Georgette Review. PMHNP- 388 QUESTIONS- WITH COMPLETE SOLUTIONS

Georgette Review. PMHNP- 388 QUESTIONS- WITH COMPLETE SOLUTIONS .3 antipscyhotics that are least likely to cause wt gain - ANSWER-lurasidone, abilify, and ziprasidone (geodon) abilify least sedating .30% of OCD also develop - ANSWER-Tic disorder, most commonly in males that have OCD at a young age .3rd trimester fetal exposure to SSRIs? - ANSWER-seizures .72 y/o F forgetful, decreased appetite, 2 mos, hx HTN on lisinopril. MMSE score 24 (mild impairment), normal physical exam, have to urge her to answer questions. - ANSWER-depression (pseudodementia) sudden onset, not confabulating and "don't know" or urging answers also a FEMALE, and postmenopause (low estrogen) .acetylcholine synthesized where - ANSWER-basal nucleus of meynert .Addiction neurotransmitters - ANSWER-GABA, dopamine .ADHD - ANSWER-deficits in precrontal cortex: inattentive ADHD dorsolateral prefrontal cortex- executive functioning, cognitive processes, working memory, problem solving .adjourning phase of group - ANSWER-preparation to end group (but remember that working towards termination begins right away during first "forming" stage) members and leaders express feelings about each other/termination overview of what is learned and remaining issues to work on .Adjustment disorder - ANSWER-occurs w/in 3 mos of stressful event, doesn't last longer than 6 months .adjustment disorder specifiers - ANSWER-With depressed mood With anxiety With mixed anxiety and depressed mood With disturbance of conduct With mixed disturbance of emotions and conduct Unspecified .Aggression/fear/anxiety/emotions - ANSWER-amygdala .Answering tips - ANSWER-if part of quesiton wrong, whole question wrong. If 3 of the same and one different usually answer is the one that's different .Answering tips - ANSWER-Priority is airway, breathing, circulation. Then maslows heirchy-- safety, needs, culture then assessment before intervention if needed. don't choose to delegate, always chose to collaborate/do it yourself .Anxiety HAM A or GAD - ANSWER-HAM-A 18+ MEDS AND therapy! GAD 10-14 moderate 15+ MEDS AND therapy! .apoptosis - ANSWER-neuronal loss/cell death .appreciative inquiry - ANSWER-an approach to organization change that focuses on strengths rather than weakness. .autism - ANSWER-gaba, glutamate, sertraline poor social interaction lack of eye contact poor communication don't respond to their name line up or stack/organize toys .Autism spectrum percent of population in US? (Prevalence) - ANSWER-1% Incidence 2-5:100,000 Male to female 4:1 Sx onset before age 3 10% have genetics Down syndrome or fragile X More common if fam hx of pervasive developmental disorders .autoimmune diseases - ANSWER-can lead to increase cytokine levels .Beck depression - ANSWER-19-29 moderate 30+ treat MEDS AND therapy! .Best benzo during pregnancy? - ANSWER-lorazepam- least metabolites .black box warning carbemazepine tegretol - ANSWER-agranulocytosis and aplastic anemia .boys age 9-16 - ANSWER-normal to have pain/swelling of nipples will often self-resolve in 6 mos .BP disorder prevalance - ANSWER-Bipolar I equal in men and women Bipolar II more common in women men more manic, women more commonly rapid cycling/mixed states, depressive, comorbid eating disorders .Brain imaging - ANSWER-CT over MRI only when pacemaker PET and SPECT helpful for cognitive decline when MRI shows nothing or nonspecific changes, can show vascular disorder, and help differientiate Alzheimers and FTD. Can't use PET or SPECT in children .Brain PET scan of schizophrenia - ANSWER-everything decreased in size except ventricles (ventricles are holes anyway, obviously they are bigger) .broken mirror theory of autism - ANSWER-claims dysfunction of the mirror neuron system may