ ANS: ✔✔- wrong Interprofessional collaboration is encouraged. ANS: ✔✔- Collaborate is usually right. Delegate is usually wrong. ADPIER ANS: ✔✔- Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium ANS: ✔✔- Normal 0.6-1.2 Lithium toxicity occurs at levels ANS: ✔✔- > 1.5 P a g e 2 | 88 2 Signs of Lithium toxicity ANS: ✔✔- severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for ANS: ✔✔- MANIA Lithium has evidence shown to ANS: ✔✔- reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester ANS: ✔✔- Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to ANS: ✔✔- rise Baseline labs before initiation of lithium ANS: ✔✔- TSH creatinine (0.6-1.2) BUN (10-20) HCG (all psychotropics females 12-51) EKG 50+ P a g e 5 | 88 5 Symptoms of hypertensive crisis ANS: ✔✔- elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + ANS: ✔✔- MEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds P a g e 6 | 88 6 Treatment for hypertensive crisis ANS: ✔✔- DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos ANS: ✔✔- floppy baby, cleft palate Teratogenic effects of tegratol ANS: ✔✔- neural tube defect teratogenic effects of lithium ANS: ✔✔- ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote ANS: ✔✔- neural tube defects/spina bifida Adverse reaction to Lamictal ANS: ✔✔- Steven Johnson's Syndrome Signs of SJS ANS: ✔✔- FEVER --high yield sore throat P a g e 7 | 88 7 facial swelling tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause ANS: ✔✔- sedation or weight gain Carbamazepine (tegretol) black box warning ANS: ✔✔- agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) P a g e 10 | 88 10 C. Methylphenidate D. Acetaminophen ANS: ✔✔- Answer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1,000 C. WBC less than 5,000 D. ANC less than 2000 ANS: ✔✔- Answer: ANC less than 1000 If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate ANS: ✔✔- A. Spina bifida P a g e 11 | 88 11 Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal ANS: ✔✔- A. Carbamazepine Bulimia, weight is ___________ ANS: ✔✔- within the normal range. Pharm treatment for bulimia ANS: ✔✔- Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa ANS: ✔✔- low BMI Amennorrhea Emaciation Bradycardua Hypotension P a g e 12 | 88 12 Pharm treatment for anorexia ANS: ✔✔- there is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands ANS: ✔✔- Low BMI If a patient is depression, low energy, fatigued, you would prescribe ANS: ✔✔- Wellbutrin Wellbutrin is contraindicated in patients with ANS: ✔✔- seizure disorder or conditions that increase risk of seizures such as eating disorder. P a g e 15 | 88 15 Ketoconazole Alcohol Chloramphenicol Erythromycin Sulfonamine Cipro Omeprazole Metronidazole Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine a. 2D6 b. 1A2 c. 2C19 d. 2C9 ANS: ✔✔- 1A2 (want A 2 cigarette break) P a g e 16 | 88 16 When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration ANS: ✔✔- Decreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium D. Decreased renal clearance of lithium ANS: ✔✔- A. decreased renal clearance of lithium P a g e 17 | 88 17 Where is norepinephrine produced ANS: ✔✔- locus coeruleus and medullary reticular formation Norepinephrine is associated with ANS: ✔✔- mood disorders Serotonin is made where in the brain ANS: ✔✔- raphe nuclei of the brainsteam Serotonin is associated with ANS: ✔✔- sleep and mood disorder Dopamine is made in ANS: ✔✔- substantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with ANS: ✔✔- addiction and psychosis Acetylcholine is made ANS: ✔✔- basal nucleus of Meynert P a g e 20 | 88 20 Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality ANS: ✔✔- frontal lobe memory, understanding, language ANS: ✔✔- temporal lobe Both hemispheres of the brain are connected by the ANS: ✔✔- corpus callosum Area of sensorimotor information exchange between two hemispheres ANS: ✔✔- corpus callosum When there is disturbances in clock drawing test, which hemisphere is compromised ANS: ✔✔- right hemisphere/right parietal lobe Area for expressive speech ANS: ✔✔- frontal lobe Broca's Area P a g e 21 | 88 21 Problems in the frontal lobe can lead to ANS: ✔✔- personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension ANS: ✔✔- Temporal lobe Wernicke's area Problems in the temporal lobe can lead to ANS: ✔✔- auditory hallucinations, aphasia, and amnesia Occipital lobe ANS: ✔✔- primary visual area problems in the occipital lobe can lead to ANS: ✔✔- Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain ANS: ✔✔- parietal lobe P a g e 22 | 88 22 problems in the parietal lobe can lead to ANS: ✔✔- Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) Cerebellum is responsible for ANS: ✔✔- gross motor skills fine motor skills balance A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the A. frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe ANS: ✔✔- frontal lobe P a g e 25 | 88 25 Which serotonin receptor antagonism makes an antipsychotic "atypical" ANS: ✔✔- 5HT2A Excess dopamine in this area causes positive schizophrenic symptoms ANS: ✔✔- meoslimbic pathway decreased dopamine leads to negative symptoms of schizophrenia ANS: ✔✔- mesocortical pathway Increased blockade of dopamine here leads to EPS ANS: ✔✔- nigrostriatal pathway Blockade of dopamine in this pathway can lead to increased prolactin levels ANS: ✔✔- tuberoinfundibular pathway Muscle spasms ninth face, neck, tongue, back/neck muscles ANS: ✔✔- acute dystonia P a g e 26 | 88 26 Oculogyric crisis, which can lead to permanent injury. Patients have prolonged involuntary upwards deviation of the eyes bilaterally. ANS: ✔✔- Rare presentation of acute dystonia. Pharm treatment for dystonia ANS: ✔✔- cogentin (IM first then oral) Restlessness, inability to sit still. Pacing. Mistaken for anxiety. ANS: ✔✔- Akathisia Commonly used rating scale for akathisia is ANS: ✔✔- Barnes Akathisia rating scale and extrapyramidal symptom rating scale. Treatment for akathisis 1st line 2nd line 3rd line ANS: ✔✔- 1st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine P a g e 27 | 88 27 Absence of movement or difficulty initiating movement ANS: ✔✔- akinesia Treatment: cogentin Presence of symptoms of Parkinson's produced by D2 blockade in the nigrostriatal pathway ANS: ✔✔- Pseudo-Parkinsonism Signs of Parkinsons ANS: ✔✔- muscle rigidity shuffling gait mask like facial expression pill rolling tremors cogwheel rigidity Treatment for pseudo parkinsonism ANS: ✔✔- cogentin P a g e 30 | 88 30 Fetal alcohol syndrome ANS: ✔✔- Everything is low low weight, small features of the face. Which if the following antidepressants is associated with the most cardiovascular side effects? ANS: ✔✔- Citalopram--causes QT prolongation What the body does to drugs? ANS: ✔✔- Pharmacokinetics What the drug does to the body ANS: ✔✔- pharmacodynamics The drug binds to the receptors and activates a biological response (opens the ion channel) ANS: ✔✔- agonist effect drug causes the opposite effect of the agonist. Binds to the same receptor but closes the channel ANS: ✔✔- inverse agonist P a g e 31 | 88 31 drug does not fully activate the receptor ANS: ✔✔- partial agonist drug binds to the receptor but foes not activate a biological response ANS: ✔✔- antagonist The study of what the drug does to the body. ANS: ✔✔- Pharmacodynamics When studying pharmacodynamics involving receptor, you know that an agonist produces the following effect? A. Does not fully activate the receptor B. Blocks the agonist from opening the channel C. Causes the opposite effect D. Activates a biological response and opens the ion channel. ANS: ✔✔- Activates a biological response and opens the channel. Medications that can cause mania (very high yield) ANS: ✔✔- Steroids Antabuse P a g e 32 | 88 32 Isoniazid Antidepressants in persons with bipolar Flonase Medications causing depression ANS: ✔✔- steroids beta blockers interferon accutate some retroviral drugs antineoplastic drugs benzos progesterone Fragile X syndrome ANS: ✔✔- all their facial structures are larger. Severe adverse effect caused by antipsychotics ANS: ✔✔- neuroleptic malignant syndrome P a g e 35 | 88 35 False belief firmly maintained despite evidence to the contrary ANS: ✔✔- delusion Do you try to convince them the delusion is wrong or isn't real? ANS: ✔✔- No Patient believes that certain news bulletins have a direct reference to them ANS: ✔✔- referential thinking MSE: Though process ANS: ✔✔- organization of the patient's thoughts and ideas. MSE: Thought content ANS: ✔✔- refers to themes that occupy the patient's thoughts and perceptual disturbances. Suicidal ideation/plan homicidal ideation/plan P a g e 36 | 88 36 Exam ised to quantify cognitive status in adults ANS: ✔✔- mini mental status exam or may say Folstein Component of Folstein/mini mental status ANS: ✔✔- I