MH709 Final Study Guide – Complete With Solutions
A patient who has been stable for 2 years on lithium shares with you that she
wants to get pregnant. What are your recommendations? Right Ans - The
options to discuss with the patient include: 1. The possibility of discontinuing
the medication 2. The possibility of continuing to take the medication during
pregnancy. Some providers might consider a medication switch, which could
also be a part of option 1, if a discontinuation of medication wasn't successful,
a new medication could be initiated. A specific anomaly associated with
Lithium is Ebstein's anomaly, which is a defect that causes tricuspid
insufficiency. A pregnant woman taking lithium would need careful
monitoring of lithium levels, symptoms and the overall pregnancy. Lithium
crosses the placenta and the fetus receives 100% of the drug. Dosage changes
are expected in different trimesters.
What is the difference between PMHNPs screening of versus assessment of
suicide? Right Ans - -Screening will identify if there is an issue that needs
further assessment, whereas assessment helps to determine the actual level of
risk.
Which is the MOST important in the PMHNP assessment of suicide risk
factors? Right Ans - -Clinical judgement.
How are chronic suicidal risk factors different than acute suicide risk factors?
Right Ans - -Chronic factors are unchangable and non-modifiable.
Age, sex, ACES
What are five examples of chronic suicide risk factors? Right Ans - History
of psychiatric illness; Substance abuse (etoh=10x greater risk, IV drug
use=14x greater risk); Age; Gender (men =4x greater risk); Chronic medical
condition or pain; Single/unmarried; Family history of suicide; History of
psychiatric hospitalizations; History of child abuse.
Which is the MOST potent chronic risk factor for suicide? Right Ans - -
Previous suicide attempt. The more lethal the past attempt, the greater the
risk.
What are five examples of suicide mitigating factors? Right Ans - No recent
history of suicide attempts; Good social supports/married; No substance
, abuse; No weapons in the home; Willing & motivated to engaged in treatment;
Non-psychotic; Able to state reasons for living; Employment; Faith beliefs
against suicide.
moral beliefs, able to make safety plan
Should the PMHNP quantify risk of suicide through the use of assessment
tools alone? Right Ans - No. Assessment tools can be used as one measure
in addition to clinical judgment. Suicide risk is difficult to quantify and
suicides are difficult to predict with accuracy.
What are the two areas of focus for the PMHNP to determine level of suicide
risk? Right Ans - SDI: Suicidal Desire and Ideation (reasons for living, lack
of deterrents to attempt), and RPP: Resolved Plans and Preparation
(availability of means, specificity of plans).
A patient with a history of multiple suicide attempts would be considered
what level of risk? Right Ans - -Chronic high risk.
What are three factors that create an "acute" risk of suicide? Right Ans - -
Presence of a crisis; Significant life stressors; Increased symptomatology.
What steps would the PMHNP take next if a patient has been determined to
have a severe suicide risk? Right Ans - -Immediate hospitalization, involve
family and possibly law enforcement.
How often should the PMHNP assess suicide risk? Right Ans - Every visit.
What steps could the PMHNP take if a patient has been determined to have a
moderate suicide risk? Right Ans - Increased frequency of visits; Create a
crisis plan; Provide 24 hour crisis service availability.
How effective are "no harm contracts" in reducing suicide? Right Ans - -Not
effective.
What are three facets of a suicide crisis response plan? Right Ans -
Concrete & specific; Collaborative; Documented.
Which factor is important in the assessment of homicide risk? Right Ans - -
Is the patient's judgement impaired by the presence of psychiatric illness
A patient who has been stable for 2 years on lithium shares with you that she
wants to get pregnant. What are your recommendations? Right Ans - The
options to discuss with the patient include: 1. The possibility of discontinuing
the medication 2. The possibility of continuing to take the medication during
pregnancy. Some providers might consider a medication switch, which could
also be a part of option 1, if a discontinuation of medication wasn't successful,
a new medication could be initiated. A specific anomaly associated with
Lithium is Ebstein's anomaly, which is a defect that causes tricuspid
insufficiency. A pregnant woman taking lithium would need careful
monitoring of lithium levels, symptoms and the overall pregnancy. Lithium
crosses the placenta and the fetus receives 100% of the drug. Dosage changes
are expected in different trimesters.
What is the difference between PMHNPs screening of versus assessment of
suicide? Right Ans - -Screening will identify if there is an issue that needs
further assessment, whereas assessment helps to determine the actual level of
risk.
Which is the MOST important in the PMHNP assessment of suicide risk
factors? Right Ans - -Clinical judgement.
How are chronic suicidal risk factors different than acute suicide risk factors?
Right Ans - -Chronic factors are unchangable and non-modifiable.
Age, sex, ACES
What are five examples of chronic suicide risk factors? Right Ans - History
of psychiatric illness; Substance abuse (etoh=10x greater risk, IV drug
use=14x greater risk); Age; Gender (men =4x greater risk); Chronic medical
condition or pain; Single/unmarried; Family history of suicide; History of
psychiatric hospitalizations; History of child abuse.
Which is the MOST potent chronic risk factor for suicide? Right Ans - -
Previous suicide attempt. The more lethal the past attempt, the greater the
risk.
What are five examples of suicide mitigating factors? Right Ans - No recent
history of suicide attempts; Good social supports/married; No substance
, abuse; No weapons in the home; Willing & motivated to engaged in treatment;
Non-psychotic; Able to state reasons for living; Employment; Faith beliefs
against suicide.
moral beliefs, able to make safety plan
Should the PMHNP quantify risk of suicide through the use of assessment
tools alone? Right Ans - No. Assessment tools can be used as one measure
in addition to clinical judgment. Suicide risk is difficult to quantify and
suicides are difficult to predict with accuracy.
What are the two areas of focus for the PMHNP to determine level of suicide
risk? Right Ans - SDI: Suicidal Desire and Ideation (reasons for living, lack
of deterrents to attempt), and RPP: Resolved Plans and Preparation
(availability of means, specificity of plans).
A patient with a history of multiple suicide attempts would be considered
what level of risk? Right Ans - -Chronic high risk.
What are three factors that create an "acute" risk of suicide? Right Ans - -
Presence of a crisis; Significant life stressors; Increased symptomatology.
What steps would the PMHNP take next if a patient has been determined to
have a severe suicide risk? Right Ans - -Immediate hospitalization, involve
family and possibly law enforcement.
How often should the PMHNP assess suicide risk? Right Ans - Every visit.
What steps could the PMHNP take if a patient has been determined to have a
moderate suicide risk? Right Ans - Increased frequency of visits; Create a
crisis plan; Provide 24 hour crisis service availability.
How effective are "no harm contracts" in reducing suicide? Right Ans - -Not
effective.
What are three facets of a suicide crisis response plan? Right Ans -
Concrete & specific; Collaborative; Documented.
Which factor is important in the assessment of homicide risk? Right Ans - -
Is the patient's judgement impaired by the presence of psychiatric illness
