Psychiatric Nurse Practitioner Certification Exam Review, Exams of Nursing

Download Psychiatric Nurse Practitioner Certification Exam Review and more Exams Nursing in PDF only on Docsity! 1 / 38 38 PMHNP certification Exam (Actual test verified A+) 1. Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank *2 risk factors D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors 2. When interview teenagers (16 y/o) that arrive with their parents what should you do?: interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confiden- tial. Parents may be upset but remember you are advocating for the child. 3. Which Ethnic group has the highest rate of suicide?: Native Americans 4. Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an- tagonism C. Increased Lipids D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER) 5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY 6. Which mood stabilizer have the least weight gain?: Lamictal 2 / 38 38 -But remember all mood stabilizers cause some weight gain 7. When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a: atypical 38 5 / 38 28.Agranulocytosis when to discontinue medication: Less than 1000 38 6 / 38 29. When monitoring for agranulocytosis in patients look for s/s of what?: - Infection -Fever, sore throat, fatigue, chills 30.Before starting any mood stabilizer in a female of childbearing age be sure to check?: HCG 31.Which two medications may decrease the risk of suicide?: clozaril and lithium 32.Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS- lisinopril 33.Ace inhibitors are treatment of choice for?: Heart Failure 34.Certain medications are known to increase lithium level, but HOW?: by reducing renal clearance 35.When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise 36.Normal Lithium Level: 0.6-1.2 37.Lithium Toxicity: 1.5 or above Discontinue and re-order lithium level 38.Lithium level of 1.4: Monitor for toxicity 39.Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY 40. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY 41.Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity 42.Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation, tremor 43.NMS: muscle rigidity, mutism (because of muscle rigidity), 38 7 / 38 increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) 44.Cherry colored urine in a patient that exercises a lot: test for myoglobinuria may be a sign of rhabdo 38 10 / 58.Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERY appointment 59.Which meds have the worse serotonin discontinuation syndrome: Those with short half lives such as zoloft 60.Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers 61.Ages of onset for schizophrenia in males vs females: -MALES 18-25 years -FEMALE 25-35 years 62.Schizophrenia increases the risk for: SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) 63.What increases the causes or increases the risk or schizophrenia: exces- sive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) 64.MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREAS- ES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT 65. Stimulants can potentiate the release of what neurotransmitter?: - Dopamine which can worsen symptoms of schizophrenia 66.Assertive Community Treatment (ACT): a form of rehabilitation post hospi- talization, in home treatment 67.What level of prevention is ACT?: Tertiary 68.What adjunctive treatment is important in schizophrenia: -social 38 11 / skills training -Exercise 38 12 / 69.Exercise for mental health patients can promote: Cognition Quality of Life Long-term health 70.ACT is ideal for patients with a history of: Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home 71.What diagnosis has the highest risk of Homicidality: Antisocial 72. In the MMSE how do you test for abstraction?: proverb interpretation (every- one that lives in glass houses shouldn't throw stones) Are they able to think abstractly 73.Thought Process-Tangential: means that their response has nothing to do with the question 74.Circumstantial: means that their response goes in circles instead of getting to the point of the question 75.Mental Status-Thought Content includes: SI/HI/AH/VH 76.Another name for MMSE: Folstein Scale 77.How to assess concentration on MMSE: Serial 7s or perform an activity backwards i.e list the days of the week backwards 78.Assess ability to learn new material: repeat 3 