PMHNP Exam Questions and Answers with Verified Marking Scheme, Exams of Nursing

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PMHNP Exam Reported Questions and their verified marking scheme  DBT (dialectical behavior therapy) - Correctrelaxation muscle prior to DBT  Greatest patient at risk for Violence - CorrectSubstance abuse  EMDR (eye movement desensitization and reprocessing) - Correcteye movement desensitization and reprocessing  What is dissemination? - CorrectGetting the research information out to those who need to know it!  Publication - highest level  Presenting at National Conference  Presenting at Local Conference  Journal Club where one person reviews an article  What does a 17 on MMSE mean? - CorrectModerate cognitive impairment  What is Tegretol in the CYP450 system? - CorrectInducer -->will lower dose of Lamictal and BCP's  What do BCP's do to Lamictal? - CorrectInducer - will lower dose of Lamictal  What is a Type I research error? - CorrectThere IS a difference but you say there isn't a difference.  What is a Type II research error? - CorrectThere is NO difference but you say there is a difference.  What is pseudo-dementia? - CorrectCognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve.  Is it normal for a 1 month old to have a palmar grasp? - CorrectYes.  What is a drug 1/2 life? - CorrectThe time it takes for 50% of a drug to be eliminated from the body.  What 3 atypicals can be used with teens? - CorrectZyprexa, Abilify, Seroquel - low doses  What is a risk of using Tramadol? - CorrectSerotonin Syndrome as it is very serotonergic.  What is the allele seen in Asians that increase the risk of SJS? - CorrectHLAB- 1502  When might you see toxic epidermal necrolysis? - CorrectWith worsening of SJS  How many generations do you include for a genogram? - Correct1st degree - mother, father, siblings  2nd degree - grandparents & cousins  3rd degree -  What does messenger RNA code for? - CorrectAmino Acids  What is epigenetics? - CorrectFactors that affect genes - environmental, smoking, stress, etc...  What part of the brain is involved with OCD? - CorrectBasal Ganglia  Occipito-Frontal  What happens to the brain during adolescence? - CorrectDendritic pruning  Emotions are controlled by amygdala  By adulthood, PFC involved as well  When do males typically present with schizophrenia? - Correct10-25 yo  When do females typically present with schizophrenia? - Correct25-35 yo  What does Erythromycin to trileptal? - CorrectYou will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor  ACE Inhibitors are the drug of choice for what? - CorrectHeart Failure  HTN  What are some psychiatric side effects seen with some asthma drugs - CorrectLeukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor  What should you watch for with Tegretol? - CorrectAgranulocytosis and Hyponatremia  What are the 3 CK muscle enzyme tests? - CorrectCKBB, CKMM, CKMB  Which one of the 3 muscle enzymes are related to cardiac muscle damage? - CorrectCKMB  For there to be a duty to a patient, what must exist? - CorrectRelationship  What is a proximate cause? - CorrectConnection between A + B.  For there to be damages, what must exist first? - CorrectNegligence  What is an occurrence basis liability insurance? - Correct"occurred" during the policy period, no matter when the claim is brought against the insured  What is a claims made/based liability insurance? - Correctprovides coverage for a claim that is brought within the policy period, no matter when the loss occurred.  Who sets the minimum requirements for NP's? - CorrectBoard of Nursing  State  What are the various controlled substance classes? - CorrectSchedule I - nobody has these - not good for health - heroin, PCP, MDMA, researchers can get it sometimes.  Schedule II - Significant Abuse Potential - morphine, methadone, methyphenidate  Schedule III - Moderate Abuse Potential - hydrocodone, codeine  Schedule IV - Low Abuse Potential - benzo's, ambien, phentermine  Schedule V - Very low abuse potential - anti-tussives, lomotil  What classes of CS's is the NP approved to prescribe? - CorrectSchedules III-V ONLY.  Where does 50% of healthcare funds come from? - CorrectThe government  Who is eligible for Medicare? - Correct>65 or under 65 with diability, ANY age with renal disease.  What is incident to billing? - CorrectMeans MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD.  Allows NP to get reimbursed at 100% rather than 85%.  How are Medicaid benefits determined? - CorrectState determines qualification - Partnership between State and Fed Govt.  Must be impoverished  Must be US resident and low or very low income.  Can you have Medicare and Medicaid? - CorrectYes, impoverished elderly but Medicaid is always payor of last resort.  Is dental care included in Medicaid? - CorrectYes, <21 gets basic dental as part of the Medicaid plan.  What is the purpose of HIPAA? - CorrectNational standards for electronic HC transactions  National ID for providers, health plans and employers.  Not SIMPLY Confidentiality.  What must be signed prior to any healthcare in the state - CorrectNotice of Privacy Practices Statement  What happens if a patient refuses to sign an ROI? - CorrectCan decline to treat  Health plan may condition enrollment on provision of consent  When is HIPAA not required? - CorrectEmergency treatment  Substantial communication barriers and consent is inferred  Involuntary committment  Is it ok to announce a patient's name in a waiting room? - CorrectYes, no other way to give care.  Is it ok to leave a message on a patient's vm? - CorrectYes, but should be limited.  What is the impact of steroid inhalers on children? - CorrectSlows bone growth and may decrease ultimate height.  What is the long-term impact of using steroid inhalers? - CorrectCataracts, glaucoma, thinning of bones and skin  What is included in the treatment of fibromyalgia? - CorrectSleeping meds  Antidepressants  Pain meds  What psychoactives are first line treatment for fibro? - CorrectCymbalta, Effexor  Elavil, Pamelor  Lyrica, Gabapentin  Ultram, Benzo's  What is the purpose of telepsychiatry? - CorrectIncrease the ability to reach rural and underserved areas.  What is the purpose of Motivational Interviewing? - CorrectExplore ambiguity  Maintain passive position  What is required for Medicare submission? - CorrectICD 10 and narrative or CPT  What is the neurotransmitter problem in Schizophrenia? - CorrectExcess dopamine in mesolimbic pathway.  What is the neurotransmitter problem in ADHD? - CorrectDopamine, norepinephrine and serotonergic dysfunction  What is the benefit of play therapy? - CorrectDon't have to confront emotions head on.  What neurotransmitters are involved in the bioamine hypothesis of depression? - CorrectNoradrenaline  Serotonin  Dopamine  MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse.  How do you test CN XII? - CorrectStick out your tongue.  What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? - CorrectCN V - Trigeminal  What are two important things to measure when using Zyprexa? - CorrectLipid level and abdominal circumference  What is included in the mini-cognitive exam? - CorrectClock, memory questions from MSE.  What is HIV related dementia often mistaken for, especially at the beginning? - CorrectDepression  What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? - CorrectStop and repeat lab.  Normal is 1500-8000 mm3  Can you take Buspar during pregnancy? - CorrectCategory B - ok if really needed.  Can you take Klonopin during pregnancy? - CorrectCategory C - avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms.  Guilt  Energy  Concentration  Appetite  psychomotor retardation  Suicide  DIGFAST for mania - CorrectDistractibility  Indiscretion  Grandiosity  Flight of ideas  Activity increase  Sleep deficit  Talking increase  5 year old tells u his brother sodomized him - CorrectTell mom don't leave him alone with patient and call CPS implement crisis  Just culture - Correct"Just culture" model: proposed to reconcile the twin needs for no-blame and appropriate accountability  The focus is on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors while maintaining individual accountability by establishing zero tolerance for reckless behavior.  Distinguishes between  Human error (e.g. slips),  At-risk behavior (e.g. taking shortcuts),  Reckless behavior (e.g. ignoring required safety steps).  In a just culture, the response to an error or near-miss is predicated on the type of behavior associated with the error, not the severity of the event.  Child reports Sexual Abuse - CorrectInterview the young child and infants child with parent  First sign of temprofrontal Dementia - CorrectBehavior and personalty changes  Tow amines related to depression - CorrectSerotonin and norepinephrine  Want to start an consulting firm what tool would be needed to show economic viability - CorrectRevenue and expenses  Patient stopped smoking (Cessation) - CorrectDecreased Zyprexia  Promote resilience in schizophrenia for a patient that lives alone and doing well - CorrectRefer to peer support  Spirit stick - CorrectTeach staff about culture competence  Problems in the parietal lobe can lead - CorrectSensory-perceptual disturbances and agnosia(inability to perceive objects)  R-L confusion  Difficulty writing (agraphia)  Aphasia(difficulty of language)  PDSA cycle - CorrectFor Plan-Do-Study-Act.  Describes how to test a change: by trying it, observing the consequences, and then learning from those consequences.  Appreciative Inquiry - Correctan organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements  Appreciative Inquiry - Correctan organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work  Appreciative Inquiry (AI) - CorrectIdentify the problem  Analyze the problem  Generate Solutions  Implement Best Solutions  Discovery (Best of what is )  Dream (Wishes or dreams of Org)  Design (Decide what you want to change)  Destiny (Make it happen, Implenting Change)  Appreciative Inquiry - CorrectDiscovery (Best of what is )  Dream (Wishes or dreams of Org)  Design (Decide what you want to change)  Destiny (Make it happen, Implenting Change)  CIWA-Ar - CorrectClinical Institute Withdrawal Assessment of Alcohol Scale, Revised  9 item symptom rating scale, max score 67; <10 does not warrant intervention  Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do - CorrectValidate his experience and provide care in a culturally specific way to that patient  Native American wants his healer present - CorrectInvolve mother of the patient and healer, mom was cleared for you to involve her  16 year old shows up with mother for first therapy is - Correctconfidential mom sits in lobby  Patient acts out due to missing session what do you do - CorrectYou relate to childhood abandonment and talk about it with the patient  How do you assess the competency of a medical procedure - CorrectIdentify a pen and recall 3 words  Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis - CorrectDelusional disorder  Increase ICP (signs and symptoms) - CorrectBaby Neuro cry  Menopausal woman - CorrectHormone therapy and replacement  Patient on antidepressants for 3 weeks and attempted Suicide - CorrectStop medication immediately  You want to decrease seclusion on your unit who considered the primary change agent - CorrectUnit staff  You are a lead NP over other NPs in a rural setting how would you go about the change - CorrectMake online form and have them vote on it  16 year old refuse treatment - CorrectSend to psych specialist for acting out kids  Positive Trendelenburg Sign - CorrectRefer to Ortho/specialist  Pelvis drops to when patient raises one foot off the floor.  Drug affects Flonase - CorrectZantac (Histamine 2 Blocker) Antagonist  Little boy wet his sheets, What kind of therapy would you suggest - CorrectBehavior therapy  DDVAP acts in much the same manner as antidiuretic hormone. - CorrectMakes less urine  Lithium level 1.2u what are you concerned with - Correct4+ Ketones  What does depakote do to Lamictal - CorrectIncrease laminate 200%  Inducers of Cytochrome P450 (CYP450) - CorrectBarbiturates, phenytoin, carbamazepine, rifampin, St. John's Wort  A substance that speeds up a chemical reaction  Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA; used to initiate movement  PDSA model - CorrectPLAN-  Do-carry out  Study -examine results  Act-decide what action  Tanner's stages - Correct  Tanner stages - Correct  MMSE (Mini Mental State Examination)- - CorrectStage  May be Normal 25-30  Mild/Early 21-24  Moderate 10-21  Severe 0-9  A pt states that she has been raped. What do you do - Correctensure safety  Hamilton D score of 28 - CorrectAssess for Suicide  Hamilton Depression Rating Scale - Correct17-21 questions  0-7 Normal  14-18 Moderate o 20 Severe Depression  Beck Depression Inventory (BDI) - Correct0-13 Minimal depression  14-19 Mild Depression  20-28 Moderate Depression  29-63 Severe Depression  Patient Health Questionnaire (PHQ-9) - Correct1-4 minimal  5-9 Mild depression  10-14 Moderate Depression  15-19 Moderate Severe Depression  20-27 Severe Depression  A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression.  