Psychiatric Disorders and Treatments, Exams of Nursing

Download Psychiatric Disorders and Treatments and more Exams Nursing in PDF only on Docsity! Which of the following are risk factors for neurolep4c malignant syndrome? Select all that apply Rapid dose escala4on; parental route of administra4on; higher potency typical an4psycho4cs Discrepancy between anatomical sex and gender is known as? B) Gender Discordance An4psycho4c medica4on provides D2 blockage in the meso-coritcal pathway causing which of the following effects? B) Increases EPS Incorrect: reduces nega4ve s/s, causes prolac4nemia, reduces posi4ve symptoms Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors? D) NMDA type receptors Incorrect: GABA, serotonin, dopamine "receptors" The diagnosis used to describe a syndrome characterized by specific s/s resul4ng from recent inges4on or exposure to a substance is known as which of the folllowing? C) Substance use disorder Incorrect: substance intox, substance withdrawal, all of the above Abnormal involuntary movements in a rhythmic paVern affec4ng the face, mouth, tongue jaw is known as which of the following? WALDEN UNIVERSITY NRNP 6675/ NRNP 6675N Final Exam (QUESTIONS AND VERIFIED ANSWERS) graded A+ with complete solutions 2024/2025 C) Tardive dyskinesia Incorrect: akathisia, dystonia, EPS A deeply held belief despite evidence to the contrary, las4ng at least 1 month, without prominent hallucina4ons, with func4onal impairment that relates to the delusional system disorder called? Delusional disorder Which of the following is true about preoccupa4on with castra4on? A) This can be serious and life threatening if castra4on is carried out without medical supervision Incorrect: consistent with transves4a4c disorder, other specified paraphillic disorder, or sexual machochism disorder Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnos4cs services rendered by clinicians? CPT Incorrect: HIPPA, DSM5-, DRG A pa4ent on Chlorpromazine states his orgasm is dry and a[erwards he will commonly have milky urine. The APRN realizes this is which of the following? A) This is likely a harmless response to the Chlorpromazine "Thorazine" A condi4on which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus and infer4lity is known as which of the following? B) Turners Syndrome Turners syndrome: tx involves hormone therapy; fer4lity treatments for women when they decide to have a baby Which of the following would be characterized as a nega4ve s/s of schizophrenia? A diffuse, unpleasant, vague sense of apprehension o[en accompanied by autonomic symptoms varies upon persons is commonly known as which of the following? C) Normal anxiety (incorrect- fear, stress, pathological anxiety If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired during which trimester is the least hazardous? D) Withdrawal from methadone should never be done while the woman is pregnant Neurochemical or neurophysiological changes in the body that results from the repeated administra4on of a drug is known as which of the following? C) Neuroadap4on incorrect: cross-tolerance, neurotransforma4on, neurocogni4ve adjustment The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following? C) Sexual sadism Which of the following is not consistent with the onset of OCD? D) The onset of OCD is typically preceded by OCD personality traits True answers about OCD: -more than 1/2 of pts with OCD have a sudden onset of symptoms -the onset of symptoms for about 50-70% of pa4ents occurs a[er a stressful event -most pa4ents keep their symptoms secret ini4ally The recurrent urge to expose one's genitals to a stranger is known ass which of the following? C) Exhibi4onism Which of the following pa4ents would be appropriate for hospitaliza4on for substance use disorder? Select all that apply D) A&B only (Pa4ents who have a substance overdose who cannot be safely tx in an outpt segng & pts who are at risk for severe or medically complicated withdrawal symptoms The nursing prac4ce model recommenda4on for nps by the na4onal Academy of Medicine and the Na4onal Council of State Boards of Nursing is which of the following? A) Full prac4ce Which of the following groups does medicare cover? Select all the above A) Individuals 65+ years and older who have enrolled and pay premiums B) Disabled individuals who quality for social security disability payments and benefits Which of the following neurotransmiVers increases libidio? D) Dopamine Incorrect: GABA, serotonin, oxytocin Which of the following factors are associated with poor prognosis for pa4ents with OCD? D) A & C (Childhood onset & Co-exis4ng major depressive disorder) Which of the following is inconsistent with current knowledge about schizophrenia? C) Dopamine level is a laboratory tests that assists in the diagnosis of schizophrenia A chronic disorder characterized by repe44ve hair pulling leading to variable hair loss that may be..to others known as? C) Tricho4llomania Which of the following are risk factors for neurolep4c malignant syndrome? B) Rapid dose escala4on C) Parental route of admin D) High potency typical an4psycho4cs A method of therapy used to tx individuals with substance use based on the fundamental principle of a psychology that reinforced behaviors are likely to be..is known as the following? B) Con4ngency Management The condi4ons in which people are born, grow, work, live and age