Georgette's LMR | Georgette's PMHNP Certification Exam Questions With Answers | Latest (GRADED)

What should you not do when advocating for a patient? {{Ans- Judge or confront What class of medication is contraindicated with tics? {{Ans- Stimulants What should you provide for prior to assessing abuse victims? {{Ans- A safe environment What are your actions if a child reports abuse? {{Ans- First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? {{Ans- Report to CPS In what setting as an inpatient provider should you interview a patient? {{Ans- Use a private room with the door partially open How should you begin your interview with adolescents? {{Ans- By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? {{Ans- Without What if an adolescent tells you they are homosexual and they don't want their parents to know? {{Ans- This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? {{Ans- Get informed consent/ROI What do you do if a medical evaluation is needed? {{Ans- Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/unwell in your office? {{Ans- Collect UDS and then refer out Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment? {{Ans- No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? {{Ans- Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? {{Ans- An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? {{Ans- Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? {{Ans- Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1:1 Psychoeducation should be based on? {{Ans- Cultural context How do you promote health in a location with multiple ethnicities and education levels? {{Ans- Multiple cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? {{Ans- Allow this - remember ROI/informed consent Normal TSH? {{Ans- 0.5-5.0 TSH 0.5 = ? {{Ans- Hyperthyroidism TSH 5.0 = ? {{Ans- Hypothyroidism Relationship between TSH & T3/T4? {{Ans- Inverse Hyperthyroidism can present as? {{Ans- Mania Hypothyroidism can present as? {{Ans- Depression Normal depakote level? {{Ans- 50-125 Toxic depakote level? {{Ans- 150+ Birth defect caused by depakote? {{Ans- Spina Bifida S/S of depakote toxicity? {{Ans- Disorientation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? {{Ans- D/C depakote and check VPA level, LFTs, and ammonia S/S of hepatotoxicity? {{Ans- RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? {{Ans- 5-40 Normal ALT? {{Ans- 5-35 Kava kava can cause? {{Ans- Liver damage and heavy sedation Kava kava is c/i with? {{Ans- Benzos or sedatives Mood stabilizer most associated with SJS? {{Ans- Lamictal Mood stabilizer with least weight gain? {{Ans- Lamictal SGAs with least weight gain? {{Ans- ziprasidone, abilify, and latuda Least sedating SGA? {{Ans- Abilify Routine labs with SGAs? {{Ans- BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? {{Ans- 1. Nonpharm = exercise or nutritional counseling 2. Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? {{Ans- Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? {{Ans- HLAB1502 Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? {{Ans- If ANC is 1000 with or without s/s of infection Lithium range? {{Ans- 0.6 - 1.2 What to do if lithium is 1.3 or 1.4? {{Ans- Monitor What to do if lithium is 1.5+? {{Ans- D/C Benefits of lithium? {{Ans- Gold standard for mania, neuroprotective, and antisuicidal effects S/S of lithium toxicity? {{Ans- Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor What to do if lithium toxicity is suspected? {{Ans- D/C and check serum levels prior to checking VS Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs? {{Ans- NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ) What demonstrates understanding of education on lithium? {{Ans- Taking extra water with patient when they go hiking NMS s/s? {{Ans- Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs Treatment of NMS and MOAs? {{Ans- D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant) Serotonin syndrome s/s? {{Ans- Hyperreflexia and myoclonic jerks Serotonin syndrome causes? {{Ans- SSRIs, SNRIs, MAOIs, -triptans (for migraines like sumatriptan/imitrex) Treatment for serotonin syndrome? {{Ans- D/C med and administer cyproheptadine Wash out from SSRI to MAOI or vice-versa? {{Ans- 14 days Wash out from Prozac to MAOI? {{Ans- 5-6 weeks Drug choice for patient that is depressed and also has cancer? {{Ans- Celexa or lexapro d/t fewer drug to drug interactions Drug choice for patient with low energy and fatigue with depression? {{Ans- Wellbutrin Drug choice for patient with sexual problems d/t medication or depression? {{Ans- Wellbutrin C/I for Wellbutrin? {{Ans- Seizure disorder or hx or present eating disorder Drug choices for patient with chronic neuropathic pain and depression? {{Ans- 1. SNRI (cymbalta) 2. TCA (amitriptyline) 3. Alpha 2 delta ligand (gabapentin or lyrica) Black box warning for SSRIs in children, adolescents, and young adults? Intervention for this? {{Ans- Increased risk of SI; always assess SI, frequency, and severity Alcohol is a form of _______-_________ and a __________ to the treatment of depression. {{Ans- self-medication; barrier Prozac can cause? Intervention? {{Ans- Insomnia; take in AM Disorder that most greatly increases thoughts of self-harm? {{Ans- Depression Disorder that most greatly increases homicidal ideation? {{Ans- Antisocial personality Why is there less evidence available supporting the use of antidepressants in children? {{Ans - Lower placebo rates Schizophrenia age of onset in men? Women? {{Ans- 18-25; 25-35 Findings on PET scan or MRI in schizophrenia? {{Ans- INCREASED ventricle size; DECREASED everything else No stimulants in schizophrenia due to? {{Ans- Increased dopamine release Tertiary prevention for schizophrenia? {{Ans- Social skills training Why should you refer a patient with schizophrenia to exercise programs, especially aerobic exercise? {{Ans- It improves cognition, quality of life, and long term health Benefits of assertive community treatment (ACT)? {{Ans- Rehab post-hospitalization, case management approach, and good for long term hx of noncompliance Oral haldol to IM conversion? {{Ans- 20x daily dose of oral dose Max IM dose of haldol per visit? How long until next injection? {{Ans- 100 mg; 5-7 days 5 mg oral haldol BID = ? IM {{Ans- 200 mg Firm belief that is maintained despite lack of evidence? {{Ans- Delusion Example of a delusion? {{Ans- Believing church members or class members are a cult MSE in preschooler (3-5 yo)? {{Ans- Listen and observe; dependent on clinical observation Thought process? {{Ans- Organization of patients thoughts and ideas Circumstantial speech? {{Ans- Go in circles but eventually answers Tangential speech? {{Ans- Never gets to answer of question Thought content? {{Ans- What themes occupy patient's mind; i.e. SI, HI, and A/VH MMSE also known as? {{Ans- Folstein scale Serial 7s or months backwards assesses patient's? {{Ans- Concentration, attention, and calculation Name 3 objects assesses? {{Ans- Registration Name 3 objects after 5 minutes assesses? {{Ans- Recall/memory Asking patient to name president of governor assesses? {{Ans- Fund of knowledge If a clock drawing test is abnormal this indicates? {{Ans- Right parietal lobe/hemisphere damage What makes SGAs different from FGAs? {{Ans- 5HT2A = less likely to experience EPS SGAs that can be administered IM? {{Ans- Invega, geodon, zyprexa, and abilify Mesolimbic DA pathway? {{Ans- Increased DA leads to + symptoms Mesocortical DA pathway? {{Ans- Decreased dopamine leads to - symptoms Nigrostriatal DA pathway? {{Ans- Decreased dopamine and increased acetylcholine lead to EPS (dystonia, akathisia, and TD) Tuberoinfundibular pathway? {{Ans- Decreased dopamine and increased prolactin lead to amenorrhea, galactorrhea, sexual dysfunction, and gynecomastia Long term increased prolactin causes? {{Ans- Osteoporosis Normal prolactin levels for men? Women? {{Ans- 20; 25 Which CYP450 enzyme metabolizes clozaril? {{Ans- 1A2 Cigarettes are inducers of what CYP450 enzyme? {{Ans- 1A2 Cigarette smoking in patients taking clozaril requires increased or decreased doses? {{Ans- Increased Cigarette cessation in patients taking clozaril requires increased or decreased doses? {{Ans- Decreased Most antibiotics are inducers or inhibitors? Intervention with substrate? {{Ans- Inhibitors; reduce substrate Medications that cause mania? {{Ans- Steroids, antabuse, isoniazid (INH), and antidepressants in patients with bipolar disorder Medications that cause depression? {{Ans- Steroids, accutane, interferon, retrovirals, antineoplastics, BZDs, progesterone, and beta blockers Accutane can cause? {{Ans- Birth defects Steroids can also cause? {{Ans- Psychosis