Hamilton Anxiety Rating Scale (HAM-A) - Correct14-17 Mild Anxiety  18-24 Moderate Anxiety  25-30 Severe Anxiety  Yale-Brown Obsessive Compulsive Scale (Y-BOCS) - CorrectOCD  0-7 subclinical  8-15 Mild  16-23 Moderate  24-31 Severe  32-40 Extreme  PTSD (Post Traumatic Stress Disorder) - CorrectEMDR  Dilated pupils - CorrectStimulant intoxication  constricted (pinpoint) pupils - CorrectOpiods  nystagmus - CorrectPhencyclidine  conjuctival injection, muchies (super hungry), psychomotor slowness? - CorrectMarijuana  Marijuana - Correcta drug, often smoked, whose effects include euphoria, impairment of judgment and concentration and occasionally hallucinations; rarely reported as addictive  Boy states that he wishes to be a girl and tells you not to tell his parent s - CorrectDon't tell  ODD what will you do to prevent it from becoming Conduct disorder - CorrectTherapy to target mood and aggression  Herpes rooster 3 weeks later sleep difficulties and sad mood - CorrectDepression  Schizophrenia in males - Correct18-25 years old  Schizophrenia in Women - Correct25-35 years old  signs of amphetamine intoxication - CorrectTears, Runny nose, restlessness, HTN, Tremors, Insomnia  Co-morbidities of bipolar - CorrectAnxiety, alcohol and substance abuse  Big Freaking Problems - CorrectBupropion Fluoxetine Paxil  Medicare - CorrectA federal program of health insurance for persons 65 years of age and older  Medicare Advantage - Correcta program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrollee  Medicare A, B, C, D - CorrectA: Inpatient services  B: Outpt services  C: Private insurance can provide medicare benefits  D: Drugs  WATCHERS for GAD  3 of these *** for 6 months - Correctworry  anxiety  tension in muscles  concentration  hyperarousal  energy loss, fatigue  restlessness  sleep trouble  Transtheoretical Model of Change - Correct1. Precontemplation  2. Contemplation  3. Preparation  4. Action  5. Maintenance  Man working at the Gym and his urine is Cherry color - Correctorder myoglobinuria  Latino women wanting prenatal class - CorrectConsult with cultural group in community  Anorexia - CorrectSet up family therapy  quasi-experimental design - CorrectResearch method similar to an experimental design except that it makes use of naturally occurring groups rather than randomly assigning subjects to groups.  The ventricle enlargement observed in clients with - Correctschizophrenia is most often accompanied by  Encopresis Treatment - CorrectBehavior management: toilet refusal behavior, scheduled toileting time, incentives.  Prevention of constipation  Counseling  Metobolic syndrome - Correctgroup of signs and symptoms including insulin resistance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDL  NAMI - Correctnational alliance on mental illness  help families of mentally ill: education, support groups  health literacy - Correcta person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness  health literacy - CorrectMan taking insulin asking him to read blood glucose level  inferential statistics - Correctnumerical data that allow one to generalize- to infer from sample data the probability of something being true of a population  Mood Disorder Questionnaire (MDQ)-SCREENING - CorrectMood Disorder Questionnaire  Patient Name ______________________________________ Date of Visit ________________ Please answer each question to the best of your ability  Has there ever been a period of time when you were not your usual self and...  ...you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?  ...you were so irritable that you shouted at people or started fights or arguments? ...you felt much more self-confident than usual?  ...you got much less sleep than usual and found that you didn't really miss it? ...you were more talkative or spoke much faster than usual?  ...thoughts raced through your head or you couldn't slow your mind down?  ...you were so easily distracted by things around you that you had trouble concentrating or staying on track?  ...you had more energy than usual?  ...you were much more active or did many more things than usual?  ...you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?  ...you were much more interested in sex than usual?  ...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?  ...spending money got you or your family in trouble?  If you checked YES to more than one of the above, have several of these ever happened during the same period of time?  How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights?  No problems Minor problem Moderate problem Serious problem  This instrument is designed for screening purposes only and not to be used as a diagnostic tool. Permission for use granted by RMA Hirschfeld, MD  YES NO  Patient comes with vague symptoms depression irritability - CorrectBECK Depression scale  DISSEMINATED ENCEPHALOMYELITIS - CorrectAssess for asymmetry of extremities  Along with this pattern, the patients usually get neurological symptoms which may include:  Confusion, drowsiness, and even coma  Unsteadiness and falling  Visual blurring or double vision (occasionally)  Trouble swallowing  Weakness of the arms or legs  Fever  HA  CBT (cognitive behavioral therapy) - CorrectAnxiety  popular integrative therapy that combines cognitive (thinking) and behavior therapy  Impulsivity (ADHD) - CorrectPre-Frontal Cortex  Involves hasty actions taken without consideration of possible negative consequences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others.  Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis - CorrectHypogylcemia  NSAIDS - CorrectLithium toxicity  Interferon - CorrectCauses depression  Beck Depression Inventory (BDI) - CorrectIntimate therapy for a child with a score of 10  a questionnaire useful for determining the level of depressive symptoms that a person is reporting  Zantac (ranitidine) - Correctaffects Flonase  Pt on Lithium - CorrectPrescribe Synthroid  Zantac (ranitidine) - CorrectH2 antagonist  H2 BLOCKER  Tegretol (carbamazepine) - CorrectINDUCES Flonase  primary prevention - CorrectActions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse.  Secondary prevention examples - Correct- Implement blood pressure and cholesterol screening; give a treadmill stress test.  Health screenings  Skin screenings for cancer  teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets.  mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes  Provide mental health interventions after stressful events.  The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides.  Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center.  Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care.  Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health.  Assess disaster victims and triage for care.  Investigate an outbreak of flulike illness in a local school.  Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems.  Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the fa  Collab with OB NP questions - Correctwants to establish a relationship so Mental Health can be reached by more people  peer consultation - CorrectMutual Benefit Critical and Supportive  Shared discussion and accountability  The regular engagement of two or more colleagues to give and receive feedback  Tegretol (carbamazepine) - CorrectANC/WBC  Papleu - Correctwhat nurses do WITH pts not TO pts  nurse as a therapeutic tool - therapeutic use of self  care for the person as well as the illness  think exclusively of patients as persons, not as a dx  phases:  orientation  working  termination  roles of the nurse  stranger  resource person  teacher  leader  surrogate  conselor  Paplau's Interpersonal Theory - CorrectProcess recording  Give Ativan - CorrectFor Alcoholic with Liver problems  detailed physical exam - Correct  Pt states that God did this to me - CorrectAssess spiritual needs  Mini-Cog - Correctis another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT)  women in military and she saw her friend die - CorrectPTSD  Man had appt, wife came and he didnt - CorrectTell wife to reschedule appt  Tagement (Cimetidine) - Correct^ Benzo  ^ Coumadin  Erythromycin - Correct^ Xanax levels  Disulfiram - Correct^ Coumadin  Pt with Eating disorder states getting full - CorrectBloating delayed Gastric emptying  Realiability - Correctconsistency  Biggest Concern with EHR - CorrectConfidentiality  Qualiatative - CorrectMeasures in natural setting i.e ?, observation  Quantitative - CorrectData that is in numbers  internal validity - CorrectWas research done right?  extent to which we can draw cause-and-effect inferences from a study  I don't know answers - Correctpseudo dementia  interferon - Correctdecrease Wellbutrin  ^ prolactin - Correctstop prolactin  EPS - Correct^ risk for TD  Assess when someone ready to quit drinking - CorrectSee what stage they in  Ask when ready to start tx  To check for Dementia - CorrectHave the patient tell you risk/benefits test capacity  dairy log - CorrectCBT  treating a 6 y/o pt WHO HAS dx with Luekemia 1 month ago. What do you expect - CorrectHe would think he is being punished fro doing something wrong  antidepressant takes - Correct5 weeks  13 year old want to smoke - Correctask him of his plan to stop smoking  placement of chronically mental ill - CorrectACT  Assertive Community Treatment  Assertive Community Treatment (ACT) - Correctcommunity-based programs that provide many of the services that are necessary for successful community living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basis  BRUISE on the padded part of his arms - CorrectSay I see you have bruises on your arm  Ask what happened  medication errors on a new floor when NP starts working. - Correcteducate the staff on policies on how to handle med errors.  ECT THERAPY - CorrectGET CERTIFIED  lesion in frontal cortex - CorrectImpaired cogitate functions  child in foster homer 5 years poor eye contact, isolated self, eat without difficulty - Correctautism  A man states his wife was so good if he could only be like her. what is this - CorrectIntellectualization  or deflecting  rare complication of anorexia nervosa binge/purge subtype that results from gastrointestinal abnormalities, including decreased gastric motility and delayed gastric emptying. Early diagnosis and intervention is critical since delay may result in gastric necrosis, perforation, shock, and death. - Correctdecreased gastric motility check measure the stomach  Tagement (Cimetidine) - CorrectPrevents acid from backing up into the esophagus and causing heartburn  Pt moving to another state - CorrectGive enough meds  Pt on Zoloft BMI 26 - CorrectBMI  Sildenafil (Viagra) - Correct1 hour prior to sex  Tadalafil (Cialis) - Correct45 minutes prior to sex  Vardenafil (Levitra) - Correct45 minutes prior to sex  Avanafil (Stendra) - Correct15 minutes prior to sex  Alprostadil (PGE1) - Correct• Ductal-dependent Congenital Heart Disease (all forms)  0.05-0.1 µg/kg/min IV/IO infusion initially, then 0.01-0.05 µg/kg/min IV/IO  Females more likely to become an alcoholic than man - Correctdue to hormones  *R*igidity  *S*weating and drooling  FEVERS- fever, encephalopathy, vitals instability, elevated white blood cell count/cpk, rigidity - CorrectNMS  Primary: prevent/promotion, classes, safety initiatives, education, classes, modifying environment  Secondary: screen-early detection, crisis hotlines, disaster  Tertiary: treat- to prevent further deterioration, rehab, restoration, day treatment, social skills - CorrectLevels of Prevention  more than 1 SSRI, st johns wart, tramadol, demerol, ultram, maperidone, 5HT - CorrectRisk factors for serotonin syndrome  aortic stenosis - CorrectGrade 2/5 hoarse systolic heart murmur  stop benzos because can cause floppy baby syndrome and cleft palate, cotinue buspar - CorrectWoman with GAD advise on medication  IM Geodon - CorrectWhat to give to agitated pt in seclusion  Folic acid, vitamin B12, ESR/CRP, HGB, MCV (liver) - CorrectLabs for macrocytic anemia  1 hour then 8 hours - CorrectWhen to assess a patient in restraints for face/face  open ended, 'tell me' - Correcttherapeutic communication  open ended questions - CorrectReluctant/silent patient  both people need to be present, reschedule - CorrectPatients husband shows up but not the patient  Hip disease, refer child out, assessed during head to toe - CorrectAbnormal Trendelenburg Test o Severe 19- 23 (monitor for SI) o Moderate 14 - 18 o Mild 8 -13  0-7 normal - CorrectHamilton Depression Scale  More than 15 severe - CorrectGAD-7 scale  Hamilton Anxiety Scale, most commonly used  14 domains, 14=mild, 18-24= moderate, 25-30=severe  Anxiety 25/15 severe - CorrectHAM-A  comes from the state, board of nursing/american nurse association - CorrectScope of practice  Able to repeat back risks and benefits  elements= nature/pupose of tx, risks/benefits of tx, risks/benefits not doing tx, alternatives, diagnosis/prognosis - CorrectElderly patient with dementia how do you know id can give consent  send enough medication is standard of practice - CorrectPatient moving states, what do you do with medication?  refers to an organization's commitment to accountability and a focus supporting universal safety in health care. Find out the error ad where went wrong - Correctjust culture  Ace inhibitors and ARBs together - Correct2 classes of medications that should not be used together?  ACT model - CorrectKeeping chronically mentally ill in the community?  Parity Laws - CorrectLaw that makes sure people with mental health issues get the same financial treatment?  make sure that he is not left alone with her and call CPS, mandatory reporter, arrange crisis therapy - CorrectBrother sexually abusing sister  male with more than one X chromosome (XXY), little to no sperm, fertility treatment - CorrectKleinfelter's Syndrome  If less than 950 discontinue the medication and get a repeat level, 1000 is the cutoff  1.5-2 cbc biweekly  1-1.5 hold, cbc q dayx 3 weeks  less than 1- Stop medication  12.5initial, target 300-900mg/d once or bid  schizophenrenia/pscyhosis  agranulocytosis, seizures, myocarditis (inflammed heart muscle -chest pain,diff breath)  wg, increase lipids/glucose  REMS pharmacy need clozaril registry to dispense  to start: WBC must be >_3500 and ANC >_2000  WBC + ANC weekly q6months, then every 2w q6months, then monthly - Correctclozaril wbc+anc  . ESR erythrocyte sedimentation rate elevation. Synovial fluid analysis. X ray of joints. Rheumatoid factor titer, CRP, Hgb - CorrectLabs for rheumatoid arthritis  prazosin - CorrectPTSD nightmares  reaction to a specific life event (identified stressor), symtoms within 3 monhts but no more than 6 months. Think about a patient move - Correctadjustment disorder  Synthesized in locus coeruleus arousal and other functions like mood, hunger, and sleep - CorrectNorepinephrine (NE)  a small nucleus in the reticular formation that is involved in directing attention - Correctlocus coeruleus  raphe nucleus - Correct5HT  a string of nuclei in the midline of the midbrain and brainstem that contain most of the serotonergic neurons of the brain - Correctraphe nuclei  midbrain structure where dopamine is produced; involved in control of movement - Correctsubstantia nigra  substantia nigra and ventral tegmental area - Correctdopamine production  midbrain structure where dopamine is produced: associated with mood, reward, and addiction - Correctventral tegmental area (VTA)  nucleus basalis of meynert - CorrectAcetylcholine (ACh)  Alzheimer disease  cognitive and memory function - CorrectNucleus basalis of Meynert  P: Population/problem  I: Intervention/issue  C: Comparison  O: Outcome  T: Time - CorrectPICOT  Increased cranial pressure - Correctshrill cry  Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. OCD- recent strep throat - CorrectPANDAS  Acute stress disorder- less than 1 month  PTSD- after 1 month - CorrectPTSD  0-63, over 30 severe, dont start medication just start therapy - CorrectBeck inventory score of 10?  stimulant and therapy together - CorrectTreatment for ADHD  may experience an increase in anxiety in elderly, expect increased side effects, do an EKG - Correct65 year old started on a SSRI  Antacids, can decrease antispsychotic effects - CorrectWhat medication can alter absorption of antipsychotics?  check LFT, - CorrectDark brown urine  Tardive dyskinesia - CorrectPerson with EPS will most likely experience what  neuron loss because of suffocation, enzyme breakdown - CorrectApoptosis?  conversion syndrome, repression of unconscious intrapsychic conflicts - CorrectPatient lost a friend now experiences paralysis  depression, not dementia - Correctpatient continues to say "I dont know"  24-30 no cognitive impairment  18-23 mild cognitive impairment  0-17 severe cognitive impairment - CorrectMMSE scores  memory, inattention, concentration changes, worry over decreased cognition - CorrectEarly signs of aids dementia  A form of dementia characterized by personality changes/social changes , - CorrectFrontal lobe dementia  delirium - CorrectWandering, disoriented person on the streets for 2 days  quality - CorrectThe health care policy is access, cost and ____  formulation, implementation, evaluation - CorrectPhases of policy making  Tegretol (inhibitor) - CorrectFlonase interacts with what mood stabilizer?  decrease the level of Zyprexa, smoking is an inducer causing decreased levels of the medication. When stop smoking re-increase the medication - CorrectSmoking cessation and antipsychotic  CN 5 Trigeminal (masseter or masticatory muscle). - CorrectClenched teeth?  CN 7 facial (sensory and motor) - CorrectPuff cheeks  Increase the dose after 1-2 weeks, therapeutic effects 4-6 weeks - CorrectStarted on a medication then comes back in 2 weeks?  H2 inhibitor - CorrectZantac is for what?  CBT, all or nothing thinking catastrophic thinking  Humanistic therapy-self  Existential- reflection/self control/personal responsibility - CorrectBest therapy for negative thinking  DBT, goal to decrease emotional reactivity/crisis bxs and self validation. - CorrectPatient is borderline and suicidal what therapy?  fairly common in children and will often remit on its own, ADHD concomittant - CorrectTics what advise?  help the parents with positive reinforcement and parenting skills, limit setting, logical consequences, consistency, power stuggle/control issues problematic, parenting/family dysfunction exacerbates - CorrectODD child  scrape toenail and sent for testing - CorrectFungus on toenial  25-35 - CorrectAge for schizophrenia female  "tell me how the medication works in your body" - Correctbipolar not taking medication  Alpha 2 delta, pregabalin- lyrica - Correctpatient has neuropathic pain, what medication will help? gabapentin not helping  consider cost and revenue, must calculate the time spent with patient vs time spent on risk called indirect vs direct processing - CorrectWhen opening independent practice  CorrectCan disclose info to medicare /CMS without consent  lithium - CorrectFirst line neuro-protective for bipolar  check HCG, blackbox for pregnancy, can cause spinal bifida-tetrogenic, also check LFTs, CBC - CorrectWhat to check in terms of depakote in young girl  Correctassertive inquiry  strengths and competencies. What is being done currently and assessment of strenghts, no problem focused, 3 steps are discovery, understanding, amplifying - CorrectAppreciate Inquiry  collaborate with ER to provide a psych assessment - CorrectNp notices teen with DKA leaving without eval  proverb interpretation, abstract vs concrete interpretations - CorrectMMSE part for thought disorder  to teens in order to normalize the grieving process - CorrectTeen commits suicide, NP does presentation  educate friends/peers - CorrectTo reduce stigma among teens seeking mental health...  best assessment is mood questionnaire for bipolar, 7/13 bipolar likely - CorrectExperiencing irritability/depression/edginess?  Licensing jurisdiction for the np - CorrectTelemedicine asking a legal question??  urine is red colored- hematuria, concerned for rhabdomyolysis (muscle breakdown), - CorrectAdolescent with substance abuse and working out has muscle aches  ability to manage a checkbook, instrumental ADLs go first (meds, phone, drive, house week, balancing check book), then ADLs eating/dressing, Exec functions=judgement, planning, taxes - CorrectWhat are you looking at when you are assessing the function of an elderly individual  large waist circumference - CorrectFirst symptom of metabolic syndrome?  this is normal, repetitive patterns of bx, impaired social interactions, verbal/nonverbal communication common - CorrectAutistic child not responding to your verbal commands  stop and address her anxiety - CorrectWomen is anxious about administering medication to a child  tests looking at reticulocytes hep evaluate conditions affecting RBCs such as anemia, low reticulocytes may be seen with iron deficiency anemia, pernicious anemia, folic acid deficiency, aplastic anemia - CorrectWhy would you be concerned about immature retuculocytes?  lithium - CorrectFirst line neuro-protective for bipolar