PMHNP certification Exam 2025(Actual test verified A+)

Comprehensive PMHNP Certification Exam 2025 Study Guide with verified actual test questions and answers (A+ rated). Includes detailed explanations covering psychiatric nursing, suicide risk assessment, psychopharmacology, antipsychotics, mood stabilizers, thyroid disorders, lithium toxicity, Depakote monitoring, Stevens-Johnson syndrome, and neuroanatomy. Updated for the latest ANCC PMHNP exam, this resource highlights key clinical reasoning, lab interpretation, side effects, and treatment guidelines essential for passing the Psychiatric Mental Health Nurse Practitioner board exam in 2025. Perfect for PMHNP students, nurses, and NP exam prep. 1 / 38 1 PMHNP certification Exam 2025(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?: Lamictal2 / 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: atypical3 / 38 2 8. A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus: Hypothalamus A, B, & D are all part of the limbic system so you can rule that out4 / 38 3 9. When a patient is hesitant to participate in treatment you should encour- ag 10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L 11. When T4 and T3 are high and TSH is low what is the diagnosis: HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE 12. Key symptoms of Heat Intolerance: Hyperthyroidism 13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE 14. Key symptoms of Cold Intolerance: Hypothyroidism 15. Hyperthyroid can mimic: Mania 16. Hypothyroid can mimic: Depression 17. A patient on depakote complains of RUQ pain and has reddish/brown urine: Hepatoxicity -Check LFTs 18. Signs of Depakote toxicity: Disorientation, confusion, lethargy 19. You suspect depakote toxicity what do you do?: Check -LFT -Ammonia -Depakote Level 20. What herbal supplement can cause hepatoxicity?: Kava Kava 21. When taking Kava Kava in combinations with other medications you should caution about: Risk of Hepatoxicity and Sedation 22. TCAs carry a risk of: Hepatotoxicity 23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin pain 24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol 25. What nationality is most suseptible of getting steven johnson?: Asians 26. When treating asians with tegretal screen for?: HLAB-1502 Allele5 / 38 27. What two medications cause agranulocytosis?: Clozaril & Tegretal 28. Agranulocytosis when to discontinue medication: Less than 10006 / 38 4 29. When monitoring for agranulocytosis in patients look for 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 INHIBITORSlisinopril 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), s/s of what?: -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 rhabdo8 / 38 5 45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta- bility, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). 46. Treatment for NMS: Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer 47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine 48. Triptans: Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN 49. patient taking Prozac and started on sumatriptan: -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP 50. How long do you wait when switching between an SSRI to an MAOI?: 2 weeks 51. How long do you wait when switching between Prozac and MAOI?: 5-6 weeks wash out period 52. What is the first line treatment for depression and why?: SSRIFirst line treatment for depression due to less risk of injury from OVERDOSE 53. If a cancer patient has depression what should you consider?: Treating with a medication with minimal drug/drug side effects like Lexapro 54. Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin 55. Primary symptoms of depression include fatigue and low energy what med would you chose?: Wellbutrin 56. Wellbutrin is contraindicated in patients with: Seizures and anorexia9 / 38 57. Which medications are best for neuropathic pain?: SNRI Gabapentin TCA10 / 6 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: -11 / social skills training -Exercise12 / 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 noncompliance -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 be13 / responsible for negative and depressive symptoms of schizophrenia 85. Nigrostriatal Pathway: -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels14 / 8 -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dysto- nia, parkin 86. Low Dopamine in the nigrostriatal pathway increases which neurotrans- mitter: -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) 87. Long-standing D2 blockade in the nigrostriatal pathway can lead to: - tardrive dyskinesia 88. Tuberoinfundibular pathway: -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN 89. Long-term hyperprolactinemia can be associated with what condition: - osteoporosis 90. Normal Prolactin Level in Men: level less than 20ng/ml 91. Normal Prolactin Level in Women: less than 25ng/ml 92. Which medication is the highest offender for increasing prolactin: - Risperdal 93. Acute Dystonia + Treatment: neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days 94. Akathisia + Treatment: may mimic anxiety, restlessness, can't sit still, rocking, pacing -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos 95. Beta-Blockers such as Inderal are contraindicated with what type of asthma medication: -DO NOT GIVE WITH BROCHODIALATOR such as AL- BUTERAL this combination can cause bronchospasm 96. akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness of movement -Treatment Cogentin15 / 9 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 e16 / Cimetidine Ketoconazol e Acute Etoh17 / Macrolide s INH Grapefruit Juice Omeprazole Crack Amigos 104. Erythromycin and Clarithromycin can cause: Increased tegretol levels 105. Patient started on Clozaril or Zyprexa and two months later starts smoking: as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose 106. Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey: as a provider you know that you must now decrease the dose of the antipyshcotic 107. Medications that cause mania: Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer 108. Medications that cause depression: steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodi- azepines, progesterone -may need to increase antidepressant 109. Accutane (isotretinoin): Can cause depression and birth defects 110. Flonase: As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression 111. Flonase can trigger mood instability but it can also cause an increase in: Psychosis patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis18 / -increase the dose of antipsychotic 112. Neurotransmitters involved in Addiction: Dopamine and GABA 113. Symptoms of Stimulant Abuse: 1. agitation/aggression 2. impaired judgment19 / 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, peer20 / conflict, verbal altercations, truancy, crying)21 / -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 1222 / Feels like impending doom23 / 136. Tourette's Syndrome: Criteria for diagnosis -TWO moto tics and ONE vocal tics -LASTS more than ONE YEAR -By age 18 **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** 137. Child presents with one tic and the parent is worried: **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** 138. Neurotransmitters involved in Tourettes: DNS: Dopamine, Norepineph- rine, Serotonin 139. Treatment for tourettes: Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine 140. What type of medication can cause tics or exacerbate them: Stimulants 141. Neurotransmitters involved in mood disorders: DNS: Dopamine, Norepi- nephrine, Serotonin + GABA 142. Neurotransmitters involved in ADHD: DNS: Dopamine, Norepinephrine, Serotonin 143. part of brain implicated in ADHD: prefrontal cortex basal ganglia reticular activating system 144. ADHD inattentive type is caused in what part of the brain: Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION 145. dorsolateral prefrontal cortex: Attention Executive Function Cognition Processing Working Memory Problem Solving 146. Deficit in the can lead to ADHD inattentive type: Prefrontal Cortex24 / 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 discharge25 / 14 -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 -When asked questions they may try to answer or MAKE UP ANSWERS26 / (confab- ulate)27 / Low levels of what labs may mimic dementia: Vit B12 and Folic Cortical Dementia: Language and memory (aphasia and amnesia) 162. Subcortical Dementia: Motor abnormalities/Mood issues like apathy, de- pression, irritability HIV Dementia is a type of subcortical dementia 163. Early signs of HIV dementia: subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordina- tion, unsteady gait 164. Treatment for HIV dementia: Antivirals 165. Pseudo Dementia: Depression causes the memory issues, common in older adults -Also assess onset of symptoms, pseudo dementia is more acute onset -When asked questions they often say "I DON'T KNOW" 166. Instruments to use to differentiate between dementia and pseudo de- mentia: -Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE 167. -Older individuals with depression may present with irritability and agitation If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present: 168. hallmark of lewy body dementia: visual hallucinations 169. Frontotemporal lobe Dementia: PICKs Disease -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes -May see slurred speech or difficulty getting words out 170. What lobe is associated with ability to understand what others are saying (comprehending speech): Temporal Lobe 171. Neurotransmitters involved in Autism: GABA, Glutamate, Serotonin 172. Autism: a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement 15 Acid28 / When play they often like to line up their toys, stack them in tidy rows29 / 16 173. 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 coordination30 / 17 187. 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 life31 / 18 195. 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 their32 / feelings which were previously suppressed 205. Group Therapy: Existential Factors: Groups enable participants to deal with the mean of their own existance33 / 19 206. Group Therapy: Corrective Refocusing: Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic 207. Group Phases: forming, storming, norming, performing, adjourning 208. Family Systems Therapy: Murray Bowen -a person's problematic bx may serve a function for the family or be a symptoms of dysfunctional patterns KEY WORDS* Self-Differentiation, Triangulation, Triangles 209. Structural Family Therapy: Salvador Minuchin -How, when, and who whom family members relate KEY WORDS* Mapping Hierarchi es Boundarie s 210. Strategic Therapy: Jay Haley -Symptoms are a way to communicate metaphorically in a family -Symptom focused KEY WORDS* Straightforward directive Paradoxical directive (reverse psychology) Reframing (you are not jealous of your sister you just care for her so much) 211. Solution Focused Therapy: -MIRACLE QUESTIONS -EXCEPTION-BASED FINDING -SCALING QUESTIONS 212. Meditation: if teaching about meditation must tell them about MUSCLE RE- LAXATION 213. If patient tells you something BEFORE you ASSESS- EXPRESS EMPA- THY "I'm sorry this happened to you.": 214. USE OPEN ENDED QUESTIONS unless talking to a child or someone that is unable to construct a narrative then use CLOSED ENDED or YES/NO:34 / 215. PICOT: P: Population I: Intervention C: Comparison O: Outcome T: Time35 / 20 If a patient has rheumatoid arthritis check: ESR Therapy session with husband and wife & only one shows up: Reschedule 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 to36 / develop LIVER DISEASE 227. When OB wants to hire psych providers: they want to increase mental health access to those that need it the most37 / 21 228. Normalizing grief and loss in children: Don't tell them what to do because grief responses vary -i.e Don't tell them to stop working that is prescriptive advise -With children the most important thing is to reinforce FAMILY support an support- ive therapy such as group therapy so they can learn from other children who have experienced similar events 229. palmar grasp reflex: normal up to 5-6 months If older baby still has this reflex- >refer to specialist 230. Moro (startle) reflex: Normal till 5-6 months If present past normal range- >refer to specialist If not present within the normal age->Xray may be a sign of a broken bone, nerve injury, or spinal injury 231. Babinski reflex: Normal up to 2 years If present past normal range->refer to specialist 232. PDE-5 inhibitors: Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) RAPIDLY ABSORBED Used for erectile disfunction 233. Difference between BMI in anorexia vs Bulemia: AnorexiaLow BMI Bulemia-Normal BMI 234. Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and you determine the patient needs to be sent for medical evaluation but the parents refuse: Contact CPS 235. You read and article that says that most children with ADHD abuse substances... -To translate this information into practice what should you do?: -Screen ALL children for ADHD for SUBSTANCE USE -OR Screen ALL children with SUBSTANCE USE for ADHD 236. accupuncture: used for pain and depression 237. Habeas Corpus: legal concept that protects patients from unlawful hospital- ization -May be a reason to leave AMA38 / 22 238. Disseminated Encephalomyelitis: inflammation of nervous system -MUST DO NEURO EXAM -EXAM: May present with ASSYMETRICAL BODY MOVEMENTS 239. Assume you are interviewing a patient and you want them to provide information in a specific timeline, but they are unable: TO help ask them specific questions which helps to ANCHOR their memory 240. Before you administer a medication, you must educate them about the medication but first you should assess: BUT FIRST ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION 241. Patient presents with iatrogenic effect: assess ALL the medications that the patient is taking -Don't assume that it is from the medication you prescribed 242. When trying to pass a policy and your co-workers are against it what should you do: educate them on how the policy will benefit patient care 243. To promote a policy how do you get the word out there: Think most FEASIBLE option with WIDE net or audiance 244. Working in outpatient setting and you want to ensure continuous im- provement in quality of care.: -Create an instrument to monitor clinical outcomes (this helps to identify what you are doing right or wrong) 245. Autoimmune disease can lead to increased: Cytokine level 246. If a child is urinating the bed: -Teach parents to use alarm clock to wake up to urinate (NON PHARM FIRST) -If that doesn't work try DESMOSPRESSIN (decreased enuresis) 247. Are you allowed to look up a patient on social media?: No it violates their trust 248. Assume you started a patient on a medication and they go home and find out that there is a black box warning on the medication that you were un- aware of. They call with concerns...: -First, go online and do your own research -Research the RISK vs BENEFIT before you tell the patient to stop the medication 249. Risk factors for sleep apnea: excessive weight, obesity, diabetes, smoking39 / 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 severe40 / >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 or inpatient is needed* especially if pregnant. REMEMBER SAFETY41 / FIRST:42 / 24 260. Idealization: Seeing someone else as perfect, ideal, or more worthy than everyone else This is often seen in grieving before acceptance of the loss 261. Appreciative Inquiry: is an approach to organizational change which focus- es on strengths rather than on weakness Example do not focus on what the employee does wrong focus on what they do well 262. Reflective Practice: Links theory to practice with a goal of correcting prac- tices that are incorrect. Example Debriefing after a restraint to find out what went wrong or what went right DEBFRIEFING MAY BE A KEY WORD -After an incident--> Debrief 263. Assume you started the patient on an antidepressant and now they complain of insomnia: 1. Before changing medication, CHANGE THE TIME OF DAY THEY ARE TAKING THE MED 264. Conflict of interest between pharmaceutical companies and Nurse Practitioners i.e promises to sponsor NP loan forgiveness. You want to create a policy to address this. First you must examine...: study the relationship between the industry provided samples and industry sponsored education 265. If a patient is involuntarily admitted can they still refuse medications?- : they can still refuse medications, UNLESS it is an emergency or if the court determines they must take medications 266. Scope of practice is determined by: State board of Nursing 267. Scope of practice defines: NP roles and actions -Varies broadly state to state 268. If you would like to perform ECT as an NP what should you review: The state scope of practice standards to see if it is allowed and what certification is needed 269. Standard of practice is determined by: ANA -Provides a way to judge nature of the care provided The PMHNP is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high-quality care consistent with established standards is critical43 / 270. Exceptions to Confidentiality: -Answering court orders, subpoenas, or summonses *high yield (if you don't release or lie about knowing this is PERJURY) -Insurance companies44 / 25 -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 high45 / abuse potential and imminent danger if he were to overdose on Xanax*46 / 26 If no history of substance use, then beneficence would be appropriate because the Xanax 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 diagnosis47 / of mental health disorders because of shame what could be done to address48 / this barrier? A. Educate the family B. Political advocacy C. Public Health Concern D. Community education programs: D. Community education programs *Narrow down to education A/D...then think WIDE NET =Community EDUCATION 289. A client with Biolar I disorder presents to your PMHNP office for a follow-up visit. During the visit the client informs you he no longer wants to be treated with medication. , and he does not have bipolar disorder, that was a misdiagnosis, He further informs you he stopped all his medications 2 months ago and is here to thank you for your care and tell you he no longer needs appointments. Understanding ethical conflict, you use which of the following ethical principles? A. Autonomy B. Nonmaleficence C. Justice D. Beneficence: A. Autonomy *Patient's have the right to self-determination* 290. Recovery Model * RELAPSE IS A LEARNING OPPORTUNITY: - Treatment approach that does not focus on full symptom resolution but emphasizes on resilience and control over problems in life -Self-Direction (do not tell them what to do) -Individualized and Person-Centered -Non-Linear, Recovery is not a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience 291. In counseling a 23 y/o married Hispanic mother who brought her 4 year old son to the clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting, and fever the PMHNO; A. Identifies what steps the mother has already tried in caring for the child B. Explain that the symptoms are viral infection C. Educates about importance of fluid electrolyte imbalance D. Respects the mother's understanding of the child's illness: A. Respects49 / the mother's understanding of the child's illness50 / 28 *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 language 300. formal operational stage: 12+ y/o during which people begin to51 / think logi- cally about abstract concepts52 / 29 KEY WORD is LOGIC think like a scientist or do a science project you must be able to use logic ABSTRACT THINKING such as doing algebra 301. sensorimotor stage: in Piaget's theory, the stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities Object permanance 302. concrete operational stage: in Piaget's theory, the stage of cognitive devel- opment (from about 6 or 7 to 11 years of age) during which children gain the mental operations that enable them to think logically about concrete events i.e finding similarities in objects, grouping things 303. Risk factors for suicide: Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (med- ical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking. WHITE Women try more often. Men succeed more often. 304. A 72 year old female brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of HTN and is being treated with Lisinopril. The exam is normal and the MMSE provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the likely diagnosis? A. Alzheimer B. Vascular Dementia C. Depression D. Medication Toxicity: C. Depression *2 months=too soon for Alzheimer's, 24 is mild MMSE, HTN is not enough info to diagnose vascular dementia HALLMARKS FOR VASCULAR DEMENTIA are carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, remem- ber PSEUDO dementia is DEPRESSION53 / 30 R DEMENTIA: carotid bruits fundoscopic ab- normalities and enlarged cardiac chambers, 306. Patient comes to the office, and you score them on HAM-D a 23 and you start an antidepressant on dose Xmg, 2 weeks later they score a 16 on the HAM-D. What would you do?: Leave the dose where it is 307. Patient is taking Zoloft 200mg and on the GAD 7 they score a 2, what do you do: Leave the dose where it is 308. Zung Depression Scale Scoring: >50 Mild >60 Moderate >70 Severe 25-49 is NORMAL RANGE 100 is max score 309. MMSE scoring: 0-10 severe >10 moderate >20 mild >25 Normal Kids under 10 years old are severely challenging to teach HIGHER THE BETTER! 310. Teratogenic Effects 1. Lithium 2. Carbamazepine 3. Depakote 4. Benzo: 1. Epstein Anomaly 2. Neural Tube 3. Neural Tube (specifically spina bifida, atrial septal defect, cleft palate) 4. Floppy Baby 311. Primary prevention: Efforts to prevent an injury or illness from ever occur- ring. -Education -Safety Initiatives -Modifying environment 312. Secondary Prevention: Efforts to limit the effects of an injury or illness that you cannot completely prevent.54 / -Early findings55 / -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 3156 / 326. Inverse agonist effect: Drug causes the opposite effect of agonist 327. partial agonist effect: Drug does not fully activate the receptors57 / 32 Antagonist effect: Drug binds to the receptor but does not activate a biolog- ical response 329. Herbals that interact with warfarin: Vitamin E Omega-3 330. Black Cohosh: herbal used for menopause 331. Bellandonna: herbal used for anxiety 332. chamomile: herbal used for sedation and anxiety 333. Ginko: Herbal used to treat memory, dementia, & sexual dysfunction from SSRIs 334. Ginseng: Herbal product used for stress reduction, fatigue, and depression 335. Valerian: herbal used for sedation 336. Hypertensive crisis can occur when MAOI are taken with: Meperidine Decongestants TCAs Atypical Antipsychotics St.Johns wart LTryptophan Stimulants Asthma meds 337. Microcytic anemia: iron deficiency 338. macrocytic anemia: due to folate or vitamin B12 deficiency Labs: Folic Acid, B12, ESR/CRP, HGB, MCV 339. 14 y/o with no axillary hair and no period: Normal tanner stage, start by 16 340. Two classes of cardiac meds that should not be used together: ACES and ARBS (angiotensin receptor blocker) Together can cause renal dysfunction 341. Abnormal Trendelenburg Test: Hip disease, refer child out, assessed during head to toe58 / 342. too little acetylcholine too much acetylcholine: Alzheimer's Parkinson's and EPS 343. 4 D's Discover, Dream, Design, Destiny: Appreciative Inquiry59 / 344. Cranial Nerve V: Trigeminal Clenched Teeth 345. WBC : 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 head growth, and disinterest in play activities 358. Signs of fetal alcohol syndrome: small head, smooth60 / palpebral fissure, inner epicanthal folds, thin upper lip 359. Tegretol side effects: Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro61 / 34 360. 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 change62 / 372. Maintanence stage: The person is engaging in behaviors to prevent relapse 373. These 3 meds cause BIG FREAKING PROBLEMS: Strong inhibitors of 2D6 Bupropion, Fluoxetine, Paxil63 / 35 374. Boy tells you he wishes to be a girl and asks you not to tell the parents- : Don't tell 375. BRUISE on the padded part of his arms: Say I see you have bruises on your arm may I Ask what happened 376. Can an advanced directive be revoked? How?: Yes at any time 377. Can you take Buspar during pregnancy?: Category B - ok if really needed. 378. Carb and barb + Coumadin: Strong Inducers of 3A4 can decrease INR 379. Who is in charge of the DEA?: State and Federal 380. Common comorbidities of bipolar: anxiety, alcohol, substance use 381. Conjunctival injection, munchies, psychomotor slowness?: Marijuana intoxication 382. Diary Log: CBT 383. Depakote and Disulfiram: increases INR 384. What 3 atypicals can be used with teens?: Zyprexa, Abilify, Seroquel - low doses *also Risperdal 385. Np wants to implement a certain policy in nursing.: start with nurse manager 386. Phenycyclidine (PCP) can cause?: Nystagmus 387. Hildegard Peplau: Theory of Interpersonal Relations Nurse as therapeutic tool -Care for the person as well as the illness -Patients are PEOPLE not DIAGNOSES 388. Patient acting out due to missing session what do you do?: You relate to childhood abandonment and talk about it with the patient 389. Patient on antidepressants for 3 weeks and attempted Suicide: stop the medication immediately 390. Patient shows symptoms of dizziness, tremors, sweating, What64 / Medical Diagnosis: hypoglycemia65 / 36 391. 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 puberty66 / -Amenorrhea67 / -Web neck, osteoporosis, lymphedema -poor social skills 404. To start your own firm as an NP and need to examine economic viability: Show Revenue and expenses 405. 3 CK muscle enzyme tests?: CKMM, CKBB, CKMB (normal 0.3 mmcg/L) 406. What are the legal ramifications of treating someone without informed consent?: The same as they are with informed consent -Respect -Beneficence -Justice 407. Two important things to measure when prescribing Zyprexa: Waist cir- cumference Lipids 408. What schedule of controlled substances are NPs allowed to prescribe?- : II-V 409. What crania nerve is affected when you ask the patient to shrug their shoulders?: XI (11) Spinal Accessory 410. These medications are renally metabolized: Gabapentin Campral Lithium 411. grapefruit juice: inhibitor that can reduce the absorption of the drug by 47% therefore the drug blood levels will be increased -Decrease dose of drug 412. How do Asians see HC providers?: As in a position of authority. Expect to give instructions and help make decisions 413. How do you protect from the evil eye?: Red ribbon on an infant Amulet for adults 414. T-test: assesses whether the means of two groups are statistically different from each other 415. Treatment for children with panic disorder: clonidine guanfacine 3768 / 416. What do BCP's do to Lamictal?: Inducer - will lower dose of Lamictal69 / 38 417. 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 Severe70 / 32-40 Extreme71 / 39 e 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.