Exam (elaborations) PMHNP ANCC

Who is covered by Medicare? Adults >65 who have worked at least 4 quarters and paid Medicare taxes End stage renal disease those who need a kidney transplant those with ALS Some younger people with disabilities Those receiving SSDI Who is covered by Medicaid? Low-income children Low-income pregnant women Elderly & disable individuals who qualify for the supplemental security income program HAM-D (Hamilton Depression Scale) 17-21 questions. Each question with 3-5 possible responses that increase in severity. 0-7 normal > or = 20 moderately severe depression 7/13/25, 9:35 PM PMHNP ANCC Exam / 2/21 Descriptive Vividness The researcher describes the data gathering process in sufficient detail that the reader can personally experience it. The data collected, often in the form of personal statements, should be quoted directly and extensively, because this is the raw data from the study. Methodological Congruence The researcher presents the philosophical and methodological approach used and cites references to support their approach. The subjects, sampling method, data- gathering and data-analysis strategies, and processes for informed consent are clearly and concisely described. Theoretical Conectedness Any theory developed from the study is clearly stated, logically consistent, reflective of the data, and in accord with other available knowledge. Analytical Precision Is not concerned with statistics and instruments. If refers to the decision-making process by which the researchers synthesize concrete data (words of the subjects) into an abstract that clarifies the meaning and the importance of the study. The last of the 5 criteria is Heuristic Relevance - The researcher clarifies the significance of the study, its applicability to public health or community nursing, and its likely influence o the future research. Phenelzine An MAOI that patients with atypical depression respond particularly well to. Atomoxetine A norepinephrine reuptake inhibitor approved for the treatment of ADHD. Loxapine A typical, tetracyclic antipsychotic with antidepressant properties. Its active metabolite is amoxapine, which is a secondary amine tricyclic antidepressant. HITECH Implementation of EHR for information exchanges and improving population health. This was done by Obama and the ARRA. 7/13/25, 9:35 PM PMHNP ANCC Exam / 3/21 Suppression The intentional or conscious exclusion of painful or disturbing thoughts or emotions from awareness. A healthy defense mechanism because the client channels conflicting energies into growth-promoting activities. Medications that can induce depression beta blockers, steroids, interferon, Accutane, benzodiazepines, progesterone, some antivirals, and antineoplasmics. Medications that can induce mania Steroids, Isoniazid, antidepressants (in people who already have bipolar disorder), and Antabuse. Medigap Insurance Policies Private insurance policies purchased by elderly individuals to cover some or all of their medical expenses not paid for by Medicare. Medicare Advantage Plan Formerly Medicare + Choice, this created regional Preferred Provider Organizations (PPOs) and gave Medicare enrollees the option of enrolling in private insurance plans. Medicare + Choice Was a part of the Balanced Budget Act of 1997 that significantly increase the number of managed care insurance plans available to recipients. This was replaced with the Medicare Advantage Plan in 200. List of the Second Generation (atypical) Antipsychotics (9) Clozaril (clozapine), Zyprexa (olanzapine), Latuda (lurasidone), ziprasidone, Risperdal (risperidone), Invega Sustenna (palperidone), Fanapt (iloperidone), Seroquel (quetiapine), Saphris (asenapine), List of First Generation (typical) Antipsychotics (10) Haldol (haloperidol), Prolixin (fluphenazine), Navane (thiothixene), Thorazine (chlorpromazine), Loxitane (loxapine), Mellaril (thioridazine), Trilafon (perphenazine), Orap (pimozide), Solian amisulpride), Stellazine (trifluoperazine) 7/13/25, 9:35 PM PMHNP ANCC Exam / 4/21 List the 6 common benzodiazepines in order from shortest to longest half-life Xanax (alprazolam): 6-10 hrs Serax (oxazepam): 8 hrs Ativan (lorazepam): 12-18 hrs Klonopin (clonazepam): 30-40 hrs Valium (diazepam): 100 hrs Librium (chlordiazepoxide): 36-200 hrs List of SNRIs (6) Cymbalta (duloxetine), Pristiq (desvenlafaxine), Effexor (venlafaxine), Fetzima (levomilnacipran), Savella (milnacipran), Strattera (atomoxetine) Action of Tricyclic Antidepressants (TCAs) They target serotonin, norepinephrine, and histamine-1 receptors List the Tricyclic Antidepressants (9) Pamelor (nortriptyline), Elavil (amitriptyline), amoxapine (no branded), Anafranil (clomipramine), Norpramin (desipramine), Tofranil (imipramine), Vivactil (protriptyline), Sinequan/Silenor (doxepin), Surmontil (trimipramine) FINISH acronym for SSRI withdrawal Flu-like symptoms Irritability Nausea Imbalance/instability/incoordinati on/dizzy (motor) Sensory disturbances Headache, hyperarousal (anxiety/agitation) Signs of NMS (Neuroleptic Malignant Syndrome) Initial Symptoms: altered sensorium, hyperreflexia, fever Then signs of autonomic instability: extreme muscle rigidity, hypotension, tachycardia, diaphoresis, tachypnea, hyperthermia, coma, death. Check for increased WBCs (leukocytosis)/LFTs/CPK Signs of Lithium toxicity Confusion, diplopia, nausea/diarrhea, ataxia, lethargy, fatigue, clumsiness, weakness, muscle cramping, severe tremor, blurred vision, nystagmus, increased DTRs, altered mental status, cardiac dysrhythmias 7/13/25, 9:35 PM PMHNP ANCC Exam / 5/21 Signs of Serotonin Snydrome agitation, restlessness, rapid heart rate, blood pressure elevation, headache, sweating, shivering, goose bumps, myoclonic jerking and loss of coordination, confusion, fevers, unconsciousness, seizures Medications that can increase lithium level NSAIDs, ACE Inhibitors (-prils), ARBs (-sartans), tetracyclines, metronidazole Medications that can decrease lithium level potassium-sparing diuretics, thiazide diuretics, theophylline Clozaril - monitoring considerations Monitor ANC (absolute neutrophil count); pt needs an ANC of at least 1500 to start clozaril therapy; watch for Benign Ethnic Neutropenia (BED); Monitor ANC weekly x6 months, every 2 weeks x6 months, then monthly if ANC is at least 1500. Substances that can cause a false + drug test for PCP & methadone Niquil, OTC cough meds Substances that can cause a false + drug test for heroin & morphine rifampin, fluoroquniolones Substances that can cause a false + drug test for cocaine NSAIDs, amoxicillin, most antibiotics Substances that can cause a false + drug test for amphetamines Prozac, Wellbutrin, Trazodone, Nefazodone, Sudafed, OTC decongestants. Schizophrenia Prevalence: Non-twin siblings of a schizophrenic parent Dizygotic twins of a schizophrenic parent Monozygotic twins of a schizophrenic parent 8% 12% 47% Birth defects caused by benzodiazepines Cleft palate, floppy baby syndrome Birth defects caused by carbamazepine Neural tube defects 7/13/25, 9:35 PM PMHNP ANCC Exam / 6/21 Birth defects caused by depakote Neural tube defects (spina bifida), cleft palate, atrial septal defects, long-term developmental deficits CYP450 Inhibitors bupropion, clomipramine, cimetidine, clarithromycin, fluoroquinolone, grapefruit, ketoconazole, nefazodone, SSRIs CYP450 Inducers carbamazepine, nicotine, hypericum (St. John's wort), phenytoin, phenobarbital Normals lab value for AST (aspartate aminotransferase) 5-40 Normal lab value for ALT (alanine aminotransferase) 5-35 Normal lab value for Alkaline Phosphastase 44-147; male be increased in gallbladder disease & with bone injury /rapid bone growth Creatine Kinase (normal range) <240. Measures muscle injury (heart, brain, and skeletal). Increased in MI (CK-MO), myositis, NMS BUN (normal range) 10-20. Creatinine 0.4-0.8 or less than 1.5 Normal GFR >90 mL/min. If a patient is on psychotropics, as long as their GRF is >60, no dose adjustments need to be made. What is the best measure of kidney function? GFR (glomerular filtration rate) Normal Plate Count 140,000-340,000 Normal hemoglobin value for males and females Males: 13.5-18 Females: 12.5-14 Normal MCV (mean corpuscular volume) value 78-100 Normal TSH Range 0.4-4 Normal Free T4 range 10-27 Substances that can cause a false + drug test for codeine poppy seeds Substances that can cause a false + drug test for benzodiazepines Zoloft 7/13/25, 9:35 PM PMHNP ANCC Exam / 7/21 Gamma glutamyl transpeptidase (GGT) normal range 10-38 Drug Category A and examples Controlled studies show no risk Vitamins within RDA, insulin, thyroxine Drug Category B and examples No evidence of risk in humans Buspirone, zolpidem, clozapine, lurasidone Beta-lactam antimicrobials (PCNs, cephalosporins, select macrocodes,azithromycin, erythromycin), acetaminophen, ibuprofen (1st & 2nd trimesters) Drug Category C and examples Risk cannot be ruled out bupropion, lamotrigine, SSRIs (except paroxetine), TCAs, duloxetine, mirtazapine, trazodone, venlafaxine, aripiprazole, Haldol, ziprasidone, risperidone