be a cause of poor social interaction and cognition w/ ASD .Carbamazepine (tegretol) - ANSWER-also can cause SJS or rash especially in asians must screen for HLAB-1502 allele first for all asains (if positive, means at increased risk for SJS, don't give) .Carbemazepine Tegretol level - ANSWER-6-12 mcg/ml .CBT - ANSWER-cognitive restructuring- changing automatic maladaptive thoughts .child abuse - ANSWER-crisis counseling report report report tell parent not to leave pt alone or leave their side .Chronic Pain and antidepressants - ANSWER-SNRI Duloxetine (cymbalta) .CIWA scale (clinical institute withdrawal assessment) - ANSWER-0-7 rating n/v tremors anxiety agitation paroxysmal sweats orientation/clouded sensorium tactile disturbances auditory visual HA .CIWAR w/drawal - ANSWER-8 start treatment moderate 16-20 if 15-- started scheduled meds or prns .Clinical Opiate Withdrawal Scale (COWS) - ANSWER-0-4/5 HR GI upset Sweating Tremor Restlessnes Pupils size (dilated) anxiety/irritability bone/joint aches gooseflesh runny nose/tearing .clock drawing test - ANSWER-assesses for neurological problems..dementia or AD advantages: fast, quick screening for dementia, only 1-2 minutes .conduct disorder - ANSWER-inflicting pain w/out remorse aggression goal to tx is to target mood and aggression- mood stabilzers, SSRIs, alpha 2 agonists, antipsychotics .Contraceptives CYP - ANSWER- .Conversion disorder - ANSWER-usually after stressful experience. sudden onset of neurological sx- blind, mutism, paralysis .Creutzfeldt-Jakob disease - ANSWER-Rapidly progressive dementia with startle myoclonus Prions (PrP) change from alpha to beta pleated sheet (resistant to proteases) Spongiform transformation of gray matter can diagnose with lumbar puncture CSF fluid biomarkers .cyclothymic disorder - ANSWER-at least ****2 years subsyndromal mood elevation and depression ...not full blow manic or MDD .DA produced where? - ANSWER-substantia nigra (regulars motor movement) and ventral tegmental area (VTA) nucleus accumbens .debriefing strategies - ANSWER-this is a reflective practice combining theory w/ practice .Decreased sex drive (in elderly female) - ANSWER-means low levels of testosterone decreased blood flow in pelvic region .delirium and bzns - ANSWER-bzns can prolong delirium for psychos w/ delirium...haldol or antipsychotics .dementia vs pseudodepression - ANSWER-depression- recent (last few months, more sudden), answer questions "don't know" dementia- chronic, slowly over time (3-5 years), confabulate w/ answers .depakote - ANSWER-not an emergency drug- so check for involuntary treatment .Depakote (valproic acid) - ANSWER-Risk for PCOS in young females Also pregnancy risk .desmopressin - ANSWER-can be used for enuresis--reduces urine production .DIGFAST - ANSWER-Distractibility Indiscretion/impuslive/irresponsibility Grandiosity Flight of ideas Activity increased Sleep (decreased need for) Talkativeness .disseminated encephalomyelitis - ANSWER-assymetrical body movements or extremities, parasthesias do a neuro exam .DMDD (disruptive mood dysregulation disorder) - ANSWER-A condition in which a child has chronic irritability and anger that culminates in frequent tantrums that are inappropriate to the circumstances and to the child's age. seems like bipolar disorder, but if age 6-17 then it would be DMDD .DMDD presentation - ANSWER-mood, angry, tantrum, irritable, sad, mad for NO REASON .Don't given stimulants to: - ANSWER-schizophrenics- would exacerbate dopamine levels. potentiates DA release .Donaldson vs. O'Connor - ANSWER-1975 - Supreme Court case that ended in the decision to deinstitutionalize patients in state mental hospitals; barred mental instatutions from committing patients involuntarily if they were not a threat to themselves or others