Exam (elaborations) PMHNP Comprehensive

CMN 548|| Introduction Guide to PMHNP Comprehensive |Exam Guide | Questions & Verified Answers | Update | 100% Correct Already graded A+ Recent Version Transgender - ANSWER Individuals whose gender identity does not conform to gender norms associated with the sex they were assigned at birth; does not imply a particular sexual orientation. Transsexual - ANSWER Individuals who identify as the opposite gender from the one they were assigned at birth; some change their bodies hormonally and surgically to conform to their gender identity. Disorganized thinking - ANSWER Problems with information organization and interpretation that is best assessed in the speech patterns of patients Loose association Derailment Tangentially Word salad Distribution - ANSWER Occurs after the drug leaves the systemic circulation and enters the interstitium and cells Thalamus - ANSWER Sensory information (except smell) is relayed from the thalamus and then processed and integrated in the cortex. Modulates flow of sensory information to prevent overwhelming the cortex. Regulates emotions, memory, and related affective behaviors thalamus functions - ANSWER relays & modulates the flow of sensory information (except smell) to the cortex regulation of emotions & memory The corpus striatum is also known as... - ANSWER the basal ganglia Therapeutic communication - ANSWER takes place betweenthe nurse and client and focuses on the client's thoughts, feelings, behavior, and roles with the expectation that the active listening of the nurse will help the client explore, understand, and change. Therapeutic index - ANSWER Relative measure of the toxicity or safety of a drug; ratio of the median toxic dose to the median effective dose THYROID FUNCTION TESTS-thyroid function, etc - ANSWER Thyroid's job is to take iodine from circulation, combine it with tyrosine, then convert it to T3 and T4; stores T3/T4 until pituitary releases TSH and tells it to release the T3/T4 Only a small amount of T3/T4 is bound to protein The free portion is what really determines the thyroid status To test (gross) motor functions, test for...... - ANSWER MUSCLE Muscle mass, tone and strength Mass - atrophy or hypertrophy? Tone - tension present when muscle resting Strength - test against resistance To test senfory functions, test for.... - ANSWER Pain, temperature, superficial touch, 2-point discrimination, stereognosis, graphesthesia If increased temp and on psychotropics, e.g., Tegretol or Clozaril, watch for agranulocytosis visual hallucinations originate in the ____ lobe - ANSWER temporal or occipital What area of the brain is involved in the recognition of the meaning of a stop sign? - ANSWER Parietal lobe (symbolic recognition) What is standard deviation? - ANSWER Inidication of the possible deviations from the mean What is variance? - ANSWER How the values are dispersed around the mean; the larger the variance, the larger the dispersion of the scores X-linked disorders - ANSWER are caused by faulty genes on an X chromosome (fragile X syndrome, color blindness) Culturally bound syndromes - ANSWER Specific behaviors related to a person's culture and not linked to a psychiatric disorder Culture - ANSWER Learned beliefs and behaviors or the socially inherited characteristics common among all member of a group--may be racial, social, ethnic or religious grouping. Culture - ANSWER The pattern of behavior of a group that includes thoughts, customs, beliefs, values, or communication patterns Culture bound syndrome - ANSWER Specific behaviors related to a person-s culture and not linked to a psychiatric disorder. Be cognizant of inaccurately judging a client's behavior as psychopathology when it is really related to his culture. Culture Competence - ANSWER Viewing the patient Viewing the patient has an individual that is unique, and providing care that is sensitive to issues related to culture, race, gender, and sexual orientation CY-BOCS - ANSWER ... CY-BOCS (Obsessive Compulsive) - ANSWER Children Yale Brown Obsessive Compulsive Scale ages 6-14 Daily dosage of lithium (Eskalith, lithobid) during acute treatment - ANSWER mg/day Daily dosage of lithium during maintenance phase of treatment - ANSWER 900-1200 mg/day DECREASED FT4 - ANSWER Hypothalamus failure - tertiary hypothyroidism - hypothalamus not sending TRH hormone to stimulate pituitary to send out TSH Pituitary failure - secondary hypothyroidism - pit not sending out TSH to stimulate thyroid Thyroid itself fails - primary hypothyroidism Thyrotoxicosis d/t T3- Renal failure Cushing's - adrenals makes cortisol; in cushing's adrenals make too much cortiso; maybe pituitary or the adrenals have a tumor Cirrhosis DECREASES LITHIUM LEVELS - ANSWER potassium-sparing diuretics, thiazide diuretics, theophyline decreases lithium DELIRIUM - ANSWER drugs, electrolytes, low 02 sat, infection, reduced sensory input, intracranial, urinary, myocardial Delirium Mnemonic - ANSWER D-Drugs E-electrolyte abnormality L-low oxygen saturation I-infection R-reduced sensory input I-intracranial U-urinary or renal retention M-myocardial Delusions - ANSWER False belief firmly maintained despite evidence to the contrary Persecutory Religious Grandiosity Somatic Referential Jealous Erotomanic Dementia Alzheimer's Type - ANSWER Most common Gradual onset and progressive decline Hallmark amyloid deposits and neurofibrillary tangles Denial - ANSWER Avoidance of unpleasant realities by unconsciously ignoring their existence Dentrites - ANSWER Collect incoming signals from other neurons and send the signal toward the neuron's cell body: deontological theory - ANSWER action is judged based on the act itself Deontological Theory - ANSWER An action is judged as good or bad based on the act itself regardless of the consequences Depakote is the gold standard for... - ANSWER rapid cycling pattern Depakote teratogenic risks - ANSWER Neural tube defects, spina bifida Depolarization - ANSWER Initial phase of the action potential; an excitatory response; influx of sodium and calcium ions into the cell Depolarization - ANSWER Initial phase of the action potential; an excitatory response; influx of sodium and calcium ions into the cell Dermatological lithium side effects - ANSWER Acne Pruritus Maculopapular rash Descriptive statistics - ANSWER Describes the basic features of the data in the study; numerical values that summarize, organize, and describe observations; can be generated by either qualitative or quantitative studies. --Mean: Average of scores --Standard Deviation: Indication of the possible deviations from the mean. --Variance: How the values are dispersed around the mean; the larger the variance, the larger the dispersion of scores. descriptive statistics - ANSWER used to describe the basic features of the data in the study deShazer, O'Hanlon, Berg - ANSWER Solution-focused therapy: miracle questions, exception finding questions, scaling questions Desipramine/Norpramin 100-300 comments - ANSWER used for ADHD Develop clinical question (PICO) - ANSWER P = Patient, population of patients, problem I = Intervention C = Comparison (Another treatment or therapy, placebo) O = Outcome. Search for relevant research evidence Critique the research evidence Make an evidence-based decision regarding implementation. Implement the change, depending on the above decision. Evaluate the change. Dexamethasone suppression test (DST) - ANSWER Not commonly used in clinical practice for screening of depression as it is too non specific. Diabetes insipidus - ANSWER Side effect of lithium Diadochokinesia - ANSWER Can do rapid, alternating movements ( patting knees alternating palms and back of the hands, thumb to finger) Diadochokinesia - ANSWER Rapid alternating movements Thumb to finger or patting knees with palms and backs of hands DIAGNOSTIC & LAB TESTING p. 70 - ANSWER FT4......... 0.8 - 2.8 ng/dl TSH..........2 - 10 mu/L Mg.............1.3 - 2.1 K................3.5 - 5.1 Ca..............8.8 - 10.5 Cl................98 - 106 Na.............. 135 -148 ALT..............5 - 35 AST.............5 - 40 GGT.............10 - 38 Diagnostic criteria for BD includes a period of abnormally or persistently elevated, expansive or irritable mood, lasting - ANSWER For at least one week Diagnostic criteria for BD: mood episode has - ANSWER Rapid development and escalation of symptoms over a few days Diagnostic tool - ANSWER Detection of disease, assessment of disease severity, and assessment of efficacy of treatment (ex AIMS and GAF) Dialectical Behavioral Therapy - Marsha Linehan - ANSWER Used w/Borderline personality disorder Focus is emotional regulation, tolerance for distress, self-mgmt. skills, interpersonal effectiveness, mindfulness with emphasis on treating therapy interfering behaviors. Goals- decrease SI,decrease therapy interfering behaviors decrease emotional reactivity, self-invalidation, crisis-generating behavior, active passivity increase realistic decision making increase accurate communications of emotions Difference between MDD & Dysthymic Disorder - ANSWER Dysthymic DO presents with less acute symptoms; more protracted chronicity; no psychotic symptoms; less discrete episodes of illness; symptoms often undetected, vegetative symptoms are much less common. Dirty side effect profile contributes to - ANSWER Poor patient compliance Dirty side-effect profile and stringent dietary restrictions promote __________________. - ANSWER Poor patient compliance Examples of ARB's - ANSWER ALL INCREASE LITHIUM Valsartan Telmisartan Losartan Irbesartan Irbesartan Azilsartan Olmesartan Olmesartan examples of potassium-sparing diuretics - ANSWER Epithelial sodium channel blockers Amiloride Triamterene Aldosterone antagonists: Spironolactone Eplerenone Exceptions to confidentiality - ANSWER Intent to harm self or others Attorneys involved in litigation When records are released to insurance companies Answering court orders, subpoenas, summons Mandatory reporting of disease and conditions Tarasoff principle: Duty to warn potential victims of imminent danger of homicidal patients Child/elder abuse Excercise - ANSWER demonstrated effects comparable to antidepressant therapy in the treatment of depression Excitatory response - ANSWER Depolarization Involves OPENING of sodium and calcium channels with these ions going INTO the cell Excitatory response - ANSWER Depolarization; involves the opening of sodium and calcium channels with these ions going into the cell Exemptions to guaranteed confidentiality - ANSWER Intent to harm self or others, attorneys involved in litigation, records released to insurance companies, when answering court orders, subponeas, or summons. State mandatory reporting. cases of child or elder abuse. Tarasoff