ANCC PMHNP Review Latest Update with Verified Solutions

ANCC PMHNP Review Latest Update with Verified Solutions Piaget's Cognitive Theory Stages: sensorimotor (object permanence), preoperational (magical thinking/language), concrete operations (logic, reversibility), formal operations (formal, logical) Henry Stack Sullivan's Interpersonal Theory behavior is in respond to interpersonal dynamics. Stages: oral gratification/first anxiety, delayed gratification, formation of peer relationships, same sex friendships, opposite sex relationships, self-identity development Maslow's Hierarchy of Needs survival, safety/security, love, self-esteem, self-actualization Health Belief Model barriers to health promotion: perception of susceptibility, seriousness of illness, perceived benefits of treatment, barriers to change, expectations of efficacy Bandura's Self-Efficacy/Social Learning Theory behavior is a result of cognitive and environmental factors, learned through observation/role-modeling, efficacy predicts change/maintenance Watson's Caring Theory Caring is essential component of nursing Frontal lobe Frontal lobe: motor function, premotor area, association cortex (decision-making), executive functions (memory, reasoning, planning, prioritizing, insight, flexibility, judgment, impulse control, intelligence, abstraction), language (expressive), personality Temporal lobe receptive language, memory, emotion, integration of vision/sensory info (damage results in A/V hallucination, aphasia, amnesia) Occipital lobe visual cortex, integration of sensory info (damage results in visual hallucinations, blindness) Parietal lobe primary sensory data, taste, reading/writing (damage results in sensory disturbances, agnosia) Cerebellum processing of sensory info from thalamus, including speech/cognition, judgment, perception, motor function, equilibrium (if damaged, atataxia, negative Rhomberg) Limbic system emotions, memory (hypothalamus, thalamus, hippocampus, amygdala) Hypothalamus regulates appetite, thirst, libido, circadian rhythm, hormones Thalamus relays sensory info and affects emotions, memory, affective behaviors Hippocampus memory Amygdala regulates mood, fear, emotion, aggression Basal ganglia/corpus striatum stabilizes motor activity, movement initiation, learning/automatic motions, EPS, involuntary motor activities (if damaged, bradykinesia, hyperkinesis, dystonia) Brainstem where NTs are produced (midbrain, pons, medulla, cerebellum) Midbrain ventral tegmental and substantia nigra (where DA is produced) Pons locus ceruleus (where NE is produced) Medulla autonomic control center for internal body functions Reticular formation system primitive brain controls involuntary movement, reflex, blood pressure, respiratory rate, vital signs, muscle tone (if damaged, LOC) Structural imaging CT (3D view of brain, nonspecific), MRI (superior but expensive) Functional imaging EEG (evoked potentials, least expensive, shows electrical function of CNS), MEG (often used with EEG, detects electrical activity in the brain), SPECT (cerebral blood flow, expensive), PET (very expensive) Structural/functional diagnostic tests fMRI, 3fEMRI, DA receptor binding Fever can indicate agranulocytosis in these meds carbamazepine, clozapine These meds should prompt PE of the integumentary system because of risk of rash Lamictal, carbamazepine ECGs common on these meds TCAs, APs Edema common side effect for this med/disorder Lithium, anorexia This medication is associated with cataracts risk Seroquel T4 labs ⇒ Increased: Graves, thyrotoxicosis, acute thyroiditis ⇒ Decreased: hypothyroidism, thyrotoxicosis, renal failure, Cushing's, cirrhosis, Hashimoto's ⇒ Med interactions: heparin, aspirin, propranolol, furosemide, methadone TSH labs ⇒ Increased: hypothyroidism, thyroiditis ⇒ Decreased: hyperthyroidism ⇒ Med interactions: ASA, corticosteroids, heparin, Li Calcium ⇒ Increased: acidosis, hyperparathyroidism, cancer, vitamin D intoxication, Addison's, hyperthyroidism, ECG changes ⇒ Decreased: alkalosis, hypothyroidism, renal failure, pancreatitis, inadequate intake ⇒ Psych symptoms: confusion (hypo), muscle issues (hypo), fatigue (hyper), anorexia (hyper), ⇒ Med interactions: thiazides, hormones, vitamin D, Ca, barbiturates, anticonvulsants, steroids, acetazolamide, heparin, laxatives, albuterol, OCs Sodium ⇒ Increased: hypovolemia, dehydration, DI, excessive salt intake, gastroenteritis ⇒ Decreased: Addison's, renal dz, GI fluid loss, diuresis ⇒ Psych symptoms: confusion (hypo), lethargy (hypo), wt gain (hypo), tachycardia (hypo/hyper), restlessness (hyper) ⇒ Med interactions: Li, vasopressin, diuretics Magnesium ⇒ Increased: Addison's, renal failure, DKA, dehydration, thyroid dz ⇒ Decreased: hyperaldosteronism, hypokalemia, DKA, malnutrition, alcoholism, acute pancreatitis, GI fluid loss, malabsorption, pregnancy-induced HTN ⇒ Psych symptoms: depression (hypo), confusion (hypo), irritability(hypo), n/v (hyper) ⇒ Med interactions: antacids, laxatives, salicylates, Li, thiazides, calcium gluconate, neomycin, aldosterone, ethanol Chloride ⇒ Increased: acidosis, hyperkalemia, hypernatremia, dehydration, renal failure, Cushing's, hyperventilation, anemia ⇒ Decreased: alkalosis, hypokalemia, hypernatremia, GI fluid loss, diuresis, overhydration, Addison's, burns ⇒ Med interactions: high TGs, KCl, methyldopa, diazoxide, guanethidine, furosemide, thiazide Potassium ⇒ Increased: acidosis, insulin deficiency, Addison's, renal failure, hypoaldosteronism, infection, dehydration ⇒ Decreased: alkalosis, excessive insulin, GI loss, laxative use, burns, trauma, surgery, Cushing's, hyperaldosteronism, thyrotoxicosis, anorexia nervosa, diet lacking meat and vegetables ⇒ Psych symptoms: marijuana use (hyper), restlessness (hyper), GI issues (hyper) ⇒ Med interactions: furosemide, thiazides, insulin, aspirin, cortisone, li, laxatives, marijuana, heparin, epinephrine, isoniazid, K-sparing diuretics ALT ⇒ Normal value = 5-35 U/L ⇒ Liver damage 50x baseline AST ⇒ 5-40 U/L ⇒ Tissue damage (liver, myocardium, skeletal muscles, kidneys, pancreas, brain) 2-5x elevated ⇒ Meds (antihypertensives, cholinergic agents, anticoagulants, methyldopa, OCs, opiates, salicylates, hepatotoxic meds, verapamil) can increase levels, so can exercise GGT ⇒ 10-38 U/L ⇒ Levels rise after any ETOH ingestion, so can phenytoin and barbituates Flu prevention yearly for geriatric, pediatric, at-risk, and anyone who desires HPV female pts should receive first vaccine at 11-12 yo with catchup at 13-26, males can receive from 9-26 yo MMR not for pregnant women, weakened immune system, people taking steroids, or recent blood transfusion TDAP age 11, then q10y Shingles > 60 who has had chicken pox, do not give to weakened immune system, high-dose steroids Varicella not for pregnant women, weakened immune systems, cancer, steroids, or recent blood transfusion Women preventative health screenings Monthly skin and oral self-exams Yearly blood pressure, bloodwork, urinalysis, PE, pap (2-3y after age 21 or within 3 years of first sexual encounter), pelvic exam, STI detection Q4y ECG after age 40 Q2y mammogram after age 50 Bone density screening after age 65 Colonoscopy q10y Men preventative health screenings Monthly testicle, skin, and oral self-exam Yearly blood pressure, bloodwork, urinalysis, PE Q4y ECG after age 40 Q19y colonoscopy AIMS clinician administered, testing for dyskinesia as a result of psychotropic meds, ⇒ Score >2 = TD BARS clinician administered, testing for drug-induced akasthisia, objective and subjective ⇒ Score >2 = akasthisia Connor's self, parent, teacher reported or clinician administered, testing for pediatric ADHD, short and long form, subsets for other common pediatric psych diagnoses ⇒ Score > 61 = mild ADHD, score > 70 = severe ADHD Vanderbilt parent and teacher report, testing for ADHD in ages 6-12, academic and behavioral assessment ASRS self-report or clinician-administered, testing for ADHD in ages 16 and up, includes items assessing quality of symptoms AUDIT-C self-report or clinician-administered, testing for use and frequency of alcohol and drug use in ages > 13 ⇒ Females > 3 = positive, males > 4 = positive, score > 8 = hazardous CAGE - self-report or clinician administered, testing for substance use in ages >13 ⇒ Score > 2 may indicate dependence CRAFFT self-reported or clinician-administered, testing for ETOH and safety in ages 14-18 ⇒ Score > 2 may indicate substance abuse BAI self-report or clinician-administered, testing for anxiety symptoms (but not worry) in ages > 17 ⇒ Score < 21 = mild, 22-25 = moderate, 25-30 = severe HAM-A clinician administered, testing for anxiety/fear/sleep disturbance/somatic complains/tension/behavior ⇒ Score 14-17 = mild, 18-24 = moderate, 25-30 = severe LSAS-CA clinician administered, testing for social anxiety/phobia in pediatrics, assesses social interactions and performance situations, includes fear and avoidance ⇒ Score 55-65 = moderate, 65-80 = marked, 80-95 = severe, >95 = severe MMSE clinician-administered, testing cognitive impairment but not dementia/delirium/frontal lobe impairment ⇒ Score 18-23, mild impairment, 0-17, severe impairment MOCA clinician administered, testing cognitive function/attention/memory/language/abstraction/visual/orientation ⇒ Score >26 = normal SPMSQ clinician administered, quick, testing for cognitive impairment ⇒ Score > 3 = dementia BDI self reported or clinician administered, testing for depression in ages >13 ⇒ Score 11-17 = mild, 18-23 = moderate, 24+ = severe CCSD self-reported or clinician administered, semistructured interview testing depression and dementia ⇒ Score 8-17 = probable depression, >18 = definite depression GDS self-report or clinician administered, testing depression in age >65 ⇒ Score 10-19 = mild, score 20-30 = severe HAM-D self-report or clinician-administered, testing for depressive symptoms ⇒ Score 8-13 = mild, 14-18 = moderate, 19-22 = severe, 23+ = very severe PHQ-9 self-report or clinician-administered, testing for depression ⇒ Score 5 = mild, 10= moderate, 15 = moderately severe, 20 = severe PHQ-2 self-report or clinician-administered, testing for depression ⇒ Score of 3 = positive QIDS self-report or clinician administered, testing for severity of depressive symptoms SDS (Zung) self-report or clinician administered, testing for mood, appetite, and SI in depressed pts ⇒ 0-50 = normal, 51-59 = mild, 60-69 = moderate, 70+ = severe Kiddie-SADS clinician interview of parent and child, testing for current and past psychopathology ⇒ Complex scoring MDQ self-report or clinician administered, testing for mania and hypomania ⇒ Score is positive if 7 or more of the items are present YMRS self-report or clinical observation, testing for mania in diagnosed pts ⇒ Score of 12 in adults = mania, score of 20 in children = hypomania, 25 = mania CYBOS self-report or clinician administered, testing for obsessions and compulsions in children age 6-14 ⇒ Scores of 0-4, with higher scores = higher severity YBOCS self-report or clinician administered, testing for type and severity of OCD within past 48 hours in ages 14 and older ⇒ Higher score indicates higher severity BPRS clinician-administered, testing for positive/negative/affective components of schizophrenia in ages 18 and older ⇒ Scores of 0-9 = negative, 10-20 = possible schizoaffective, 20+ = likely schizoaffective PANSS self-report or clinician administered, testing for positive and negative components of psychotic disorders SPS self-report or clinician administered, testing for suicide risk in ages 13 and older ⇒ Higher the score, greater the risk CIWA clinician administered, testing for alcohol withdrawal syndrome ⇒ Scores <10 are negligible COWS testing for severity of withdrawal syndrome, used for induction of suboxone ⇒ Scores 5-12 = mild, 13-24 = moderate, 25-36 = moderate/severe, 36+ =severe