words after me 79.Assess ability to recall: repeat 3 words after 5 minutes 80.Assess fund of knowledge: Who is the president 81.What is a quick and easy way to assess for neurological issues: Clock drawing test 82. If patient is unable to draw a clock this indicates: Problem with the right hemisphere, cerebrum, or parietal lobe 83.mesolimbic pathway: Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms 84.mesocortical pathway: -Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia 38 15 / -Treatment Cogentin 38 16 / 97.PSEUDOPARKINSON or PARKINSONIAN + Treatment: caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN 98. tardive dyskinesia + Treatment: abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT 99.Does Cogentin Treat TD: COGENTIN MAKES TD WORSE 100. Typical onset of TD: OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO 101. What non-psych med can cause TD?: REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discon- tinue reglan if TD develops 102. InDucers CYP450: DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylure as Crap GPS Induces me to Madness! 103. InhIbitors of CYP450: INCREASE Ciprofloxaci n Ritonavir Amiodaron e 38 17 / Cimetidine Ketoconazol e Acute Etoh 38 20 / 3.euphoria 4.elevated BP 5.tachycardia 6.dilated pupils 7.hallucinations 8.TREMORS 9.IMSOMNIA 114. If an anorexic patient complains of pain or bloating after eating this may indicate: delayed gastric emptying 115. Medications that delay gastric emptying: Omeprazole, ranitidine, famoti- dine 116. Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI 117. When initiating an SSRI on an elderly patient you should advise about- : increased anxiety 118. Paradoxical effect: when meds cause the opposite effect than expected 119. Apoptosis: programmed cell death/neuronal loss 120. At age 45 and above the patient displays mania for first time what should be ruled out: MEDICAL CONDITION 121. Patient with bipolar disorder presents with depressed mood & emotion- al lability: Give Depakote 122. Hallmark sx of Borderline Personality: Recurrent self harm 123. Treatment for Borderline Personality: DBT 124. Creator of DBT: Marsha Linehan 125. What activity is helpful in making a diagnosis of borderline personality- : Journaling or diary keeping 126. Conversion Disorder: STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism 127. Adjustment Disorder: adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer 38 21 / conflict, verbal altercations, truancy, crying) 38 22 / -Symptoms occur within 3 months of the stressor If question states recently moved, recent death....THINK ADJUSTMENT 128. factitious disorder: when patients introduce foreign substances into their body or contaminate their food -Faking illness but NO MOTIVE BEHIND IT 129. Malingering: Faking illness for financial gain 130. Reactive Attachment: common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver 131. ODD: They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting 132. Conduct Disorder: violence, criminal, fire setting, killing animals, gang activ- ity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsy- chotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine 133. Acute Stress Disorder: similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH 134. PTSD: -OVER ONE MONTH -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoid- ance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT 135. Panic attack vs Panic disorder (treatment): Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC 38 25 / 147. Teacher reports that the stimulant only works for first few hours of class: medication has worn off too fast. Order multiple dosing throughout the day 148. When does the aftercare plan start: on admission 149. If parents become anxious while you are educating about a new diag- nosis what should you do: -Provide patient and parents information immediately don't wait till discharge 38 26 / -Parents may become anxious after a diagnosis of mental illness such as ADHD, stop teaching offer support because they will not absorb the education. Provide supportive therapy 150. Neurotransmitters involved in OCD: serotonin, dopamine, glutamate & GABA 151. A tic may also be a: Compulsion 152. Facts about OCD: Obsession/Compulsion -A tic may be a compulsion -If first order relative has OCD the child's risk of developing OCD is increased -Streptococcal infections