would like you to could backwards from 100 by 7s or do serial 7s Folstein/mini mental status registration/ability to learn new material ANS: ✔✔- repeat after me, bed, bat, ball Suiciidal risk factors ANS: ✔✔- previous attempt Male 45+ Female 55+ Divorced, single, separated white living alone psychiatric disorder physical illness substance abuse P a g e 37 | 88 37 family history recent loss male gender Characteristics of therapeutic relationship ANS: ✔✔- Genuineness Acceptance Nonjudgment Authenticity Empathy Respect Professional boundaries displacement of feelings for significant people int he client's past onto the PMHNP ANS: ✔✔- transference Nurses's emotional reaction to the client based on past experiences. ANS: ✔✔- Countertransference P a g e 40 | 88 40 anxiety agitation tactile disturbances auditory disturbances visual disturbances headache altered sensorium agitation Rating scale of opiate withdrawal ANS: ✔✔- COWS Signs and symptoms of opioid withdrawal ANS: ✔✔- yawning, irritability, pupillary dilation piloerection muscle aches lacrimation rhinorrhea P a g e 41 | 88 41 Treat COWS when score is greater than ANS: ✔✔- 7 Moderate withdrawal on COWS ANS: ✔✔- 13-24 Moderate withdrawal on CIWA ANS: ✔✔- scoring 15 Treatment for COWS ANS: ✔✔- Buprenorphine (Suboxone) Treatment for CIWA ANS: ✔✔- scheduled meds plus diazepam SBIRT stands for ANS: ✔✔- Screening, Brief Intervention, and Referral to Treatment SBIRT FRAMES ANS: ✔✔- Feedback--tell them about their risk of their current alcohol use Responsibility--reinforce their responsibility for change P a g e 42 | 88 42 Advice--based on facts about their drinking, offer simple and direct advice Menu--provide a menu of options for behavior change Empathetic interviewing--consider their perspective. Be non-judgemental Self-efficacy--encourage person to believe they can change. CAGE screening tool ANS: ✔✔- cut down, annoyed, guilty, eye opener Acute onset altered level of consciousness inattenion poor prognosis--1 year mortality rate of is up to 40% ANS: ✔✔- delirium Treatment of choice for delirium ANS: ✔✔- haloperidol Avoid which class in delirium as it tends to prolong it ANS: ✔✔- benzos P a g e 45 | 88 45 A 24 year olf female attempts suicide by overdose on an MAOI phenelzine. She is stabilized in the hospital. Ten days later she is started on venlafaxine and becomes tachycardia and diaphoretic, and develops myoclonic jerks. What condition is this? A. NMS B. Opisthotonos C. Akathisia D. Serotonin syndrome ANS: ✔✔- serotonin syndrome a 17 year old arrives at the emergency department with nonspecific complaints The patient's temperature is 100.8, pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline for the treatment of depression. the patient has a history of substance use and smoked marijuana one week ago. The diagnosis is ANS: ✔✔- serotonin syndrome Patient being treated for psychosis for 2 weeks develops symptoms of NMS. The following factors help the pMHNP to differentiate NMS from serotonin syndrome. P a g e 46 | 88 46 A. autonomic instability, diaphoresis, tremors B. Hyperthermia, leukopenia, tachycardia C. Rigidity, hyperrefelexia, orthostatic hypotension D. Mutism, leukocytosis, myoglobinuria ANS: ✔✔- mutism, leukocytosis, myoglobinuria Appraisal of the patient's SI plan, intent and access to implement plan would be documented in which part of standard psychiatric evaluation A Review of symptoms. B. Diagnosis C. Mental status exam D. History of presenting illness ANS: ✔✔- C mental status exam a 48 year off Caucasian male presents for his therapy appointment. He is sad about losing his wife recently to covid 19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk of suicide? A. Previous attempt P a g e 47 | 88 47 B. Age C. Gender D. Marital Status ANS: ✔✔- A previous attempt Which of the following patients is at higher risk of suicidie? A. 30 year old married African American female with previous attempt B. A 35 year old single Asian male with previous suicide attempt C. A 38 year old single African American male who is manager of a bank D. A 68 year off single Caucasian male with depression ANS: ✔✔- D. 68 year old single, caucasian male, depression A 64 year old caucasian male referred for treatment of refractory depression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority? A. Prior and current meds, dose, clinical response, side effects. B. Thoughts