Psychiatric NP Exam 94 Questions with Verified Answers,100% CORRECT

Psychiatric NP Exam 94 Questions with Verified Answers Under HIPPA, what is the insurance policy that allows you to hold the company's insurance for 18 months after leaving job? - CORRECT ANSWER COBRA T/F a patient has a right to make changes to their chart as well as see it - CORRECT ANSWER True Summarize general goals for healthy people 2020 - CORRECT ANSWER Increase the quality and years of life while eliminating health disparities What are the 5 conditions NPs are required to report? - CORRECT ANSWER STDs like Gonorhea, Chlamydia, and Syphillis, as well as TB and HIV (as well as animal bites) Nurse practitioners are legally required to report what kind of abuse, and what kind is allowed to be left alone? - CORRECT ANSWER Child and elder abuse, but domestic violence is not required to be legally reported What percentage of mental illnesses appear by the age of 18? - CORRECT ANSWER 75% Genetic inheritance that will be present in more than one generation? - CORRECT ANSWER Autosomal dominant (rare) like huntington's disease What is the difference between a normal grief response and a protracted grief response? - CORRECT ANSWER protractive grief response is a risk for pathology characterized by a loss of self esteem which does not happen with normal grief What is the rate of schizophrenia admissions to the hospital when both parents are infected by the illness? one parent? both bipolar? one bipolar? - CORRECT ANSWER almost 40%, 7%, almost 25% and almost 5% respectively. How would you treat someone who is psychotropic naive? - CORRECT ANSWER use lower doses due to no tolerance and no down regulation. When asking a patient about medical history during a psychiatric interview, what diseases should we pay particular attention to? Why? - CORRECT ANSWER Autoimmune conditions (possible use of steroids), metabolic syndrome like heart disease, hyperlipidemia, and diabetes. These can be made worse in the presence of psychiatric illness or vice versa. Describe normal patterns of sleep - CORRECT ANSWER Begin in Non-Rem (Stage 1), move into deeper non-rem or slow wave sleep (Stages 2-4), 1st stage of Rem sleep 80-100 minutes later and repeats with each REM stage lasting longer. What kind of sleep declines markedly with organic brain dysfunction and is sensitive to temperature extremes? - CORRECT ANSWER REM Describe REM Sleep - CORRECT ANSWER Great EEG activation, muscle atonia, rapid eye movements, muscle twitches, and breathing irregularities. Describe Non Rem Sleep - CORRECT ANSWER minimal mental activity, inactive yet actively regulated brain in a movable body. Describe the pneumonic SLAP for assessing suicide - CORRECT ANSWER Social support, lethality, Access, Plan DSM 5 criteria for Depression requires: - CORRECT ANSWER at least 5 out of 8 symptoms in the last 2 weeks- 1 being diminished interests/depressed mood, Sleep problems, guilt (worthlessness/hopelessness), energy deficit, concentration problems, appetite problems, psychomotor agitation or retardation, suicidality. DIGFAST Pneumonic for assessing Bipolar disorder - CORRECT ANSWER Distractability, Indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness. Pneumonic for OCD- CCR - CORRECT ANSWER continuously, constantly, reptitious Mental Status Exam Pneumonic- All Bad Subjects Are Tough Troubled Characters - CORRECT ANSWER Appearance, behavior, speech, affect, thought content/process, Cognitive exam. Why do we ask people to interpret proverbs in the mini mental status exam? - CORRECT ANSWER to assess abstract versus concrete interpretations What does a score of 30 mean on the MMSE? - CORRECT ANSWER 100% recall MMSE 18-24 - CORRECT ANSWER Moderate impairment MMSE 17 or lower - CORRECT ANSWER severe impairment what is it called when you point to a pen, ask a patient to name it, and they cannot? - CORRECT ANSWER agnosia What are the scores of the SLUMS mental status exam? - CORRECT ANSWER high= 30, 0-20= dementia What is the scoring of the HAM-D - CORRECT ANSWER the higher the score, the ^ in number of depressive symptoms. 23= very severe, 0-7 is no depression (others in between= mild, moderate, severe). What are the standard cut offs for the Beck Depression Inventory scale? - CORRECT ANSWER 0-9= not depressed 10-18= mild to moderate 19-29= moderate to severe 30-63 severe depression phQ9 Depression scores - CORRECT ANSWER 1-4 minimal 5-9 mild 10-14 moderate 15-19 moderate/severe 20-27 severe What is the WHODAS 2.0 and what are its 6 domains - CORRECT ANSWER DSM 5 replacement of the GAF scale: 6 domains= understanding and communicating, getting around, self care, getting along with people, life activities, participation with society. What is a positive AIMS and what areas of the body does it test? - CORRECT ANSWER 2 or more. Tests oral facial movements, extremity movements, trunk movements, judgement r/t symptoms present, and dental and denture status what are basic lab tests to order in psychiatry? - CORRECT ANSWER CBC, Chem panel, Thyroid, Hepatic panel, B12 Folate, Vit D This maps out and localizes mental activity within the brain. If radiographic substance is injected, the metabolic activity, blood flow, neurotransmitter activity can be determined. - CORRECT ANSWER PET Scan This looks at the gross structure of the brain, and can diagnose new onset psychosis or dementia. It can delineate gray matter from white matter. ** cannot be used in patients with metal objects such as a pace maker - CORRECT ANSWER MRI This looks at the electrical activity within the brain and can determine the cause of a seizure or diagnose epilepsy. Can determine subdural hematomas, infarcts, hemmorages. - CORRECT ANSWER EEG This is a map of the brain and spinal cord and is useful for evaluating people with migraines, trauma, or episodes of vertigo or dizziness. This can determine areas that are ischemic, dysfunctional areas as a result of dementia, brain abnormalities with schizophrenia - CORRECT ANSWER CT "slices, slices, slices" When would you order a CT? - CORRECT ANSWER Falls, trauma, migraines, vertigo/dizziness. Oh Oh Oh To Touch And Feel Very Good Velvet AH - CORRECT ANSWER olfactory (smell), optic (visual acuity), oculomotor (eye movement 6 positions), trochlear (superior oblique eyes), trigeminal (mastication/corneal reflex, show teeth), abducens (specific eye movements), facial (taste anterior tongue, sensation on face, tickle in ear canal), vestibulocochlear (whisper test, Rinne test), glossopharyngeal (swallow, taste posterior), vagus (gag reflex), accessory (shoulder shrug, face push), hypoglossal (tongue fasiculations). When would you do a blood test for lead and why? - CORRECT ANSWER 9-12 months, and as needed in high risk areas annually due to increased irritability in children What kind of screening would you do in a child with an increased BMI? - CORRECT ANSWER Cholesterol Who and when should a patient get the pneumococcal vaccine? - CORRECT ANSWER 19-64 if smoker or have asthma This detects true positives, the degree to which those who have the disease screen positive - CORRECT ANSWER Sensitivity This detects true negatives or the degree to which those who do not have a disease screen negative - CORRECT ANSWER Specificity The frequency at which a disease appears in a population - CORRECT ANSWER Incidence The proportion of a population that is affected by a disease or has a condition at a particular time - CORRECT ANSWER Prevalence People in the age group of 12-19 have a high liklihood of dying from which causes? - CORRECT ANSWER MVCs, Suicide, Homicide Young adults 20-39 have a high liklihood of dying from which causes and AAs have the highest killer of? - CORRECT ANSWER MCVs, homicide, suicide; Homicide What do middle aged adults/older adults die from? - CORRECT ANSWER Heart disease, Lund cancer, CVAs, which cancer in men and women leads to the highest mortality - CORRECT ANSWER lung this type of prevention the Tx of early disease so theres no further progression ie. regular exams, screening tests - CORRECT ANSWER Secondary Prevention This type of prevention is to promote health before any diseases occur like exercising, eating a healthy diet, immunizations, wearing a seat belt etc. - CORRECT ANSWER Primary Prevention This includes rehabilitation and restoration of health like physical therapy - CORRECT ANSWER tertiary prevention What is the LDL goal in a patient with diabetes, previous MI, or known CAD? - CORRECT ANSWER 70 mg/dl Recommendations for treating AAs for blood pressure? - CORRECT ANSWER Thiazide diuretics and CCB Which two blood pressure medications should not be used together? - CORRECT ANSWER ACEi and ARBs Which psychiatric medication should not be used concurrently with ACE inhibitors and why? - CORRECT ANSWER Lithium, these levels may be increased in the presence of ACEI This is the ethical principle that relates to the distribution of the limited resources of healthcare benefits to the members of society. - CORRECT ANSWER Justice The ethical principle that involves performing actions that are for the purpose of benefitting another person - CORRECT ANSWER Beneficience Obtain informed consent - CORRECT ANSWER • Subjects must agree to be subjects in the study. - Competence: differentiating between good/bad - Voluntary - Fully informed of risks and benefits - Comprehending and the ability to reason Who has the right to refuse care? - CORRECT ANSWER Anyone as long as they are competent and have decisional capability. Where did the role of the NP begin and in what