PMHNP ACTUAL EXAM 2024 UPDATE QUESTIONS WITH ANSWERS GUARANTEED PASS 100%

PMHNP ACTUAL EXAM 2024 UPDATE QUESTIONS WITH ANSWERS GUARANTEED PASS 100% 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)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? 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?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 Syndromeanswer== D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain?answer== Latuda, Abilify, (also least Which mood stabilizer have the least weight gain?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 aanswer== 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. Hippocampusanswer== 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? answer== Bring a support person like a husband Thyroid-Stimulating hormone normal level answer== 0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis answer== HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance answer== Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis answer== (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance answer== Hypothyroidism Hyperthyroid can mimic answer== Mania Hypothyroid can mimic answer== Depression A patient on depakote complains of RUQ pain and has reddish/brown urine answer== Hepatoxicity -Check LFTs Signs of Depakote toxicity answer== Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? answer== Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? answer== Kava Kava When taking Kava Kava in combinations with other medications you should caution about answer== Risk of Hepatoxicity and Sedation TCAs carry a risk of answer== Hepatotoxicity Signs of Stevens-Johnson Syndrome answer== -fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome answer== lamictal and tegretol What nationality is most suseptible of getting steven johnson? answer== Asians When treating asians with tegretal screen for? answer== HLAB-1502 Allele What two medications cause agranulocytosis? answer== Clozaril & Tegretal Agranulocytosis when to discontinue medication answer== Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? answer== Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? answer== HCG Which two medications may decrease the risk of suicide? answer== clozaril and lithium Medications that increase lithium level answer== NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? answer== Heart Failure Certain medications are known to increase lithium level, but HOW? answer== by reducing renal clearance When educating a patient about lithium teach them about answer== Hyponatremia Dehydration-hot days, exercise Normal Lithium Level answer== 0.6-1.2 Lithium Toxicity answer== 1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 answer== Monitor for toxicity Labs before starting lithium 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 answer== 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects 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 answer== confusion, ataxia, GI upset, palpitation, tremor NMS 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 answer== test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome 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 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 answer== Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine Triptans answer== Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan 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? answer== 2 weeks How long do you wait when switching between Prozac and MAOI? answer== 5-6 weeks wash out period What is the first line treatment for depression and why? answer== SSRI-First line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? answer== Treating 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? answer== Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? answer== Wellbutrin Wellbutrin is contraindicated in patients with answer== Seizures and anorexia Which medications are best for neuropathic pain? answer== SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? answer== Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome answer== Those with short half lives such as zoloft Symptoms of serotonin withdrawal syndrome answer== Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females answer== -MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for answer== SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia answer== excessive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) MRI or PET scan what is seen in schizophrenia answer== EVERYTHING DECREASES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter? answer== Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) answer== a form of rehabilitation post hospitalization, in home treatment What level of prevention is ACT? answer== Tertiary What adjunctive treatment is important in schizophrenia answer== -social skills training -Exercise Exercise for mental health patients can promote answer== Cognition Quality of Life Long-term health ACT is ideal for patients with a history of answer== Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality answer== Antisocial In the MMSE how do you test for abstraction? answer== proverb interpretation (everyone that lives in glass houses shouldn't throw stones) Are they able to think abstractly Thought Process-Tangential answer== means that their response has nothing to do with the question Circumstantial answer== means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes answer== SI/HI/AH/VH Another name for MMSE answer== Folstein Scale How to assess concentration on MMSE answer== Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material answer== repeat 3 words after me Assess ability to recall answer== repeat 3 words after 5 minutes Assess fund of knowledge answer== Who is the president What is a quick and easy way to assess for neurological issues answer== Clock drawing test If patient is unable to draw a clock this indicates answer== Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathwayanswer== Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms