PMHNP Board Prep 1 - 12 (Answered) Complete Solution

PMHNP Board Prep 1 - 12 (Answered) Complete Solution symptom presentation affective, cognitive, physical autosomal dominant genetic inheritance. will present in more than one generation. 50/50 chance of passing on trait (Huningtons) autosomal recessive two copies must be present (cystic fibrosis prior to MSE assessment includes ROS, VS, heart tone, lung sounds, neuro exam, muscle tone, rigidity SLUMS 11 items. Max 30, 27-30 normal for high school education, 21-60 mild neurocognitive disorder, 0-20 dementia MMSE 11 components. Max 30, no impairment 24-30 Delirium/dementia 18-23 mild, 0-7 severe SLAP suicide assessment. Social support, Lethality, Access to means, Plan/Previous attempt Hamilton Anxiety Rating scale most popular anxiety scale Vanderbilt Assessment Scale free ADHD assessment tool Abnormal Involuntary Movement Scale (AIMS) total score is less important than monitoring areas of the body. 2 or more is positive. Question 7 examines trunk movements WHODAS 36 item, measures six domains, understanding and communicating, getting around, self care, getting along with people, life activities and participation with society. 0=no disability, 100=full disability Metabolic syndrome abdominal obesity and any two of the following: triglycerides 150, HDL 40/50, BP 130/85, FSBS 100 or prior type 2 diabetes general screening labs CBC, chemistry panel, thyroid labs, hepatic panel, B12/folate and vitamin D PET scan localizes mental activities, primarily as experimental basis and is very expensive cranial nerves olfactory=smell, sensory optic=vision, sensory oculomotor=most EOM, motor trochlear=downward and inward eye movement, motor trigeminal=mastication muscles, sensation of face, both abducens=lateral eye movmement, motor facial=move face, close eyes, taste, saliva, tears, both acoustic=hearing and balance, sensory glossopharyngeal=phonation, gag, carotid, swallowing, taste, both vagus=talk, swallow, carotid, both spinal accessory=shrug shoulders, motor hypoglossal=moves the tounge, motor tender lymph node classic sign of infection rubbery lymph node classic sign of lymphoma soft lymph node insignificant nontender lymph node classic sign of potential malignancy lymph node size insignificant if less than 2cm, 3cm in axilla and inguinal. but if supraclavicular fossa, 1cm is significant lasts longest in the urine cannabis. 3 days to 4 weeks pneumococcal vaccine give to 19-64 year old smoker or if have asthma Pap smear every 3 years, HPV every 5 years. discontinue at age 65-70 if have 3 consecutive negative and no abnormal tests in 10 years prostate exam digital begin at age 40 and PSA at age 40 if have family history of prostate cancer or AA. ALL males 50 years and older should get screening colorectal screening starting at 50 years old, annual fecal occult blood test, flex sig every 5 years and colonoscopy every 10 years Medicare B screening coverage for cervical, breast, prostate, colorectal cancer top 4 killers of adults in US heart disease, cancer, lower resp disease, CVA lung cancer highest cancer mortality in women and men, primary prevention PROMOTES health PRIOR. healthy diet, exercise, avoiding things secondary prevention focuses on early identification and treatment of existing problems. includes REGULAR exams and screening like pap tertiary prevention rehab and restoration of health hepatitis A vaccine for military, travelers to endemic areas, men who have sex with men diabetes screening impaired if FSBS 100-125 diabetes if 126 on two separate occasions cholesterol screening evaluate serum lipid levels Total cholesterol 200 Triglycerides 150 HDL 40-60 LDL 100 (70 if heart disease) Joint National Committee Classifications (JNC) to treat hypertension AA start of thiazide diuretics, Ca channel blockers mitral regurgitation S3 at 5th ICS MCL, musical TSH 20 weight gain is more likely 4.2 indicates hypothyroid low T4 indicates disease state is due to thyroid gland hyperthyroid low TSH, high or normal T4 mimics mania hypothyroid high TSH, low T4 mimics depression management of hypothyroid in adults levothyroxine (synthroid) if less than 60, generally healthy, start 100mcg or 1.7mcg/kg daily. geriatric start at 25mcg daily synthroid adjustments monitor levels every 4-6 weeks and increase until therapeutic HIV transmission via needle stick 1:350 HIV screening ELISA for initial screening western blot is confirmatory Chlamydia treatment zithromax OR doxy. report to health department Gonorrhea rocephin 250mg IM one dose + ziethromax 1gm one dose Syphilis benzathine penicillin G 2.4 million units IM. how often depends on the stage. doxy if allergic Structure of the mind Id: unconscious instinctual drives, pleasure principle Ego: rational, maintains harmony between id and superego Superego: perfection principles, forms the conscious relief behaviors actions, healthy and not healthy, to reduce stress Ego defense mechanisms Are many in number. Must be evaluated Goals of therapy make the conscious conscious and strengthen the ego so that behavior is based more on reality and less on instinctual drives Interpersonal Therapy Harry Stack Sullivan good me, bad me, not me Transactional Analysis Eric Berne Ego states include the Parent (shoulds), the Adult (gather information) and the Child (feelings, impulses Goal is to assist client to make new decisions about present behavior and life Gestalt Therapy Frederick Perls Focuses on the now psychoanalytic psychotherapy is best matched with the client with MATURE defenses, some object constancy Person centered therapy Carl Rogers qualities of therapist are accurate empathy, warmth, unconditional positive regard. Does NOT include history taking Motivational Interviewing based on collaboration between therapist and client, evoking or drawing out the clients ideas about the change, emphasizing autonomy of the client Stages of change pre contemplation contemplation preparation action maintenance relapse Behavioral Therapy Pavolov, Skinner, Bandura, Wolpe Differs fundamentally from psychodynamic approach "why" is not useful how behavior impacts functioning and affect currently Anxiety treatment classical and operant conditioning Rational Emotive Therapy Albert Ellis personal relationship is not essential goal to eliminate clinents self defeating outlook on life psychopathology has similiar set of underlying irrational beliefs Cognitive Behavioral Therapy