increase risk of OCD -Treatment SSRI-prozac, Zoloft, if adult you may also use TCA such as clomipramine 153. If question asks if the patient has Tourette's vs OCD listen for mention of streptococcal treatment this will trigger you to think OCD: 154. DMDD: 6-17 years ONLY -Irritability for no reason, sad, depressed mood, tantrums, crying, moody, always mad 155. If patient presents with irritability or labile mood and you need help further delineating symptoms: Administer MOOD QUESTIONAIRE 7/13 Bipolar Diagnosis Likely 156. Sleep Disorders are often So what should you assess if a parent reports that a child is having night- mares: GENETIC ask if someone in the family has a similar issue with sleep...look for family patterns of sleep problems 157. GAD: Worry, apprehension, fear must LAST ATLEAST 6 MONTHS 158. Delirium: -ACUTE (within hours to days) onset of disturbance of LOC, COG- NITION, inattention -Urinary Tract Infections are common cause for DELIRIUM always check UA -Treatment is antipsychotics like HALDOL 159. Dementia: -Chronic and slow onset (months to years to develop) -Mental decline in cognition, irritability, personality changes 38 27 / -When asked questions they may try to answer or MAKE UP ANSWERS (confab- ulate) 38 30 / 173. Broken Mirror Theory of Autism: Explains that the child's presentation is caused by the mirror neuron i.e dysfunction in the mirror neuron 174. Risk Factors for Autism: Male gender, genetic loading, intellectual disability, parents ages, preterm 175. Screening tools for Autism: ADOS-G (autism diagnostic observation schedule-genetic) ASQ (ages and stages questionnaire) M-CHAT (modified-checklist for autism-toddler) 176. Where is Norepinephrine produced?: locus coeruleus and medullary retic- ular formation 177. Where is serotonin produced?: raphe nuclei 178. Where is dopamine produced?: substantia nigra, ventral tegmental area, nucleaus accumbens 179. Where is acetylcholine synthesized?: Basal nucleus of Meynert 180. Hippocampus: a neural center located in the limbic system; helps process memory and manage stress 181. Limbic System: The limbic system is the part of the brain involved in our behavioral and emotional responses, especially when it comes to behaviors we need for survival: feeding, reproduction and caring for our young, and fight or flight responses. -Hippocampus -Amygdala -Hypothalamus -Thalamus 182. Amygdala function: Responsible for the response and memory of emotions, especially fear 183. Thalamus function: relay station for sensory impulses, pain 184. hypothalamus function: homeostasis, temperature, thirst, appetite, sex dri- ve, sleep cycle, emotions * believed to serve a regulatory role in aggression 185. anterior cingulate cortex: brain region that regulates cognitive function, decision making, empathy, impulse control, and emotions 186. Cerebellum: Balance and coordination 38 31 / 187. signs of lead toxicity: developmental delay, learning diff., irritability, loss of appetite, weight loss, sluggishness, fatigue, abdominal pain, vomiting, constipa- tion, hearing loss, seizures, eating non-food items PICA Hint home built before 1970's TEST FOR LEAD 188. When caring for an infant that is about to die?: GIVE THE BABY TO THE PARENTS and allow them to grieve 189. Risk factors for osteoporosis: Age smoking caffeine lack of exercise diet lacking calcium and vit D *Provide Education* 190. If discharging a patient that is not following up with outpatient care, organize ways to help the patient get to the appointment REMEMBER STAY INVOLVED IN THE CARE: 191. Assume you are doing group therapy and there is a patient that is not comfortable sharing but you are trying to promote interpersonal learning. What should you do?: Provide adjunctive individual session that will help facilitate group participation 192. Cognitive Therapy: -Aaron Beck Replacing irrational or distortive thoughts with positive thoughts 193. Behavioral Therapy: -Arnold Lazarus focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors -Exposure -Relaxation -Skills training -Role Playing 194. Humanistic Therapy: -Carl Rogers person-centered therapy -Self-actualization -Self-Directive Growth -Everyone has the potential to actualize and find meaning in life 38 32 / 195. Existential Therapy: Victor Frankl -an insight therapy that focuses on the ele- mental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices. -Emphasizes