are known as? Social determinants of health All of the following is consistent with the anccs rules regarding recer4fica4on EXCEPT: A) You are required to have a maximum of 25 credit hours during each cer4fica4on period Correct: B) you can start the recert process 1 year before your expira4on date, but no later than 3 months before C) You must have 1000 clinical prac4ce hours in a clinical speciality within the preceding 5 years D)you must have at least 25 contact hours in pharmacotherapy Risks factors for school violence include which of the following? Select all that apply A) Bullying B) Being bullied C) Isola4on Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas in the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of 4me are demonstra4ng characteris4cs with which of the following personality disorders? C) Dependent personality disorder Incorrect: avoid PD, passive PD, an4social PD Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels? D) >25 meq/L (TOXICITY) A form of child abuse in which a pa4ent or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical interven4on is then sought in an ER is known as which of the following? D) Munchausen Syndrome by Proxy C) The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, discon4nues the lithium immediately, orders a lithium level, serum electrolytes and renal func4on tests The ARNP takes a posi4on in which a specific amount is paid according to a set job descrip4on. This type of pay structure is known as? D) Hourly rate A PD characterized by emo4onal constric4on, orderliness, perseverance, stubbornness, indecisiveness, a inflexibility as which of the following? Obsessive compulsive PD Which of the following is consistent with NP prac4ce parameters when prescribing buprenorphine? D) the NP is require to complete specific training to prescribe and dispense buprenorphine Which of the following are consistent with current data related to the prevalence of drinking alcohol? B) Men and women with higher educa4on and income are more likely to drink alcohol A pt with hx of hypoglycemia reports feelings of fear, worry and restlessness that has persisted over the past 6 months. The pt states these feelings are worse when glucose is low. The ARNP suspects the pt has which of the following dx? A_) GAD aVributable to another medical condi4on Which of the following is not consistent with benzo withdrawal? B) The best way to proceed with benzo withdrawal is to stop it immediately and tx withdrawal s/s Which of the following is true about the legal prac4ce of the PMHNP? D) A&B only A) all have some degrees of prescrip4ve privileges in all states and the district of columbia B) all are considered primary providers in all states and the district of columbia Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical features of PTSD? A) Intrusion Symptom B) Symptom of Avoidance In which ways are nps and pas different? D) A&B A) nps differ from pas in legal defini4on, scope of prac4ce, licensure, and independence of prac4ce B) nps prac4ce under their own license and independent of the physician, pas always work under the supervision of a physician Which of the following ini4als would a PMHNP use to designate appropriate creden4als? PMHNP-BC Varia4ons from norms in gender roles such as toy preferences, rough and tumble play, aggression, or playmate gender is known as which of the following? B) Gender role behavior 3 major neurotransmiVers associated with anxiety, based on animal studies and response to drug tx include? B) GABA, norepinephrine and serotonin Which of the following is consistent with the epidemiology of schizophrenia in the US? D) Onset of schizophrenia before the age of 25 is extremely rare Clinical findings that may indicate abuse include which of the following? Select all that apply B) Explana4on by the pt which is inconsistent with the type of injury C) Psychological distress such as depression, anxiety, SI, and/or sleep disorder D) Explana4on by the parent that is inconsistent with the type of injury According to the APA, which of the following is consistent with the EBP for telepsych? B) In popula4ons with severe anxiety, tele psychiatry is preferred Which of the following is consistent with literature regarding the term psychosexual? D) None of the above -psychosexual is used to describe personality development and func4oning -psychosexual is synonymous with libidio in the Freudian sense -Psychosexual basically refers only to sexual feelings and behavior Bleuler iden4fied 4 fundamental s//s of schizophrenia, known as the 4 a's, which include which symptoms? A) Associa4ons, Affect, Au4sm, Ambivalence The fear/anxiety regarding places from which escape may be difficult is known as which of the following: C) Agoraphobia All of the following are one of the 5 major categories of third-party payers EXCEPT: D) only A & B A) Medicare/medicaid B) Managed care organiza4on (mcos) Which of the following are risk factors for sexual assault EXCEPT: A) Religion Incorrect: serious mental illness, substance use disorder, family hx of sexual abuse Which of the following is consistent with what is known about PP depression? D) All of the above (feelings of guilt/ and inadequacy are o[en present and excessive; thoughts of harming the baby are o[en present; typical onset is within 3-06 months of delivery) Affirma4vely ac4ng to benefit another or others, going beyond what is required by law is known as which of the following?> C) Beneficence Which of the following is used for trea4ng alcohol dependence individuals seeking to con4nue to remain alcohol free a[er they have stopped drinking? D) Acamprosate The NP can impact health policy and healthcare by doing which of the following? D) All of the above -becomes an ac4ve member of local, state, and/or na4onal NP -becomes familiar with the resources available on NP organiza4on websites Cluster A a. Paranoid PD b. Schizoid PD C. Schizotypal PD Characterized by appearing drama4c, emo4onal, or erra4c PD? Cluster B a., an4social b. Borderline c. Histrionic d. Narcissis4c Inner emp4ness, unstable rela4onships and emo4onal dysregula4on? BPD AVen4on seeking and excessive emo4onability? Histrionic Social irresponsibility, diregard for others, deceivulness, and manipula4on of others for personal gain An4social Self-grandiosity, need for admira4on and lack of empathy Narcissis4c PD Eccentric ideas and behaviors PD? Schizotypal PD Disinterest in others PD? Schizoid Mistrust and suspicion PD? Paranoid PD Characterized by appearing anxious or fearful. It includes which pds? Cluster C a. Avoidant PD b. Dependent PD c. Obsessive compulsive PD Perfec4onism, rigidity and obs4nacy traits PD? OCD PD Avoidance of interpersonal contact due not rejec4on sensi4vity PD? `Avoidant Submissiveness and a need to be taken care of PD? Dependent PD Which of the following is NOT consistent with recommenda4ons for psychiatric hx taking and the MSE of older adults? B) Pt should be seen alone even in cases of clear evidence of impairment to persevere the privacy of a doctor/pt rela4onship Low health literacy has been linked with which of the following? D_ All of the above -poor health outcomes -lower rates of hospitaliza4on -less frequent use of preventa4ve services A claim of malprac4ce requires that a pa4ent/plain4ff prove which of the following? Select all that apply A) The existence of a client-professional rela4onship--duty 4 care C) a causal link b/t the provider's failure to confirm to tx standards and harm to the pt D) Actual injury to the pt According to USDHHS and the Federal Bureau of Primary Health Care, which of the following individuals would be considered homeless? D) All of the above -an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommoda4ons -an individual who is a resident in transi4onal housing -a person who is living w /a friend` A par4cular form of psychotherapy used for pts with BPD, especially those with parasuicidal behaviors, such as frequent cugng is known as which of the following? A) DBT incorrect: mentaliza4on based tx; transference focused psychotherapy and exposure therapy` As a pmhnp, one of the most common areas you will counsel your pa4ents about is the importance of sleep hygiene. Which of the following is NOT consistent with common recommenda4ons for good sleep hygiene? B) Set a cool room temp True sleep hygiene 4ps: -avoid alcohol and caffeine -set TV to turn off within 1 hr of falling asleep -go to bed at the same 4me each night The need for nps to prac4ce to the full extent of their educa4on and training is necessary for which of the following reasons? Select all of the above A) The growth in number and propor4on of older Americans B) The projected PCP shortages by 2025 C) increased number of individuals who have access to healthcare According to Freud, stubborn, parsimonious and highly conscien4ous traits are associated with? B) Anal stage Freud's Psychosexual Theory and 5 Stages of Human Development? 1.Oral stage 2. Anal stage 3. Phallic stage 4. Latent stage 5. Genital stage The mouth, sucking, swallowin ect Stage 1- oral stage EGO develops in which phase? ORAL phase 1 The penis or vagina-sexual intercourse? Stage 5 genital `The anus- withholding or expelling feces 2. Anal stage LiVle to no sexual mo4va4on present? Stage 4. Latent phase The penis or clitoris- masturba4on Stage 3 Phallic Important serious side effects of Lithium: Hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity How do we decrease the risk of lithium toxicity? Blood level monitoring therapeu4c range: 0.6 - 1.2 Lithium levels are known to (increase/decrease) when used concurrently with diure4cs, thiazides, ACE inhibitors and nsaids? Increase ACE inhibitors: lisinopril, catopril, enalapril Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline Decrease Concurrent use of lithium and an4depressants and/or an4psycho4cs can cause what? Serotonin syndrome & Neurolep4c malignant syndrome The term "suicide survivor" refers to which of the following? A) those who have lost a loved one to suicide At a minimum, a psychiatric evalua4on in an emergency should include which of the following? Select all the above C) is the problem organic, func4onal or a combina4on? A pt presents with a formal, tense manner. He reluctantly responds a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjus4fied concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the pt likely has which of the following pds? B) Paranoid PD The obliga4on to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following? B) Beneficence `In about 1/2 the cases in which suicides occur while pts are in a psychiatric unit, a lawsuit occurs. Which of the following is NOT consistent with what court expects related to inpt psych unit suicide events? D) Evidence of formula4on of a tx plan with a high level of security Using the LIAASE: A general cultural competency tool, the ARNP would do which of the following? D) all of the above -agree to disagree on differences in values -solicit other op4ons or points of view -acknowledge and validate powerful emo4ons when expressed Which of the following is NOT consistent with what is known about PP psychosis? A) symptoms of PP psychosis can o[en begin within days of delivery Concerns when trea4ng geriatric pa4ents with psychotherapeu4c drugs includes all of the following EXCEPT: B) Elderly persons may be more suscep4ble to adverse effects of psychotherapeu4c drugs A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specific number of days is known as which? C) Termina4on clause Standards of care are now being set, modified, monitored and publicized by certain self-appointed consumer-oriented agencies as well as government agencies, including which of the following? D) All of the above -Medicare -the Joint Commission -The agency for healthcare research and quality The differences in the quality of healthcare across individuals and groups in regards to access of care, treatment op4ons, and preventa4ve services is known as? B)Health dispari4es incorrect: racism, vulnerable popula4ons, SDOH Which of the following medical condi4ons can present with prominent mental status changes that mimic common psychiatric illnesses. Select all that apply B) Thyroid diseases C) Head trauma Incorrect: DM, AIDS Risks factors for school violence include which of the following? Select all the above A) bullying B) being bullied C) Isola4on Being knowledgeable about one's own thoughts, feelings and sensa4ons as well as the ability to reflect on how these can affect one's interac4ons with others is known as? A) Cultural awareness A pt with an inability to conform to the social norms that ordinarily govern many aspects of a person's behavior is consistent with which of the following pds? D) Narcissis4c PD Which of the following meds are associated with neural tube defects when given during pregnancy? C. Valproic acid Curriculum content supports the NP scien4fic competency area includes which of the following? Select all that apply A) Comparison of pt data sets with evidenced based standards to improve care B) Science from other disciplines relevant to heath care Self-injurious behaviors with a nonfatal outcome, accompanied by explicit or implicit evidence that the person intended to die, is most specifically known as what? C) Suicide aVempt The ARNP is working with a pt who has heightened sense of self-importance and grandiose feelings of uniqueness. The pt also lacks empathy for others, although is very sensi4ve to minor cri4cisms. The ARNP recognizes these s/s as consistent with which of the following PD? C) Narcissis4c PD D)_ Pseduo-parkinsonism What of the following is consistent with current epidemiology literature about gender and OCD? D) Adult men and women are equally likely to have OCD A type of schizophrenia in which the individual has a marked disturbance of motor func4on and may involve stupor, nega4vism, rigidity, excitement or posturing or mu4sm is? B) Catatonic A pt who presents with the inability to remain s4ll with motor restlessness, would be assessed to have? B) Akathisia Method of therapy used to tx individuals with substance use disorders? B) Con4ngency Management Ethnocentrism results in which of the following? C) provides care givers the ability to care for pts of various cultures Which of following demographic characteris4cs is consistent with high suicide risk? D) Over age 45 In educa4ng the pt beginning to take Lithium, the ARNP explains which of the following is related to diet and fluid intake? D) All of the above -caffeine and alcohol act as hydra4on agents and can raise your lithium concentra4ons -drink @ least 1 gal of water or more each day & limit your salt intake -if you go on A diet, your doctor may need to increase the frequency of blood tests Three major neurotransmiVers associated with ANXIETY, based on animal studies and response to drug tx include? B) GABA, norepinephrine and serotonin What neurotransmiVer increases libidio? D) Dopamine Concerns when trea4ng geriatric pts with psychotherapeu4c drugs includes all of the following EXCEPT? C) Elderly persons may metabolize psychotherapeu4c drugs more rapidly Concerns when trea4ng geriatric pts with psychotherapeu4c drugs? A) Elderly people can be more suscep4ble to adverse effects of drugs B) Elderly persons may metabolize drugs more slowly D) Elderly people may excrete psychotherapeu4c drugs more slowly. Persons who subordinate their own needs to those of others, get other to assume responsibility for major areas of their lives, lack self-confidence and may experience intense discomfort when alone for more than a brief period of 4me are demonstra4ng characteris4cs consistent with what PD? C) Dependent PD According to Sullivan, which of the following are consistent with a mentor/mentee rela4onship? C) Goals for the mentoring rela4onship are set mutually incorrect: mentors are assigned; mentor rela4onships are shorter term; A&B only The need for nps to prac4ce to their full extent of their educa4on and training is necessary: select all of the above All of the above 3 mul&ple choice op&ons The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A) Diet 3 mul&ple