Review 2 PMHNP Questions and Answers correct

Review 2 PMHNP Questions and Answers correct NSAIDS Increases Lithium Levels Reliability consistency of measurement Reliability is another term for consistency. If one person takes the same personality test several times and always receives the same results, the test is reliable. internal validity Refers to how well an experiment is done, Was it done RIGHT extent to which we can draw cause-and-effect inferences from a study Qualitative Data in the form of recorded descriptions rather than numerical measurements. Quantitative relating to, measuring, or measured by the quantity of something rather than its quality. Data in numbers Biggest concern with EMR Privacy confidentiality Scope of Practice STATE Standards of Practice ANA The standard of practice limitations imposed upon a healthcare provider are based on local regulations and which of the following elements? Beck Depression 0-9: indicates minimal depression 10-18: indicates mild depression 19-29: indicates moderate depression 30-63: indicates severe depression. Hamilton Depression Scale TOTAL ITEMS 1 TO 17: _______________ 0-7=Normal 8 - 13 = Mild Depression 14-18 = Moderate Depression 19 - 22 = Severe Depression > 23 = Very Severe Depression PHQ9 Score Depression severity Comments 0-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderate Severe depression 20-27 Severe 0-4 Minimal or none Monitor; No TX 5-9 Mild Use clinical judgment (symptom duration, functional impairment) to determine necessity of treatment 10-14 Moderate 15-19 Moderately severe Warrants active treatment with psychotherapy, medications, or combination 20-27 Severe Anorexia/Bulimia Admission to Hospital for Pediatrics American Academy of Pediatrics Criteria for Inpatient Hospitalization in Eating Disorders Anorexia nervosa Heart rate < 50 beats/min daytime; < 45 beats/min nighttime Systolic blood pressure < 90 mm Hg Orthostatic changes in pulse (> 20 beats/min) or blood pressure (> 10 mm Hg) Arrhythmia Temperature < 96°F < 75% ideal body weight or ongoing weight loss despite intensive management Body fat < 10% Refusal to eat Failure to respond to outpatient treatment Bulimia nervosa Syncope Serum potassium < 3.2 mmol/L Serum chloride < 88 mmol/L Esophageal tears Cardiac arrhythmias including prolonged QTc Hypothermia Suicide risk Intractable vomiting Hematemesis Failure to respond to outpatient treatment Anorexia Admission How long does antidepressants work 4-6 weeks Yalom Yalom's eleven therapeutic factors that influence change and healing in group therapy: 1. The instillation of hope creates a feeling of optimism. 2. Universality helps group members realize that they are not alone in their impulses, problems, and other issues. 3. Imparting information helps to educate and empower people with knowledge pertaining to their specific psychological situation. 4. Altruism allows clients to gain a sense of value and significance by helping other group members. 5. Corrective recapitulation provides for the resolution of family and childhood events within the safety of the group family. 6. Socializing techniques promote social development, tolerance, empathy, and other interpersonal skills. 7. Through imitative behavior group members learn to adopt the coping strategies and perspectives of other group members. 8. Interpersonal learning teaches clients how to develop supportive interpersonal relationships. 9. Group cohesiveness gives members a sense of acceptance, belonging, value, and security. 10. Catharsis releases suppressed emotions and promotes healing by disclosing information to group members. 11. Existential factors incorporate learning how to just exist as part of something larger than oneself. This factor brings a client into the awareness that life will continue on, with pain, death, sadness, regret, and joy. By living existentially, clients learn how to accept these conditions without escaping from them. Instead, they learn how to live with them and through them. Tegretol Check ANC and WBC- Causes Agranulocytosis Delirium versus Dementia Delirium is Acute Dementia is progressive Steroids Trigger Mania Positive Trendelenburg test REFER to Ortho A positive Trendelenburg test usually indicates weakness in the hip abductor muscles: gluteus medius and gluteus minimus.