accepting freedom and making responsible choices -Focus on the present Why am I here, What is my purpose 196. Interpersonal Therapy: Gerald Kierman & Myrna Weissman --Used for people who have trouble interacting with others, relationship distress -Marital conflict -12-16 weeks (3-4 months) 197. EMDR Phases: Desensitization Phase: visualize the trauma, verbalize neg- ative thoughts but remain attentive to physical sensations Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within 198. Group therapy: Installation of hope: participants develop hope for creating a different life; they gain hope from others 199. Group therapy: Universality: people have similar problems, thoughts, and feelings and they are NOT ALONE 200. Group Therapy: Altruism: sharing of oneself with another and helping an- other 201. Group Therapy: Imitative Behavior: Patients can increase their skills by imitating the bx of others 202. Group Therapy: Interpersonal learning: interacting with others increases adaptive interpersonal relationships 203. Group Therapy: Group Cohesiveness: Patients develop an attraction to the group and other members as well as a sense of belonging 204. Group Therapy: Catharsis: Patients openly express their 38 35 / 215. PICOT: P: Population I: Intervention C: Comparison O: Outcome T: Time 38 36 / 216. If a patient has rheumatoid arthritis check: ESR 217. Therapy session with husband and wife & only one shows up: Resched- ule 218. A patient's mother calls and tells you that her son has been sodomized by their 15 year old brother: tell mother DO NOT LEAVE THE CHILD ALONE WITH THE BROTHER -Provider calls CPS -Arrange crisis therapy for family 219. Patient is moving out of state: if there is no imminent danger then provide enough medication for them to establish a new provider 220. Level 1 evidence: systematic reviews of random control trials (RCTs) or Meta-analysis or RCT-highest internal validity due to randomizations At least (2) 221. Level 2 Evidence: systematic reviews of cohort studies -little bias because the subjects are identified prior to outcome - randomization is lost 222. Shrill Cry: Intracranial pressure 223. Child between the ages of 3-6 masterbating: Normal to play with genitals (PHALLIC STAGE) NORMAL do not assume they have been abused* 224. Mom is concerned that her son age 10 has swelling in his chest and she is concerned he is developing breasts: Young boys ages 9-16 years old often have NORMAL BREAST ENLARGEMENT which disappears within 6 months *reassure them that this is normal 225. Elderly female presents with decreased sex drive: Check Testosterone level Sex Hormone-Testosterone is involved in sex drive -MUST KNOW THAT WOMAN have TESTOSTERONE TOO 226. alcohol dehydrogenase: an enzyme active in the stomach and the liver that metabolizes alcohol -WOMAN HAVE LOWER ALCOHOL DEHYDROGENASE (metabolizes alcohol) -This is why woman get drunk faster -Lower levels of this enzyme may also cause a higher propensity to 38 37 / develop LIVER DISEASE 227. When OB wants to hire psych providers: they want to increase mental health access to those that need it the most 38 40 / diabetes, smoking 250. Tolerance: you need higher doses of the medication in order for the medica- tion to be effective 251. PHQ-9: > 5 mild depression >10 moderate >15 moderately severe 38 41 / >20 severe Max score 27 252. HAM-D: >10 Mild >14 Moderate >17 Severe 253. HAM-A: >8 Mild >15 Moderate >24 Severe 254. Beck Depression Inventory (BDI): 0-13 Subclinical >14 Mild >20 Moderate >29 Severe >40 EXTREME Max score 63 255. GAD-7 Scoring: 0-4: Minimal Anxiety >5 Mild Anxiety >10 Moderate Anxiety >15 Severe Anxiety Max score 21 256. COWS: Medicate with PRNS at score of 7 or above Consider Subutex or Suboxone at 13 or above Remember Methadone is the LEAST safe option due to cardiac issues 257. CIWA: Begin PRN medication at 8 or above Scores of 15 or above consider scheduled medications 258. Patient in alcohol withdrawal and you are choosing medication for CIWA, check what?: LFT if liver disease use ATIVAN because of short half life over VALIUM 259. *REMEMBER DETOX SHOULD NOT OCCUR OUTPATIENT-->residential 38 42 / or inpatient is needed* especially if pregnant. REMEMBER SAFETY FIRST: 38 45 / -Giving information to attorneys involved in litigation -Intent to harm self or others -Meeting state of federal requirements for reporting disease states -When the need for information outweighs the principle of confidentiality i.e uncon- scious patient and their life is at stake 271. Tarasoff principle: 1976 - duty to warn victims of potential harm from client may vary by state so you must check with your state board of nursing first...it may not be your responsibility to notify 272. If you are taking care of a patient and during the process of interview she tells you that her husband just texted her that her husband is going to kill self: -Call the police, provide the address 273. informed consent: -Communication process between the provider and client that results in client's acceptance or rejection of proposed treatment -Ensure they understand the risks vs benefits 274. If patient is able to reiterate the risks vs benefits of procedure or treat- ment, they are able to give consent* Example patient comes to the hospital, and they are unable to give consent i.e to sick to agree to treatment you must: assess need for involuntary treatment 275. Justice: doing what is fair, fairness in all aspects of care 276. Nonmaleficence: do no harm 277. Beneficence: doing good/promoting well-being 278. Fidelity: being true and loyal 279. Veracity: telling the truth, patients have the right to know the truth about their treatment 280. Autonomy: doing for self (right to self-determination) 281. New male patient has a 10 year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward? A. Beneficence B. Fidelity C. Non-Maleficence D.Veracity: C. Non-Maleficence *Do no harm, giving Xanax would endanger him secondary to the 38 46 / high abuse potential and imminent danger if he were to overdose on Xanax* 38 47 / If no history of substance use, then beneficence would be appropriate because the Xanax would help the anxiety 282. Acute agitation and anxiety vs acute agitation and psychosis IM ordered: IM ativan for agit/anx IM antipsychotic for agit/psychosis 283. Patients have the right to be treated in the Least: Restrictive Setting 284. The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP's next step is to: A. Create interdisciplinary teaching team B. Develop Outcome measures C. Market the educational plan D. Utilize a survey to assess the educational needs of the staff: D. Utilize a survey to assess the educational needs of the staff *3 Interventions vs 1 Assessment* FIRST YOU NEED TO ASSESS FIRST 285. What is the best way to reduce stigma: THROUGH EDUCATION *THINK WIDEST AUDIENCE 286. Just Culture: individuals are continually learning, designing safety systems, and managing behavioral choices 287. The PMHNP is concerned about access-to-care issues in the local com- munity and wants to help develop health care policy to help patients access care more effectively. A. Asking the clinical manager to explore options for access B. Organizing a political protest C. Working with the local chapter of the nurses professional association D.Writing letters to the editor of the local newspaper: C. Working with the local chapter of the nurses professional association *Remember strength in numbers but STAY INVOLVED i.e asking the manager just passes off* 288. If a patient from a specific culture is refusing to accept any diagnosis 38 50 / the mother's understanding of the child's illness 38 51 / *In cultural questions remember RESPECT FIRST! Even before assessment 292. Quality Improvement: Projects designed to improve systems, decrease cost, and improve productivity 293. What is an example of a quality improvement process?: Plan, Do, Study, Act 294. Retrospective Chart Review is an example of a Quality Improvement Process If they ask HOW the NP would do a quality Improvement Process the answer may be Plan, Do, Study, Act: 295. The NP is responsible for initiating quality improvement at a community clinic. The effective strategy for evaluating the clients services is to A. Chart review analysis B. A root cause analysis C. Plan DO Study Act D. Failure effect mode analysis: C. Plan Do Study Act 296. SBIRT: Screening, Brief Intervention, and Referral to Treatment * Use to screen substance use disorders 297. Erikson's stages of psychosocial development: 1. trust vs. mistrust 2.autonomy vs. shame and doubt 3.initiative vs. guilt 4.industry vs. inferiority 5.identity vs. role confusion 6.intimacy vs. isolation 7.generativity vs. stagnation 8.integrity vs. despair 298. Piaget's stages of cognitive