PMHNP Study/practice questions with correct answers

PMHNP Study/practice questions Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiery disorders? A. Increase levels of CRF in amygdala, hippocampus and LC increase symptoms of anxiety. B. Decreaseing GABA in the Mesolimbic cortex diminishes symptoms of anxiery. C. Increasing serotoneric activity in the amygdala diminishes symptoms of anxiety. D. Decreasing NE in the LC diminishes symptoms of anxiety. - correct answersA, C & D are all correct so the answer is B As a PMHNP, you know anti-psychotic meds have side effects. Which side effects of antipsychotic meds has an insidious delayed-onself of 1-2 after starting the medication? - correct answersA. Dry Mouth B. Tardive Dyskinesia C. Wt gain D. Sedation We know that Dry mouth, drowsiness, dizziness, restlessness, wt gain, constipation & N/V are all SE but, Tardive Dyskinesia does not start for 1-2 years. My answer - B. *Tardive Dyskinesia (TD*) ** long standing blockage of DA2 in nigrostriatal pathway leads to TD Which Serotonin receptor antagonism makes an antipsychotic "atypical"? A. 5HT1A B. 5HT3A C. 5HT4A D. 5HT2A - correct answersAtypical antipsychotic drugs such as clozapine, olanzapine, quetiapine, risperidone, sertindole, and ziprasidone are potent 5-HT2a receptor antagonists and relatively weaker dopamine D2 antagonists. Commonly Prescribed Typical and Atypical Antipsychotic Medications Typical antipsychotics include: Haldol (haloperidol); Loxitane (loxapine); Mellaril (thioridazine); Geodon (ziprasidone) Moban (molindone); Seroquel (quetiapine) Navane (thiothixene); Zyprexa (olanzapine) Prolixin (fluphenazine); Serentil (mesoridazine) Stelazine (trifluoperazine); Trilafon (perphenazine) Thorazine (chlorpromazine) Atypical antipsychotics include: Abilify (aripiprazole); Clozaril (clozapine) Geodon (ziprasidone); Seroquel (quetiapine) Zyprexa (olanzapine) Which medication inhibits both dopamine and norepinephrine? A. Venlafaxine (effexor) B. Duloxetine (Cymbalta) C. Buproprion (Wellbutrin) D. Imipramine (Tofranil) - correct answersC. Buproprion (Wellbutrin) Bupropion inhibits the presynaptic reuptake of both dopamine (DA) and noradrenaline (NA), leading to increased levels of both of these neurotransmitters in the synaptic cleft Current understanding of Dopamine (DA) pathways & clinical symptoms in schizophrenia is reflected in which statement? A. Neg symptoms are related to DA deficit in meslimbic system and pos (+) symptoms are related to DA excess in the (SN) substanita nigra & (VTA) ventral tegmental area. B. (-) symptoms are related to DA excess in the CC cerebral cortex; + symptoms are related to DA in the (NA) nucleus accumbens and mesolimbic system C. (-) related to DA in (MS) mesolimbic system; + are related to DA deficit in the SN and VTA D. (-) related to DA deficit in the CC; (+) related to DA excess in the NA & MS - correct answersANS. D? In the case of schizophrenia and other psychological disorders, a positive symptom is one that adds a behavior, thought or feeling, whereas a negative symptom takes away a behavior, thought or feeling. Dopamine pathways Mesolimbic => pathway projections from VTA to the NA (nucleus accumbens in the limbic system; Increased dopamine in the Mesolimbic pathway mediates (+) symptoms. VTA => Mesocortical; Decreased DA in Mesocortical => (-)negative symptoms Nigrostriatal Pathway => (SN) Substantia nigra to the basal ganglia or striatum =>decreased DANigrostriatal (NS) Pathway (mediate motor movement)=> (SN) Substantia nigra to the basal ganglia or striatum =>decreased DA => dystonia, parkinsonian symp and akathsia. Hyperactivity of DA in NS pathway => hyper-movements disorders - tics, chorea (jerky movements) and dyskinesias (involuntary muscle movements). Tuberoinfundibular (TI) Pathway: projects from the hypothalamus to anterior pituitary TI pathway decreases prolactin release, increased DA=> positive symptoms (hyperprolactinemia, amenorrhea, galactorrhea & sexual dysfunction) What medication is recommended to be used in the treatment of NMS? - correct answersDantrolene (Dantrium) NE is a neuro transmitter that is implicated in alertness and Anxiety. What area of the brain has a large majority of NE neurons? A. Amygdala B. Hippocampus C. Nucleus Accumbens D. Locus Coeruleus - correct answersLocus Coeruleus, located in the pons An inverse agonist produces which effect? A. Opposite of agonist, & causes the receptor to close the ion channel. B. Blocks the agonist from opening the channel, but does not activate the biological responw C. Does not fully activate the receptor and causes only limited actions D. Activates a biological response, and opens the ion channel - correct answersA. Opposite of the agonist... An inverse agonist is a compound that binds to a receptor and produces a pharmacological response that is opposite to that of the corresponding agonist. An agonist increases the activity mediated by a receptor, an inverse agonist reduces it. In the presence of the agonist the inverse agonist acts as an antagonist. Adverse reactions from Antabuse (Disulfiram) - correct answersDo not take disulfiram if you have consumed alcohol within the past 12 hours. Do not drink alcohol while taking disulfiram, and for up to 14 days after you stop taking this medicine. Disulfiram should never be given to a person without his or her knowledge of taking the medicine. does adding folic acid 0.8mg to lamictal and seroquel help - correct answersFolic acid interaction Lamotrigine can inhibit folate metabolism, and it had been thought that adding folate would be useful. Until further data are gathered on folate augmentation in patients taking the combination of lamotrigine and quetiapine, Assessing an elderly patient who complains of tinnitus, what findings are associated with acoustic neuroma? A. Suppuration of the labyrinth B. Unilateral ringing in the ear C. Perforation of tympanic membrane D. Inflammation of middle ear - correct answersB. Unilateral ringing in the ear The most common presenting feature of acoustic neuromas, occurring in 90 percent of patients, is unilateral hearing loss. ... Other symptoms of the acoustic neuroma include asymmetric tinnitus (ringing in the ear), dizziness and disequilibrium (difficulty with balance). Which of the following hematologic changes is associated with lithium? A. Anemia B. Agranulocytosis C. Leukocytosis D. Leukopenia - correct answersANS. => C. Leukosytosis Acute exposure to lithium can cause leukocytosis, whereas chronic exposure can produce aplastic anemia. Which mood-stabilizing drug has consistently been shown to decrease the risk of suicide for bipolar patients? - correct answers Which mood-stabilizing drug is most associated with a life-threatening rash? A. Lamotrigine (Lamictal) B. Divalproex (Depakote) C. Carbamazepine (Tegretol) D. Lithium (Eskalith) - correct answersA. Lamictal Which brain structure is activated in patients with extreme frea, panic and anxiety? A. Hippocampus B. Thalamus CCingulate gyrus D.Amygdala - correct answersANS =>amygdala The brain amygdala appears key in modulating fear and anxiety. Patients with anxiety disorders often show heightened amygdala response to anxiety cues. PMHNP would expect to see what when doing a physical exam on a patient with bulimia nervosa? A. Obesity B, Alopecia C Erosion of dental enamel D. Tachycardia17 - correct answersC. Erosion of enamel Tooth Erosion Studies show that between 47 and 93 percent of bulimia nervosa patients who vomit exhibit damage to tooth enamel. ... Over time as the enamel is eroded by repeated exposure to gastric acid, teeth may lose their shine, break, turn yellow, wear down, chip, and look ragged. Which Serotonin receptor antagonism makes an antipsychotic "atypical"? A. 5HT1A B. 5HT3A C. 5HT4A D. 5HT2A - correct answersD. 5HT2a Which antidepressant is associated with dose related adverse effects to cardiovascular system? (ie adhere to max recommended dose) A. Sertraline (Zoloft) B. Venlafaxine (Effexor) C. Mirtazapine (Remoran) D. Citalopram (Celexa) - correct answersAnswer: B. Venlafaxine (Effexor) Elderly patient presents for evaluation and is not able to correctly draw the face of the clock (MMSE), which area of the brain is likely to have compromised functioning? A. Right Hemisphere B. Left Hemisphere C. Wernicke's Area D. Corpus Callosum - correct answers? D. Corpus Callosum Changes in mental status, fever and rigidity are all symptoms of A. Serotonin Syndrom B. NMS C. Anticholinergic withdrawal syndrome D. EPS SE - correct answersNeuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. Pt, 62 yo female, bipolar I disorder is taking valproate & resperidone. Has shingles and is given corticosteroids. Adding corticosteroids may cause: A. Stevens-Johnson Syndrome B. a manic episode C. NMS D. hypertensive crisis - correct answersA. Stevens-Johnson Syndrome PMHNP is evaluating a child. what features might raise concerns for genetic testing for Fragile X Syndrome? - correct answersLong head, big ears, short stature and extension of joints. Which medication has a unique mechanism of action - both being dopamine and norepinephrine reuptake inhibitors? A. Venlafaxine (Effexor) B. Duloxetine (Cymbalta) C. Bupropion (Wellbutrin) D. Imipramine (Toframil) - correct answersC. Bupropion (Wellbutrin) What screening tests has high sensitivity and specificity for identifying cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? A. Global deterioration Scale B. Dementia Rating Scale C. Clock Drawing Scale D. MMSE - correct answersD. MMSE The information of SI, plan, or past attempt would be included in what part of the intake? - correct answersH&P The Five A's for Health Behavior Change include the following: - correct answers5 A's elements (Assess, Advise, Agree, Assist, Arrange). What does the CAGE questionnaire stand for? - correct answersCut down (Ever feel you need to cut down on ___) Annoyed with others' comments about your drinking? Guilty (about your use) Eye opener (need to use in AM to function) When assessing a patient, what is the most important predictor of potential for violence? A. History of abuse B. History of SZ C. History of Head injury D. History of aggressive rage - correct answersD. History of aggressive rage Why is general screening for dementia for the general population not recommended? - correct answersScreening of apparently healthy individuals is only justified if there is an effective treatment for specific conditions identified. Screening of populations or groups before symptoms develop is clearly NOT justified at present as there is no drug that arrests clinically diagnosed dementia of the Alzheimer's type. MMSE is a brief standardized screening tool designed for use on what population? - correct answersThe Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the elderly; it includes tests of orientation, attention, memory, language and visual-spatial skills. 1. Alert Level: In general participant scoring below education-adjusted cut-off scores* on the MMSE may be cognitively impaired. An FNP colleague asks you, the PMHNP what antidepressant to start for a patient who scored a 15 on the PHQ9. - correct answersAnswer=> Score of 15 is moderate severity (MDD) give SSRI and refer to therapy. PHQ-9 Score Provisional Diagnosis Treatment RecommendationPatient Preferences should be considered5-9 Minimal Symptoms* Support, educate to call if worse, return in one month10-14 Minor depression ++ Support, watchful waitingDysthymia* Antidepressant or psychotherapyMajor Depression, mild Antidepressant or psychotherapy15-19 Major depression, moderately severe Antidepressant or psychotherapy>20 Major Depression, severe Antidepressant and psychotherapy(especially if not improved on monotherapy) PMHNP is evaluating the functional status of an elderly patient with depression. The Instrumental ADL scale tests which of the following activities? A. Toileting B. Telephone use C. Filing Taxes D Bathing - correct answersAns => Unsure if A or D => both are listed below Common ADLs include feeding ourselves, bathing, dressing, grooming, work, homemaking, cleaning oneself after defecating and leisure A middle aged male with a HX of schizophrenia is asked about his education level. Pt answers: tells you where he went to HS, his HS friends, activities he was involved in and his HS graduation. He then says, that was the end of my education. This is an example of what... A. Loosening of associations B. Tangentiality C. Perseveration D. Circumstantiality - correct answersAns => D. Circumstantiality Circumstantial speech (also referred to as circumstantiality) is a communication disorder in which the focus of a conversation drifts, but often comes back to the point. In circumstantiality, unnecessary details and irrelevant remarks cause a delay in getting to the point. PMHNP is a member of a crisis intervention team after a tornado destroyed over 100 home is the rural midwest. Which of the following statements is most appropriate at the initial encounter? A. "What is your biggest concern right now? I will help you as much as possible? B. "Tell me everything that happened. We'll sort through the next steps" C. "What medications were you taking? Let me work on that first" D. "You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK" - correct answersA. what's your biggest... During an initial psychiatric eval, the patient reports ETOH and illicit drug use. This information whould be most appropriate in which part of the evaluation? A. Chief Complaint B. Mental Status Exam C. Review of systems D. Personal and social HX - correct answersD. Personal and social history What is Clerambault syndrome - correct answersPopularly called erotomania, the syndrome is characterized by the delusional idea, usually in a young woman, that a man whom she considers to be of higher social and/or professional standing is in love with her. What is Capgras syndrome? - correct answersdelusional belief that one or more individuals in the environement are imposters or doubles imitating someone else What is Fregoli phenomenon? - correct answersThe Fregoli delusion is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. ... This means that for any face that is similar to a recognizable face to the patient, the patient will recall that face as the person they know. What is displacement? - correct answerstransfer of feelings to a less threatening person What is rationalization? - correct answersMaking excuses for behaviors that are considered unacceptable Dissociation - correct answersa split in consciousness, which allows some thoughts and behaviors to occur simultaneously with others Which medication for ADHD is FDA approved for a 3 yo? A. Fluoxetine B. Amphetamines C. Methylphenidate D. Bupropion - correct answers