specialty - CORRECT ANSWER University of colorado for children in ambulatory/Emergency outpatient setting This 3rd party payer sets the standards for reimbursement and cost, and then other insurances follow - CORRECT ANSWER Medicare What does Medicare Part A cover? - CORRECT ANSWER -Hospitalization (partly up to 150 days) -Skilled nursing facility (for first 20 days free) -Home healthcare (up to 100 days) -Hospice care (if physician certified terminal illness) What does medicare part B cover? - CORRECT ANSWER physician services, labs, diagnostic equipment, NP services (85% reimbursement), PT/OT. Must pay an annual deductible as well as monthly payment. Medicare part C? - CORRECT ANSWER If you have A, and pay for B, you now have C which are the two combined. What will medicare NOT reimburse? - CORRECT ANSWER Regular physical exams therefore it needs to be follow up for previous issues. Medicare part D - CORRECT ANSWER limited prescription drug coverage- premium and co payment on EACH prescription APRN Scope of Practice - CORRECT ANSWER is licensed and determined by state boards of nursing. This is called the Nurse Practice Act (differing prescriptive authority per state). Licensure determines... - CORRECT ANSWER meeting minimal standards Nursing certifications determines.... - CORRECT ANSWER mastery standards (has nothing to do with government). Credentialling - CORRECT ANSWER a process whereby a peer group judges an individual's qualifications to perform certain services. (permission to practice with hospital). This group of individuals often believe that once symptoms improve, they can stop taking their medication - CORRECT ANSWER African Americans and Hispanics This group has a minister to make executive health care decisions - CORRECT ANSWER AA Which group of individuals is usually concerned about the addictiveness of medications? - CORRECT ANSWER Hispanics in which ethnicity/culture is the paternal grandmother the primary healthcare decision maker? - CORRECT ANSWER Hispanics This group does not use allopathic medicine NOR is into preventative healthcare. - CORRECT ANSWER AA This cultural group highly favors herbal remedies (which increase drug drug interactions), is the best insured population and has elders as the primary decision makers? - CORRECT ANSWER Asians This culture believes that illnesses are spiritual imbalances in family, healing is considered sacred. - CORRECT ANSWER Native Americans This group heavily relies on alternative medicine like chiropractors, herbals, etc. - CORRECT ANSWER Whites Pain, mental health, and alcoholism can all be treated by which culture - CORRECT ANSWER Indian medicine Who developed the 9 provisions of the Nursing Code of Ethics? - CORRECT ANSWER The American nurses Association What are the specific responsibilities involved in the standards of advanced practice? - CORRECT ANSWER Documentation, patient advocacy, continuous quality improvement, research and education What comes out of statutory law? - CORRECT ANSWER Nurse practice Acts What does the scope of practice per state give? - CORRECT ANSWER guidelines- what is allowed legally both in the state and the nation Who does not have a hand in credentialing? - CORRECT ANSWER The government NPs and CNMs have the ability to write certain prescriptions since what year? - CORRECT ANSWER mid 1970s In what year did every state allow a degree of ability to write prescriptions - CORRECT ANSWER 1988 How many states have NO collaboration requirement? - CORRECT ANSWER 12 APRNs can work in collaboration/agreement with who? - CORRECT ANSWER physician, podiatrist, or chiropractor What is 'incident to'? - CORRECT ANSWER a billing rate of 100% IS allowed with incident to billing IF the physician is in the practice and has access to the patient. How is the NP able to provide and augment primary care to patients/families? - CORRECT ANSWER consultation services like assessing growth, development, risk factors, providing interventions such as diet/exercise, referring patients to specialists or organizations like drug rehab Licensure portability - CORRECT ANSWER better for RNS, but in 2015 the National Council of State Boards of Nursing approved an APRN compact model but it has not yet been widely adopted. Tarasoff v. Regents of the University of California (1976) - CORRECT ANSWER duty to warn- breach confidentiality if the patient is a risk to self or others The Olmstead Decision 1999 - CORRECT ANSWER Court mandated that people with disabilities, and mental health patients, must be moved out of institutions and into less restrictive settings and that the waiting list for services must be reduced. The least restrictive environment should be an integrative environment that allows patients to interact with those who are not disabled.