ANCC PMHNP Cert Exam Review Questions and answers verified for accuracy

How do you assess cranial nerve V trigeminal? Tell patient to close eyes, take piece of cotton or other soft item and lightly touch either one of both sides of each of the three divisions of the trigeminal. How do you assess for cranial nerve VII facial? Observe the patient for nystagmus or twitching of the eye. This nerve controls facial movements and expression, check for symmetry. Have the patient wrinkle forehead, close eyes, smile, pucker lips, show teeth, and puff out cheeks. primitive reflexes reflexes, controlled by "primitive" parts of the brain, that disappear during the first year of life Mororeflex Extending of limbs when they hear a loud noise (defend themselves) rooting reflex a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple palmer grasp grasping with the whole hand scope of practice The range of clinical procedures and activities that are allowed by law for a profession Quality Improvement (QI) an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy PDSA model Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI) Trendelenburg sign Occurs with severe subluxation of one hip When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side CYP450 inhibitors Fluvoxamine Fluoxetine Paroxetine Duloxetine Sertraline CYP450 inducers Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin St John's Wort What is the adverse effect of Depakote on the liver? can cause liver damage, and the risk is more likely to occur during the first 6 months of taking the medication. Signs might include nausea or vomiting, loss of appetite, abdominal pain, dark-colored urine, facial swelling, and yellowing of the skin or white of eyes What would you do for a patient on Depakote with +4 protein in the urine? Rule out UTI, no adjustment for medication is needed What happens when you take carbamazepine (tegertal) and erythromycin together? It will decrease the effect of the antibiotic by inhibition What happens when you take zyprexa and smoke? nicotine will increase the excretion of the drug thereby inhibiting it's effect ICP in Infants S/S Bulging fontanels, high-pitch cry, irritability, restlessness ICP CHILDREN signs and symptoms • Headache • Vomiting (usually projectile) • Seizures • Diplopia (Dbl vision), blurred vision Neuro cry high-pitched and very grating on the ears due to their neurological sxs being overwhelmed Neuroleptic Malignant Syndrome Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes. FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles NMS treatment Dantrolene D2 agonists (e.g., bromocriptine). lead poisoning A medical condition caused by toxic levels of the metal lead in the blood Lead poisoning treatment chelation therapy Amygdala's role in emotion - Aggression center - Role in storing implicit emotional memories - Stimulation (+) anger/violence or fear/anxiety - Damage (-) mellow; hyperorality; hypersexuality; dis-inhibited behavior Amygdala role in aggression Small volume increase aggression. Frontal Lobe Atrophy As neurons die in the frontal and temporal regions, these lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally controlled by these parts of the brain. ... Scientists think that FTLD (frontal temporal lobe dementia) is the most common cause of dementia in people younger than age 60 Four dopaminergic pathways mesocortical mesolimbic nigrostriatal tuberoinfundibular mesocortical pathway a path through which dopaminergic projections travel to reach the neocortex mescolimbic pathway The mesolimbic pathway, sometimes referred to as the reward pathway, is a dopaminergic pathway in the brain. The pathway connects the ventral tegmental area in the midbrain, to the ventral striatum of the basal ganglia in the forebrain. The ventral striatum includes the nucleus accumbens and the olfactory tubercle. Nigrostriatal pathway the dopaminergic tract from the substantia nigra to the striatum Tuberoinfundibular pathway from hypothalamus to anterior pituitary -> DA released from these neurons inhibit prolactin secretion -> when DA receptors here are blocked prolactin levels rise cause galactorrhea) primary prevention Efforts to prevent an injury or illness from ever occurring. secondary prevention Efforts to limit the effects of an injury or illness that you cannot completely prevent, screening exams. tertiary prevention actions taken to contain damage once a disease or disability has progressed beyond its early stages menopause hormone therapy most effective therapy for moderate -severe vasomotor symptoms - use quality of life scales to identify degree of vasomotor symptom severity *should not be used for protection against CVD or dementia congestive heart failure and depression MDD is highly prevalent in these patients Thyroid levels while on lithium Because of the high incidence of thyroid dysfunction that occurs during lithium treatment, patients should have a careful thyroid physical examination and determination of serum thyroid-stimulating hormone (TSH) and antithyroid peroxidase antibody titers before lithium treatment is begun. Patients with normal thyroid function initially should be reevaluated every 6 to 12 months for several years, and thyroid dysfunction should be treated if diagnosed. The development of thyroid dysfunction does not typically require discontinuation of lithium. If thyroid function is abnormal at the initial evaluation, lithium can still be given if necessary, but the thyroid dysfunction should be treated. SSRIs MOA block reuptake of serotonin by inhibiting the presynaptic reuptake SNRIs mechanism Inhibit 5-HT and norepinephrine reuptake. Lithium mechanism of action Not established, possibly related to inhibition of phosphoinosital cascade It inhibits excitatory neurotransmitters such as dopamine and glutamate, and promotes GABA-mediated neurotransmission. Carbamazepine mechanism Block voltage-dependent sodium channels Structural Therapy A therapeutic approach directed at changing or realigning the organization of a family to modify dysfunctional patterns and clarify boundaries. Developed by Salvador Minuchin. crisis intervention five-step problem-solving technique to promote adaptation and improve future coping Irvin Yalom A leading figure in contemporary group therapy, especially the interpersonal approach group therapy therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction boderline personality disorder impulsive actions, often with the potential for self-harm as well as mood instability and chaotic relationships DBT (dialectical behavior therapy) a form of therapy used to treat borderline personality disorder that combines elements of the behavioral and cognitive treatments with a mindfulness approach based on Eastern meditative practices eating disorder treatment -correct dangerous eating patterns -address psychological and situational factors that have led to / are maintaining the disorder -often requires family and friend participation When to admit for eating disorder? 75% below ideal body weight and/or electrolyte imbalances just culture culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action