of self-harm, plan, intent, access C. Extent of alcohol use, and motivation to reduce to safe levels P a g e 50 | 88 50 Moderate level on the PHQ-9 ANS: ✔✔- 10-14 Moderate level on the Beck ANS: ✔✔- 10-29 Moderate on GAD 7 ANS: ✔✔- 10-14 Moderate on COWS ANS: ✔✔- 13-24 Moderate on CIWA ANS: ✔✔- 15 Dementia is characterized by _____________ onset. ANS: ✔✔- gradual Alzheimers is cortical or subcortical dementia ANS: ✔✔- cortical Cortical dementia causes ANS: ✔✔- language and memory problems. Examples of subcortical dementia ANS: ✔✔- Huntington's disease P a g e 51 | 88 51 Parkinson's disease AIDS dementia complex Which type of dementia can cause depression, motor symptoms, and apathy ANS: ✔✔- subcortical Cognitive decline (concentration, attention), motor abnormalities(lack of coordination, ataxia, tremors, dystonia, muscle rigidity) and behavioral abnormalities (HIGH YIELD) ANS: ✔✔- dementia r/t HIV Recurrent visual hallucinations Parkinson features Adversely reacts to antipsychotics ANS: ✔✔- Lewy body dementia--- recurrent visual hallucinations. caused by cardiovascular disease. Common in hypertension and CVD ANS: ✔✔- vascular dementia P a g e 52 | 88 52 Hallmark signs of vascular dementia ANS: ✔✔- carotid bruits, fundoscopic abnormalities, and enlarged cardiac chambers Personality, language (slurred) and behavioral changes ANS: ✔✔- Picks disease --frontal lobe changes Huntington's disease ANS: ✔✔- subcortical, think motor symptoms High incidence of depression nd psychosis First line agent for psychotic symptoms of dementia ANS: ✔✔- antipsychotics avoid benzos A 69 year old man with diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms? A. Haloperidol P a g e 55 | 88 55 Neurotransmitters involved in ADHD ANS: ✔✔- DNS dopamine norepineph serotonin ADHD causes DNS ANS: ✔✔- dopamine noreip serotonin Hallmarks of ADHD ANS: ✔✔- persistent pattern of inattention or hyperactivity, impulsivity, or both. What to check prior to prescribing a stimulant? ANS: ✔✔- cardiac history, family history of CVD and get an EKG prior to starting Amphetamines are approved in children as young as ANS: ✔✔- 3 P a g e 56 | 88 56 Signs of stimulant abuse ANS: ✔✔- insomnia tremors heart palpiations increased BP and HR Rating scale for ADHD ANS: ✔✔- Connors and Vanderbilt Must monitor in two settings Hallmarks of borderline personality disorder ANS: ✔✔- impulsivity with self-damaging behavior Recurrent suicidal behavior Treatment for Borderline ANS: ✔✔- DBT Hallmarks of antisocial personality ANS: ✔✔- reckless disregard for welfare of others P a g e 57 | 88 57 lack of remorse indifference to the feelings of others INCREASED HOMICIDAL IDEATION --HIGH YIELD Primarily in girls normal development then decline loss of purposeful hand movements stereotypic hand movements --flapping of hands deceleration of head growth ANS: ✔✔- Rett syndrome Chronically moody, sad irritable for no reason ANS: ✔✔- Disruptive mood dysregulation disorder patient reacts grossly out of proportion to situation sudden rage/anger outbursts ANS: ✔✔- Intermittent explosive disorder P a g e 60 | 88 60 treatment resistant depression Which characteristic of fluoxetine provides the greatest degree of safety for patients who have severe depression A. Greater efficacy than an TCA B. Less potential drug interaction C. Less potential for injury with intentional overdose. D. Less potential for suicidal thinking. ANS: ✔✔- less potential for injury with intentional overdose. Do no harm contracts reduce the risk of suicide ANS: ✔✔- NO A 72 year old is brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is being treated with lisinopril. The exam is normal and the mini mental status exam provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis? A. Alzheimers disease P a g e 61 | 88 61 B. Vascular dementia C. Depression D. Delirium ANS: ✔✔- depression During patient education on sertraline, the PMHNP focuses upon the potential side effect of A. agranulocytosis B. hypernatremia C sexual dysfunction D weight loss ANS: ✔✔- sexual dysfunction A 23 year old woman is Brought in to to the ER after attempting to commit suicide by cutting her wrists. Which action by the PMHNP would be of highest priority initially? A. Assess her coping behaviors B. Assess her current level of suicidality C. Take her vital signs D. Asess her health history ANS: ✔✔- take her vital signs P a g e 62 | 88 62 Bipolar Mnemonic (DIG FAST) ANS: ✔✔- Distractibility impulsivity grandiosity flight of ideas agitation, psychomotor sleep need decreased talkativeness, pressured speech What is the gold standard treatment for mania ANS: ✔✔- lithium What is neuroprotective treatment for bipolar I ANS: ✔✔- lithium Normal Free T4 ANS: ✔✔- 0.8-2.8 Normal TSH ANS: ✔✔- 0.5-5.0 P a g e 65 | 88 65 A male patient informs as adult PMHNP that he has not slept in three days, has poor concentration, and denies fatigue. The patient's diagnosis is: A. ADHD B. Bipolar disorder C. Panic disorder D. Primary insomnia ANS: ✔✔- bipolar disorder The neuroprotective treatment of choice for bipolar disorder is ANS: ✔✔- lithium According to the current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes: A.) Lithium B. Citalopram C. Lamotrigine D. Quetiapine ANS: ✔✔- quetiapine P a g e 66 | 88 66 intrusive reexperiencing of a traumatic event ANS: ✔✔- PTSD symptoms of PTSD ANS: ✔✔- hyperarousal, avoidance of stimuli associated with trauma, intrusive symptoms Pharm treatment for pTSD ANS: ✔✔- SSRI (Zoloft) TCA Prazosin AVOID BENZOS Risk factors for OCD ANS: ✔✔- first degree relative and PANDAS-- associated with strep infection, Tourette's ANS: ✔✔- At least 2 motor tics and at least one vocal tic have been present. Cause of tourettes ANS: ✔✔- dopamine --hyperactivity of the dopamine system. P a g e 67 | 88 67 use of external agents that mimic disease (patient ingests foreign body) ANS: ✔✔- factitious disease excessive worry more than 6 months ANS: ✔✔- GAD Age of onset of schizophrenia in males ANS: ✔✔- 18-25 Age of onset of schizophrenia in females ANS: ✔✔- 25-35 Cause of schizophrenia ANS: ✔✔- intrauterine insults prenatal exposure to toxins, including viral agents Problem in the brain in schizophrenia ANS: ✔✔- enlarged ventricles, everything else decreases Things to monitor and labs while on antispychotic ANS: ✔✔- serum glucose, serum lipid panel, weight, BMI, waist to hip ratio. P a g e 70 | 88 70 Initimacy vs isolation ANS: ✔✔- Early adulthood 20-35 Intimacy vs isolation virtue ANS: ✔✔- love Generativity vs stagnation ANS: ✔✔- middle adultgood 35-65 years generatively vs stagnation virtue ANS: ✔✔- care key event: parenting integrity vs despair (VERY HIGH YIELD) ANS: ✔✔- late adulthood greater than 65 years integrity vs despair virtue ANS: ✔✔- wisdom fulfillment and comfort with life willing to face death, sense of integrity P a g e 71 | 88 71 Piaget focuses on ANS: ✔✔- behavior Piaget Sensorimotor 0-2 ANS: ✔✔- object permanence and object constancy Piaget Preoperational (VERY HIGH YIELD) 2-7 years ANS: ✔✔- magical thinking egocentric pretend play Piaget Concrete operational 7-11 years ANS: ✔✔- Thinks logically about concrete objects Understands conservation and reversibility Piaget Formal Operational (VERY HIGH YIELD) P a g e 72 | 88 72 12+ years ANS: ✔✔- Reason abstractly Freud Oral Stage ANS: ✔✔- 0-1 Erogenous zone: mough Freud Anal Stage ANS: ✔✔- 1-3 years Erogenous zone: anus Freud Phallic Stage ANS: ✔✔- 3-6 years Erogenous zone is genitals Freud latent stage ANS: ✔✔- 6 to puberty Representation of sexual feelings Freud Genital stage ANS: ✔✔- •puberty-adulthood •sexual urges reawaken & are directed to an individual outside the family circle •unresolved conflicts from previous stages arise P a g e 75 | 88 75 person is thinking about change, is aware there is a problem, but is not committed to changing ANS: ✔✔- contemplation action in contemplation ANS: ✔✔- help the person find a change strategy that is realistic, acceptable, accessible, and effective. Person has made the decision to change and is ready for action ANS: ✔✔- preparation action step in preparation ANS: ✔✔- help the person find the change strategy that is realistic, acceptable, appropriate, and effective. person is engaging in specific, overt actions to change ANS: ✔✔- action action step in action ANS: ✔✔- support and advocate help accomplish steps for change. P a g e 76 | 88 76 person is engaging in behaviors to prevent relapse ANS: ✔✔- maintenance action step in maintenance ANS: ✔✔- help the person identify the possibility of a relapse identify strategies to prevent relapse. therapy that changes the clients irrational beliefs and negative cognitive disortions ANS: ✔✔- cognitive therapy. method that uses journaling, cognitive restructuring ANS: ✔✔- cognitive therapy. Who invented DBT ANS: ✔✔- Marsha Linehan used for borderline personality disorder Goal of DBT ANS: ✔✔- reduce suicidal behaviors P a g e 77 | 88 77 Emphasizes accepting freedom and making responsible choices ANS: ✔✔- existential therapy well suited to those facing issues of existence, for example those with terminal illness, those contemplating suicide, or going through transition in life Goal: focus on present and personal responsibility focus on a. patient's subjective world ANS: ✔✔- Existential therapy therapy that is person centered self-directed growth self-actualization ANS: ✔✔- Humanistic therapy therapy that focuses on interpersonal issues causing distress to understand manage relationship problems ANS: ✔✔- interpersonal therapy therapy used for PTSD Goal: achieve adaptive resolution P a g e 80 | 88 80 Yalom's Curative Factors ANS: ✔✔- - Altruism: giving of oneself to help others - Catharsis: relieving of emotions by expressing one's feelings - Universality: recognizing shared feelings and that one's problems are not unique - Existential factors: address accepting the fact that respons. for change comes from w/in oneself - Self-understanding: discovering and accepting unknown parts of oneself - Family reenactment: understanding what is was like growing up in one's family through group exp. - Guidance: accepting advice from other members - Identification: benefiting from imitation of the positive behaviors of other group members - Instillation of hope: experiencing optimism through observing improvement of other members - Interpersonal learning: occurs when receiving feedback from grp members re: one's bx (input), learning successful ways of relating to group members (output) P a g e 81 | 88 81 study of long term sequel of adverse childhood events found ANS: ✔✔- positive relationship between heart disease, obesity, DM, unintended pregnancy, depression, anxiety, cancer, COPD, sleep disorders, dissociative disorders, and substance use disorder. Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral therapy in DBT include which of the following? A. Skills training and exposure B. Examination of feelings and relating feelings to visceral sensations C. Working through the transference with the therapist D. Cognitive interpretation of past traumatic events. ANS: ✔✔- A skills training and exposure treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life. Recovery isn't about getting rid of the problem, but recognizing and fostering their abilities, interests, and dreams. ANS: ✔✔- Recovery Model P a g e 82 | 88 82 Goals of Assertive COMMUNITY Treatment ANS: ✔✔- help people become more independent and integrate into the community reduce reliance on hospitals providing around the clock care. NP Core Competencies ANS: ✔✔- Scientific Foundations Leadership Quality Practice Inquiry Technology and Information Literacy Policy Health Delivery System Ethics Independent Practice who identifies our scope of practice ANS: ✔✔- state board of nursing P a g e 85 | 88 85 doing for self ANS: ✔✔- autonomy Rennie v Klein Court Case ANS: ✔✔- involuntary patient not found incompetent, has a right to refuse psychotropic medications, goal of case management ANS: ✔✔- promote quality and cost-effective outcomes. Stark Law ANS: ✔✔- you can't refer to family members for treatment of your patients. PICOT ANS: ✔✔- Patient or problem intervention comparison outcome time P a g e 86 | 88 86 evidence from systematic review or meta analysis of many RCTs ANS: ✔✔- level 1 evidence evidence from at least one RCT ANS: ✔✔- level 2 evidence Before implementing/creating change of policy ANS: ✔✔- assess/address/identify potential organizational barriers and facilitators meet with stakeholders patient advocacy ANS: ✔✔- reduce stigma of mental illness through education help patients receive available services Seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix system issues ANS: ✔✔- just culture of safety P a g e 87 | 88 87 Process for quality improvement ANS: ✔✔- plan, do, study, act reflective practice ANS: ✔✔- debriefing strategies goal: to improve practice Highest rate of suicide in US ANS: ✔✔- native Americans True or false A culturally expected response to a stressor does not always mean a mental illness ANS: ✔✔- true grasp palmar reflex disappear by ANS: ✔✔- 5-6 months moro startle reflex disappear by ANS: ✔✔- 5-6 months babinski reflex normal until ANS: ✔✔- age 2