PMHNP BOARD CERTIFICATION EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE, Exams of Nursing

Download PMHNP BOARD CERTIFICATION EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE and more Exams Nursing in PDF only on Docsity! PMHNP BOARD CERTIFICATION EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE 2024 | ALREADY GRADED A+ Which medication is the Gold Standard for anti-suicidal effects and is the neuroprotective treatment of choice for bipolar disorder? What is the recommended tx for Bipolar with depression? -------CORRECT ANSWER--------------Lithium (Eskalith), bipolar with depression tx is Lamictal What were the 8 high yield side effects of Lithium? -------CORRECT ANSWER------------- -hypothyroidism, maculopapular rash, fine hand tremors, GI upset (diarrhea, vomiting, cramps, anorexia), T-wave inversions, and Leukocytosis (increased WBC), Diabetes insipidus (polyuria, polydipsia) What mood stabilizer is used to tx seizure disorders, manic phase of bipolar and prevent migraine headaches? -------CORRECT ANSWER--------------Valproate Acid (Depakote) Spinal bifida and neural tube defects can be caused by which mood stabilizer? ------- CORRECT ANSWER--------------Valproate Acid (Depakote) Most common MAOI's ? -------CORRECT ANSWER--------------selegiline, Marplan (isocarboxazid), phenelzine, and tranylcypromine. Monoamine oxidase inhibitors inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A and monoamine oxidase B. They are best known as effective antidepressants in the tx for? -------CORRECT ANSWER--------------Treatment- resistant depression and atypical depression. HTN Crisis occurs when MAOIs are taken in conjunction with? -------CORRECT ANSWER--------------Tyramine (a dietary precursor to norepinephrine, Meperidine (Demerol contains Meperidine), Simulants (Methylphenidate) and other sympathomimetics, decongestants Symptoms of HTN crisis? -------CORRECT ANSWER--------------elevated BP, Sudden explosive-like headache (usually in occipital region (back of head). Facial flushing, palpitations, pupils dilate, diaphoresis, fever. TX dc offending agent (MAOI) Lamotrigine (Lamictal) (anticonvulsant) has a black box warning for? symptoms? ------- CORRECT ANSWER--------------Stevens Johnson Syndrome (severe rash). Symptoms fever, prodromal HA, arthralgia (joint stiffness) Carbamazepine (Tegretol) high yield three black box warnings? Particularly in what race? -------CORRECT ANSWER--------------Agranulocytosis (decreased WBC), aplastic anemia (symptoms:pallor, fatigue, headache, fever, nosebleeds, bleeding gums, skin rash, SOB). Three A's - Agranuloctosis/aplastic anemia/Asians In addition, Steven-Johnson syndrome, particularly in Asians (screen for HLAB-1602 allele before initiating therapy). HLA-B 1502 allele is highly associated with carbamaepine-induced Stevens Johnson Syndrome. Check pregnancy status (HCG) before starting a female patient on psychotropic medication of what childbearing age range? -------CORRECT ANSWER--------------12-51 years of age What dose of folic acid is recommended when planning or capable of becoming pregnant? -------CORRECT ANSWER--------------0.4mg-0.8mg of folic acid daily is recommended DC Tx of Carbamazepine (Tegretol) when absolute neutrophil count (ANC) is? ------- CORRECT ANSWER--------------<1000, because of neutropenia (increases risk of infection) 5HT4A, 5HT3A, 5HT2A, 5HT1A -------CORRECT ANSWER--------------The mechanism of action that makes an antipsychotic medication "atypical" is related to the 5HT2A receptor antagonism and D2 receptor antagonism. What is a first sign of acoustic neuroma when a patient complains of tinnitus? ------- CORRECT ANSWER--------------unilateral ringing in ear 22 y.o. male Bipolar c/0 of Oculogyric Crisis (acute dystonia) on 15 mg of Abilify Q4 days ago what do you do? -------CORRECT ANSWER--------------DC Abilify start Benztropine Mesylates 1 mg po BID for 5 days and return to provider for bipolar management. Aripiprazole (Abilify) is a third generation atypical antipsychotic and a dopamine serotonin system stabilizer (DSS) that is effective against positive and and negative symptoms of schizophrenia. It has a low propensity for extrapyramidal side effects, causes minimal weight gain, sedation, produces no elevation in serum prolactin levels and no cause of prolongation of QTc intervals. Arcus Senilis is? When seen in clients before the age of 40 is associated with ? ------- CORRECT ANSWER--------------A gray opaque band seen around the cornea separated from the limbus by a narrow clear zone. When seen in clients before the age of 40 is is associated with Hyperlipidemia. Antidepressants associated with dose-related cardiovascular adverse effects ? An a typical second generation antipsychotic associated with OT prolonged intervals? ------- CORRECT ANSWER--------------Citalopram (Celexa) and a Atypical second generation antipsychotic Ziprasidone (Geodon) prolongs QT interval) Extrapyramidal Side Effects -------CORRECT ANSWER-------------- Anticholinergic withdrawal syndrome -------CORRECT ANSWER--------------abruptly stopping can cause cholinergic rebound, symptoms of which include nausea, sweating, and urinary urgency. Neuroleptic Malignant Syndrome -------CORRECT ANSWER--------------acute mental status changes, fever, rigidity. Serotonin Syndrome is caused by? -------CORRECT ANSWER-------------- antidepressants, Prescribing and SSRI with a MAOI (increase serotonin, norepinephrine, and dopamine), placing patient on more than one SSRI, SSRI and St. Johns Wart will increase Serotonin. Imitrex, some retroviral drugs, Benzos, progesterone. Dopamine pathways of negative and positive symptoms of schizophrenia? ------- CORRECT ANSWER--------------Negative symptoms are related to DA deficit in the cerebral cortex. Positive symptoms are related to DA excess in the nucleus accumbent and mesolimbic systems. Hematologic changes associated with lithium? -------CORRECT ANSWER-------------- Leukocytosis (WBC increase therefore order CBC during therapy to monitor tx) Serious side effect of trazodone (Desyrel)? -------CORRECT ANSWER-------------- Priapism An inverse agonist has the opposite affect of an agonist? -------CORRECT ANSWER---- ----------True, an inverse agonist does the opposite of an agonist by causing the receptor to close the ion channel. 60 y.o. female with Bipolar I disorder on valproate and risperidone is prescribed corticosteroids you concern is? -------CORRECT ANSWER--------------a manic episode, Corticosteroids have been known to be a pharmacologic cause of mania. Asian and Japanese populations are more likely to be a poor metabolizer of? ------- CORRECT ANSWER--------------SJS occurring in association with phenytoin and carbamazepine occurs more frequently in East Asians who have the gene marker HLA- B*1502. The majority of these associations are due to Asians more commonly being poor metabolizers of cytochrome P450 (CYP) 2C19 Lithium exposure within the first 8 weeks of pregnancy causes? -------CORRECT ANSWER--------------Ebstein Anomaly (improper development of the tricuspid valve in the first 8 wks of fetal growth. Antisocial personality disorder is five times more common among? -------CORRECT ANSWER--------------First-degree relative of men with the disorder. Those with antisocial pd have the Highest homicidal risk. Side effects produced by dopamine antagonisms in the tuberoinfundibular pathway? ---- ---CORRECT ANSWER--------------Galactorrhea is caused from dopamine blockade in the TF pathway by antipsychotic drugs. decrease DA increases prolactin. Delayed-onset typically 1 to 2 years after continuous exposure to antipsychotics? ------- CORRECT ANSWER--------------Tardive Dyskinesia (TD) Contraindicated medication when taking a Monoamine oxidase inhibitor (MAOI) (Selegiline (Emsam), Isocarboxazid (Marplan), phenelzine (Nardil), and Tranylcypromine (Parnate) ? -------CORRECT ANSWER--------------Meperidine (Demerol) due to the risk of hypertensive crisis and death. BMI how to calculate? BMI ranges from low to obese? -------CORRECT ANSWER-------- ------Weight (lbs) divided by height (inches) = BMI <18.5 underweight, 18.5-24.9 normal, 25.0-29.9 overweight, 30+ obese Anorexia Nervosa is considered when BMI is less than? Symptoms? -------CORRECT ANSWER--------------18.5, symptoms amenorrhea, emaciation, bradycardia, hypotension. No FDA approved pharm intervention. Behaviroal psychotherapy (CBT, group, family) Clozapine (Clozaril) can decrease risk of suicide in pts with? -------CORRECT ANSWER--------------Schizophrenia Norepinephrine-dopamine reuptake inhibitors (NDRI) target? Common NDRI ------- CORRECT ANSWER--------------norepinephrie and dopamine. Wellbutrin Inducers define? -------CORRECT ANSWER--------------inducing CYP450 enzyme to metabolize drugs quicker which decreases serum level of drugs which cause lower subtherapeutic drug levels Clozapine (Clozaril) is metabolized by -------CORRECT ANSWER--------------CYP1A2 CYP450 Inducers are? -------CORRECT ANSWER--------------BullShit CRAP GPS induces rage - Mnemonic Increase CYP450 Activity - Drug Clearance Faster + Drugs have LESSER effect. Barbituates St. Johns Wart Carbamazepine Rifampin Alcohol (Chronic use) Phenytoin Griseofulvin Phenobarbital Sulfonylureas CIGARETTE SMOKING Dopamine is produced where? -------CORRECT ANSWER--------------Substantia Nigra Dopamine regulates? -------CORRECT ANSWER--------------regulates motor movement and is associated with addition and psychosis GABA is what type of neurotransmitter? -------CORRECT ANSWER--------------Calming, most abundant inhibitory neurotransmitter in the brain Inhibitors mnemonic? -------CORRECT ANSWER--------------SICK FACES.COM Sodium Valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (Acute) Chloramphenicol Erythromycin Sulfonamide Ciprofloxacin Omeprazole Metronidazole What lobe of the brain controls executive functioning? -------CORRECT ANSWER--------- -----Frontal Lobe What lobe of the brain controls language, EXPRESSIVE speech? -------CORRECT ANSWER--------------Frontal lobe (Broca's Area) What part of the brain control Personality? -------CORRECT ANSWER--------------The frontal lobe problems in the frontal lobe can lead to personality changes, emotional changes, intellectual changes, social skill problems, behavioral changes and aggression. What part of the brain controls RECEPTIVE speech, language COMPREHENSION? ---- ---CORRECT ANSWER--------------Temporal Lobe (Wernickes Area) What part of the brain controls auditory and memory? -------CORRECT ANSWER--------- -----Temporal Lobe, problems in the temporal lobe can lead to auditory hallucinations, aphasia, and amnesia. What part of the brain controls sensory, taste, reading and writing? -------CORRECT ANSWER--------------Parietal Lobe, problems in the parietal lobe can lead to sensory- perceptual disturbances, tactile disturbances, and agnosia (inability to interpret sensations and recognize things) What part of the brain controls cognition, gross motor skills, fine motor skills, and balance? -------CORRECT ANSWER--------------Cerebellum What are the structures in the Limbic System? -------CORRECT ANSWER-------------- Hypothalamus, Thalamus, Hippocampus, amygdala Hypothalamus regulates? -------CORRECT ANSWER--------------stress Thalamus regulates? -------CORRECT ANSWER--------------Sensory relay station, emotions, memory, and regulated affective behaviors Hippocampus regulates? -------CORRECT ANSWER--------------memory and converts short-term memory into long-term memory, motivation Amygdala regulates? -------CORRECT ANSWER--------------regulates emotion, emotional memories, fear, anxiety, anger, stress, aggression. Substantia Nigra regulates? -------CORRECT ANSWER--------------motor movements Dopamine pathways Mesolimbic pathway, excess dopamine is responsible for? ------- CORRECT ANSWER--------------Positive schizophrenic symptoms To avoid Serotonin Syndrome when switching a client from a SSRI to a MAOI wait? ----- --CORRECT ANSWER--------------14 days To avoid Serotonin Syndrome when switching a client from fluoxetine (Prozac) to a MAOI or TCA wait? -------CORRECT ANSWER--------------5-6 weeks To avoid Serotonin Syndrome when switching a client from MAOI back to Prozac wait? - ------CORRECT ANSWER--------------2 weeks Abrupt discontinuation of SSRI or SNRI causes what symptoms? -------CORRECT ANSWER--------------Mnemonic - FINISH Flu like symptoms Insomnia Nausea Imbalance Sensory disturbance - electric shock sensations, visual Hyperarousal Onset 24-72 hours, Resolution 1-14 days, incidence 20-40% Agonist definition -------CORRECT ANSWER--------------drug that binds to receptors and activates a biological response (opens the ion channel) Inverse Agonist Effect -------CORRECT ANSWER--------------Drugs that decrease the activity at the receptor site. Causes the opposite effect of an agonist. binds to the same receptor and closes the ion channel Partial Agonist Effect -------CORRECT ANSWER--------------a drug that does not fully activate the receptor. Between an agonist and an antagonist. Antagonist Effect -------CORRECT ANSWER--------------Antagonist, BLOCK receptors to prevent neurotransmitters from doing their normal job. What is referential thinking? -------CORRECT ANSWER--------------positive symptoms of schizophrenia, Ex: believing that certain news bulletins have a direct reference to them, music is played on the radio for them. What is the definition of delusions, and treatment suggestions? -------CORRECT ANSWER--------------false beliefs firmly maintained despite evidence to the contrary. do not try to convince them they are wrong or delusion isn't real. Does not require reorientation as they are not disoriented. Safety first. if a pt says they are going to poison someone notify the police. On the Mental Status Exam what is the thought process? -------CORRECT ANSWER---- ----------Assesses the organization of thoughts and ideas, not speech. On the Mental Status Exam Circumstantial thought process means? -------CORRECT ANSWER--------------Going in circles but eventually gets to the point On the MSE what are we assessing under the clients" Thought Content"? ------- CORRECT ANSWER--------------S/I, plan, homicidal ideation/plan, Visual H, AH, Cognition, The Mini Mental Status Examination-MMSE (Folstein scale) is used to quantify an adults cognitive status by? Scoring (mild, moderate, severe) -------CORRECT ANSWER--------------Concentration/attention/calculation - count backwards from 100 by sevens. Registration/ability to learn new material - say the names of three unrelated objects clearly and slowly. Recall (memory) - ask the pt if he or she can recall the three words you previously asked. Fund of knowledge - Whos the is the president? 25-30 Normal 21-24 Mild 10-20 Moderate 0-9 Severe Suicidal Assessment is based on who has the most risk factors, one risk is not higher than another? -------CORRECT ANSWER--------------PREVIOUS suicide attempt, men above the age of 45 women 55. divorced, single, separated. White, living alone. American Indian and Alaskan Native Races highest rate of suicide. Transference is ? -------CORRECT ANSWER--------------When a client displaces feelings for significant people in the clients past onto the PMHNP in the present relationship. Countertransference is? -------CORRECT ANSWER--------------When the PMHNPs emotional reaction to the client is based on past experiences. What is the assessment tool for Substance (ETOH) Use Disorder? What are some of the symptoms observed during substance withdraw? What is the shorter version of the CIWA? TX? -------CORRECT ANSWER--------------CIWA - Clinical Institute Withdrawal Assessment Symptoms Tremors sweats agitation tactile disturbances - formication auditory disturbances visual disturbances Shortened version of the CIWA is the CIWA-AR - used to determine when to administer medication for ETOH withdrawal/detoxication. Tx begins when score is > or = to 8 with PRN meds only: Lorazepam (Ativan) shorter half life if hepatic or liver comprise is present use Ativan due to its shorter half life, Diazepam (Valium) longer half life. Score of =/> 15 or higher tx scheduled meds - FDA approved medication for AUD Mnemonic - Decrease Nuisance of Alcohol disulfiram (Antabuse) Naltrexone (Vivitrol) Acamprosate (Campral) Moderate 16-20 Single, separated, divorced pregnant less educated low income or those in relationship with low income and educational disparities Race, educational level, locations associated with Binge drinking? -------CORRECT ANSWER-------------- Instrumental activities of daily living (IADLs) are ? -------CORRECT ANSWER-------------- Shopping, transportation, using a telephone Capgras Syndrome/Delusion is? -------CORRECT ANSWER--------------The belief that their loved one has been replaced by an imposter. The recognition of a loved one by appearances, without the love or even feeling of familiarity. (Denies that the person is their loved one) What is Kindling? -------CORRECT ANSWER--------------Kindling in reference to substance withdrawal (alcohol, Benzos) leads to more severe withdrawal symptoms than previous episodes which lowers the seizure threshold. Deference between Dementia and Delirium? -------CORRECT ANSWER-------------- Dementia is slow onset (months to years) normal speech, where as delirium is acute onset (hrs to days) slurred speech or LOC. Delirium can be caused by fever, intoxication, medications, sleep depreivation, and emotional stress