PMHNP CERTIFICATION EXAM TEST

PMHNP CERTIFICATION EXAM TEST 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) - CORRECT ANSWER-D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors When interview teenagers (16 y/o) that arrive with their parents what should you do? - CORRECT ANSWER-interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. Which Ethnic group has the highest rate of suicide? - CORRECT ANSWER-Native Americans 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 antagonism C. Increased Lipids D. Metabolic Syndrome - CORRECT ANSWER-D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? - CORRECT ANSWER-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 Which mood stabilizer have the least weight gain? - CORRECT ANSWER-Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a - CORRECT ANSWER-atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus - CORRECT ANSWER-Hypothalamus A, B, & D are all part of the limbic system so you can rule that out When a patient is hesitant to participate in treatment you should encourage? - CORRECT ANSWER-Bring a support person like a husband Thyroid-Stimulating hormone normal level - CORRECT ANSWER-0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis - CORRECT ANSWERHYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance - CORRECT ANSWER-Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis - CORRECT ANSWER-(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance - CORRECT ANSWER-Hypothyroidism Hyperthyroid can mimic - CORRECT ANSWER-Mania Hypothyroid can mimic - CORRECT ANSWER-Depression A patient on depakote complains of RUQ pain and has reddish/brown urine - CORRECT ANSWER-Hepatoxicity -Check LFTs Signs of Depakote toxicity - CORRECT ANSWER-Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? - CORRECT ANSWER-Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? - CORRECT ANSWER-Kava Kava When taking Kava Kava in combinations with other medications you should caution about - CORRECT ANSWER-Risk of Hepatoxicity and Sedation TCAs carry a risk of - CORRECT ANSWER-Hepatotoxicity Signs of Stevens-Johnson Syndrome - CORRECT ANSWER--fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome - CORRECT ANSWERlamictal and tegretol What nationality is most suseptible of getting steven johnson? - CORRECT ANSWERAsians When treating asians with tegretal screen for? - CORRECT ANSWER-HLAB-1502 Allele What two medications cause agranulocytosis? - CORRECT ANSWER-Clozaril & Tegretal Agranulocytosis when to discontinue medication - CORRECT ANSWER-Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? - CORRECT ANSWER-Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? - CORRECT ANSWER-HCG Which two medications may decrease the risk of suicide? - CORRECT ANSWERclozaril and lithium Medications that increase lithium level - CORRECT ANSWER-NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? - CORRECT ANSWER-Heart Failure Certain medications are known to increase lithium level, but HOW? - CORRECT ANSWER-by reducing renal clearance When educating a patient about lithium teach them about - CORRECT ANSWERHyponatremia Dehydration-hot days, exercise Normal Lithium Level - CORRECT ANSWER-0.6-1.2 Lithium Toxicity - CORRECT ANSWER-1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 - CORRECT ANSWER-Monitor for toxicity Labs before starting lithium - CORRECT ANSWER-TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium - CORRECT ANSWER-4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects - CORRECT ANSWER-hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity Signs of lithium toxicity - CORRECT ANSWER-confusion, ataxia, GI upset, palpitation, tremor NMS - CORRECT ANSWER-muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot - CORRECT ANSWER-test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome - CORRECT ANSWER-With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Treatment for NMS - CORRECT ANSWER-Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer Treatment for Serotonin Syndrome - CORRECT ANSWER-Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine Triptans - CORRECT ANSWER-Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan - CORRECT ANSWER--call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP How long do you wait when switching between an SSRI to an MAOI? - CORRECT ANSWER-2 weeks How long do you wait when switching between Prozac and MAOI? - CORRECT ANSWER-5-6 weeks wash out period What is the first line treatment for depression and why? - CORRECT ANSWER-SSRIFirst line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? - CORRECT ANSWERTreating with a medication with minimal drug/drug side effects like Lexapro Patient with depression worries about sexual dysfunction what would be the medication of choice? - CORRECT ANSWER-Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? - CORRECT ANSWER-Wellbutrin Wellbutrin is contraindicated in patients with - CORRECT ANSWER-Seizures and anorexia Which medications are best for neuropathic pain? - CORRECT ANSWER-SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? - CORRECT ANSWER-Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome - CORRECT ANSWER-Those with short half lives such as zoloft Symptoms of serotonin withdrawal syndrome - CORRECT ANSWER-Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females - CORRECT ANSWER--MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for - CORRECT ANSWER-SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide.