Assessing and Managing Mental Health Issues, Exams of Nursing

Download Assessing and Managing Mental Health Issues and more Exams Nursing in PDF only on Docsity! PMHNP Exam Reported Questions -341 Questions With Verified Answer. What is dissemination? - Correct answerGetting the research information out to those who need to know it! Publication - highest level Presenting at National Conference Presenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? - Correct answerModerate cognitive impairment What is Tegretol in the CYP450 system? - Correct answerInducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? - Correct answerInducer - will lower dose of Lamictal What is a Type I research error? - Correct answerThere IS a difference but you say there isn't a difference. What is a Type II research error? - Correct answerThere is NO difference but you say there is a difference. What is pseudo-dementia? - Correct answerCognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve. Is it normal for a 1 month old to have a palmar grasp? - Correct answerYes. What is a drug 1/2 life? - Correct answerThe time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? - Correct answerZyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? - Correct answerSerotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? - Correct answerHLAB- 1502 When might you see toxic epidermal necrolysis? - Correct answerWith worsening of SJS How many generations do you include for a genogram? - Correct answer1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - What does messenger RNA code for? - Correct answerAmino Acids What is epigenetics? - Correct answerFactors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? - Correct answerBasal Ganglia Occipito-Frontal What happens to the brain during adolescence? - Correct answerDendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? - Correct answer10-25 yo When do females typically present with schizophrenia? - Correct answer25-35 yo What does Erythromycin to trileptal? - Correct answerYou will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? - Correct answerHeart Failure HTN What are some psychiatric side effects seen with some asthma drugs - Correct answerLeukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol? - Correct answerAgranulocytosis and Hyponatremia What are the 3 CK muscle enzyme tests? - Correct answerCKBB, CKMM, CKMB Which one of the 3 muscle enzymes are related to cardiac muscle damage? - Correct answerCKMB What is the risk of a seriously elevated CKMB? - Correct answerPolymyositis Rhabdo What is a normal CKMB? - Correct answer0.3 mcg/L What psychoactives does Detrol interact with? - Correct answerTopamax KCL What is a claims made/based liability insurance? - Correct answerprovides coverage for a claim that is brought within the policy period, no matter when the loss occurred. Who sets the minimum requirements for NP's? - Correct answerBoard of Nursing State What are the various controlled substance classes? - Correct answerSchedule I - nobody has these - not good for health - heroin, PCP, MDMA, researchers can get it sometimes. Schedule II - Significant Abuse Potential - morphine, methadone, methyphenidate Schedule III - Moderate Abuse Potential - hydrocodone, codeine Schedule IV - Low Abuse Potential - benzo's, ambien, phentermine Schedule V - Very low abuse potential - anti-tussives, lomotil What classes of CS's is the NP approved to prescribe? - Correct answerSchedules III- V ONLY. Where does 50% of healthcare funds come from? - Correct answerThe government Who is eligible for Medicare? - Correct answer>65 or under 65 with diability, ANY age with renal disease. What is incident to billing? - Correct answerMeans MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD. Allows NP to get reimbursed at 100% rather than 85%. How are Medicaid benefits determined? - Correct answerState determines qualification - Partnership between State and Fed Govt. Must be impoverished Must be US resident and low or very low income. Can you have Medicare and Medicaid? - Correct answerYes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? - Correct answerYes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? - Correct answerNational standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state - Correct answerNotice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? - Correct answerCan decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? - Correct answerEmergency treatment Substantial communication barriers and consent is inferred Involuntary committment Is it ok to announce a patient's name in a waiting room? - Correct answerYes, no other way to give care. Is it ok to leave a message on a patient's vm? - Correct answerYes, but should be limited. What is the impact of steroid inhalers on children? - Correct answerSlows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? - Correct answerCataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? - Correct answerSleeping meds Antidepressants Pain meds What psychoactives are first line treatment for fibro? - Correct answerCymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's What is the purpose of telepsychiatry? - Correct answerIncrease the ability to reach rural and underserved areas. What is the purpose of Motivational Interviewing? - Correct answerExplore ambiguity Maintain passive position What is required for Medicare submission? - Correct answerICD 10 and narrative or CPT What is the neurotransmitter problem in Schizophrenia? - Correct answerExcess dopamine in mesolimbic pathway. What is the neurotransmitter problem in ADHD? - Correct answerDopamine, norepinephrine and serotonergic dysfunction What is the benefit of play therapy? - Correct answerDon't have to confront emotions head on. What neurotransmitters are involved in the bioamine hypothesis of depression? - Correct answerNoradrenaline Serotonin Dopamine MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse. How do you test CN XII? - Correct answerStick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? - Correct answerCN V - Trigeminal What are two important things to measure when using Zyprexa? - Correct answerLipid level and abdominal circumference What is included in the mini-cognitive exam? - Correct answerClock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? - Correct answerDepression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? - Correct answerStop and repeat lab. Normal is 1500-8000 mm3 Can you take Buspar during pregnancy? - Correct answerCategory B - ok if really needed. Can you take Klonopin during pregnancy? - Correct answerCategory C - avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms. What is the concern when prescribing Lamictal with Depakote? - Correct answerBoth are CYP450 inducers of the other and therefore together will lower the level of both drugs. Can asthma medications cause depression? - Correct answerYes. DIGFAST for mania - Correct answerDistractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase 5 year old tells u his brother sodomized him - Correct answerTell mom don't leave him alone with patient and call CPS implement crisis Just culture - Correct answer"Just culture" model: proposed to reconcile the twin needs for no-blame and appropriate accountability The focus is on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors while maintaining individual accountability by establishing zero tolerance for reckless behavior. Distinguishes between Human error (e.g. slips), At-risk behavior (e.g. taking shortcuts), Reckless behavior (e.g. ignoring required safety steps). In a just culture, the response to an error or near-miss is predicated on the type of behavior associated with the error, not the severity of the event. Child reports Sexual Abuse - Correct answerInterview the young child and infants child with parent First sign of temprofrontal Dementia - Correct answerBehavior and personalty changes Tow amines related to depression - Correct answerSerotonin and norepinephrine Want to start an consulting firm what tool would be needed to show economic viability - Correct answerRevenue and expenses Patient stopped smoking (Cessation) - Correct answerDecreased Zyprexia Promote resilience in schizophrenia for a patient that lives alone and doing well - Correct answerRefer to peer support Spirit stick - Correct answerTeach staff about culture competence Problems in the parietal lobe can lead - Correct answerSensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) PDSA cycle - Correct answerFor Plan-Do-Study-Act. Describes how to test a change: by trying it, observing the consequences, and then learning from those consequences. Appreciative Inquiry - Correct answeran organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements Appreciative Inquiry - Correct answeran organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work Appreciative Inquiry (AI) - Correct answerIdentify the problem Analyze the problem Generate Solutions Implement Best Solutions Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) Appreciative Inquiry - Correct answerDiscovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) CIWA-Ar - Correct answerClinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do - Correct answerValidate his experience and provide care in a culturally specific way to that patient Native American wants his healer present - Correct answerInvolve mother of the patient and healer, mom was cleared for you to involve her 16 year old shows up with mother for first therapy is - Correct answerconfidential mom sits in lobby Patient acts out due to missing session what do you do - Correct answerYou relate to childhood abandonment and talk about it with the patient How do you assess the competency of a medical procedure - Correct answerIdentify a pen and recall 3 words Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis - Correct answerDelusional disorder Increase ICP (signs and symptoms) - Correct answerBaby Neuro cry Menopausal woman - Correct answerHormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide - Correct answerStop medication immediately You want to decrease seclusion on your unit who considered the primary change agent - Correct answerUnit staff You are a lead NP over other NPs in a rural setting how would you go about the change - Correct answerMake online form and have them vote on it 16 year old refuse treatment - Correct answerSend to psych specialist for acting out kids Positive Trendelenburg Sign - Correct answerRefer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor. Drug affects Flonase - Correct answerZantac (Histamine 2 Blocker) Antagonist Little boy wet his sheets, What kind of therapy would you suggest - Correct answerBehavior therapy DDVAP acts in much the same manner as antidiuretic hormone. - Correct answerMakes less urine Lithium level 1.2u what are you concerned with - Correct answer4+ Ketones What does depakote do to Lamictal - Correct answerIncrease laminate 200% Inducers of Cytochrome P450 (CYP450) - Correct answerBarbiturates, phenytoin, carbamazepine, rifampin, St. John's Wort A substance that speeds up a chemical reaction Inhibitor - Correct answerA substance that slows down or stops a chemical reaction cytochrome p450 inhibitors - Correct answerCRACK AMIGOS Cimetidine Ritonavir Tanner's stages - Correct answer Tanner stages - Correct answer MMSE (Mini Mental State Examination)- - Correct answerStage May be Normal 25-30 Mild/Early 21-24 Moderate 10-21 Severe 0-9 A pt states that she has been raped. What do you do - Correct answerensure safety Hamilton D score of 28 - Correct answerAssess for Suicide Hamilton Depression Rating Scale - Correct answer17-21 questions 0-7 Normal 14-18 Moderate > 20 Severe Depression Beck Depression Inventory (BDI) - Correct answer0-13 Minimal depression 14-19 Mild Depression 20-28 Moderate Depression 29-63 Severe Depression Patient Health Questionnaire (PHQ-9) - Correct answer1-4 minimal 5-9 Mild depression 10-14 Moderate Depression 15-19 Moderate Severe Depression 20-27 Severe Depression A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression. Hamilton Anxiety Rating Scale (HAM-A) - Correct answer14-17 Mild Anxiety 18-24 Moderate Anxiety 25-30 Severe Anxiety Yale-Brown Obsessive Compulsive Scale (Y-BOCS) - Correct answerOCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme PTSD (Post Traumatic Stress Disorder) - Correct answerEMDR EMDR (eye movement desensitization and reprocessing) - Correct answereye movement desensitization and reprocessing Dilated pupils - Correct answerStimulant intoxication constricted (pinpoint) pupils - Correct answerOpiods nystagmus - Correct answerPhencyclidine conjuctival injection, muchies (super hungry), psychomotor slowness? - Correct answerMarijuana Marijuana - Correct answera drug, often smoked, whose effects include euphoria, impairment of judgment and concentration and occasionally hallucinations; rarely reported as addictive Boy states that he wishes to be a girl and tells you not to tell his parent s - Correct answerDon't tell ODD what will you do to prevent it from becoming Conduct disorder - Correct answerTherapy to target mood and aggression Herpes rooster 3 weeks later sleep difficulties and sad mood - Correct answerDepression Schizophrenia in males - Correct answer18-25 years old Schizophrenia in Women - Correct answer25-35 years old signs of amphetamine intoxication - Correct answerTears, Runny nose, restlessness, HTN, Tremors, Insomnia Co-morbidities of bipolar - Correct answerAnxiety, alcohol and substance abuse Big Freaking Problems - Correct answerBupropion Fluoxetine Paxil Medicare - Correct answerA federal program of health insurance for persons 65 years of age and older Medicare Advantage - Correct answera program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrollee Medicare A, B, C, D - Correct answerA: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs WATCHERS for GAD 3 of these *** for 6 months - Correct answerworry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep trouble Transtheoretical Model of Change - Correct answer1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance Man working at the Gym and his urine is Cherry color - Correct answerorder myoglobinuria Latino women wanting prenatal class - Correct answerConsult with cultural group in community Anorexia - Correct answerSet up family therapy quasi-experimental design - Correct answerResearch method similar to an experimental design except that it makes use of naturally occurring groups rather than randomly assigning subjects to groups. The ventricle enlargement observed in clients with - Correct answerschizophrenia is most often accompanied by Encopresis Treatment - Correct answerBehavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation Counseling Medication that contradicts albuterol - Correct answerAdderall (amphetamine / dextroamphetamine) Advair Diskus (fluticasone / salmeterol) amoxicillin (Amoxil, Trimox, Apo-Amoxi, Moxatag, Amoxicot, DisperMox, Biomox, Moxilin, Wymox) Ativan (lorazepam) health literacy - Correct answera person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness health literacy - Correct answerMan taking insulin asking him to read blood glucose level inferential statistics - Correct answernumerical data that allow one to generalize- to infer from sample data the probability of something being true of a population Mood Disorder Questionnaire (MDQ)-SCREENING - Correct answerMood Disorder Questionnaire Patient Name ______________________________________ Date of Visit ________________ Please answer each question to the best of your ability 1. Has there ever been a period of time when you were not your usual self and... ...you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble? ...you were so irritable that you shouted at people or started fights or arguments? ...you felt much more self-confident than usual? ...you got much less sleep than usual and found that you didn't really miss it? ...you were more talkative or spoke much faster than usual? ...thoughts raced through your head or you couldn't slow your mind down? ...you were so easily distracted by things around you that you had trouble concentrating or staying on track? ...you had more energy than usual? ...you were much more active or did many more things than usual? ...you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? ...you were much more interested in sex than usual? ...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky? ...spending money got you or your family in trouble? 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? 3. How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights? No problems Minor problem Moderate problem Serious problem This instrument is designed for screening purposes only and not to be used as a diagnostic tool. Permission for use granted by RMA Hirschfeld, MD YES NO Patient comes with vague symptoms depression irritability - Correct answerBECK Depression scale DISSEMINATED ENCEPHALOMYELITIS - Correct answerAssess for asymmetry of extremities Along with this pattern, the patients usually get neurological symptoms which may include: Confusion, drowsiness, and even coma Unsteadiness and falling Visual blurring or double vision (occasionally) Trouble swallowing Weakness of the arms or legs Fever HA CBT (cognitive behavioral therapy) - Correct answerAnxiety popular integrative therapy that combines cognitive (thinking) and behavior therapy Impulsivity (ADHD) - Correct answerPre-Frontal Cortex Involves hasty actions taken without consideration of possible negative consequences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others. Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis - Correct answerHypogylcemia NSAIDS - Correct answerLithium toxicity Interferon - Correct answerCauses depression Beck Depression Inventory (BDI) - Correct answerIntimate therapy for a child with a score of 10 a questionnaire useful for determining the level of depressive symptoms that a person is reporting Zantac (ranitidine) - Correct answeraffects Flonase Greatest patient at risk for Violence - Correct answerSubstance abuse DBT (dialectical behavior therapy) - Correct answerrelaxation muscle prior to DBT Pt on Lithium - Correct answerPrescribe Synthroid Zantac (ranitidine) - Correct answerH2 antagonist H2 BLOCKER Tegretol (carbamazepine) - Correct answerINDUCES Flonase primary prevention - Correct answerActions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse. Secondary prevention examples - Correct answer- Implement blood pressure and cholesterol screening; give a treadmill stress test. - Health screenings - Skin screenings for cancer - teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets. - mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes - Provide mental health interventions after stressful events. - The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides. - Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center. - Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care. - Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health. - Assess disaster victims and triage for care. - Investigate an outbreak of flulike illness in a local school. - Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems. - Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the fa Collab with OB NP questions - Correct answerwants to establish a relationship so Mental Health can be reached by more people anorexia nervosa - Correct answerBMI less than 18.5 an eating disorder in which an irrational fear of weight gain leads people to starve themselves Anorexia admission Criteria for hospitalization includes: - Correct answerweight loss over 30% over 6 months, severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm Hg, and hypokalemia (less than 3 mEq/L). - care for the person as well as the illness - think exclusively of patients as persons, not as a dx phases: 1. orientation 2. working 3. termination roles of the nurse - stranger - resource person - teacher - leader - surrogate - conselor Paplau's Interpersonal Theory - Correct answerProcess recording Give Ativan - Correct answerFor Alcoholic with Liver problems detailed physical exam - Correct answer Pt states that God did this to me - Correct answerAssess spiritual needs Mini-Cog - Correct answeris another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT) women in military and she saw her friend die - Correct answerPTSD Man had appt, wife came and he didnt - Correct answerTell wife to reschedule appt Tagement (Cimetidine) - Correct answer^ Benzo ^ Coumadin Erythromycin - Correct answer^ Xanax levels Disulfiram - Correct answer^ Coumadin Pt with Eating disorder states getting full - Correct answerBloating delayed Gastric emptying Realiability - Correct answerconsistency Biggest Concern with EHR - Correct answerConfidentiality Qualiatative - Correct answerMeasures in natural setting i.e ?, observation Quantitative - Correct answerData that is in numbers internal validity - Correct answerWas research done right? extent to which we can draw cause-and-effect inferences from a study I don't know answers - Correct answerpseudo dementia interferon - Correct answerdecrease Wellbutrin ^ prolactin - Correct answerstop prolactin EPS - Correct answer^ risk for TD Assess when someone ready to quit drinking - Correct answerSee what stage they in Ask when ready to start tx To check for Dementia - Correct answerHave the patient tell you risk/benefits test capacity dairy log - Correct answerCBT treating a 6 y/o pt WHO HAS dx with Luekemia 1 month ago. What do you expect - Correct answerHe would think he is being punished fro doing something wrong antidepressant takes - Correct answer5 weeks 13 year old want to smoke - Correct answerask him of his plan to stop smoking placement of chronically mental ill - Correct answerACT Assertive Community Treatment Assertive Community Treatment (ACT) - Correct answercommunity-based programs that provide many of the services that are necessary for successful community living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basis BRUISE on the padded part of his arms - Correct answerSay I see you have bruises on your arm Ask what happened medication errors on a new floor when NP starts working. - Correct answereducate the staff on policies on how to handle med errors. ECT THERAPY - Correct answerGET CERTIFIED lesion in frontal cortex - Correct answerImpaired cogitate functions child in foster homer 5 years poor eye contact, isolated self, eat without difficulty - Correct answerautism A man states his wife was so good if he could only be like her. what is this - Correct answerIntellectualization or deflecting rare complication of anorexia nervosa binge/purge subtype that results from gastrointestinal abnormalities, including decreased gastric motility and delayed gastric emptying. Early diagnosis and intervention is critical since delay may result in gastric necrosis, perforation, shock, and death. - Correct answerdecreased gastric motility check measure the stomach Tagement (Cimetidine) - Correct answerPrevents acid from backing up into the esophagus and causing heartburn Pt moving to another state - Correct answerGive enough meds Pt on Zoloft BMI 26 - Correct answerBMI Sildenafil (Viagra) - Correct answer1 hour prior to sex Tadalafil (Cialis) - Correct answer45 minutes prior to sex Vardenafil (Levitra) - Correct answer45 minutes prior to sex Avanafil (Stendra) - Correct answer15 minutes prior to sex Alprostadil (PGE1) - Correct answer• Ductal-dependent Congenital Heart Disease (all forms) • 0.05-0.1 µg/kg/min IV/IO infusion initially, then 0.01-0.05 µg/kg/min IV/IO Females more likely to become an alcoholic than man - Correct answerdue to hormones Apoptosis - Correct answercell death in aging/elderly solution therapy - Correct answerconducted through direct observation of clients' responses to a series of precisely constructed questions. Np wants to implement a certain policy in nursing. - Correct answerstart with nurse manager