Nurses' Political Advocacy and Mental Health Policies, Exams of Nursing

Download Nurses' Political Advocacy and Mental Health Policies and more Exams Nursing in PDF only on Docsity! 1 ANCC PMHNP PSYCH-MENTAL HEALTH NP LATEST TEST 1 ,2,& 3 EXAM QS & ANS PLUS RATIONALE LATEST 2023- 2024 (LATEST VERSIONS 100QS AND ANS EACH) NEW VERSION ALREADY GRADED A TEST 1 Your patient, whose wife died a few months ago, appears to be very unkempt and apathetic. Although several months have passed since his wife's death he has not progressed at all through his grieving. You assess this condition as which of the following? disenfranchised grief panic disorder complicated grief physiologic grief - -Correct Answer: complicated grief RATIONALE: A person has uncomplicated grief when he or she has normal physical, psychological, cognitive and spiritual responses to the death of a significant other. But when the person shows persistent maladaptive behaviors such as not taking care of personal hygiene and/or appearance and does not progress through the mourning process, this is complicated grief. If a patient has had a myocardial infarction, which of the following atypical antidepressants should not be prescribed within the recovery phase? Trazodone Duloxetine Bupropion Desvenlafaxine - -Correct Answer: Trazodone 2 RATIONALE: If a patient has had a myocardial infarction, during the recovery phase, the patient should not be prescribed this medication. Trazodone (Desyrel) can cause the patient to develop orthostatic hypotension and priapism. To get your teaching ideas and concepts across to a poor reader which of the following would be most appropriate? Use longer sentences. Use abstract concepts. Discourage questioning. Use examples and review. - -Correct Answer: Use examples and review. RATIONALE: To get the idea across to a poor reader use examples and review. The other choices are not helpful. You should use short sentences and easy to read layouts; be concrete rather than abstract; and teach them how to ask questions about their health. Also, tell context first and use visual, use common words and examples, and explain meaning. A 21-year old woman presents with complaints of milky discharge from her breasts. She doesn't have any other symptoms and is not pregnant, nor has been before. She tells the nurse about each medication that she takes. Which of these drugs may be implicated as the cause of the symptom? aspirin Lamotrigine Risperidone sertraline - -Correct Answer: Risperidone RATIONALE: Risperidone can cause the greatest prolactin elevation among atypical psychotics. A milky white discharge known as galactorrhea could be a sign of an underlying condition. The fact that the woman takes Risperidone, an atypical antipsychotic, would likely point to the cause and should be switched with one less likely to have that same side effect. Which of the following would be considered one of the main things that is responsible for about 2/3 of psychiatric hospital readmissions? Not sufficient care. Medication noncompliance Biophysical assessments None of the above - -Correct Answer: Medication noncompliance RATIONALE: Medication noncompliance is a major problem with the psychiatric mental health patients. The home health nurses assists by helping the patients to see the relationship between their compliance with their medication regimen and control of their symptoms. 5 Which of the following acts have provided the greatest protection for the individual not to lose or be denied health insurance coverage? Patient Protection and Affordable Care Act OSHA ISPN None of the above - -Correct Answer: Patient Protection and Affordable Care Act RATIONALE: The other 3 options above are incorrect. For several decades now, the ANA (American Nurses Association) has been working and advocating for reforms that will help to guarantee the access of high-quality health care. This act has helped millions of people, but ANA recognizes the fact that this debate is far from being over. The ANA is dedicated to educating the nursing public about the changing systems and their impacts on people's lives and the nursing profession. Which of the following is an example of Western alternative medical systems? TCM (traditional Chinese medicine) naturopathy ayurveda acupuncture - -Correct answer: naturopathy Naturopathy and homeopathy are examples of Western alternative medical systems. Naturopathy emphasizes health restoration rather than disease treatment and combines nutrition, homeopathy, therapeutic counseling and other therapies. The underlying belief is that the individual assumes responsibility for his or her recovery. What is NOT a sign of alcohol intoxication? Nystagmus Mood lability The face has pale skin. Aggressive impulses - -Correct Answer: The face has pale skin. RATIONALE: A flushed face is a sign of alcohol intoxication. Other signs include disinhibition of sexual impulses, impaired judgment, and impaired occupational functioning. In terms of styles of leadership in therapeutic groups, which type of leader encourages individual creativity and group cohesiveness? autocratic democratic laissez-faire psychotherapeutic - -Correct 6 Answer: democratic 7 RATIONALE: There are three main styles of group leadership: autocratic, democratic, and laissez-faire. A democratic leadership style focuses on the members of the group. Members are encouraged to participate fully in problem-solving of issues that relate to the group. This type of leader encourages individual creativity and group cohesiveness. All of the following are considered to be types of family structures except? Nuclear family Behavioral family Blended family Extended family - -Correct Answer: Behavioral family RATIONALE: The major types of family structures are: Nuclear family Blended family Extended family Single-parent family Other familial systems What would NOT be an appropriate way to deal with a patient in the psychiatric unit who is prone to protracted angry outbursts? Using reassuring touch Determining the source of the patient's anger Remaining calm Setting verbal limits on behavior - -Correct answer: Using reassuring touch RATIONALE: This would not be appropriate for interacting with an angry patient. When coping with an angry patient, don't shout or argue with the client and avoid touching the client or invading the client's space. This can escalate the anger. Touching the client can be threatening and make them feel cornered. This may result in retaliation. N-STAT is an ANA program that does which of the following? unifies nurses' political voices recommends nursing health policies assures a safe workplace for nurses evaluates Medicare and Medicaid reforms - -Correct Answer: unifies nurses' political voices RATIONALE: Nurses are the largest group among the health care disciplines The Nurses Strategic Action Team (N-STAT) is an ANA program that unifies nurses' political voices across the country to enact measures to benefit health care for everyone. Examples of DSM-V diagnostic criteria for schizophrenia include all of the following EXCEPT: hallucinations 10 RATIONALE: The muscular system is responsible for extrapyramidal side effects. The best way to prevent involuntary muscular movements that could be irreversible is to monitor carefully. If symptoms are present, it can be treated by reducing the current dose, or changing the patient to an atypical agent. The gathering and interpretation of data based on valid observed and patient-reported information, in addition to research-derived evidence, is known as which of the following? Interventions Managed care Evidence-based Crisis intervention - -Correct Answer: Evidence-based RATIONALE: Evidence-based practice is typically used in the nursing process. The best available evidence is applied in order to improve the quality of clinical judgments. Preventative factors are those that protect the individual from a disorder. Which of the following would be considered a social preventative factor? healthy nutritional status good self-esteem healthy ego defenses higher level of education - -Correct answer: higher level of education RATIONALE: Preventative factors are those that protect the individual from a disorder. They are coping mechanisms or resources that facilitate a healthy response to stress. Social preventative factors include: low-stress occupations; higher socioeconomic status; and a higher level of education. Which of the following would probably not be considered as having a partnership with community-based mental health care? Crisis centers Insurance companies Group homes Shelters - -Correct Answer: Insurance companies RATIONALE: Insurance companies would not be the typical partner with mental health care. Such places could include: Crisis centers Group homes 11 Shelters Patient homes Work sites Mental health clinics Senior centers Schools/colleges Clinics for the homeless What action would be appropriate for documenting a patient's care? Charting opinions Charting in ink Charting events before they happen Charting generalizations - -Correct Answer: Charting in ink RATIONALE: This is the only appropriate charting action. You would not chart the following: opinions that are not supported by facts or defame patients, chart events before they happen, chart generalizations, suppositions or pat phrases, obliterate, erase, alter or destroy a record, or leave blank spaces. If an incident report is filed, do not note it in the chart. Relationships between people are each unique. However, all relationships can be categorized into three major types. They are: social, intimate, and therapeutic social, intimate, and empathetic social, warm, and empathetic public, private, and therapeutic - -Correct Answer: social, intimate, and therapeutic RATIONALE: The three categories of relationship types are: social, intimate, and therapeutic. Social relationships are primarily for friendship. Intimate relationships involve two people who are emotionally committed to each other. The therapeutic relationship focuses on the needs, experiences, feelings, and ideas of the client only. If the client cannot organize his or her thoughts, or has difficulty answering open-ended questions, the nurse should do which of the following? continue to ask the open-ended questions until the client can answer stop questioning the client altogether ask more direct questions focused on one specific behavior or symptom ask general multiple choice questions - -Correct Answer: ask more direct questions focused on one specific behavior or symptom RATIONALE: If the client cannot organize his or her thoughts, or has difficulty answering open-ended questions, the nurse should use more direct questions to obtain information. Questions need to be clear simple, and focused on one specific behavior or symptom; they should not cause the client to remember several things at once. 12 The study of the distribution, incidence, prevalence, and duration of a disease is known by which of the following terms? pharmacokinetics etiology epidemiology pathogenesis - -Correct Answer: epidemiology RATIONALE: Epidemiology is the study of the distribution, incidence, prevalence, and duration of a disease. Etiology refers to cause or origination of a disease. Pathogenesis is the manner of development of the disease. Pharmacokinetics refers to the movement of the drug into, through and out of the body. Which of the following would not be considered a common side effect of paroxetine? Somnolence GI upset Headache Hypokalemia - -Correct Answer: Hypokalemia RATIONALE: Some of the more common side effects of paroxetine would be considered: Somnolence GI upset Headache Dizziness Insomnia Which of the following physical conditions could potentially cause a patient to exhibit potential psychiatric symptoms such as confusion? Urinary tract infections Chest pain Thyroid disorders Both A and C - -Correct Answer: Both A and C RATIONALE: When a patient is having an admission assessment, there should be a physical examination performed prior to the psychiatric assessment. Such problems as urinary tract infections, especially with the older adults can cause the patient to exhibit symptoms of confusion, among other things. Which of the following does the nurse typically work with to help determine the potential outcomes and goals for the patient? Family Housekeeping 15 Which of the following would be an example of a secondary prevention measure for psychiatric practice? disaster response 16 day treatment programs social skills training case management for vocational needs - -Correct answer: disaster response RATIONALE: Disaster response would be a secondary prevention measure that is aimed at decreasing the prevalence of mental disorders. The other three choices are tertiary prevention measures that are aimed at decreasing the disability and severity of a mental disorder. What is used to delineate the responsibilities and authority at all levels for the various activities in the organization? Mission statement Policy Philosophy statement Procedures - -Correct answer: Policy RATIONALE: The governing body of an organization establishes broad policies for regulating the relations, operations, and outcomes in a health care enterprise. Policies are needed to guide actions in given sets of circumstances. They serve to delineate responsibilities and authority at all levels and for various activities in the organization. What activity is least likely to reduce role conflict and ambiguity of role? Discouraging freedom in the role Use of the chain of command Personal development Adaptation to change - -Correct answer: Discouraging freedom in the role RATIONALE: This is least likely to reduce role conflict and ambiguity of role. Toleration of freedom is more likely to reduce role conflict and ambiguity. Other activities to reduce role conflict and ambiguity include increased need fulfillment, structure and standards, and facilitation of teamwork. Of the following statements about involuntary admission to a psychiatric facility, which is the least accurate? Involuntary admission requires that the patient retain freedom from unreasonable bodily restraints. Those patients who have been involuntarily admitted no longer have the right to refuse medications. Patients have the right to legal counsel and to take their cases before a judge who may order release. Forced treatment raises ethical dilemmas regarding autonomy versus paternalism. - - Correct answer: Those patients who have been involuntarily admitted no longer have the right to refuse medications. 17 This statement is least accurate. Involuntary admission requires that the patient retain the right to refuse medications. This refusal can include psychotropic or antipsychotic medications. Managed care is used by whom? Stake holders. High Management. Purchasers of health services. Insurance companies. - -Correct Answer: Purchasers of health services. Managed care is used or employed by purchasers of health services. These people will make decisions about different services so that quality and costs can be monitored. In this type of program, people will get health care based on their needs. 75 year old male is suffering from an altered mental status. What is happening to him? The memory is overloaded. There are changes to the brain's normal functions. The patient is dying. There is no change to the patient's brain activity. - -Correct Answer: There are changes to the brain's normal functions RATIONALE: Patients suffering from an altered mental status suffer general changes to the brain's normal functions. Symptoms that are associated with this state are confusion, loss of orientation, amnesia, and poor regulation of emotions. In order to provide health care, a health care professional must be assertive. This would include all of the following attributes EXCEPT: confidence in the necessary competencies and skills direct and effective communication acting as an advocate and consultant to the client pressuring a client to accept treatment - -Correct Answer: pressuring a client to accept treatment RATIONALE: A client has the right to accept or refuse treatment. Being assertive does not mean that the nurse can impose his or her opinions on the client. What term best describes a nurse's ability to best determine the end result? Expected outcome. Evaluation. Competency. Autonomy. - -Correct Answer: Expected outcome. RATIONALE: 20 hippocampus hypothalamus 21 gonads pancreas - -Correct answer: hippocampus The hippocampus is not a part of the neuroendocrine system. It is a part of the brain located in the medial temporal lobe. It is an important site for the formation and storage of immediate and recent memories. The neuroendocrine system contains the hypothalamus, pituitary gland, thyroid gland, adrenal glands, gonads, and pancreas. In which stage of the standards of practice for psychiatric nursing would the nurse document measurable goals? assessment implementation planning outcomes identification - -Correct Answer: outcomes identification Outcomes identification includes documenting expected outcomes as measurable goals. It also includes identifying attainable and culturally expected outcomes and including time estimate for expected outcomes. The type of hospital admission to a psychiatric inpatient setting that does not require a written application is which of the following? voluntary admission involuntary admission temporary admission informal admission - -Correct Answer: informal admission Informal admission is one type of voluntary admission that is similar to any general hospital admission in which there is no formal or written application. An informal admission is sought by the patient. The normal doctor-patient relationship exists, and the patient is free to stay or leave, even against medical advice. Which of the following is NOT a drug associated with date rape? Risperidone GHB Rohypnol Ketamine - -Correct answer: Risperidone Risperidone is not a drug associated with date rape. It is an antipsychotic. Date rape drugs may render a woman incapable of resisting a rape and are purported to facilitate acquaintance rape. Once the drugs are ingested, victims lose their ability to ward off attackers, develop amnesia and become unreliable witnesses. 22 What is the term used for the study of ethical problems resulting from scientific advances? Medical ethics Ethical acculturation Bioethics Deontology - -Correct Answer: Bioethics Nursing ethics is part of a broader system known as bioethics. New questions surface as science and technology produce new ways of knowing. Bioethics is the term used for the study of ethical problems resulting from scientific advances. The responsibilities of the nurse leader in using change management include all but which of the following? using change theory serving as a change agent supporting staf f during times of difficult transitions having a rigid leadership style - -Correct Answer: having a rigid leadership style Having a rigid leadership style is not part of good change management. Adapting leadership style to situational needs is more effective. The responsibilities of the nurse leader in using change management include all of the first three choices. They also include: recognizing one's own reaction to change and striving to remain open to new ideas and approaches. The NP asks a patient with schizophrenia what the saying, "people in glass houses shouldn't throw stones" means to him. The patient replies that "the glass might break." This is an example of the patients inability to process which of the following? concrete thinking abstract thinking delusion echolalia - -Correct Answer: abstract thinking This patient is not able to process abstraction. Concreteness is often assessed through the patient's interpretation of proverbs. Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time. If you teach a client how to navigate through the complexities of the health care delivery system to receive prompt treatment this is a form of: primary prevention secondary prevention tertiary prevention enabling - -Correct Answer: secondary prevention 25 Assess the risk of suicide. Have the patient talk about the traumatic event. Encourage her to talk to others who have had similar experiences. - -Correct answer: Assess the risk of suicide. A patient with post traumatic stress syndrome (PTSD) has experienced a traumatic event that has affected their life severely. The patient will be experiencing a high level of anxiety and as a result, the possibility of self- destructive behavior is present. This should be the first concern to be addressed. What statement concerning conduct disorder in children is accurate? Conduct disorder is more common in children of parents with antisocial personality disorder than in the general population. Conduct disorder affects more girls than boys. Onset is earlier for girls than boys. The child must have one or more symptoms of the disorder in the past year to be diagnosed with conduct disorder. - -Correct answer: Conduct disorder is more common in children of parents with antisocial personality disorder than in the general population. This is the accurate statement. It is also more common in children of parents with alcohol dependence, mood disorders, or schizophrenia rather than in the general population. Conduct disorder affects more boys than girls. Its onset is earlier for boys than girls. The child must have three or more symptoms of the disorder in the past year and at least one symptom in the past 6 months to be diagnosed with conduct disorder. What atypical antipsychotic is preferred for adolescent patients? Haldol Haloperidol Zyprexa ASA - -Correct Answer: Zyprexa Zyprexa is an atypical antipsychotic. This medication is preferred for patients between the ages of 13 and 17. There are multiple formulations for specific needs. In terms of complementary and alternative medicine which of the following would be classified as a whole medical system? chiropractic therapy meditation naturopathy herbal therapy - -Correct Answer: naturopathy Naturopathy is a whole medical system. It focuses on enhancing the natural healing responses of the body. Interventions include nutrition, herbology, hydrotherapy, acupuncture, physical therapies, and counseling. 26 What term is used to describe the failure to exercise the standard of care that another would issue in the same situation? Negligence. Attention. Disregard. Heed. - -Correct Answer: Negligence Negligence is the failure to exercise the standard of care that another would issue in the same situation. Negligence also describes any conduct that falls below the legal standard that protects patients from risk of harm. What is a characteristic of dementia, but is not characteristic of delirium? Duration of hours to days Gradual change in mental status Change in psychomotor activity, either hyperactive or hypoactive Perceptual disturbances - -Correct answer: Gradual change in mental status This is a characteristic of dementia. The other choices are all characteristic of delirium. Dementia has a gradual and insidious onset. Delirium does not have an insidious onset; its onset is abrupt. It can usually be noted at a precise date as a rapidly progressive change in mental status. There are how many conditions that allow NPs to challenge a patient's refusal of treatment after informed consent? 3 . 4 . 5 . 6 . - -Correct Answer: 5 . There are five conditions that allow NPs to challenge a patient's refusal to treatment. They include: when a patient is mentally incompetent, when refusing treatment causes danger to the life/health of another, in an emergency situation, when the patient is a child, and in the case of therapeutic privilege. When would a patient's informed consent not be necessary? The patient has dementia. The patient has delusional thoughts. The patient is exhibiting violent ideation. The patient has bipolar disorder. - -Correct answer: The patient is exhibiting violent ideation. Informed consent is not always necessary. Exceptions are made in an effort to preserve life. A patient who is experiencing violent ideation and is a threat to others may be treated without informed consent. 27 According to studies, which group of people with bipolar I is more likely to experience rapid cycling? Older people Men Young people Women - -Correct answer: Women According to evidence, female patients are more likely to experience rapid cycling. Male patients have a higher risk of manic episodes. Long-term involuntary admission to a psychiatric inpatient setting is for extended care and treatment of the mentally ill. The patient can be admitted for this type of admission through which of the following means? medical certification judicial review administrative action all of the above - -Correct answer: all of the above Long-term involuntary admission has as its primary purpose extended care and treatment of the mentally ill. Those who undergo extended involuntary hospitalization are admitted through medical certification, judicial review, or administrative actions. This type of involuntary hospitalization generally lasts 60 to 180 days, but may also be for an indeterminate period. If there is an absence of state statutes, what is used as the basis of liability for injuries related to negligence? Federal law. Common law. Administrative law. Criminal law. - -Correct Answer: Common law If there is an absence of state statutes, common law is used as the basis of liability for injuries related to negligence. Common law is also used for malpractice as well, if there is an absence of state statutes. What key principle of ethical decision making is defined as the right of self- determination, independence, and freedom? Autonomy Justice Fidelity Beneficence - -Correct answer: Autonomy Autonomy is the right of self-determination, independence, and freedom. Autonomy in the healthcare setting involves the healthcare provider's willingness to respect patients' 30 Conduct the interview in private. 31 Be understanding. Inform the patient if a referral to protective services must be made. Probe for answers that the patient is not willing to give. - -Correct Answer: Probe for answers that the patient is not willing to give. The interview should be non-threatening and supportive. Probing for answers that the patient is not willing to give is something that you must not do. Also you should not try to prove abuse by accusations, display disapproval of the perpetrator or the situation, place blame or make judgments. Which of the following best defines the term "values clarification"? the science that deals with the rightness and wrongness of actions conduct that results from serious critical thinking about how individuals ought to treat others a process of self-exploration through which individuals identify and rank their own ideals and concepts that give meaning to their lives a valid, legally recognized claim or entitlement - -Correct answer: a process of self-exploration through which individuals identify and rank their own ideals and concepts that give meaning to their lives Values are ideals or concepts that give meaning to an individual's life. Values clarification is a process of self-exploration through which individuals identify and rank their own personal values. This process increases awareness about why individuals behave in certain ways. What term is used to describe the science that looks at the rightness and wrongness of an action taken or to be taken? Morality. Ethics. Factual decision making. Hard morality. - -Correct Answer: Ethics. Ethics is the science that looks at the rightness and wrongness of an action taken or to be taken. It is a mental health nurse's responsibility to always act in the best interest of the patient, and protect them. When patients in the psychiatric unit of a hospital are expected to be on time for scheduled activities, where limits are set and the focus is on the here and now, what type of therapy is this? psychosocial therapy behavior modification milieu therapy cognitive therapy - -Correct Answer: milieu therapy 32 Milieu therapy is used to promote the mental health of the patients. Milieu therapy incorporates the planned use of people, resources and activities to assist patients to improve their personal skills and perform their normal daily activities. What action does the court take in most negligence cases? Makes a new determination every case. Makes a determination using the Ethics code of conduct. No specific action. It uses previous cases for decisions. No specific action. Negligence cases are always dismissed. - -Correct Answer: No specific action. It uses previous cases for decisions. For negligence cases, most outcomes are based on legal precedent. This means outcomes are based on previous decisions on similar cases. In these cases, the courts will not take specific action. What type of drug may cause a risk of floppy baby syndrome and/or cleft palate during a pregnancy? Lithium Benzodiazepines Depakote Tegretol - -Correct answer: Benzodiazepines Some drugs can be teratogenic for pregnant women. Benzodiazepines may result in floppy baby syndrome or cleft palate. Tegretol and Depakote may result in neural tube defects. Lithium may cause an Epstein anomaly. Approximately what percentage of people with mental retardation have profound mental retardation? less than 1% 1% - 2% 5% 3% - 5% - -Correct Answer: 1% - 2% Profound mental retardation is defined as an IQ level below 20 or 25. 1% - 2% of people with mental retardation have profound mental retardation. They have a minimal capacity for sensorimotor functioning. Motor development, self-care and communication skills may improve if appropriate training is provided. If a mental health nurse is found guilty by criminal law, her punishment may be which of the following? Fines. Loss of medical license. Imprisonment. All of the above - -Correct Answer: All of the above. 35 d. Psychiatric clients cannot be trusted to make good healthcare decisions and, therefore, the nurse's best clinical judgment should guide actions - ANSWER- C. As with any client, psychiatric clients can refuse treatment unless a legal process resulting in involuntary commitment or mandatory court order for treatment has been obtained. Which of the following statements best reflects the difference between the nurse-client (N-C) relationship and a social relationship? a. In the N-C relationship, the primary focus is on the client and the client's needs. b. Goals in the N-C relationship are deliberately left vague and unspoken so that the client can work on any issue. c. In the N-C relationship, the nurse is solely responsible for making the relationship work. d. In the N-C relationship, there is no place for social interaction. - ANSWER- A. Social relationships are mutual interpersonal relationships in which the needs of both parties are addressed. The N-C relationship is most concerned with meeting the needs of the client. A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this is an example of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Protective factorial prevention - ANSWER- A. This action focuses on interventions designed to reduce the incidence of new cases of disease. Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave because "this place can't help me." The best nursing action that reflects the legal right of this client is a. Discharge the client b. Explain that the client cannot leave until you can complete further assessment c. Allow the client to leave but have her sign forms stating she is leaving against medical advice d. Immediately start the paperwork to commit the client and to allow you to treat her against her wishes - ANSWER- B. Almost every state allows for a brief for a period detainment to assess a client for dangerousness to self or others before allowing the client to leave a hospital setting, even if the admission was voluntary. In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship- building. Which of the following is an essential part of building a therapeutic relationship? a. Collecting a family history b. Like-mindedness 36 c. Authenticity 37 d. Accuracy in assessment - ANSWER- C. Authenticity. Being genuine, honest, and respectful are essential elements in establishing a working relationship with any client. Like-mindedness is not a part of the therapeutic relationship. Although an important aspect of the PMHNP role, collecting a family history and accuracy in assessment does not in and of itself facilitate relationship building. According to the DSM-5, which of the following is true? (Ch. 3) a. A mental disorder is equivalent to the need for treatment. b. Diagnostic criteria are used to inform clinical judgment. c. Socially deviant behavior is considered a mental disorder. d. A culturally expected response to a stressor is not a mental disorder. - ANSWER- D. All DSM-5 disorders need to be made taking a person's culture into account. A cultural expression of a response to grief, loss, or stress is not considered a DSM-5 diagnosis. Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services, and is displaying an increase in regressive defense mechanisms. What is the best explanation for Ms. French's behavior? a. An exacerbation of her symptoms related to stress b. The normal cyclic nature of chronic mental health symptoms c. A sign of normal resistance to termination seen in the termination phase of therapy d. A sign of pathological attachment to the therapist that must be addressed - ANSWER- C. Clients frequently display resistance and regression at the termination of a meaningful therapeutic process. The PMHNP is responsible for planning an effective termination and monitoring clients during the termination period. A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development: a. Infancy b. Early childhood c. Late childhood d. School age - ANSWER- B. These signs indicate developmental failure of early childhood. Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful? a. Pleasure principle 40 c. Opportunity and waste 41 d. Affordable and quality - ANSWER- A. Health care efficiency is making risk and benefit decision about how care resources are allocated and equity is ensuring that there is a fair distribution of the resources. What four elements need to be present for a malpractice lawsuit to be filed? a. Beneficence, Non-Maleficence, Truthfulness, and Justice b. Duty of care, Breach of standard of care, Injury, and Injury must be related to breach of the standard of care c. Abandonment, Breach of care, Violation of ethics, and Reimbursement for poor care d. Breach of standard of care, Injury, Deceit, and Malpractice - ANSWER- B. The four elements that must be satisfied for malpractice to have occurred are a duty of care between clinician and patient, breach of standard of care, an injury to the patient, and the patient's injury must be related to the clinician's breach of care. Mary is a Psychiatric-Mental Health Nurse Practitioner (PMHNP) who is working in a hospitalist role. Mary has encountered over five incidences in which attending psychiatrists and medical residents have been demeaning to nursing staf f and not answering calls in the middle of the night or telling the nursing staf f to write orders and the MD would sign of f in the a.m. Mary is concerned about errors and wants to improve quality, reduce errors to promote safety. What concept is Mary employing? a. Bullying b. Abuse c. Civil Disobedience d. Just Culture - ANSWER- D. The ANA has a position statement that nurses are responsible for developing health care settings that include just culture initiatives understanding that human error can cause error and harm by creating an open and fair environment. The role of neurotransmitters in the central nervous system is to function as a. A communication medium b. A gatekeeper for transmissions c. A building block for amino acids d. An agent to break down enzymes - ANSWER- A. Neurotransmitters in the central nervous system function as a communication medium. Serotonin is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra - ANSWER- C. Serotonin is produced in the raphe nuclei. Dopamine is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra - ANSWER- D. Dopamine is produced in the substantia nigra. 42 A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? a. Thalamus b. Hypothalamus c. Limbic system d. Hippocampus - ANSWER- B. Appetite, sleep, and libido are regulated by the hypothalamus. In considering whether to order an MRI of the head for a client, which of the following would be a contraindication to this diagnostic test? a. Prosthetic limb b. History of head trauma c. Pacemaker d. Pregnancy - ANSWER- C. A client with a pacemaker should not receive an MRI of the head. The primary excitatory neurotransmitter is a. GABA b. Serotonin c. Dopamine d. Glutamate - ANSWER- D. Glutamate is the primary excitatory neurotransmitter. A client who is 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 or her knowledge that these symptoms represent problems with the a. Frontal lobe b. Temporal lobe c. Parietal lobe d. Occipital lobe - ANSWER- A. Problems with working memory, planning and prioritizing, insight into problems, and impulse control indicate a problem in the frontal lobe. The concept of target symptom identification is best explained as a. Identification of the major clinical presentation of the client b. Identification of specific, precise, and individualized symptoms reasonably expected to improve with medication c. Identification of the secondary messenger system syndrome d. Intentional modulation of synaptic pathways - ANSWER- B. Target symptom identification is the identification of specific, precise, and individualized symptoms reasonably expected to improve with a given medication. The goal of the psychiatric assessment process performed by the PMHNP is to a. Gain an understanding of the life experiences of the client 45 take at this time is a. Increase his dose of antidepressant medication to better capture symptoms 46 b. Change him to another antidepressant for better symptom control c. Augment his antidepressant with an atypical antipsychotic medication d. Order a comprehensive metabolic panel - ANSWER- D. Client symptoms are consistent with electrolyte imbalance and a physical cause of his symptoms must be ruled out first. Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? a. Omeprazole b. Propranolol c. Levothyroxine d. Clarithromycin - ANSWER- B. Beta blockers can cause or exacerbate depression. 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 - ANSWER- C. Older adults usually have decreased protein levels. Most psychotropic medications are highly protein- bound. It is the unbound (free) concentration of the drug that is active; the bound concentration of the drug is inert. Thus, with decreased protein available for binding, more free (active) drug remains in the body, which then predisposes older adults to toxicity. Which known teratogenic effects can be caused by the common psychotropic medications divalproex and lithium? a. Divalproex—Epstein anomaly; lithium—cleft palate b. Divalproex—spina bifida; lithium—Epstein anomaly c. Divalproex—limb malformations; lithium—seizure disorder d. Divalproex—mental retardation; lithium—spina bifida - ANSWER- B. Divalproex can cause spina bifida and lithium can cause Epstein's anomaly. The study of what the body does to drugs is called a. Pharmacodynamics b. Pharmacology c. Pharmacokinetics d. Distribution - ANSWER- C. Pharmacokinetics is the study of what the body does to drugs. Your client Sam is being treated for panic disorder with agoraphobia. He currently is being prescribed paroxetine (Paxil CR, 37.5 mg q.d.) and clonazepam (Klonopin, 0.5 mg q.d., p.r.n.). He has been on clonazepam for 2 years and admits to needing 4 pills to 47 achieve the same effect that 1 pill initially produced. This is possibly an example of which process? a. Kindling b. Addiction c. Tolerance d. Potency - ANSWER- C. Tolerance means needing more to achieve the same effect. Why is group therapy beneficial? a. It assists the client to focus on self b. It lacks theoretical frameworks c. It enables participants to acquire therapeutic factors d. It is always time limited - ANSWER- D. Group therapy is beneficial because it increases social skills, is cost-effective, and enables participants to acquire the curative factors. Which of the following is the best rationale for using cognitive behavioral therapy? a. Recognize and change his or her automatic thoughts b. See reality as you see it c. Change his or her reality by changing his or her environment d. Recognize and accept that automatic thoughts suggest delusional thinking - ANSWER- A. Cognitive behavioral therapy helps clients recognize and change their automatic thoughts. When working with a dysfunctional family, you find that the father, Jim, worries excessively and is resistant to change. You give Jim a paradoxical directive to worry extremely well for 1 hour per day, knowing that he will likely be noncompliant, and thus change will occur. With this technique, you are using which type of therapy? a. Experiential therapy b. Structural therapy c. Strategic therapy d. Solution-focused therapy - ANSWER- C. Paradoxical directives are used in strategic therapy. Which of the following best describes homeostasis in a family system? a. Choices a family makes to keep the peace b. Balance or stability that the family returns to despite its dysfunction c. Need for change and balance in a family d. Calm in a family that returns after a crisis - ANSWER- B. Homeostasis is balance or stability that the family returns to despite its dysfunction. In an attempt to bring the client toward the goal he or she is working on, you ask the client, "If a miracle were to happen tonight while you slept, and you awoke in the morning and the problem no longer existed, how would you know, and what would be different?" This technique is used in which type of therapy? a. Behavioral therapy 50 has gone beyond euthymia. Mr. D. is a 35-year-old, married, high-tech industry executive who is referred to the PMHNP for "insomnia." Mr. D. reports that he falls asleep quickly, but has difficulty staying asleep. He wakes up several times during the night, and believes he tosses and turns even when he is sleeping. He wakes up feeling exhausted and drinks "a pot of coffee" to stay awake and concentrate during his long work day. He drinks 1 glass of wine most evenings. He denies any illicit substance use. He denies any symptoms of a mood or anxiety disorder, but is feeling increasingly frustrated and concerned about his sleep. Which of the following is the most likely contributing factor to Mr. D.'s ongoing middle insomnia? a. Obstructive sleep apnea (OSA) b. Caffeine dependence c. Alcohol withdrawal d. Attention-deficit hyperactivity disorder (ADHD) - ANSWER- A. OSA is the only plausible possibility if the rest of the information given by the client is accurate. OSA causes clients to have frequent awakenings and a sense that they are not sleeping deeply ("tossing and turning") that is caused by apnea. The client should be assessed further for snoring and awareness of apnea. Although the client states he drinks a lot of coffee, this is driven by his sleep issues. Drinking 1 glass of wine in the evening would not cause the degree of sleep pathology he is exhibiting. Other than diminishing concentration that is consistent with sleep deprivation, there are no other signs and symptoms of ADHD. Tina is a 54-year-old single white woman who has been a Psychiatric-Mental Health Nurse Practitioner for over 20 years. She is considering making application to a Doctor of Nursing Practice (DNP) program but states "if a DNP is required to practice I'll get grandfathered in, no need for me to go back to school." Following the 2008 License, Accreditation, Certification, and Education (LACE) Consensus Model for Advanced Practice Registered Nurse Regulation, which statement is correct? a. Tina is correct: if the DNP becomes a requirement, she will be grandfathered in and obtain a DNP degree. b. The DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfathered in a DNP. c. Tina will be grandfathered in and obtain a DNP only if her state requires a DNP to practice as an APRN. d. The DNP is a certification and Tina will have to take an examination to be grandfathered in to obtain a DNP. - ANSWER- B. APRNs are not grandfathered into an academic degree; degrees must be earned from accredited academic institutions. Tim is a board-certified Psychiatric-Mental Health Nurse Practitioner (PMHNP) working in a busy community mental health center (CMHC). He is currently seeing a client diagnosed with bipolar I disorder who has comorbid hypertension and diabetes. During the visit, Tim takes the client's blood pressure and her reading is 160/94 mm Hg. The client denies any 51 headaches, nausea, chest pain, or shortness of breath. The client states "I can't afford all these medications so I haven't seen my doctor in 7 months and I am out of all my blood pressure and sugar medications, can you give me some?" What is Tim's most appropriate action? a. Call the pharmacy to find out what medications the client is taking and refill for 1 month to cover until she can get in to see his primary care provider. b. Tell the client he cannot refill her medications and inform her to go to the emergency room should she develop any signs or symptoms of an elevated blood pressure or hyperglycemia. c. Call the client's primary care provider, explain the situation, and coordinate the client getting an appointment and medication refills. d. Send the client to an urgent care clinic to get refills today. - ANSWER- C. It is not within the scope of practice of a PMHNP to treat hypertension. Coordination of care to ensure the client does not run out of medication is the appropriate course of action. The chief nursing officer of a large behavioral health system approached the PMHNP to discuss the new Healthcare Effectiveness Data and Information Set (HEDIS) behavioral health measures and specifications. The PMHNP is asked to do a retrospective chart review of all hospital discharge clients who received a follow-up visit within 7 days of discharge and within 30 days of discharge. The PMHNP has been asked to engage in which of the following? a. Needs assessment project b. Plan, do, study, act project c. A task that is outside of the PMHNP's scope of practice d. Quality improvement initiativ - ANSWER- D. Engaging in a project to assess whether a standard of care was met is a quality improvement project. A PMHNP who is working on the consult liaison service is referred to a patient in the medical intensive care unit by the attending hospitalist. The consult note read "Evaluate the patient for competency to make independent medical decisions and consent for a surgical procedure." Based on the scope of practice of a PMHNP, which response would be most appropriate? a. Complete the patient assessment and write up the findings in the patient's medical record. b. Complete a patient assessment, including the mini mental status examination and family collateral data to determine competency. c. Call the hospitalist and provide education that competency is a legal concept and explain that you can assess the patient for the capacity to make medical decisions. d. Refuse the consult and inform the hospitalist that this is outside your scope of practice. - ANSWER- C. The legal system makes determination whether a person is competent; practitioners can assess and make a determination about a person's capacity to make medical decisions. 52 You are asked by a church organization to work with members within your health system to develop a flu vaccination program. According to public health principles, this is an example of what level of prevention? a. Secondary b. Preventative c. Tertiary d. Primary - ANSWER- D. Prevention of illness is primary prevention and administration of flu vaccinations in a community is intended to prevent a flu outbreak. A client with bipolar I disorder presents to your PMHNP office for a follow-up visit. During the visit the client informs you that he no longer wants to be treated with medication, and he does not have bipolar disorder, that was a misdiagnosis. He further informs you he stopped all his medication 2 months ago and is here to thank you for your care and tell you that he no longer needs follow-up appointments. Understanding the ethical conflict, you use which of the following ethical principles in working with this client? a. Autonomy b. Nonmaleficence c. Justice d. Beneficence - ANSWER- A. Clients who are legally competent have the ability to make medical decisions and maintain individual autonomy. A new client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3-year-old son. She goes on to say that the boyfriend has thrown things at her and on one occasion threw a glass of water at her that hit her son in the back. Should the PMHNP report this to child protective services (CPS)? a. Yes, the client is issuing a cry for help for her son. b. Yes, the PMHNP has a duty to report. c. No, this does not constitute a reportable offense. d. No, a report to CPS will escalate the violence. - ANSWER- B. PMHNPs are mandated reporters of child abuse. The 3-year-old is being exposed to violence and although not the target, could have been injured when the boyfriend threw the glass of water. Which of the following is a function of the psychiatric interview? a. Understand the client's psychosocial needs and communicate them to the treatment team b. Identify the mental health needs of the client c. Review previous medical records d. Evaluate a treatment plan - ANSWER- B. During a psychiatric interview, the PMHNP is responsible to identify symptoms and needs of a client to develop an appropriate treatment plan. 55 When conducting a neurological examination on a client, the PMHNP asks the client to hold out her arms and stick out her tongue while assessing for tremors. Which cranial nerve is being assessed? a. Glossopharyngeal b. Vagus c. Trigeminal d. Hypoglossal - ANSWER- D. The tongue is controlled by the hypoglossal cranial nerve. A 20-year-old Asian man who was recently diagnosed with schizophrenia comes to your office for a follow-up appointment. During the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10 p.m. evening news. What symptom is the client describing? a. Paranoia b. Illusions c. Ideas of reference d. Neologisms - ANSWER- C. Ideas of reference are misinterpretations of incidents and events that one believes have a direct personal reference to oneself. You are working with a family: mother, father, and two biological children. Sam, the father, is very rigid and controlling, which seems to be out of fear that something might happen to his family. He worries daily and it affects his family relationships. You give Sam a paradoxical directive and instruct him to intensely worry about everything he can think of for 1 hour a day. Using a paradoxical directive is part of which therapy? a. Experimental b. Structural c. Strategic d. Cognitive - ANSWER- C. Paradoxical directives may be used in strategic family therapy. As a PMHNP working in an outpatient addiction clinic, you often refer your clients to community AA and NA meetings. Using Yalom's therapeutic factors, you are aware that peer-led groups can inspire and encourage other group participants. Which therapeutic factor is instilled in AA and NA group members? a. Hope b. Altruism c. Catharsis d. Existential factors - ANSWER- A. Working in support groups such as AA and NA, hearing stories of others who had similar struggles, instills hope. Which of the following client statements best describes imitative behavior as a therapeutic factor in group therapy? a. Group members talk over one another so the loudest person is heard b. Group members begin to model aspects of other members of the group and group leaders 56 c. Group members discuss past situations when they were bullied and felt ashamed d. Group leaders take charge of the group and redirect members when they monopolize the group - ANSWER- B. As group progresses the leader is less active and the members of the group take over and begin to model other members and the leaders. Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral theory 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 experiences - ANSWER- A. DBT focuses on cognitive and behavioral techniques, mindfulness including meditation, and emotional regulation. Dialectical behavioral therapy (DBT) affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. This philosophy is a supportive principle of DBT training. The central dialectical pattern emphasized in DBT involves the tension between: a. Radical acceptance and change b. Cue exposure and block avoidance c. Problem avoidance and problem-solving d. Crisis survival and acceptance - ANSWER- A. DBT emphasis acceptance of the current reality of what is and the ability to engage in personal change. Samantha is a 26-year-old partnered woman who works full time as a teacher. She is in a long-term relationship with Mary and they are getting along well, and doing well financially. They have two children, ages 2 and 6. Samantha is seeing the PMHNP to address her concerns that she is feeling down and sad for no reason and states, "I know my life is going well but I just don't feel happy. I have always worried a lot and have been sad most of my life." As a PMHNP trained in transactional analysis (TA), you understand that personality is multifaceted and wonder if which of the following is affecting her ability to experience happiness: a. She had long periods of separation from her primary caregiver as a child and now has a difficult time accepting and receiving love and experiencing happiness b. She likely had a traumatic event in her childhood and her thoughts and feelings related to the event are locked together in her brain and cannot be accessed c. Her unhappiness is likely related to distorted thoughts and feelings about her relationship d. As an adolescent she experienced an event that was processed in an ego state as an older sibling - ANSWER- B. According to TA, when a person is traumatized the thoughts and feelings get tied together and the process of therapy is to unlock the two. 57 You have been working with a 54-year-old man who has been treated for schizophrenia since age 19. He has limited social interactions, likes to be alone, and has never dated nor had a desire to date. His symptoms are best explained by which of the following? 60 activities such as dancing. If you were to fall and break a hip, this could lead to prolonged hospitalization, loss of independence, and ultimately increase your risk of dementia." - ANSWER- B. While it was once thought that brain neurons did not regenerate, we now known that while most brain development occurs early in life, we continue 61 to form some new brain cells throughout life. As we age, we need to engage in activities that keep our brains healthy by encouraging this growth. Examples are diet, exercise, socialization, and cognitive stimulation. What is the best treatment for AIDS dementia complex? a. Acetylcholinesterase inhibitors b. Symptom-targeted pharmacologic treatments c. Nonpharmacologic supportive care d. Antiretroviral therapy - ANSWER- D. All persons with AIDS should be treated with antiretroviral therapy. Those who develop dementia complex should have those symptoms treated with appropriate pharmacological or nonpharmacological interventions. As a PMHNP working on the consult liaison team, you know the importance of preventing delirium due to which of the following? a. Risk of 1-year mortality rate b. Risk of harm to the client and staff c. Risk of unremitting psychosis d. Risk of aspiration - ANSWER- A. Studies have identified high rates of mortality post hospitalization for delirium so the best treatment is prevention. When working with a 26-year-old, Mike, who presents for treatment of cannabis use and gambling, you use motivational interviewing techniques. As a PMHNP, you are familiar with the core counseling skills used in motivational interviewing. Mike made the following statement: "I don't know why I came here in the first place but I thought maybe some medication would help me." You respond by saying, "You're feeling confused about the process" and Mike replies, "I never thought I'd need to come to a place like this." You respond, "You kept your appointment today and I appreciate the courage it took for you to come here." What two motivational interviewing techniques are used in this interaction? a. Interrupting and reassurance b. Affirming and reflecting c. Open-ended questions and summarizing d. Clarification and data collection - ANSWER- B. When a person is in contemplation stage, interventions should be affirming and reflecting. You are a PMHNP working in a hospitalist role on an acute inpatient psychiatric unit at a local hospital. As you make rounds, the registered nurse informs you that a 32-year-old client who was admitted for alcohol detox has a score of 17 on the Clinical Institute Withdrawal Assessment for Alcohol. What phase of withdrawal is this client in? a. Mild withdrawal b. Moderate withdrawal c. Severe withdrawal d. Delirium tremens - ANSWER- B. CIWA cut of f scores are as follows: 0-9, absent or very mild withdrawal; 10-15, mild withdrawal; 16-20, moderate withdrawal; and 21-67, severe withdrawal. 