choice op&ons What are social determinants of health and lifestyle choices? The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the condi4ons in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the condi4ons of daily life. In educa4ng the pt about Lithium, the NP explains which of the following is related to diet and fluid intake? D) All of the above 3 mul&ple choice op&ons The goal of psychotropic tx is to eliminate all manifesta4ons of a disorder to below the syndromal threshold, which is defined as which of the following? B) Remission 3 mul&ple choice op&ons The NP can impact health policy and healthcare by doing which of the following? D) All of the above 3 mul&ple choice op&ons A term used to describe individuals and families who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following? D) A& B 3 mul&ple choice op&ons Which of the following is consistent with current literature regarding the epidemiology of dependent PD? C) Persons with chronic physical illness in childhood may be the most suscep4ble to this disorder 3 mul&ple choice op&ons Pts who injure themselves by self-mutaliza4on but usually do not wish to die are said to have which of the following? C) Parasuicidial behaviors 3 mul&ple choice op&ons The NP preceptor should have which of the following? D) All of the above 3 mul&ple choice op&ons The tx choice of pts with histrionic PD include which of the following? D) A & B 3 mul&ple choice op&ons The an4psycho4cs that are most likely to cause neurolep4c induced parkinsonism have which of the following effects? C) High potency drugs with high levels of an4cholinergic ac4vity 3 mul&ple choice op&ons Tx aimed at reducing in4mate partner violence and DV includes which of the following? D) A&B only 3 mul&ple choice op&ons Pt presents with a formal, tense manner. He reluctantly reports a longstanding pervasive suspiciousness of others, preoccupied with trustworthiness of Being knowledgeable about one's own thoughts, feelings and sensa4ons as well as the ability to reflect on how these can affect one's interac4ons with others is known as? A) Cultural awareness The NP recognizes which are the long-term effects of sex trafficking on vic4ms? D) All of the above 3 mul&ple choice op&ons Wernickles encephalopathy= considered a medical emergency or not? Is a medical emergency Is a degenera4ve brain disorder caused by lack of vitamin B1 Aim of tx for wernickles encephalopathy Prompt and quick correc4on of the thiamine deficiency in the brain Is wernickles encephalopathy reversible? It is considered reversible Wernickles encephalopathy is caused from? Alcohol abuse, dietary deficiencies, prolon ged vomi4ng, ea4ng disorders, effects of chemotherapy =s/s mental confusion, vision problems, coma, hypothermia, low bp, lack of muscle coordina4on (ataxia) Lack of muscle coordina4on? Ataxia Clinical triad of ophthalmoplegia, ataxia and confusion? Wernickles encephalopathy = acute neurological condi4on Korsakoff's Syndrome: Neuropsychiatric disorder associated with confabula4on and significant deficits in anterograde and retrograde memory This disorder is associated with pts fabrica4ng stories in the segng of clear consciousness Korsakoff's A common inci4ng event that precepitates WE is? An acute infec4on other triggers include: prolonged carb or glucose loading in the presence of thiamine deficiency Hallmark sign of WE? Is ocular abnormali4es especially nystagmus other oculomotor s/s: include cranial nerve involvement of oculomotor, abducens and ves4bular nuclei causing conjugate gaze palasises; pupillary sluggishness, ptsosis and anisocoria is also common Some pts can present with hyperac4ve delirium secondary to possible alcohol withdrawal symptoms alongside this disorder? WE Can WE cause death? Yes- less than 5% of pts with WE can present with a severely depressed level of consciousness that will eventually lead to coma or death Warning s/s of WE that could indicate coma or death? Hyperthermia and hypotension other s/s include peripheral neuropathy--lower extremi4es are normally involved and the exam would reveal distal sensory los Clinical dx of WE is present if the pt has two of the following features: A) eye signs B) Dietary deficiency in thiamine C) AMS D) Cerebellar dysfunc4on Normal brain imaging cannot rule out? WE -therefore not very beneficial What does thiamine do? Help brain cells produce energy from sugar Korsakoff's syndrome is o[en, but not always, preceded by an episode of? WE however, it can occur in someone who has never had a prior episode of WE S/s of Korsakoff's syndrome? Problems learning new informa4on, inabilty to remember recent events and long-term memory gaps. =confabula4on -hallucina4ons may be present Cornerstone of effec4ve long term tx of Korsakoffs /wes? Abstaining fro alcohol and maintaining a healthy diet Pt on lithium with a hx of ETOH presents with dry mouth, ataxia, dizziness, abdominal pain and slurred speech-the NP should do what? B) recognizes these are s/s of mild to moderate lithium toxicity--the NP decreases the lithium by half and encourages the pt to drink more fluids Walking on eggshells, appeasement and avoidance behaviors by the vic4m is characteris4c of what phase of DV? C) Tension building phase What stage of the cycle of DV is characterized by overt aggressive behavior towards the vic4m? B) Abusive incident Inability to conform to the social norms that ordinarily govern many aspects of a person's behavior? (PD) B) An4social PD Which of the following medical condi4ons can present with prominent mental health status changes that mimic common psych illnesses? Select all that apply A, B, D 3 mul&ple choice op&ons According to teh AANP Process of Care Standards, performing or ordering prevenatjve and diagnos4c procedures based on the pt's age and hx is part of what component? A) Assessment of health status 3 mul&ple choice op&ons A pt on lithium and que4apine presents to the ED with anorexia, persistent nausea, persistent vomi4ng, blurred vision, choreoathetoid movements, muscle fascicula4ons and hyperac4ve deep tendon reflexes- the ARNP should do all of the following EXCEPT: A) DC the lithium 3 mul&ple choice op&ons A pt on risperidone presents to the ED with increased agita4on, restlessness, muscle discomfort, and dysphoria. The NP recognizes these symptoms of _____ and recommends which of the following? Select all that applies 3 mul&ple choice op&ons NP working as an at will employee realizes which of the following. Unless the NP has a contract for a specified term of employment, the employee: D) A&C only 3 mul&ple choice op&ons The US supreme court upheld the psychotherapist-pt privilege in which of the following cases? A) Jaffee vs Redmond 3 mul&ple choice op&ons Loyalty, fairness, truthfulness, advocacy and dedica4on in professional rela4onships is known as? B) Fidelity 3 mul&ple choice op&ons Which of the following is consistent with pds? C) Involves impairment in at least 1 out of 4 areas of cogni4on, affec4vity, interpersonal func4on or impulse control 3 mul&ple choice op&ons A late appearing adverse effect of neurolep4c drugs is known as? D) Neurolep4c induced tardive dyskinesia The failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession is known as? B) Malprac4ce 3 mul&ple choice op&ons A somatpsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about one week before the onset of menses characterized by irritability, emo4onal liability, HA, anxiety and depression is known as? D) Premenstrual psychosoma4c disorder 3 mul&ple choice op&ons Persons who exhibit impulsive traits also show high levels of which of the following hormones? Select all that apply D) A& C only 3 mul&ple choice op&ons In educa4ng a pt beginning on lithium, the NP explains which of the following related to need for blood tests? D) A&B only 3 mul&ple choice op&ons The incidence of suicide is highest for which of the following popula4ons? B) Older white men 3 mul&ple choice op&ons Which of the following defense mechanisms does the abuser use during the honeymoon phase? B) Projec4on 3 mul&ple choice op&ons SIB pa4ents should be engaged in what type of therapy (BPD individuals who engage in SIB) A) DBT 3 mul&ple choice op&ons The _____stage begins at 18 months of age and lasts un4l the age of 3 Anal Stage 3 mul&ple choice op&ons Freud believed that the libidio source shi[ed from the mouth (in stage 1) to the anus in what stage of development? Anal stagen(stage 2) At what point does a child begin to understand that they have some degree of control over their lives, including when and where they defacate? Anal stage This can lead to difficul4es with poVy training *primary erogenous zone is pleasure derived from controlling bladder and bms Adults who are anal reten4ve tend to be: Stubborn, very neat, rigid and s4ngy Adults who are anal expulsive tend to be: Messy, wasteful and harsh During the ____ stage, the child develops an aVrac4on to the parent of a different sex to them, which is caused the Oedipus Complex for boys and the Electra Complex for girls Phallic stage (stage 3) Phallic stage occurs at what age? Las4ng from the ages of 3-6 *the libido centers upon the genitalia and children become aware of their bodies When a child recognizes that the parent of another sex is unavailable, the child learns to model their own behavior a[er the same-sex parent? Phallic stage According to Freud, those who do not exhibit gender appropriate behavior have not completed this stage of psychosexual development? Phallic stage Introjec4on Learning right fro wrong -how children incorporate values from others into their value set Introjec4on occurs at what phase? Phallic stage The development of play is an important milestone to early childhood because:? Great way for children to express their thoughts, emo4ons, fears and anxie4es Erikson: Ini4a4ve vs Guilt Influenced by Freud, Erikson believed that the rela4onships that people have, not psychosexual stages, are what influence personality development Johann is five years old and even though he really struggles with shoe tying, he protests when his parents try to help him. According to Erikson, Johann does this because? A) Johann is exploring his autonomy 3 mul&ple choice op&ons Stage 1: Trust vs Mistrust is associated with what age and virtue? Infant -18 months, hope Stage 2: Autonomy vs Shame/doubt is associated with what age and virtue? 18 months to 3 years will B & D 3 mul&ple choice op&ons Which of the following meds is FDA approved for the tx of MDD with seasonal varia4on? D) Buproprion HCL ER 3 mul&ple choice op&ons A period of at least one week in which both a manic episode and a major depressive episode occur almost daily is consistent with which dx? C) Bipolar I disorder, mixed episode 3 mul&ple choice op&ons According to APA "psychologists seek to promote accuracy, honesty and truthfulness in the prac4ce of psychology' reflec4ng which of the following ethical principles? A) Integrity 3 mul&ple choice op&ons Promo4ng the Welfare of children and adolescents addresses which of the following ethical issues? C) beneficence 3 mul&ple choice op&ons Which of the following disorders is characterized by episodic bouts of intake of excessive amount of food without purging or similar compensatory behavior C) Binge ea4ng The ARNP working w a 5 year old child in a busy pediatric prac4ce is seeking to use levl 1 and level 2 cross-cugng symptoms measures. Which of the following is true in this situa4on? B) These level 1 and 2 assessments can help the NP iden4fy the presen4ng problem for the kid 3 mul&ple choice op&ons Which of the following meds are approved by the FDA for trea4ng OCD in children ages 6-17? C) Zolo[ (age 6+) 3 mul&ple choice op&ons A form of CBT that requires aVending skills group in addi4on to individual therapy sessions are known as which of the following? D) DBT 3 mul&ple choice op&ons Manic episodes are considered dis4nct when they are separated by what length of 4me without significant symptoms of mania or hypomania? C) 2 months 3 mul&ple choice op&ons Which of the following meds are NOT FDA approved to tx restless leg syndrome? B) Modafinil 3 mul&ple choice op&ons Persistant Depressive Disorder lasts at least? 2 years MDD episodes are separated by how long? At least 2 months The clinician asks the adolescent how long they have been sad--greater than 1 year? C) MDD A dissocia4on between the pt's experience of sleeping and the objec4ve polygraph measures of sleep is known as which of the following? A) Sleep state mispercep4on (now known as paradoxial insomnia) -disorder which causes people to feel awake even while they are asleep, leading them to underes4mate how many hours they sleep at night Which of the following is NOT consistent with the code of ethics for the profession of nursign? C) The code of ethics explicit the primary obliga4ons of nursing profession 3 mul&ple choice op&ons Which of the following is approved by the FKA to tx OCD in children ages 10- 17? Check all that apply D) Clomipramine (Anafranil) -TCA (serotonin and norepinephrine reuptake inhibi4on) -more SE than ssris -considered a second-line med for OCD A variant of Bipolar I disorder characterized by episodes of MDD and hypomania is known as which of the following? D) Bipolar I disorder, hypomanic type 3 mul&ple choice op&ons Which of the following hormone levels is increased in anorexia nervosa? A) Cor4cotrophin-releasing hormone 3 mul&ple choice op&ons Hormone released in response to starva4on? Cor4cotrophin-releasing hormone (CRH) Lithium toxicity? The chronic form of lithium toxicity can occur when you take lithium daily but your serum blood level has crept up into the toxic range. -Possible causes for this level increase?: A) a dosage increase, B) being dehydrated, C) interac4ons with other medica4ons, and D) problems with kidney func4on In addi4on to elevated lithium levels, what other laboratory values are associated with lithium toxicity? BUN, crea4nine What are drugs that should not be taken with lithium? -ACE inhibitors -Angiotensin II receptor antagonists (sta4ns) -Diure4cs -NSAIDS Nightmares and night terrors are associated with disorganiza4on and arousal during which stage of sleep? Stage 3 The right to assent of dissent from tx for a child or adolescent is reflected in which American Academy of Children & Adolescent ethical issues? Autonomy A 10-year-old child presents with developmentally inappropriate and persistent Anorexia Nervosa peripheral edema can be caused by a variety of condi4ons, but the presence of Russell's sign indicates possible anorexia. What is Russell's sign? Scarring or callouses on the dorsal surface of the hand caused by self-induced vomi4ng anorexia 82 year old woman arrives at the office with her son; over the past year, she has had trouble remembering once-familiar things, such as phone #s and friends names. She also does not recognize family members who visit o[en; she has become unusually moody and struggles with wriVen tasks. What is the most likely dx? A) Alzheimers Disease alzheimers can be associated with: deficits in language, motor func4on and recogni4on 3 mul&ple choice op&ons Demen4a with Lewy Bodies typically is accompanied by? EPS Hun4ngton's disease is accompanied by? Spasmodic movement and incoordina4on Frontotemporal demen4a is normally accompanied by? Extremely talka4ve and disinhibited ___ is one of the most usual symptoms of anxiety and a direct response to the ac4va4on of your sympathe4c NS Shaking The comorbid psychiatric dx frequently associated with anorexia is? OCD OCD-PD is also another comorbidity of those with anorexia Ethical ques4ons about what we "ought" to do or be are addressed within which domain of ethics? Norma4ve ethics looks into the ques4ons that arise regarding how one ought to act in a moral sense. It is also the study of ethical behavior Which of the following meds are approved by the FDA for tx of mania in children 12-17? Lithium first FDA approved med for children ages 12-17 with mania Which of the following is important to realize when tx a child with an anxiety disorder? B. Repeated exposures of a feared situa4on will always help the child to unlearn the fear response Developmental impairments and disrup4ve behavior problems are predominant issues during which of the age ranges? A. 0-5 Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical [s of PTSD A) Intrusive s/s 3 mul&ple choice op&ons AFAB Assigned female at birth AMAB Assigned male at birth _____is good for older adults with anxiety and depression? Remeron The smaller the dose of Remeron, the more ________? Seda4ng What medica4on decreases psycho4c s/s, & rumina4ng thoughts? A) Seroquel 3 mul&ple choice op&ons What medica4on decreases psycho4c s/s, decreases peserva4on, decreases rumina4ng thoughts while trea4ng delusional/mixed beliefs and mood disorders/txs bipolar I disorder? A) Zyprexa Drug used to tx NMS? Dantrolene + Bromocrip4ne mesylate Bromocrip4ne is given to reverse the hypodopaminergic state and is administered orally (or via nasogastric tube), star4ng with 2.5 mg 2 or 3 4mes daily and increasing doses by 2.5 mg every 24 hours un4l a response or un4l reaching a maximum dose of 45 mg/d. Dantrolene sodium uncouples the heat-genera4ng mechanism in muscle and is the drug of choice in trea4ng malignant hyperthermia and neurolep4c malignant syndrome, which cause excessive muscular heat produc&on. The poten4al benefit of this drug in trea4ng heat stroke has been debated. S/S of NMS occur within? Rapid onset of 24-72 hours "cis" Matching "Trans" Moving across the range Blockade of muscarinic M3 is linked to? Cardio-metabolic risk but is NOT linked to weight gain specifically Amantadine is a medica4on that is used to tx? EPS ex. 100 mg @ bed4me Amantadine is a _______ medica4on primarily used to tx parkinson's disease but is alos used to help drug-induced parkinsonism Dopaminergic agent; also is a weak NMDA antagonist (similar to Namenda) Fewer an4cholinergic SE of cogni4ve impairment, dry mouth & cons4pa4on? Amantadine Benztropine has increased amount of an4cholinergic SE Amantadine (Symmetrel)'s dopaminergic effects can theore4cally worsen? Psychosis however @ doses used to tx EPS, this is not a normal occurance MOA: decreases glucose produc4on by liver and increases insulin sensi4vity Common se of mevormin? GI side effects diarrhea, nausea, abdominal bloa4ng, flatuence and discomfort Typical dose of Mevormin used to reduce weight related to an4pscyho4cs? 500-1000mg BID --average of 3k of weight loss in pts How can you decrease the nausea and diarrhea side effect of Mevormin? (affects 50% of pa4ents) Take with food or use ER formula4on Best tool for assessing TD? AIMS 12 item test, takes approx 10 minutes. Best tool for monitoring the severity of TD What causes TD? An4psycho4cs but other medica4ons (nausea and reflux meds) can cause TD as well: reglan, compazine and other agents that block dopamine Medica4ons used to tx TD? (3) FDA approved: Valbenazine (Ingrezza) + Deutrabenazine (Austedo) Not FDA approved for TD, but FDA approved for HD: tetrazbenazine (Xenazine) Meds that cause severe weight gain? An4psycho4cs- especially clozapine, olanzapine, que4apine An4depressants- mirtazepine, tcas, Paxil Mood stabilizers- Lithium, Valproic Acid Meds that cause moderate weight gain? Risperidone and invega Meds that cause less weight gain? Ability, haldol, geodon, lurasidone First line tx for weight gain for psych meds? A. Topamax ----se: cogni4ve dulling B. Mevormin ER C. Olanzapine/Samidorphan (Lybalvi)--used as an alterna4ve to zyprexa to help reduce weight gain D. Orlistat (Xenical). ---se: diarrhea E. Abilify--may be useful for olanzapine induced weight gain as an adjunct Second line tx for weight loss? A. Wellburin SR B. Any s4mulant C. Naltrexone/Bupropion (Contrave). --*an4obesity drug D. Phentermine (Suprenza)-*an4obesity drug E. Phentermine/topimate (Qsymia). ---*an4obesity drug F. Glucagon like pep4de agonists---such as Liraglu4de or Ozempic (Semaglu4de) G. Niza4dine (Axid) ---antacid OTC H. Amantadine (symmetrel) Tx of akathisia? First line: propanolol, inderal LA, benzos second line: cogen4n, amandtadine, clonidine, gabapen4n, trazodone, mirtazepine, Cyproheptadine Blocks D2 blockade? Decreases akathisia High potency an4psycho4cs increase risk of? Akathisia ex. Haldol, Abilify, Invega, Risperidone, Brexipiprazole Akathisia typically has an onset of? Can be within a few hours, but normally takes days to weeks to appear ______ invol grinding of teeth Bruxism How to tx Bruxism? 1st line= Buspar 2nd line= benzos, gabapen4n Botox is another tx op4on that is effec4ve (in the masseter) Xerostomia? Dry mouth caused by an4psycho4cs, an4depressants, lithium, s4mulants, and meds used to tx EPS (cogen4n, Artane, ect) First line tx of Xerostomia? A) Biotene line prouces 2nd line= Procholinergic drugs ex. Pilocarpine (Salagen) ______ can worsen dry mouth? Caffeine products, so recommenda4on is to decrease caffeine dose Another common cause of dry mouth? Old age Involuntary contrac4ons of muscles due to an4psycho4cs Dystonia D2 blockade First line tx= cogen4n, benadryl second line= benzos, Amantadine, Artane 90% of what reac4ons in EPS? Occur within the first 5 days, although can occur hours to days a[er an an4psycho4c is started Hyperhidrosis? Excessive swea4ng caused by an4depressants, espcially snris (venlafaxine, duloxe4ne, and levomilnacipran) and bupropion Tx for hyperhidrosis? 1st line= A) Terazosin (Hytrin) alpha1 blocker B) Clonidine C) Cogen4n D) Glycopyyrolate (Robinul)