principle. Existential - Viktor Frankl - ANSWER Philosophical approach in which reflection on life and self-confrontation are encouraged. Emphasizes accepting freedom and making responsible choices. States that a basic dimension of humans includes finding meaning and purpose in life, "why am I here" and "what is my purpose" goals are to live authentically and to focus on the present and on personal responsibility. Experiential Therapy Gist & Goals - ANSWER Bx decided by personal experience - NOT by external reality Focus on being authentic, freedom of choice, human validation, experiencing the moment. Goals: to develop authentic, nurturing communication, increased self-worth of each family member Goal is overall growth vs. symptom reduction alone No particular techniques EXPERIENTIAL THERAPY Originator - ANSWER Virginia Satir expressive speech area of brain - ANSWER Broca's Area (inferior frontal cortex) external validity - ANSWER when the sample is representative of the population and the results can be generalized External validity - ANSWER When the sample is representative of the population and the results can be generalized External validity - ANSWER When the sample is representative of the population, and the results can be generalized. Facts regarding homeless population - ANSWER 50% have co-occurring substance use disorders and serious mental illness. Schizophrenia accounts for 15-45% of the US homeless pop. Symptoms are often active and untreated. This results in paranoia, hallucinations, mania, anxiety, and depression, making it difficult to maintain employment, relationships, and other ADL's. These people are at greater risk for violence, medication noncompliance, and treatment resistance. Family - ANSWER Group of adults and children who are usually related and whose adults participate in carrying out the essential functions of providing food, clothing, shelter, safety, and education of children. Initially teaches the belief patterns, religion, culture, and mores of a society. Concept broadened beyond the traditional husband-wife-children pattern. Family Homeostasis - ANSWER Family tendency to resist change to keep a steady state Family Structure - ANSWER invisible set of demands that set up how members react w/ each other Subsystems (marital, parental, siblings) Coalitions (2 members against 3rd) Boundaries FAMILY SYSTEMS Therapy - Originator - ANSWER Murray Bowen Family Systems Therapy concepts - ANSWER Triangles Nuclear family emotional system Multitransmission process Family projection process Emotional cutoffs Sibling position Family Systems Therapy Gist & Goal - ANSWER Pt's problematic behavior serves a purpose for the family or is a symptom of dysfunctional patterns. -Focus on chronic anxiety in family Goal: increase family member's awareness of their function w/in family and to increase self-differentiation. Family systems therapy originated by.. - ANSWER Bowen FDA Pregnancy Ratings for Medications - ANSWER A - Controlled studies show no risk B - No evidence of risk in humans C - Risk cannot be ruled out D - Positive evidence of risk X - Absolutely contraindicated in pregnancy FH, family tree, pedigree, genogram - ANSWER Tools used in determining likelihood of genetic disorder in family, inheritance patterns, and risk of recurrence in family members fidelity - ANSWER being true and loyal Fidelity - ANSWER Being true and loyal Fifteen percent (15%) - ANSWER Of people with MDD will commit suicide First-pass metabolism - ANSWER Process by which the drug is metabolized by P450 enzymes in the intestines and liver before going to the systemic circulation Fish Oil - ANSWER Bipolar, HTN, lower triglycerides, decrease blood clotting Maybe interact w/ Coumadin, ASA, NSAIDS, garlic, ginkgo Maybe change glucose regulation Fissures - ANSWER Deeper grooves extending into the brain Flight of ideas - ANSWER Speech pattern characterized by accelerated speech and rapid shifts in topic Disorganized, difficult to follow, but syntax and vocabulary remain intact Flu-like symptoms, fatigue and lethargy, myalgia, decreased concentration, nausea/vomiting, impaired memory, shock-like sensations; irritability, anxiety, insomnia, crying without provocation, dizziness and vertigo: - ANSWER Symptoms of discontinuation syndrome Foods to avoid with MAOIs - ANSWER Cheeses, meat, fish, beverages like wine/chianti/whiskey, beer Bean curd, soy chocolate, MSG, nuts, bananas forensic nursing - ANSWER based on crime committed and investigational aspects Calcium 8.8-10.5 - ANSWER Needed for hormone secretion, transmission of nerve impulses and the contraction of muscles. hypocalcemia causes confusion, paresthesia, hyperreflexia, seizures, prolonged QT, tetany. hypercalcemia causes fatigue, weakness, behavioral vhanges, shortened QT, heart block Cerebellum (located in the brain stem) - ANSWER Maintains equilibrium and acts as a gross movement center (balance, posture) Problems would cause ataxia. Rhomberg test would be used to test cerebellum function. Each hemisphere is ipsalateral (same side control). Cerebral cortex - ANSWER This area of the brain is responsible for much of the behavior that makes us human: speech, cognition, judgment, perception, and motor function. Cerebrum - ANSWER Largest part of the brain composed of cerebral cortex, limbic system, thalamus, hypothalamus and basal ganglia Chromosomes - ANSWER Structures of DNA