62 A client who has been addicted to opioids has not used in 15 days. During your medication management visit, the client states, "I'm going to die from not having my Opanas. You need to give me something now." The PMHNP's best response is: a. "I know you are feeling very uncomfortable and we need to get you to the emergency room immediately to prevent a seizure." b. "I know you are feeling very uncomfortable, let's take your vital signs and talk about a trial on Catapres to treat your withdrawal symptoms." c. "You have been using Opana for a long time and it is going to take several months for the withdrawal to end. In the meantime, I will see you weekly." d. "There is no treatment for opioid withdrawal; you will have to wait it out." - ANSWER- B. Opioid withdrawal symptoms can be treated with central alpha agonists. Signs and symptoms of cannabis intoxication include: a. Increase sensitivity to external stimuli b. Enhanced motor skills c. Fast passage of time d. Lower heart rate - ANSWER- A. Persons intoxicated on cannabis exhibit distorted perceptions, increase relaxation and sensitivity, and loss of coordination. Which defense mechanisms are commonly used by persons with obsessive- compulsive personality disorder? a. Rationalization, isolation, and intellectualization b. Projection, distortion, and hypochondriasis c. Regression, somatization, and dissociation d. Sexualization, displacement, and reaction formation - ANSWER- A. Persons with obsessive-compulsive personality disorder use defense mechanisms of rationalization, isolation of affect, and intellectualization to make sense of their behavior. You have been working with Cody, a 30-year-old single man, in weekly individual psychotherapy for 3 weeks. At the start of session 4 he says, "I noticed when I came in that your usual parking spot has a new car in it with temporary tags, and it's a BMW. Nice car." What is the best response from the PMHNP psychotherapist to Cody? a. "Thanks for noticing, it is a nice car." b. "How do you know what spot I park in?" c. "I noticed you drive a BMW as well, how do you like your car?" d. "Sounds like having expensive things is important to you." - ANSWER- D. In a therapy relationship, the therapist should try to understand the meaning of a client's statement rather than engage in social conversations. When working in individual psychotherapy with a client who has a personality disorder, what are the primary treatment goals? a. Change the client's personality structure and make him or her more 65 b. Declining invites by friends or family to attend social gatherings c. Describing information with very little affect variation 66 d. Being an introvert in the work setting to prevent talking with coworkers - ANSWER- C. Isolation is a defense mechanism often used by people with obsessive-compulsive personality disorder and has to do with affect and emotion rather than getting out and being social. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), how should a personality disorder be coded? a. Coded with the major psychiatric disorder b. Coded on Axis II c. Coded on Axis III d. Coded on Axis IV - ANSWER- A. DSM-5 no longer uses the axial system. When prescribing a selective serotonin reuptake inhibitor (SSRI) for a child or young adult up to age 24, what education must be included? a. Black box warning about increased suicidality in this population b. Black box warning about increased risk of mania in this population c. Risk of sexual side effects on this class of medication d. Risk of stomach upset and headaches, to prevent unnecessary primary care visits - ANSWER- A. The SSRIs all carry a black box warning for increased suicidal ideation for this age group. Tommy is an 8 year-old who presents to the PMHNP for evaluation of attention-deficit hyperactivity disorder. His mother completed the Vanderbilt ADHD rating scale and brought in the Vanderbilt teaching rating scale. Both your clinical interview and the rating scales indicate Tommy has ADHD. What assessment indicator(s) need to be completed prior to starting a stimulant mediation? a. Get a copy of the rating scale completed by his grandparents. b. Assess for family history of cardiovascular disease and, if positive for conduction problems, order an electrocardiogram before prescribing medication. c. Obtain blood pressure, and pulse, and begin the stimulant medication. d. Assess for a family history of bipolar disorder. - ANSWER- B. American Academy of Child and Adolescent Psychiatry practice parameters require physical exam, pulse, weight, height, and blood pressure workup prior to the start of stimulant medication. Because his grandfather had a cardiac conduction problem, an electrocardiogram (ECG) should also be obtained prior to the start of medication. A mother brings in her 7-year-old son for a psychiatric follow-up visit with the PMHNP. This is the fourth visit the PMHNP has had with the client, his mother, and his younger sister, Renee, now 7 months old. You notice that she has a decrease in head growth, along with stereotypic motions of the hands, often licking and slapping. Renee has also lost her language skills. What medical condition do you suspect Renee has developed? a. Autism spectrum disorder b. Rett syndrome c. Selective mutism d. Childhood onset diabetes - ANSWER- B. Girls with Rett's syndrome develop 67 normally and around the 7th month regress, with a decrease in head size and language loss. 70 What SSRIs are L2? - ANSWER- Think "Likely/safe Later in the alphabet" or "Sorry, go to the end of the line/ alphabet": Paroxetine/ paxil (is a D in pregnancy); Sertraline/ zoloft; and trazadone/ desyrel List some SNRIs - ANSWER- Think: SNRI snarky and mean/ine if not on time; Venlafaxine/effexor, Duloxetine/cymbalta, Desvenlafaxine/Pristiq SNRI side effects - ANSWER- Usually transient: agitation; bowel changes; dizziness; dry mouth; fatigue; Nausea; sexual side effects (can be chronic), elevated blood pressure (may require monitoring if people are on BP meds); With dose increases, nausea is the most common side effect. What is the scoring of the BECK depression inventory? - ANSWER- 0-13 minimal depression; 14-19 is mild; 20-28 is moderate; 29-63 is severe depression 26 yo with 2yo daughter reports depression starting after the child's birth. Beck Depression Inventory BDI score of 23. Healthy & 16 w pregnant. Which would be inappropriate? A-no meds or psychotherapy now, B-Weekly interpersonal therapy, C-Initiate citalopram/celexa, D-Initiate sertraline/zoloft - ANSWER- Inappropriate would be A-no meds or psychotherapy. What pregnancy category is a drug that has been demonstrated to cause teratogenic effects, but benefits usually outweigh risk *in a life threatening situation* - ANSWER- D. An example would be Lithium (fetal heart issues), valproic acid (fetal neural tube issues) and most benzos (caution; as some benzos are X so check). Is ECT safe in pregnancy? - ANSWER- yes There is positive evidence that Lithium use while breastfeeding can pose risk to infant; this makes it what lactation category? - ANSWER- L4 Overdose of what category of medications would be most likely to be fatal: Tricyclic antidepressants, SSRIs, SNRIs? - ANSWER- Tricyclic antidepressants; often they were only dispensed in week or two week amounts. What drug class is sertraline? - ANSWER- Sertraline/zoloft is an SSRI 71 What drug class is phenelzine? - ANSWER- Phenelzine/nardil is an MAOI What drug class is selegiline /Eldepryl? - ANSWER- MAOI What drug class is phenelzine /Nardil? - ANSWER- MAOI What do MAO inhibitors do? - ANSWER- MAO is an enzyme which metabolizes serotonin, norepinephrine and dopamine. By inhibiting this, MAOIs increase levels of those neurotransmitters. Is there a "less dangerous" MAOI? - ANSWER- Yes. Reversible inhibitors of monoamine oxidase type A (RIMAs) are distinguished from the older MAOIs by their selectivity and reversibility. Dietary restrictions are not required during RIMA therapy, hypertensive crises are quite rare. Moclobemide / Aurorex [unavailable in the US], and Brofaromine/ Consonar. What do you never use an MAOI with? - ANSWER- Anything that blocks serotonin re- uptake. Examples: SSRIs, What food interaction MUST you be aware of when prescribing an MAOI? - ANSWER- Foods high in tyramine can precipitate a crisis. So aged meats or cheeses, dried, smoked, unpasteurized beer, saurkraut, kim chee. Is there a dose of an MAOI that does not require dietary restrictions? - ANSWER- If you eat it, you have to watch your eating; however if your not eating, there is one: EMSAM is the name of the transdermal selegiline patch; a dose of 6 mg per 24 hours does not require dietary adjustment. What drug class is Fluoxetine? - ANSWER- Fluoxetine/prozac is an SSRI What is a chant to remember symptoms of overdose in opiates? - ANSWER- Cool to the touch, unresponsive to pain, Hunger diminished, and scars over vein. Pupils pinpointed, and blood pressure low, Urine diminished, and breathing is slow What are side effects of TCAs? - ANSWER- Anticholinergic effects: constipation; delirium; dry mouth; EKG changes: [flattened T waves; depressed S-T segments]. orthostatic hypotension; sedation; tachycardia; urinary retention. What of f label use is there for Wellbutrin (bupropion)? - ANSWER- Attention- deficit/hyperactivity disorder (ADHD) 72 What drug category is Wellbutrin/ bupropion? - ANSWER- It is a norepinephrine and dopamine reuptake inhibitor; NDRI. What are appropriate psychotherapy choices for Major Depressive Disorder (MDD)? - ANSWER- 1-Cognitive Behavioral Therapy (CBT); 2- Interpersonal Therapy (IPT); 3- Problem solving therapy; 4-psychodynamic therapy How long is a sufficient trial of pharmacologic treatment before changing or augmenting? - ANSWER- 4-8 weeks If there is no improvement in your patient in 4-8 weeks, what do you assess? - ANSWER- Assess for 1-diagnosis (is it accurate), 2-adverse or side effects, 3- complicating co-occurring or co-morbid conditions, 4- psychosocial factors, 5-quality of therapeutic alliance, 6-treatment adherence What is the normal range of TSH? - ANSWER- 0.5 to 4.5 or 5.0 What are options for treatment-resistant depression? - ANSWER- ECT, Transcranial magnetic stimulation, vagus nerve stimulation Once a depressive patient is stabilized ("back to 100%"), how long do you keep them on maintenance medication dosages? - ANSWER- Continue antidepressants - or whatever was effective - for 4-9 months, & monitor for signs of relapse. Use standardized tests, screening tools and if possible include the family to help identify prodrome symptoms such as oversleeping. What is the lifetime prevalence of Major Depressive Disorder? - ANSWER- 17%, initially equal between genders, after 13 women get it twice as often as men. What is age of onset for Major Depressive Disorder? - ANSWER- Mean age is 40 years, prevalence decreases as age increases. What is the recurrence rate for Major Depressive Disorder (MDD)? - ANSWER- 20% within 6 months; 50-80% at least one recurrence during lifetime. List risk factors for relapse for Major Depressive Disorder (MDD) - ANSWER- 1- Persistant mild symptoms, 2-hx of MDD, 3-early age of onset, *4-comorbid chronic medical or psychiatric disorders* (either of these indicates maintenance treatment), 5- chronic psychosocial stressors, 6-negative coping style, 7-chronic sleep disorders, 8- family history of psychiatric disorders List risk factors for Major Depressive Disorder - ANSWER- 1-Genetics, 2-low self esteem, 3-history of an episode, 4-conduct disorder, 5-trauma, 6- stressful life events, 7- parental loss, 8-marital problems, 9-low socioeconomic status, 10-low education achievement, 11-medical inpatients are at 15% higher risk, 12-Peri- and post- partum. 75 How do lamictal/ lamotrigine and valproic acid/ depakote interact? - ANSWER- valproic acid (VPA)/ depakote inhibits the clearance of lamotrigine (LTG)/ lamictal. This can raise the level of lamictal by up to 200% How can Valproic Acid/depakotes (VPA) inhibition of metabolism of lamotrigine/Lamictal be utilized in treatment? - ANSWER- 1-low-dose (250 mg/day) VPA potentially can be used to deliberately inhibit metabolism of Lamictal 2-Use of this low dose; a-can cut Lamictal dose/cost by 50%; b-the risk of adverse events related to valproic acid/depakote will be lower. What adverse events/ side effects are associated with Valproic Acid/ Depakote? - ANSWER- dysmenorrhea/ painful menstruation in women of child-bearing age; elevated liver enzymes; headaches; vision changes; weight gain; Describe the pregnancy category ratings for drugs - ANSWER- A-Adequate and well- controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). B-Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women C-Animal reproduction studies show adverse effect on the fetus; no adequate and well- controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks D-Positive evidence of human fetal risk based on adverse reaction data from investigation or marketing experience or studies in humans; in emergency situations, potential benefits may warrant use X-Studies in animals or humans have demonstrated fetal abnormalities and/or positive evidence of human fetal risk based on data from investigational or marketing experience, and the *risks involved in use of the drug in pregnant women clearly outweigh potential benefits* N-FDA has not categorized the drug yet What are some examples of a Category A medications. - ANSWER- There are very few, but Vitamin A (except large doses); thyroxine, insulin Describe age ranges from a psychosocial perspective - ANSWER- Infant: birth-1 year. Preschool: 2-4 years. School age: 5-12 years. Adolescent: 13- 17 years. Adult: 18-64. (young adult would be 18-30) Young-old: 65-74. Middle-old: 75-84. Oldest-old: 85+ What is certification used for? - ANSWER- Entry into practice; validation of competence; (knowledge, skills, 76 ability) 77 recognition of excellence; regulation of a profession and/or specialty What is certification? - ANSWER- recognition granted to an individual; who has met predetermined criteria; by a non-governmental agency or association What does NP certification do? - ANSWER- Tests knowledge, skills & abilities for entry into practice Name two resources for Evidence Based Practice (EBP) for psychiatric NPs - ANSWER- American Psychiatric Association (APA) practice guidelines; American Academy of Child and Adolescent Psychiatry (AACAP). What is Evidence Based Practice (EBP)? - ANSWER- Delivery of individualized health care on the basis of an awareness of. 1-the impact and strength of related/ relevant scientific evidence and. 2-clinical guidelines What would an Evidenced Based Care Plan include? - ANSWER- 1-diagnosis, 2-follow up, 3-specific goals, 4-thoughts on possible plan B Cranial nerve I - ANSWER- Olfactory: Sense of smell [finger to nose] Cranial nerve II - ANSWER- Optic: Two fingers to eyes Cranial nerve III - ANSWER- Occulomotor: three finger point at things and FOCUS Which neurotransmitters are variable? - ANSWER- Acetylcholine/ ACh enables muscle action, learning and memory [Alzheimer's patients experience a deterioration of ACh]; Dopamine aids movement, learning, emotions [especially pleasurable ones], and attention. Describe the extremes in dopamine - ANSWER- Summary: too much dopamine = psychosis and schizophrenia, too little = parkinson's How much of the exam is related to biology, psychopathology, neurology, neuro- anatomy, physical exam/assessment and other foundational sciences? - ANSWER- Slightly less than a third. Think that a little less than one question in three may be on these topics. Note this section may also address theories and models, diagnostic reasoning. How much of the exam will focus on quality improvement, leadership, and health and health care policies? - ANSWER- Slightly more than a quarter; think that a little more than one question in four may be on these topics. 80 Is checking A1C secondary or tertiary? - ANSWER- If she is a known diabetic, it's tertiary (evaluates treatment), if she is not, it could be considered secondary (screening). Prior to immunizations, how much damage did polio do? - ANSWER- 10,000 children paralyzed, 3,000 children died PER YEAR Prior to immunizations, how much damage did German Measles do? - ANSWER- German measles/rubella 20,000 newborns with birth defects (developmental disability, blindness, death) PER YEAR Prior to immunizations, how much damage did Measles do? - ANSWER- 4 million children infected, 3,000 died per year Prior to immunizations, how much damage did Meningitis do? - ANSWER- Meningitis/haemophilus influenzae type b (HiB) effected 15,000 children PER YEAR, many with permanent disability Prior to immunizations, how much damage did Dipheria do? - ANSWER- Killed 10,000 people annually, mostly school-age children What is the difference in onset and duration between active and passive immunity? - ANSWER- Active: onset can take a month, duration is usually lifetime. Passive: onset within hours, duration is 6-9 months Can influenza and antipneumococcal immunizations be done on the same day? - ANSWER- yes Why and when should HPV be given to males? To females? - ANSWER- Males: 9-26yo to reduce acquisition of genital warts Females: 9-26 yo to prevent cervical cancer Who should not get the flu shot? - ANSWER- Infants under 6 months Zoster Vaccine should be given to all patients of what ages? - ANSWER- Herpes Zoster or shingles vaccine should be given to anyone 60+ years Does medicare part D cover vaccines? - ANSWER- Only zoster vaccine Cranial Nerve VI - ANSWER- Abducent: groups of three moving away - each eye to the side Cranial Nerve V - ANSWER- Take hand/5 fingers wipe forehead, across under nose, across chin, then bite, then chew. Three innervations: Ophthalmic (to bottom of eye), Maxillary is from bottom of eye across nose to top of lip, third is mandibular. Bite & chew all the muscles of mastication. 81 grimacing: cry, drool sublingual & submandibular glands, nose watering, a spider gets in your mouth and you taste it with the anterior two thirds of your tongue. Cranial nerve VIII - ANSWER- Vestibular cochlear nerve [hands/4 fingers to ears to 'hear'] balance and hearing Cranial Nerve VIIII - ANSWER- Put your nine fingers against your throat and make clucking noise; throat muscles, posterior 1/3 of tongue, parotid glands (most saliva). With respect to SSRI side effects, what three systems are commonly effected? - ANSWER- GI, CNS and sexual dysfunction Describe potential SSRI side effects to the CNS by area of the brain - ANSWER- receptors in the basal ganglia can be associated with: Akathesia, psychomotor retardation, parkinsonism and dystonic movements. 5ht2a and 5ht2c receptors can also cause mental side effects: anxiety, agitation or panic attacks. Cranial Nerve X - ANSWER- Vagus: all fingers out, hands across chest/heart. Only cranial nerve that innervates below the neck and everything it touches, it innervates: larynx, pharynx, esophagus, lungs, trachea, heart, gut Cranial nerve XI - ANSWER- two fingers to sides of neck - sternocleidomastoid, two fingers to back of neck/top of back - trapezius Define Secondary prevention. - ANSWER- Early finding of an asymptomatic disease through use of a screening test. How do you justify using screening? - ANSWER- 1-sufficient Prevalence; 2- health problem has significant effect on quality/quantity of life; 3-condition has long asymptomatic period; 4-known progression, 5-treatment must be available/possible; 6- treatment must help; 7-screening must be available, safe, sensitive, specific. In a woman with bipolar I; what would NOT be secondary prevention? A. skin survey for per-cancerous lesions, B. Checking serum LDL. C. Measuring Iron levels. D. Administering influenza vaccine. - ANSWER- Vaccination; that is primary. Which is the most accurate indicator for alcoholism? A. Elevated liver enzymes. B. Positive response to 2 items on the CAGE. C. elevated creatinine. D. Low LDL/HDL ratio. - ANSWER- B. Positive response to two CAGE questions. What is the CAGE questionnaire? - ANSWER- 1-Ever felt you should *C*ut down your drinking? Cranial nerve VII - ANSWER- Facial nerve. Spiders against face and 82 2- Anyone *A*nnoy you by criticizing your drinking? 3- Ever felt *G*uilty about your drinking? 85 Age, Gender, Race, Total cholesterol, HDL cholesterol, Systolic blood pressure, Blood pressure lowering medication use, Diabetes status, and Smoking status. 86 What are the side effects of Valproic acid/depakote: - ANSWER- Most serious/less common: hepatotoxicity, thrombocytopenia, pancreatitis - acute abdominal pain, nausea, vomiting. Less serious/more common: sedation, tremor, dizziness. What are the Dosages of lamictal/lamotrigine: - ANSWER- 100 mg - 200 mg daily; titrate slowly up by 25 mg steps in several day or week or even two week steps. Thiazide diuretic would be the first pharmacologic intervention for who? - ANSWER- All ages including diabetics; not for people with CVD. Atorvastatin / lipitor is used for what? - ANSWER- Statin - it's for cholesterol, side effects of statins include 1-liver damage which is rare, 2-confusion or memory loss - fairly rare, 3-diabtes or metabolic problems - fairly rare, 4- myopathy - muscle weakness or pain. Cognitive Behavioral Therapy - ANSWER- Developed for personality disorders; event - then irrational or non-useful belief about event - then choice of action based on that belief. Treatment is identification and restructuring of personal belief systems. Drugs that are ACE inhibitors usually end in what suffix? - ANSWER- P R I L What theorist stresses holism? - ANSWER- Gestalt? What theorist and theory include unconditional positive regard? - ANSWER- Carl Rogers, person centered therapy What theoretical approach is based on Attachment theory and Sullivan. - ANSWER- Interpersonal therapy; it was developed by Harry Stack Sullivan to treat patients with depression and schizophrenia According to the Bio-psychosocial theory of mental illness, describe the general biologic basis for mental illness. - ANSWER- Mental illness is caused by alterations or abnormalities in the brain's structure, function and chemistry. According to the biopsychosocial theory of mental illness, what things contribute to the brain's function or dysfunction? - ANSWER- 1-Genetics, 2-pre- and post-natal substance or drug exposure, 3-injury, illness or physical disability, 4-pattern of activity or diet According to the bio-psychosocial theory of mental illness, describe the general psychologic basis for mental illness. - ANSWER- Mental illness is caused by past conflicts that affect current thoughts an emotions. 87 Why are diuretics first line drugs for patients with hypertension? - ANSWER- 1-They are practical; they are effective, cheap and have few side effects. 2- They are synergistic with other antihypertensives, 3- they counteract salt and fluid retention which can be common side effects of other antihypertensives, 4- they are useful in patients with heart failure What does reptilian brain refer to? - ANSWER- Brainstem and Cerebellum; all the vegetativ What are the parts of the brainstem? - ANSWER- Pons, medulla oblongata, midbrain What are the effects of damage to the brainstem? - ANSWER- Impaired inhibition, anxiety, depression, personality changes What psychiatric conditions are attributed to the brainstem? - ANSWER- Post traumatic stress disorder (PTSD), paralysis, psychosis, coma and death what does the cerebellum do? - ANSWER- coordination of balance, movement, memory, impulse control, cognition, language What psychiatric conditions are attributed to the cerebellum? - ANSWER- Autism and attention deficit hyperactivity disorder (ADHD). What would be the effects of damage to the cerebellum? - ANSWER- ataxia, tremors, emotional blunting and lack of inhibition. What are the functions of the amygdala? - ANSWER- Regulates basic powerful emotions such as fear, rage and sexual desire. What effects would damage to the amygdala cause? - ANSWER- PTSD and panic disorder, depression, autism, and schizophrenia. What are the functions of the hippocampus? - ANSWER- Picture a horse at college; Memory; specifically in making new ones (which means converting something from short to long term storage), learning. What effects would damage to the hippocampus cause? - ANSWER- The horse is no longer on campus: Impaired new memory formation and attention; think Alzheimer's disease What are the functions of the Hypothalamus - ANSWER- The vegetative functions: homeostasis, sleep, appetite, thirst, temperature regulation. 90 first line treatment for Bipolar for a patient who comes in during a manic episode? - ANSWER- Lithium and an antipsychotic. Note: 1-valproate rather than lithium if a mixed episode. 2-Second generation antipsychotics. 3-If they are on an antidepressant, taper it. For a young woman on birth control pills (BCP) what mood stabilizer has a higher than average chance of interactions with her BCP - ANSWER- It is well established that several of the older AEDs (carbamazepine tegretol, phenytoin /dilantin and phenobarbital [generally only generic]), are strong inducers of the hepatic cytochrome P450 (CYP) 3A4 enzyme system, and are associated with increased the risk of contraceptive failure. What is the likelihood of a co-morbid psychiatric disorder in a patient with Generalized Anxiety Disorder? - ANSWER- 50-90% What are the recommended pharmacologic treatments for Generalized Anxiety Disorder? - ANSWER- First line: SSRI Second line: Buspirone, SNRIs Possibly with short-term benzos. No more than 2-3 weeks. What are the recommended therapeutic treatments for Generalized Anxiety Disorder? - ANSWER- First line: Cognitive Behavioral Therapy (CBT); also teach relaxation techniques such as deep breathing, visualization as tools to deal with stressful events. Lifetime prevalence of social phobia? - ANSWER- 11% for a specific phobia, 3-13% for social phobia. What is the most common type of compulsion? - ANSWER- Self doubt; such as checking and re-checking locks. What is the prevalence of compulsive disorders by gender? - ANSWER- Men > Women, boys = girls. Mean age of onset is 20 y; slightly younger for men. What is the prevalence of PTSD? - ANSWER- 1-Lifetime 6-8% 2-Vietnam vet: 30% 3-Iraq/Afghanistan vet: 14-17% What is the spontaneous healing/remission rate for PTSD? - ANSWER- 30% What is the 2-year readmission rate after a first incidence of schizophrenia? - ANSWER- 50% What does tobacco do to liver enzymes? - ANSWER- 1-Tobacco byproducts are inducers of Cytochrome p450 1A2. 2- This decreases blood concentrations of certain medications. 91 3- Examples include: Clozapine/ Clozaril, olanzapine /Zyprexa and haldol /haloperidol. List some first generation antipsychotics - ANSWER- Chlorpromazine/ Thorazine Fluphenazine / Prolixin Perphenazine / Trilafon Thironridazine / Mellaril or Melleril [alternate: what class are these medications/this medication] What is neuroleptic malignant syndrome (NMS)? - ANSWER- Hot, stif f and out of it. Elevated temp, BP, pulse, change in level of consciousness. Where is the body's temperature regulation done? - ANSWER- Hypothalamus. What is telangiectasia? - ANSWER- A telangiectasis refers to a visibly dilated blood vessel on the skin or mucosal surface; also called spider veins. What are dupuytrens contractures? - ANSWER- The palm of the hand contains a deep layer of tissue called the palmar fascia, which extends across the palm to the fingers. Dupuytren's contracture is a thickening and shortening of this web of fascia that gradually causes clawing of the fingers as they are pulled towards the palm. The ring and little finger are usually targeted, but any finger can be affected. Describe Wernicke's encephalopathy - ANSWER- Wernicke's encephalopathy is a medical emergency that causes life-threatening brain disruption, confusion, staggering and stumbling, lack of coordination, and abnormal involuntary eye movements. What three symptoms may indicate Wernicke's encephalopathy? - ANSWER- Delirium, ataxia and opthaloplegia. Describe Korsakof f syndrome - ANSWER- Korsakof f syndrome causes problems learning new information, inability to remember recent events and long-term memory gaps. For example, individuals may seem able to carry on a coherent conversation, but moments later be unable to recall that the conversation took place or to whom they spoke. What medications can be used to attempt to reduce craving? - ANSWER- Acamprosate / Campral for alcohol craving Bupropion / Wellbutrin for tobacco craving With respect to neuroreceptor action, what is a non-competative antagonist? - ANSWER- Non-competitive antagonists reduce the magnitude of the maximum response that can be attained by any amount of agonist. This property earns them the name "non-competitive" because their effects cannot be negated, no matter how much agonist is present. 92 How does regular alcohol use affect the MCV? - ANSWER- If the person has recently had alcohol to drink, the cells become large, so the MCV is high, usually 100 or more. What is carbohydrate-deficient transferrin (CDT) and how is it used in patient assessment. - ANSWER- CDT is a collection of various isoforms of the iron transport protein transferrin. Alcohol consumption above 50-80 g/d for 2-3 weeks appears to increase serum concentrations of CDT. CDT tends to distinguish chronic heavy drinkers from light social drinkers How does naltrexone / revia / vivitrol work? - ANSWER- Blocks release of endogenous opiodes; also blocks opioid receptors - don't give to someone on opioids (they will stop working). What is vivitrol? - ANSWER- A depot formulation of naltrexone/ revia. What are the symptoms of amphetamine withdrawal? - ANSWER- DSM: 2 of fatigue, sleep disruption (hyper earlier, hypo later), psychomotor changes (hypo earlier, hyper later), increased appetite, vivid dreams. Also usual but not diagnostically required: bradycardia, irritation/ paranoia (occasionally violence), somatic complaints/ pain. What are the symptoms of opioid withdrawal? - ANSWER- DSM: 2 of autonomic hyperactivity (diaphoresis, ^P [over 100]) hand/muscle tremors/cramps, insomnia, N & V, hallucinations (can be tactile, auditory, visual), psychomotor agitation, anxiety, seizures. Think CIWA. What personality disorder is indicated in someone who has no conscience and no remorse? - ANSWER- Anti social What personality disorder is indicated when a patient is constantly suspicious of others' motives? - ANSWER- paranoid What personality disorder is indicated in someone with a constant need for admiration and who lacks empathy? - ANSWER- Narcissistic What personality disorder is indicated when someone has unstable interpersonal relationships, unstable self-image and is very impulsive? - ANSWER- Borderline What personality disorder is indicated in a person with excessive emotionality and attention seeking? - ANSWER- Histrionic What personality disorder is indicated in someone who is very submissive, clinging and fears separation? - ANSWER- Dependent What personality disorder is indicated in someone quite distant from social relationships and restricted in affect? - ANSWER- Schizoid 95 At what age can the average child sit up for 30 seconds unassisted? - ANSWER- 6-8 months When is stranger anxiety likely to begin to manifest? - ANSWER- 8-10 months of age First words - ANSWER- 10-12 months of age What is the Vanderbilt Assessment Scale used for? - ANSWER- To evaluate children for ADHD; you need information from family and then from teachers. What is the Conners Assessment Scale used for? - ANSWER- To evaluate children for ADHD; there is a version for preschool age children and a self- evaluation for adolescents. What is Phenelzine used for? - ANSWER- Phenelzine / Nardil is an MAO inhibitor. It is used for neurotic depression and those with agoraphobia and social phobias. What is the CRAFFT mnemonic used for? - ANSWER- Evaluation of Adolescent substance abuse: C Car - ever been in a car with an impaired driver? R Relax - used substances to relax? A Alone - used substances alone? F Forget - forget things done will using a substance? F Friends - feedback about cutting down from friends or family? T Trouble - ever gotten into trouble while using a substance? 2 or more yes answers is considered positive What is the HEADDS - ANSWER- Screening adolescents *H*ome; who lives there; how much privacy; any changes in definition of family what does "getting home" mean *E*ducation; academic present and proposed future *D*rug use or experimentation *D*rinking or experimentation *S*exuality; seen, education, interest, exploration "do you have a special someone" *S*uicidality; mental health; social support If you have ADHD as a child, what chance to still have it as an adult? - ANSWER- 50% What is the gender breakdown for ADHD - ANSWER- Boys to girls; 2 to 1 What is the gender breakdown for conduct disorder? - ANSWER- Boys to girls; 4 to 1 96 What medications are approved to treat depression in adolescents? - ANSWER- Fluoxetine / Prozac Citalopram / Celexa 97 Both you can begin prescribing at age 8. List MAO-B inhibitors - ANSWER- 1- selegiline /Eldepryl (trade) and Zelpar (orally disintegrating form); 2-Rasagaline (Azilect) What is the difference between MAO-A inhibitors and MAO-B inhibitors? - ANSWER- MAO-A is involved in the metabolism of serotonin, noradrenaline and dopamine whereas MAO-B metabolizes dopamine. Monoamine oxidase A inhibitors have been typically used in the treatment of depression. Monoamine oxidase B inhibitors are typically used in the treatment of Parkinson's disease. Before starting amphetamine salts treatment what testing is appropriate? - ANSWER- A cardiac workup possibly including EKG. How long does a dose of Methylphenidate / Concerta last? - ANSWER- 10-12 hours How long does a dose of Methylphenidate / Ritalin SR last? - ANSWER- 4-8 hours How long does a dose of Methylphenidate / Methylin ER last? - ANSWER- 6-8 hours How long does a dose of Methylphenidate / Metadate ER last? - ANSWER- 6-8 hours What are the side effects of a cholinesterase inhibitor? - ANSWER- Nausea and diarrhea Who is the most likely abuser of an elder? - ANSWER- 90% are family members. How long do you have to interview a school-age child before they become less able to engage with you? - ANSWER- 30-45 min. A medically emancipating condition will mean that the child/adolescent's parents do not need to be notified. What is a medically emancipating condition? - ANSWER- Pursuant to statute, several jurisdictions grant medical emancipation to a minor who has become pregnant or requires sexual-health services, or is seeking treatment related to substance abuse. thereby permitting medical treatment without parental consent and, often, confidentiality from; their parents What must be given consideration when treating a patient with epilepsy and ADHD. - ANSWER- Stimulants which are the mainstay of ADHD treatment, may lower the seizure threshold. What family history puts a child at increased risk for Conduct Disorder? -