with acute onset. What are the patients symptoms? Prognosis is? Recommended TX? -------CORRECT ANSWER--------------Altered cognition/concentration, inattention, Prognosis is poor 1 years mortality rate is up to 40%. Tx includes Haloperidol (Haldol for agitation and psychotic symptoms. What is the most common form of dementia? -------CORRECT ANSWER-------------- Alzheimer's disease Alzheimer's disease is what onset and decline? Causing cerebral what and enlarged ? - ------CORRECT ANSWER--------------Gradual onset and progressive decline. Causing cerebral atrophy and enlarged ventricles. What are the early and late signs of Dementia caused by HIV (subcortical dementia)? -- -----CORRECT ANSWER--------------Early signs - cognitive decline (concentration attentions, Motor abnormalities**** (lack of coordination, ataxia, tremors, dystonia, muscle rigidity) and behavioral abnormalities. Late signs - cognitive impairment, mutism, seizures, hallucinations, delusions, apathy, and mania. Lewy body dementia symptoms? LBD adversely reacts to what type of medication? ----- --CORRECT ANSWER--------------Recurrent visual hallucinations***/ adversely reacts to antipsychotics Vascular Dementia is how common? Most common in what gender? What are the Hallmarks of VD? -------CORRECT ANSWER--------------VD is the second most common type of dementia. Most common in men with HTN and CVD. Hallmarks*** are carotid bruits, fundoscopic abnormalities, and enlarge cardiac chambers. Picks Disease is also know as Frontal lobe or Frontotemporal dementia. More common in? Changes occur? -------CORRECT ANSWER--------------More common in men, changes occur in personality, language (slurred) and behavioral changes. Huntington's Disease is a subcortical type dementia. Characterized by? ------- CORRECT ANSWER--------------motor abnormalities, psychomotor slowing, difficulty with complex tasks. Decreased acetylcholine (Ach) and norepinephrine in DAT, genetic loading. Cortical affects memory and language whereas subcortical (below the cortical) affects depression, irritability apathy, movement. Examples of dementias for both cortical and subcortical. -------CORRECT ANSWER--------------Alzheimer's and Creutzfeldt- Jakob disease are two forms of dementia affected by cortical area of the brain. Parkinson disease (movement), HIV dementia or Huntington's Disease dementia are examples of sub-cortical affects that cause a slowing down of thinking clumsiness, but the end states of subcortical dementia result in the same breakdown of brain function as the cortical dementias. Treatment of psychosis and agitation in Dementia? -------CORRECT ANSWER------------ --First try non pharmacological therapies then atypical antipsychotics. Benzos should be avoided if possible in most pts with dementia because it can make them vulnerable to their adverse effects such a sedation, falls and delirium. The BMI of patients with bulimia nervosa are normal usually true or false? What is the Russell's Sign? TX? -------CORRECT ANSWER--------------True, Russell's sign is the scarring or calluses on the dorsum of the hands secondary to self inducted vomiting which is also in anorexia. Prozac is the treatment for bulimia Nervosa, SSRI and TCA effective in reducing binging and purging. Vyvanse for binge eating disorder. Implementing a non-diet health therapy ***that looks at eating a healthy diet at the weight you are to teach good food habits and normal eating at the wt the patient occupies. anorexia nervosa -------CORRECT ANSWER-------------- ASD has persistent deficits in? Risk factors? -------CORRECT ANSWER-------------- Social communication and social interaction associated with deficits in nonverbal communication (social ques) Risk factors - male intellectual disability genetic loading. ASD hallmarks? Sceening? -------CORRECT ANSWER--------------Hallmarks are no response when called by name, little to no eye contact, children with AD like to line up, stack, or organize objects and toys. Screening tools are M-CHAT (modified checklist for autism in toddlers), ADOS- G autism dx observation schedule generic), and ASQ (all ages and stages questionnaire) antidepressants Intermittent Explosive Disorder (IED) is a? What is the difference between IED and ODD? -------CORRECT ANSWER--------------A type of impulse-control disorder characterized by repeated episodes of sudden rage/angry outbursts. , or violent behavior, in which the client reacts grossly out of proportion to the situation***. The difference between (IED) from both ODD and DMDD is that while they have episodes of explosive behavior, they are generally happy and euthymic at their baseline level of functioning. What is the diagnosing Major Depression Disorder mnemonic? -------CORRECT ANSWER--------------SIGECAPs Pseudodementia (depression) is? Has what type of onset and progression? What is the primary dx? What is the general response with pseudodementia? -------CORRECT ANSWER--------------Pseudodementia is a cognitive and functional impairment imitating neurodegenerative disorders caused secondary to neuropsychiatric symptoms sudden/acute onset and rapid progression. In MDD cognitive changes have a relatively acute onset and are significant when compared to premorbid functioning. Primary dx is depression even when pseudodementia presents. (pseudodementia is a symptom, not a dx. General response is "I don't know". In primary dementia "lack of answers, confabulate answers" is the response. First Line tx for MDD is? Second line? How long to gain therapeutic effect? Once started how long to continue? What can happen when stopping antidepressants abruptly? -------CORRECT ANSWER--------------SSRI - 1st line because they are much safer in overdose than TCA's. TCA second line - Avoid abrupt withdrawal due to significant discontinuation syndrome, avoid prescribing for pts at high suicidal risk. inform patient that therapeutic effect can take 4-6 weeks. Once started continue for 6-12 months. If pt has 2+ episodes of MDD, consider continuing antidepressants indefinitely. Rebound is common when stopping antidepressant abruptly esp when drugs with short half-lives are involved (ex Zoloft has a short half life verses Prozac does not) Blackbox warning for ALL antidepressants? -------CORRECT ANSWER-------------- Increase suicidal thoughts in children adolescents, and young adults < or = to 24 yrs of age. SSRI's can cause the three S's? -------CORRECT ANSWER--------------sexual dysfunction, serotonin syndrome, severe gastrointestinal upset. If the client does not want sexual side effects choose wellburtrin. What is a non-pharm tx for MDD with psychotics features and tx resistant depression? -- -----CORRECT ANSWER--------------ECT What are adverse effects associated with ECT? -------CORRECT ANSWER-------------- systemic effects headaches, muscle aches, drowsiness True or false there has been no evidence to support "no harm contracts" in reducing he risk of suicide in clinical management of suicidality shows no evidence to support? ------- CORRECT ANSWER--------------True , Not a preventative factor for suicide. What is the mnemonic for Bipolar Disorder? -------CORRECT ANSWER--------------DIG FAST Distractibility Impulsivity Grandiosity Flight of ideas Activities - psychomotor agitation Sleep - decreased need Talkativeness - pressured speech Thyroid dysfunction can mimic depression and bipolar symptoms. Hyperthyroidism is when? Hyporthyroidism is when? -------CORRECT ANSWER--------------HYPER Elevated T 4 and T3 increases and decrease. TSH <0.5 Hypothyroidism is when T4 and T3 decreases and TSH increases >5.0 Hypothyroidism mimics depression how? Hyperthyroidism mimics bipolar by causing? -- -----CORRECT ANSWER--------------HYPO dx when TSH > 5.0 and causes decreased libido, lethargy, cold intolerance, weight gain. Dx when TSH <0.5 mimics bipolar by heat intolerance sensitivity, irritability an agitation, anxiety, mood swings, tachy, wt loss. Normal LFTs (AST and ALT) are ? -------CORRECT ANSWER--------------AST 5-40 U/I ALT 5-35 When liver damage occurs, serum levels of ALT rise to as much as 5X normal. In AUD elevation of what three occur? -------CORRECT ANSWER--------------Elevation in MCV, Total cholesterol, triglycerides In AUD a decrease in what occurs? -------CORRECT ANSWER-------------- hemoglobin/hematocrit Behaviors of Oppositional defiant Disorder (ODD) are? Non-Pharm tx? What can ODD progress into? -------CORRECT ANSWER--------------loses temper, defiant not aggressive***. Non pharm tx is family therapy will emphasis on child management skills. ODD can progress into conduct disorder CD (which are aggressive towards animals, etc. Conduct Disorder (CD) has characteristics of? What is the difference of anti-social disorder and CD? -------CORRECT ANSWER--------------Aggression towards animals, bullies, threatens, initiates physal fights, uses a weapon to cause harm., physical cruelty to people or animals, stealing while confronting victim, forced sexual activity on someone. Destruction of property***fire setting, Deceit or theft ***break into house. Lack of remorse. TX target mood and aggression with antipsychotics, mood stablizers, SSRi. Conduct disorder is typically diagnosed in children, so if an adult meets the criteria for both disorders, then they would be given the antisocial personality disorder diagnoses instead of conduct disorder. Positive symptoms of Schizophrenia are? -------CORRECT ANSWER-------------- hallucinations, delusion, referential thinking, disorganized behavior, hostility, grandiosity, mania, suspiciousness. negative symptoms of schizophrenia -------CORRECT ANSWER--------------Affective flattening, alogia or poverty of speech, avolition lack of motivation, apathy, abstract thinking problems, anhedonia, attention deficits. What is enlarged in the brain for those with schizophrenia? -------CORRECT ANSWER-- ------------ENLARGED VENTRICLES (everything else is decreased) Neurotransmitters associated with Schizophrenia? -------CORRECT ANSWER------------- -Increased dopamine in mesolimbic pathway, increased glutamate, Decreased GABA, and serotonin. Preventative care (labs, assessment, exams) associated with schizophrenia is ? ------- CORRECT ANSWER--------------Serum glucose, serum lipid panel weight BMI, and waist to hip ration (due to antipsychotic weight gain). Annual eye exam. What is a non pharm logical tx for schizophrenia? -------CORRECT ANSWER-------------- ACT Assertive Community Treatment What is the antipsychotic mediation that is the only once to reduce the risk of suicide in schizophrenia? -------CORRECT ANSWER--------------Clozaril (clozapine) Weight neutral antipsychotics to tx schizophrenia? -------CORRECT ANSWER------------- -Ziprasidone (Geodon) and aripiprazole (Abilify) also least sedating, and lurasidone (Latuda) Normal Sodium serum levels and lithium therapy? Normal serum creatinine is ------- CORRECT ANSWER--------------Normal range 135-145 mEq/L decrease in sodium can increase lithium levels and vise versa. Normal serum creatinine is <1.5 mg/dl. elevated creatinine indicates decreased renal function. Lithium is excreted through the kidney and decreased renal function can result in lithium toxicity. Evidence based findings to reduce co-morbid substance use in patients with schizophrenia? -------CORRECT ANSWER--------------manualized group intervention with motivational enhancement. What QTc interval range would increase the risk of a client for torsades de pointes? ----- --CORRECT ANSWER--------------> 500 milliseconds or greater In managing the maintenance phase of bipolar 1 Disorder what medications are recommended? -------CORRECT ANSWER--------------LITHIUM is superior to a placebo in preventing a manic, hypomanic, or mixed episode. LAMOTRIGINE, but not lithium, is superior in preventing a depressive episode. lITHIUM AND LAMOTRIGINE are superior in delaying the onset of mood-related episodes. CARBAMAZEPINE extended-release formulation for the tx of acute manic or mixed episodes but NOT indicated for maintenance for Bipolar I. A pervasive pattern of grandiosity, lack of empathy, and need for admiration is what personality disorder? -------CORRECT ANSWER--------------Narcissistic When prescribing Lurasidone (Latuda) instruct the patient to do what before taking to encourage full absorption?. -------CORRECT ANSWER--------------Recommend eating 350 calories of carbs or turkey to obtain full absorption. The FDA approved fluoxetine (Prozac) in combination with what atypical antipsychotic for the tx of bipolar depression? -------CORRECT ANSWER--------------olanzapine (Zyprexa) What laboratory test should be ordered to rule out a medial cause of dementia? ------- CORRECT ANSWER--------------Vitamin B12 - has been associated with the development of dementia-like symptoms, and when dementia is a diff dx a vit b12 level should be checked. What is Contrave prescribed for? What is the dosing? -------CORRECT ANSWER--------- -----appetite suppression. Titrate over 4 weeks to reach a max dose of 32 mg naltrexone/360 mg bupropion. Do not cut chew or crush. (one pill is 8mg/90mg) In the elderly SSRI an cause symptoms of nausea, fatigue, feeling weak, headache and decreased appetite. due to? -------CORRECT ANSWER--------------hyponatremia. normal blood sodium level is 135 to 145 milliequivalents/liter (mEq/L) Before prescribing lithium (Eskalith) for 33 y.o. female what lab test are appropriate to obtain? -------CORRECT ANSWER--------------Thyroid function , renal function test (creatinine) and pregnancy test since she is of childbearing age. Antipsychotic medication that comes in dosage formulations which include oral tablets, orally disintegrating tabs, short-acting injections, and long acting injections? ------- CORRECT ANSWER--------------Olanzapine (Zyprexa) Who requires a Risk Evaluation and Mitigation Strategy (REMS) for Clozapine? ------- CORRECT ANSWER--------------FDA and the Manufacturers of Clozpine Clozapine is recommended in the tx of severely ill pts with schizophrenia where other meds have not worked. Clozapine is associated with severe neutropenia. Therefore the FDA requires a REMS to ensure safe use. When taking clozapine what is the recommended cut off point to discontinue tx WBC count ? -------CORRECT ANSWER--------------Below 1000 ANC must be at least 1500/ML for the general population and at least 1000 ML for pts with documented benign ethnic neutropenia. What are some key concepts of Transtheoretical Model of Change? -------CORRECT ANSWER--------------Precontemplation -Action step - provide feedback to raise the clients awareness of the problem. Do not tell them what to do. Contemplation - thinking about change, benefits of change and the consequences of not changing. Preparation - made the decision to change, client is ready for action. Help them find a change strategy that is realistic, acceptable, accessible, appropriate, and effective. Action - Support, advocate, Help accomplish steps towards change. Maintenance - prevent relapse Relapse - examine causes, help the person holistically look at the situation. Who is responsible for Cognitive Therapy? -------CORRECT ANSWER--------------Aaron Beck What is the goal of Cognitive Therapy? -------CORRECT ANSWER--------------change a clients irrational/distorted beliefs ***(neg thoughts) and cognitive distortions. Recognizing patterns of thoughts and how thoughts influence feelings and behaviors. Replacing negative thoughts with positive thoughts. Includes journaling, cognitive restructuring. What does CBT aim to change? -------CORRECT ANSWER--------------CBT - aims to change our thought patterns, both conscious and unconscious beliefs, attitudes, and ultimately our behavior so that we can face difficulties and achieve our goals. During CBT how does the therapist and client work? -------CORRECT ANSWER----------- ---Both therapist and client work together as a team to identify the clients problems, devise strategies for addressing them and create solutions. CBT is a combination of? -------CORRECT ANSWER--------------Cognitive and behavioral therapies. If asked a question about cognitive or CBT choose CBT as it would be more effective. What is the focus of Behavioral Therapy? -------CORRECT ANSWER--------------focuses on changing maladaptive behaviors by participating in active behavioral techniques such as Exposure Relaxation skills training problem solving role playing modeling What psychiatric disorder is Dialectical Behavioral Therapy used for ? What is the most critical goal of DBT to decrease? -------CORRECT ANSWER--------------Used for borderline personality disorder, goal is to decrease suicidal behaviors. Therapist needs to be active and directive not passive. What is the focus of Existential Therapy? Who can benefit from ET? -------CORRECT ANSWER--------------ET emphasizes accepting freedom and making responsible choices. Suited for those with terminal illness, those contemplating suicide, or even those going through a transition in their life. Existential Therapy focuses on? -------CORRECT ANSWER--------------present and personal responsibility. Understanding pts subjective*** experience/world might find something positive so they change their contemplation of suicide or existence. Individual is responsible for making meaning out of life. Humanistic Therapy by Carl Rogers is a patient centered therapy that can initiate? ------- CORRECT ANSWER--------------self directed growth and self-actualization. Each person has the potential to actualize and find meaning in life. Interpersonal Therapy focuses on? -------CORRECT ANSWER--------------interpersonal issues that are causing stress. What are the goals of interpersonal therapy? -------CORRECT ANSWER-------------- identify and modify interpersonal problems To understand/manage relationship problems Last up to 12-16 weeks, good for marital conflict Eye Movement Desensitization and Reprocessing (EMDR) is used for? How does it help change the negative trauma? -------CORRECT ANSWER--------------PTSD, with the goal to achieve adaptive resolution. Relate trauma from a negative thought to a positive thought. Process of EMDR? Acronym DIB -------CORRECT ANSWER--------------Desensitization Phase -visualize the trauma, maintains rhythmic eye movements. Installation Phase - strength of positive thoughts to replace the original neg thought. Body Scan - visualizes the trauma along with the positive thought then sans their body to identify any tension within. Biofeedback is a process that provides ? -------CORRECT ANSWER--------------A patient visual or auditory information about the autonomic physiologic function of his or her body. Ex BP, muscle tension, brain wave activity. This can be helpful in cases of stress anxiety, insomnia, and pain. What are the four types of Family Therapy? Families seek in the face of change? ------- CORRECT ANSWER--------------Family Systems Thearpy/Systemic Thearpy Structural Family Therapy Strategic Therapy Multisystem Family Therapy Homeostasis/Equilibrium When working with avoidant clients with trauma techniques that are helpful increase or decrease arousal? -------CORRECT ANSWER--------------increasing arousal is helpful Biopsychosocial Framework of Care tx approach and recovery focus on? ------- CORRECT ANSWER--------------not getting rid of the problem but seeing beyond a persons mental health problems by recognizing and fostering their abilities, interest***, and dreams***. Non-linear (learning from experience)/ Tertiary prevention. Factors which support recovery? -------CORRECT ANSWER--------------Support to achieve their goals. Health, Home, Purpose, Community Assertive Community Treatment (ACT) is where mental health services can be provided within the community. The goals of ACT are? -------CORRECT ANSWER-------------- Allows a holistic approach! By allowing case management approach for mental health. Tertiary Prevention. Helps clients become independent and integration the community Reduce reliance on hospitals Tx is centered around patients personal strengths, needs, and desires for the future. Motivational Interviewing (MI) -------CORRECT ANSWER--------------a brief form of therapy, often used in areas of substance abuse and addiction, that allows clients to explore their desires, reasons, ability, and need for change What is the main difference between repression and suppression? -------CORRECT ANSWER--------------Repression is involuntary/unconscious of painful or disturbing thoughts. Where as Suppression is intentionsal/voluntary and a conscious act. When a child exhibits not feeling safe with their caregiver and unable to feel comfort what attachment theory could explain and guide tx? -------CORRECT ANSWER----------- ---Bowlby attachment theory. Whose concept is that infants and caregivers are biologically predisposed to form attachments. Four stages of attachment theory. Secure, Avoidant, Ambivalent, and Disorganized. Children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive. Scope of practice for PMHNP is determined by? -------CORRECT ANSWER-------------- State legislative statues (BON). Scope is STATE Standard of Quality of Practice is determine by? -------CORRECT ANSWER-------------- ANA, not state. Quality of care is the same no matter where you work. PMHNP are required by law to carry out care in accordance with? -------CORRECT ANSWER--------------what other reasonably prudent nurses would do in the same or similar circumstances which includes high-quality care consistent with established standard. Confidentiality of PMHNP clients assume? What must be signed to release medical records and information requested by a family member or another provider? ------- CORRECT ANSWER--------------info given to a provider will not be disclosed. A signed*** medical authorization and consent forms to release medical records and info when requested by the family member or another provider. Does HIPPA allow the PMHNP to make most disclosures about psychotherapy notes for a patients condition without their authorization? -------CORRECT ANSWER------------- -No, HIPPA does not allow the PMHNP to disclose w/out clients authorization. What are the circumstances that exceptions to the Confidentiality agreement. justify breaking the agreement? -------CORRECT ANSWER--------------Client is suicidal (intent to harm self) or homicidal (intent to harm others, and if patient is unconscious, must inform client of this before sessions begin. Also in cases of court orders, subpoenas, or summonses. Two separate releases of information (ROI) are required to release information on the on a clients chemical and psychiatric care to? -------CORRECT ANSWER--------------3rd party (family member or pharmacy, provider, etc) Need permission from the patient first. What is Tarasoff Principal? What is the 1st thing to do? -------CORRECT ANSWER------- -------1st thing to do is verify with your State BON (Maryland supports Tarasoff) to see if they support Tarasoff. Tarasoff Principal is that the provider has a duty to warn potential victims of imminent danger of homicidal pts. Informed consent is between whom? The patient can ? the proposed tx plan? The provider must document this where? -------CORRECT ANSWER--------------The prover and pt via the communication process, which can result in the acceptance or rejection of the proposed tx plan. In the clients medical record that IC was obtained. Competency is a medical or legal term? -------CORRECT ANSWER--------------Legal Ethical Principles of Justice involve? -------CORRECT ANSWER--------------fairness to ensure care is provided on a fair and equal basis. The ethical principle of nonmaleficence means to cause? -------CORRECT ANSWER---- ----------No harm Beneficence ethical principle means to? -------CORRECT ANSWER--------------Promote well-being and doing good by the client Fidelity (ethical principle) means to? -------CORRECT ANSWER--------------be loyal***, faithfulness***and promise*** keeping, integrity while meeting the pts reasonable expectations while maintaining professionalism***. Ex: keeping the 10am appt and prescribing what you told them you would. Ture or False, Online surveys reach the most people for policy advocacy? ------- CORRECT ANSWER--------------True What is Habeas Corpus? -------CORRECT ANSWER--------------a writ requiring a person under arrest to be brought before a judge or into court, especially to secure the person's release unless lawful grounds are shown for their detention. Ture or False, Quality Improvement Assurance is designed to improve systems, decrease cost, and improve productivity? -------CORRECT ANSWER--------------True The process for Quality Improvement is PDSA cycle. What does PDSA stand for? ------- CORRECT ANSWER--------------Plan (the change) Do (carry out the plan) Study (the results) Act (actions that will improve the process) Reflective Practice is when PMHNP's implement? with the goal to? -------CORRECT ANSWER--------------Debriefing Strategies*** To improve practice What are considerations the PMHNP should consider to ensure Patient Centered Care Model/Culture? -------CORRECT ANSWER--------------Consider Health Literacy Level, family patterns and situations (traditions, folk remedies). Communicate in language that the pt can understand. Positive symptoms of Schizophrenia are caused by? How do antipsychotic tx positive symptoms of Schizphrenia? -------CORRECT ANSWER--------------from high levels of Dopamine in the MesoLIMBIC Pathway -VTA Ventral Tegmental Area to NA (Nucleus Accumbens). Antipsychotics decrease the DA in the mesolimbic pathway Negative symptoms in schizophrenia are caused by? -------CORRECT ANSWER---------- ----Decreased levels of DA in the mesoCortical pathway. Decreased level of DA from VTA to the Cortex. When we decrease the DA in the Nigrostriatal Pathway (we can induce EPS symptoms) with antipsychotics we can induce Parkinsonian symptoms ( in our patient due to the decreased DA within the Substantia Nigra (SN) to Striatum (caudate plus the putamen). -------CORRECT ANSWER-------------- Both organic and drug induced (antipsychotic) induced Parkinsonian symptoms are caused from lower levels of DA within the Substantia Nigra. What are the symptoms? --- ----CORRECT ANSWER--------------cogwheel rigidity, shuffling gate, mask facies resting tremors. Tuberoinfundibular Pathway (hypothalamus, pituitary gland) Increased DA from HT to PG decrease Prolactin Decreased DA HT >PG >^ Prolactin Prolactin and FSH relationship is high yield Increased Prolactin inhibit FSH which will cause amenorrhea and increased prolactin will caused galactorrhea*** -------CORRECT ANSWER-------------- First Generation (Typical) antipsychotics ? Have the highest risk of? Receptor profile (Anti HAM)? -------CORRECT ANSWER--------------Haloperidol***, Fluphenazine, Chlorpromazine, Thioridazine EPS and NMS. Histamine -1 , Alpha - 1, Muscarinic - 1 Weight gain, sedation, orthostasis, hypotension, priapism, and dry mouth. Second Generation Antipsychotics (Atypicals) are? What mechanism do they inhibit? ADR's ? -------CORRECT ANSWER--------------Risperdal (Risperidone), Olanzapine (risk for obesity), Ziprasidone (Geodon) prolongs QT interval), Clozapine, Quetiapine (Seroqueul), Aripiprazole (Abiify) hits both DA and SE so used for augmenting for refractory depression, Lurasidone. D2 + 5HT2a inhibition. Weight Gain, Hyperprolactinemia caused by most common SGA Risperidone Agranulocytosis - most common caused by SGA Clozapine Monitor cloz-ly (pt must be put into the national registry). What test to order if rx clozapine... CBC Dystonia - tx anticholinergic Benztropine or Benadryl Akathisia - beta blocker Parkinsonism - tx anticholinergic Benztropine, or Benadryl Tardive Dyskinesia - tx*** dc antipsychotic, clozapine, -------CORRECT ANSWER--------- -----Dystonia - Sustained muscular contraction, involving two things...oculogyric crisis (eye stuck looking up) and torticollis of the neck. Akathisia - restless, pacing, tapping, can not sit still!!! True restlessness. Akinesia/Parkinsonism - cogwheel rigidity, mask-facies, shuffling gait, resting tremor. Loss of ability to move muscles voluntarily Tardive Dyskinesia - repetitive uncontrolled lip-tongue smacking, repetitive and uncontrolled. ***does not always go away like the Extrapyramidal stopping the antipsychotic. 3-5 % chance of permanent TD for every year a patient is on antipsychotic. Neuroleptic Malignant Syndrome? confusion, agitation, muscle rigidity fever (>105 F) tachycardia, seizures. -------CORRECT ANSWER--------------Rhabdomyolysis increased CK, K, and WBC TX dc antipsychotic, dantrolene, dopamine agonists. Acute Stress Disorder timeline dx is? Verses PTSD? GAD? -------CORRECT ANSWER- -------------3 days to one month verse PTSD is when symptoms progress beyond one month. GAD is most days for atleast 6 months. The COWS rating scale is to rate the detection of what substance? What is the mild and moderate range scoring plus tx? -------CORRECT ANSWER--------------Opiate withdrawal. 0-4 - none 5-12 - MILD Tx is Clonidine 13-24 - Moderate tx Buprenorphine or suboxone 25-35 Moderated to severe 36 - Severe