[1] These findings can be associated with various hip abnormalities such as congenital hip dislocation, rheumatic arthritis, osteoarthritis. Tegretol and Erythromycin Erythromycin inhibitor. You would decrease Tegretol. Erythromycin would causes toxic Tegretol levels. CYP Inducers BULLSHIT CRAP GPS Decrease other medication Barbituates St. Johns Wart Carbamazepine Rifampin Alcohol Phentoin Griseofluvin Phenobarbital Sulfonyureas CYP Inhibitors SICKFACE.COM Sodium Valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol Chloramphenicol Erythromycin Sulfonamides Cipro Omeprazole Metronidazole Carb and Barb inducers Decrease Coumadin Depakote and Disulfram Inhibitors Increase Coumadin Nicotine Inducer-1A Decreases/metabolizes Zyprexia quicker GAL (Gabapentin, Acamprosate, Lithium) Renally Metabolized STOP SMOKING Decrease Zyprexia NSAIDS and ACE inhibitors Increase Lithium Levels Nigrostriatal pathways EPS Dilated Pupils and Hypertension Opiate Withdrawal Behavioral Therapy For a Child Who Bed Wets DDVAP Decreases amount of urine OTL (Oxazepam, Temazepam, Lorazepam) Metabolized outside the liver by conjugation. 1/2 lives are the same even with advanced liver disease Negligence Autonomy-Independent Justice -Fair Beneficence- Do good Non-maleficence-Do no harm Validity-Faithful Veracity-Truthful Scope of Practice Statutory Law- State Define NP Roles ID competencies Standard of Practice Legally describes the stands of care Judge care provided ANA Certification Title Protection Determines scope of Practice Ensure Knowlegdes Credentialing Minimal level of professional competence Licensure State Government grants permission to edge in practice of profession Therapeutic Nurse Client Relationship Orientation:objectives, establish, daig eval Working : measure outcomes, reprioritize plan Termination: Review prog, disengage, refer Transtheoretical Model of Change 1. Precontemplation: No Change 2. Contemplation: Thinking 3. Preparation: Made decision to Change 4. Action: Overt action of Change 5. Maintenance: Prevent relapse Erickson Stages i) Trust vs. mistrust (first year) ii) Autonomy vs. shame (1-2) iii) Initiative vs. guilt (3-5) iv) Industry vs. inferiority (6-12) v) Identity vs. role confusion (12-20) vi) Intimacy vs. isolation (20-40) vii) Generativity vs. stagnation (40-65) viii) Integrity vs. despair (65- death) Frued's Psychosexual Stages oral stage, anal stage, phallic stage, latency stage, genital stage Sullivan's Stages of Development 1. Infancy (birth-18 mos)- Oral gratification; anxiety occurs for 1st time 2. Childhood (18 mos- 6 years)- Delay of gratification 3. Juvenile (6 years-9 years)- Forming peer relationships 4. Pre-adolescent (9-12 years)- Same sex relationships 5. Early Adolescent (12-14 years)- Opposite sex relationships 6. Late adolescent (14-21 years)- Self-identity developed Tanner Stages Girls Stage I-Prepubertal pattern Stage II-Breast bud and areola starts to develop Stage III-Breast continues to grow with nipples/areola(one mound/no separation) Stage IV- Nipples and areoola become elevated from the breast (a secondary mound) Stage V-Adult pattern Tanner stages boys Stage 1: prepuberty Stage 2: testes begin to enlarge/increased rugation of scrotum Stage 3: penis elongates. Testicular/scrotal growth continues. Scrotal color starts to darken Stage 4: penis thickens and increases in size. Larger testes and scrotal skin darker Stage 5: adult pattern Defense mechanisms Health Belief Model Perceived Susceptibility Serious Illness Perceived Severity Perceived Benefits of treatment Perceived Barriers to change Expectation Self Efficacy Stages of Cognitive Development (Piaget) Sensorimotor stage (birth to age 2) Pre-operational stage (age 2 to about age 7) Concrete operational stage (from age 7 to 11) Formal operational stage (adolescence into adulthood) Transference Displacement of feelings fro significant people in the client's past onto the PMHNP in the present relationship Countertransference The nurse emotional reaction to the client based on her or his past experiences Fever Sore throat PANDA PICOT P: Population I: Intervention C: Comparison O: Outcome T: Time Zantac (ranitidine) H2 antagonist Depakote Check for Pregnancy Increased ICP in Infants - First Sign high pitched cry, Bulging fontanels, irritable, Nausea, Seizures, incoordination, MMSE (Mini Mental State Examination)- simplified scored form of the cognitive functions of the mental status exam Interpretation of the MMSE Single Cutoff <24 Abnormal Range <21 Increased odds of dementia Range >25 Decreased odds of dementia Education 21 Abnormal for 8th grade Education <23 Abnormal for high school Education <24 Abnormal for college Ed Severity 24-30 No cognitive impairment Severity 18-23 Mild cognitive impairment Severity 0-17. Severe cognitive impairment Prazosin alpha 1 antagonist TX Night mares DBT (dialectical behavior therapy) Borderline Healing Stick Spirit Stick Culture competence Prozac (fluoxetine) SSRI Causes increase in Anxiety for Elderly Amygdala function Responsible for the response and memory of emotions, especially fear Stereognosis ability to recognize objects by feeling their form, size, and weight while the eyes are closed Turner Syndrome A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. Rett Syndrome Neurodevelopment of child (girl, as boys die in utero) fails between age 1-4, with poor head growth PDSA model Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI). The Plan-Do-Study-Act (PDSA) method is a way to test a change that is implemented. AIDS dementia SIGN memory loss Less ability to think clearly (cognitive impairment) Trouble concentrating or staying focused Trouble speaking clearly or accurately Lack of interest in previously enjoyable activities Slow loss of motor skills, or reduced coordination Loretta Ford , RN, and Henry Silver, MD -started the first "NP-type Program" at the university of colorado -1968 Child Health Associate Program -developed to assist pediatric physicians Tourette syndrome a complex neurological disorder characterized by involuntary tics, grunts, and compulsive utterances that sometimes include obscenities Medicare Part B The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. Medicare A Hospital Medicare D Drug Improvement and Modernization Act of 2003 Medicare C Medicare advantage plan, approved by Medicare and ran by private companies Part C plans must pay for at least the same health care services as Original Medicare. But they sometimes pay for things that are not covered by Original Medicare, such as vision and dental care. Tegretol (carbamazepine) Induces Flonase Propanolol (Inderal) Makes Depression worse ACE INHIBITORS HF "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension High blood pressure Coronary artery disease Heart failure Diabetes Certain chronic kidney diseases Heart attacks Scleroderma Migraines frontal lobe A region of the cerebral cortex that has specialized areas for movement, abstract thinking, planning, memory, and judgement left hemisphere of brain The left hemisphere of the brain is responsible for control of the right side of the body, and is the more academic and logical side of the brain. right hemisphere of brain The right hemisphere of the brain is responsible for control of the left side of the body, and is the more artistic and creative side of the brain. Right and Left Side of the Brain Connected by a large bundle of matter (corpus callosum) frontal lobe A region of the cerebral cortex that has specialized areas for vol movement, abstract thinking, planning, memory, and judgement, impulse control, language (Broca) expressive speech, personalty, Problems with the Frontal Lobe Leads to personalty changes, emotional, and intellectual changes, temporal lobe A region of the cerebral cortex responsible for hearing and language (Wernicke area). Receptive speech or language comprehension, memory, emotion Problems in the Temporal Lobe Lead to Visual and auditory hallucinations, aphasia, and amnesia occipital lobe A region of the cerebral cortex that processes visual information Problems in the Occipital Lobe Lead to Visual deficits, blindness, and visual hallucinations parietal lobe A region of the cerebral cortex whose functions include processing information about touch, Taste, Reading and writing Problems in the Parietal Lobe Lead to sensory perceptual disturbance and agnosia Agnosia inability to recognize objects cerebral cortex outer region of the cerebrum, containing sheets of nerve cells; gray matter of the brain contralateral (opposite) side of the body. right controls the left side of the body and vice versus Sensory-relayed from Thalamus Responsible: Behavior human: speech, judgement, and motor function limibic system A set neural structures at the edge of the brainstem; associated with fear and aggression and drives like food and sex. Hypothalamus Thalamus Hippocampus Amygdala hypothalamus function water balance/bp/temp regulation/hunger/thirst/dian rhythms Thalamus function relay station for sensory impulses, pain (no Smell) emotions, memory, and affected behaviors Hippocampus A neural center located in the limbic system that helps process explicit memories for storage. basal ganglia function Also known as the Corpus Striatum Movement Automatic actions walking and driving a car Invol motor activities Nerve tract EP motor system -psycho trophic meds affect this area causing EPS contains caudate and putamen Problems with basal ganglia Leads to Bradykinesia, Hyperkinesias, Dystonia brainstem function consists of medulla: pons midbrain Cerebellum origin of most cranial nerves, contains reticular formation (important for arousal, sleep-wake cycles), location of respiratory, cardiovascular, and digestive control centers medulla oblongata Part of the brainstem that controls vital life-sustaining functions such as heartbeat, breathing, blood pressure, and digestion. Pons function Houses the Locus Ceruleus ( area of norepinephrine synthesis)