development: 1. sensorimotor 2.preoperational 3.concrete operational 4.formal operational 299. Preoperational Stage includes: 2-7 y.o- MAGICAL THINKING IS NORMAL, if they believe that monsters can fly this is NORMAL Egocentric Understand 38 52 / language 300. formal operational stage: 12+ y/o during which people begin to think logi- cally about abstract concepts 38 55 / -Early findings 38 56 / -Screening -Prompt and effective treatment Example: Crisis hotline, disaster response 313. Tertiary Prevention: -aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -Rehab Services -Day treatment -Case management -Social Skills training 314. Pharmacokinetics: what the body does to the drug 315. Pharmacodynamics: what the drug does to the body 316. messenger RNA codes for: amino acids 317. Poor relationships, lack of future hope, suspicious of others indicates developmental failure of what stage: infancy, trust vs mistrust 318. Poor self-esteem, low self control, self-doubt, lack of independence indicates failure of what stage: early childhood 1-3, autonomy vs shame and doubt 319. Lack of self-initiative, lack of goal orientation indicates failure of what stage: Late childhood 3-6 y/o initiative vs guilt 320. sense of inferiority, difficulty with working/learning indicates a failure of what stage: school age 6-12 y/o industry vs inferiority 321. identity confusion, poor self-identification in groups indicates failure of what stage: adolescence 12-20 y/o identity vs inferiority 322. emotional isolation, egocentrism indicates a failure of what stage: early adulthood 20-35 y/o intimacy vs isolation 323. self-absorption, inability to grow and change as a person, inability to care for others indicates a failure at what stage: middle adulthood 35-65 y/o generativity vs stagnation 324. bitterness, sense of dissatisfaction with life, despair over impending death indicates failure of what stage: >65 y/o integrity vs despair 325. agonist effect: Drug binds to receptors and activates a biological response 38 57 / 326. Inverse agonist effect: Drug causes the opposite effect of agonist 327. partial agonist effect: Drug does not fully activate the receptors 38 60 / 344. Cranial Nerve V: Trigeminal Clenched Teeth 345. WBC 1500-2000: Biweekly labs Less than 1000 Stop 346. How can you assess cranial nerve XII?: Ask patient to stick out their tongue 347. First sign of metabolic syndrome: large waist circumference 348. Grade 2/5 hoarse systolic heart murmur: aortic stenosis 349. Ibuprofen + lithium: increases the serum level of lithium up to double 350. Kleinfelter's Syndrome: male with more than one X chromosome (XXY) -Decreased sperm, fertility issues 351. Mental Health Parity Act: forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits 352. what does nuchal rigidity indicate?: meningitis 353. Patient is on interferon and lexapro, as a provider you understand that: interferon can increase depression therefore you may have to increase the lexapro 354. Patient complains of neuropathic pain and neurontin is not working: Try Lyrica (pregabalin) its absorbed quickly and the maximum rate of absorption is 3x of Neurontin 355. Patient is in hospital with no family and is failing cognitive test what should you do?: MRI Tox Screen 356. Phases of policy making: formulation, implementation, evaluation 357. Rhett Syndrome: a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally until about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated 38 61 / head growth, and disinterest in play activities 358. Signs of fetal alcohol syndrome: small head, smooth palpebral fissure, inner epicanthal folds, thin upper lip 359. Tegretol side effects: Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro 38 62 / 360. Telemedicine legal question?: Licensing Jurisdiction for the NP must be considered 361. A person is seen wandering the streets for 2 days: Delirium 362. Medication used for serotonin syndrome: Cyproheptadine Why? it is an H1 blocker but is also has serotonin receptor blocking activity. Specifically, it acts to block 5-HT1A and 5-HT2A receptors which are the ones responsible for serotonin syndrome 363. When to assess a patient in restraints?: initially within 1 hour; then 8 hours 364. Why would you be concerned with immature reticulocytes?: Reticulo- cytes are involved in conditions affecting RBCs such as anemia. -Low reticulocytes may be seen is iron def. anemia, pernicious anemia, folic acid deficiency, and aplastic anemia 365. pharm treatment for agoraphobia: short term benzo, SSRI, SNRI, TCA, or beta-blocker off label 366. Anorexia admission Criteria for hospitalization includes:: weight loss over 30% over 6 months severe hypothermia temp less than 96.8 HR less than 40 BP less than 70 Hypokalemia less than 3mEq/L BMI<16 367. ANOVA: ANalysis Of VAriance - btwn means of 3 or more groups An inferential statistical test for comparing the means of three or more groups 368. precontemplation stage: stage of change in which people are unwilling to change their behavior 369. Contemplation stage: person is considering making a change, aware that there is a problem but is not quite committed to changing 370. Preparation Stage: Person has made the decision to change, is ready for action 371. Action Stage: Person is engaging in specific, overt actions to change 38 65 / 390. Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis: hypoglycemia 38 66 / 391. Pearson's r: a statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scale 392. pincer grasp: 9 months 393. Problems in the parietal lobe can lead: Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) 394. To promote resilience in a patient with schizophrenia that lives alone consider referral to: -ACT -Peer support 395. Patient on Lithium and Depakote and has temp, right flank pain, brown urine. What do you do FIRST?: Check LFT If fine then check creatinine 396. Pt states "god did this to me.": Assess spiritual needs first 397. Patient taking breathing treatment Albuterol/Proventil: Do not take MAOI or TCA 398. p-value: The probability of results of the experiment being attributed to chance. 399. Reliability: consistency of measurement 400. Stereogenesis: identify an object without sight i.e dice in hand 401. Tagamet (cimetidine): H2 receptor antagonist (antacid) Increases benzo Increases coumadin 402. Trazadone concerns: EKG-QT prolongation Priapism Glaucoma 403. Turner Syndrome: A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. -Delayed puberty 38 67 / -Amenorrhea 38 70 / 417. What does an increased retic count indicate: Bone marrow disorder or Vitamin Deficiency Normal Range 0.5-1.5 418. What do you see in Labs with HIV dementia: CD4 <200 Viral Load is high <20% get it with antiretroviral treatment 419. What is occuring in the adolescent brain?: Dendritic pruning Emotions are controlled by amygdala Prefrontal Cortex is still not fully developed (may be why young boys are risk takers) 420. Indomethacin is a: NSAID- WATCH WITH LITHIUM 421. Tramadol: Highly serotonergic 422. Dissemination: the act of spreading widely -publication-highest level -Presenting at national conference -Journal club 423. Sensitivity vs. Specificity: sensitivity - how well a test identifies truly ill people (True positive) specificity - how well a test identifies truly well people (True negative) *In medical diagnosis, testing sensitivity is the ability of a test to correctly identify those with the disease (true positive) whereas test specificity is the ability of the test to correctly identify those without the disease (true negative) 424. What is the purpose of HIPAA?: National standards for electronic HC trans- actions -National ID for providers, health plans and employers. -Not SIMPLY Confidentiality. 425. DETROL interactions: Topamax KCL Zonegran 426. Yale-Brown Obsessive Compulsive Scale (Y-BOCS): OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 38 71 / 32-40 Extreme 38 72 / 427. If you want to decrease the use of seclusion who would be considered the primary change agent: Unit staff 428. Rennie vs Klein: • right to refuse any treatment Until court orders it "due process" 429. Roger vs. Oken: determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment. ROGERS GUARDIAN 430. Donalson vs O'Connor: Confinement -It is unconstitutional to commit a person involuntarily who is not imminently dangerous to self or others Donalson was a patient hospitalized for 15 years 431. Dusty vs United States: incompetent to stand trial 432. Durham vs King: Insanity defense 433. Riese vs St. Mary's Hospital: 7/8 8B ruling says that there should be court determination of incompetence for involuntary committed mental persons to re- ceive antipsychotic medications 434. Stark Law: Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment.