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PMHNP Questions and Answers 2022/2023
what term describes a scientific study that gathers multiple studies and analyzes them to draw a larger conclusion? systematic review borderline pe... [Show More] rsonality disorder falls under which cluster of personality disorder traits? B a 36 year old caucasian male arrives for his usual monthly medication appointment. diagnosed with schizophrenia & has been stabilized on haldol for 9 years. today he states he has an inner feeling of restlessness & inability to remain still. what type of E.P.S is suspected? akathisia which part of medicare provides optional coverage for beneficiaries? part c the cerebrum contains all of the following areas of the brain except one. cerebral cortex, brainstem, limbic system, or hypothalamus brainstem in a family systems context, what is the definition of morphogenesis? a family's tendency to adapt to change when changes are necessary. how does the body remove both serotonin and norepinephrine from the synaptic cleft? an active re-uptake process a 53 year old menopausal woman presents with complaints of anhedonia, depressed mood, & vasomotor symptoms. what medication effectively treats both vasomotor symptoms and depression? desvenlafaxine/pristiq it is an S.N.R.I. which personality disorder is most likely to have fantasies of success? narcissistic who should receive a shingles vaccine? anyone over the age of 60 who has had chickenpox some states use the umbrella term advanced practice nurse to refer to all of the following except which one? nurse anesthetists, certified nurse midwife, mid-level providers, or nurse practitioners mid-level providers eating disorders are characterized by what? disordered patterns of eating, accompanied by distress, disparagement, preoccupation, & a distorted perception of one's body shape the federal government offered financial awards to encourage hospitals to implement meaningful use. the financial awards are tied to specific objectives related to the effective use of electronic health records. give 3 examples of this. 1. electronic prescribing 2. electronic medication interaction checks 3. computerized provider order entry for an act to be considered criminal, it must have 2 components: actus reus & mens rea. what is actus reus? voluntary conduct which complementary & alternative medicine technique is based on manipulating the flow of energy throughout the body? acupuncture who authored the report crossing the quality chasm, which emphasized the need for inter professional collaboration in order to improve the quality of health care? institute of medicine is a durable power of attorney limited to terminal illness only? no what term describes a system where the insurer is not only the payer but also the provider of care? managed care what term best describes a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market? health alliance freud would argue that adults who use 'biting' sarcasm as a defense mechanism are fixated in which psychosexual stage of development? oral what term is used to describe patients who injure themselves by self-mutilation but who do not wish to die? parasuicide what most accurately describes an individual with avoidant personality disorder? these patients are timid and easily wounded by criticism from others what are 3 reasons for homelessness? mental illness, poverty, & inadequate public assistance what is the primary goal of the AMA's scope of practice partnership initiative? to limit patients' choice of which health care provider they can see for treatment as a nurse practitioner you are expected to be competent in what areas? policy, practice inquiry, and technology and information literacy what term describes a digital version of a patient's medical file? electronic health record what term describes the death rate for a given population? mortality rate what action takes place during the working phase of a therapeutic relationship? clarifying patient expectations and mutually identifying goals at what age would you expect a child to sit alone with good coordination, imitate scribble, develop mild separation anxiety, and respond to social play such as peek-a-boo? 40 weeks or about 8 months old physical exam findings of Rett syndrome include what? seizures, irregular respirations, and scoliosis what endocrine findings are suggestive of alcohol dependency? testicular atrophy, sexual dysfunction, and gynecomastia what is sexual identity? it refers to whom someone is affectionately attracted what are some examples of monoamine neurotransmitters? dopamine, norepinephrine, and serotonin what percent of the incarcerated population in the U.S. has a severe mental illness? 15 to 24 percent statistically, gambling disorder is most prevalent among what ethnic/racial group? african americans what cranial nerve assessment tests smell, ensures patency of nasal passages, and is performed by having the client close the eyes to identify smells? olfactory what are the most common potentially law-breaking sexual behaviors? voyeuristic acts what psychiatric disorder is characterized by at least one psychotic symptom present for less than one month? brief psychotic disorder in almost every state, nurse practitioners are reimbursed at what percentage of the allowable physician rate? 85 percent which part of medicare provides optional coverage for outpatient pharmaceuticals? part D which class of medications would be most appropriate for treating a patient stabilized on haldol that is exhibiting mild pseudo-parkinson's symptoms? muscarinic 1 agonist patient switched to halodol last week presents with oriented to self, fever of 105.3, heart rate 126, breath rate 22, extremities are stiff and rigid, WBCs of 14, creatinine of 2.6. what is the most serious complication of her presentation? rhabdomyolsis what is the primary purpose of the corpus callosum? connect right and left hemispheres and facilitate sensorimotor information exchange what medication can produce a false positive for methamphetamines? prozac/fluoxetine what medication can produce a false positive for benzodiazepines? zoloft/sertraline what medication can produce a false positive for cocaine? motrin what food product can produce a false positive for morphine or heroin? poppy seeds how do managed care organizations control health care costs? bargain with medical practices for reduced rates on visits autism spectrum disorder can present with what deficits? lack of social reciprocity, insistence on sameness, & nonverbal communication what are the general functions of norepinephrine? alertness, focused attention, learning, & memory what are the general functions of dopamine? thinking, fine muscle action, & reward-seeking behavior what are the general functions of GABA? reduces arousal, aggression, & anxiety what are the general functions of serotonin? regulates sleep, pain, mood states, & temperature what is an example of a psychological preventative factor that protects someone from developing a psychiatric disorder? healthy ego defenses compared with physicians, nurse practitioners save the consumer & the insurance company what percent of costs? 20 percent a person who is proficient in the use of software, hardware selection, & computer maintenance possesses what skill? computer competency what underlying psychiatric disorder is not linked to insomnia? oppositional defiant disorder the institutional review board ensures what? 1. risks to participants are minimized 2. participant selection is equitable 3. adverse events are reported 4. risks & benefits are evaluated 5. informed consent is obtained & documented 6. data safety monitoring plans are implemented when indicated what are signs & symptoms of stevens johnsons syndrome? facial swelling, tongue swelling, macules/papules/burning confluent red rash, skin sloughing, pro-dromal headache, malaise, arthralgia, & painful mucous membranes may occur before rash what is stevens johnsons syndrome? immune reaction to a foreign antigen that can occur with exposure to any anticonvulsant drug what is the therapeutic range for lithium? 0.6-1.2 If first onset of manic symptoms occurs after age 40, what is likely the cause? another medical condition what are the side effects of lithium toxicity? slurred speech, confusion, coarse hand tremors, severe GI effect what medications when taken with lithium can double the level? NSAIDs and ACE inhibitors which personality disorder is most likely to be excessively scrupulous? obsessive-compulsive what EPS has a mask like appearance and a shuffling gait? pseudo-parkinson's what findings do you expect to support autism spectrum disorder? flat or blunted affect, little or no eye contact, and lack of emotional reciprocity what psychiatric medication is an inducer of the hepatic cytochrome P450 enzyme? carbamazepine intimate partner violence is defined as what? physical, emotional, economic, or sexual pain and injury that is intentionally inflicted by a person's intimate partner what term describes the amount that people spend before their health insurance pays for the cost of health care? deductible what cranial nerve assessment tests for tactile perception of the facial skin? trigeminal which act incentivizes pharmaceutical companies to develop drugs to treat rare disease? orphan drug act true or false: females have an earlier age of onset than males in obsessive-compulsive disorder false in a hospital psychiatric consultation setting, what is one of the most common mental illness diagnoses? adjustment disorder what are the systemic effects of hypothyroidism? decreased libido, constipation, & weight gain an NP helps a local school district implement a new DARE program. this is an example of what type of prevention strategy? primary prevention following fda labeling, what medication can be started at age 3 for A.D.D.? amphetamines what area of the brain has been indicated to modulate pain and can help explain how transcranial magnetic stimulation can help decrease pain? prefrontal cortex when assessing an elderly patient complaining of tinnitus, the PMHNP would associate what finding with an acoustic neuroma? unilateral tinnitus, ringing in the affected ear the statement that 'this group has enabled me to not feel so alone' is an example of which yalom curative factor? universality what medication is not currently indicated for the maintenance phase of treatment in bipolar 1, but has shown efficacy in treatment of acute manic or mixed episodes? extended release carbamazepine which medication is strictly contraindicated with selegiline, an M.A.O.I.? meperidine/demerol what is the current understanding of dopamine pathways and clinical symptoms in schizophrenia? negative symptoms are due to hypoactivity of mesocortical dopaminergic tract & positive symptoms are due to hyperactivity in the mesolimbic tract primary deficit may be mesocortical tract where dopamine function is diminished & decreasing inhibitory effects of the mesolimbic tract [Show Less]
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ANCC PMHNP Exam Questions and Answers 2023
mesocortical pathway executive function: attention, focus, depression nigrostriatal pathway from substantia nigra (brainstem) to striatum (muscles... [Show More] ): Parkinson's mesolimbic pathway projects to nucleus accumbens (part of limbic system). Pleasure, reward, positive symptoms of schizophrenia: Addiction, gambling Tuberoinfundibular pathway regulation of prolactin (acts on pituitary). Hypersexuality in mania Dopamine produced in substania nigra and VTA. D2 & D4 receptors most important. Elevated in the mesolimbic pathway associated with pleasure and psychosis. Antispychotics block dopamine. travels through mesocoritcal, mesolimbic, nigrostriatal, and tuberinfundibular pathways Serotonin 5-HT. produced in raphe nucleus. emotion, impulses, dreams. 5HT2A receptors = atypical antipsychotics. Norepinephrine produced in locus coeruleus. arousal and vigilance GABA inhibitory. produces calm in conjunction with benzodiazepines. ACTH motor control, learning, memory, sleep, and dreams. Helps with balance. Decrease in Alzheimer's disease hypothalamus-pituitary-adrenal axis (HPA) CRH, ACTH, then cortisol. Worsens with stress and depression hypothalamus-pituitary-thyroid (HPT) TRH, TSH, T4. Hypothyroid causes depression, weight gain, slow metabolism. Hyperthyroid is opposite. hypothalamus-pituitary-gonadal (HPG) GnRH, FSH, LH. Malfunctions cause infertility problems. gray matter neurons are found frontal lobe executive function, voluntary movement, speech (Broca's area) Temporal lobe memory, cognition, speech, emotions (aka limbic area) parietal lobe receive and process sensory input Wernicke's area temporal and parietal lobes; speech amygdala fear response. hippocampus memory. Make up limbic system with amydgala HIPAA 1. education about privacy protection, 2. access to own medical records, 3. request amendment to health information to which they object, 4. require permission for disclosure of medical issues forensic nursing based on crime committed and investigational aspects correctional nursing offender's current mental health and medical condition research utilization process critique, synthesize, apply, measure PICO question patient, intervention, comparison, outcome internal validity when the independent variable (treatment) caused a change in the dependent variable (outcome) external validity when the sample is representative of the population and the results can be generalized descriptive statistics used to describe the basic features of the data in the study standard deviation indication of the possible deviations from the mean variance how the values are dispersed around the mean - the larger the variance, the larger the dispersion of scores inferential statistics numerical value that enable one to reach conclusions that extend beyond immediate data alone - generated by quantitative research designs t-test assess whether means of 2 groups are statistically different from each other ANOVA analysis of variance - tests difference of 3 or more groups Pearson's r-correlation relationship between 2 variables probability 0-1: likelihood of an event occurring p value level of significance: describes the probability of a particular result occurring by chance alone HOPE sources of hope, organized religion, personal spirituality, effects on medical care/end of life OLDCARTS for HPI onset, location, duration, character, alleviating/aggravating factors, radiation, time of occurrence, severity Cranial Nerves Olfactory, optic, ocular motor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, accessory spinal, hypoglossal dysdiadochokinesia inability to perform rapid alternating movements (finger to thumb), cerebellar lesion astereognosis inability to distinguish objects (such as paperclip) based on touch, parietal lesion Free T4 0.8-2.8 TSH 0.4-0.5 - decreases when T3 & T4 are high, increases when T3 & T4 are low. Elevated in primary hypothyroidism. Values may decrease with aspirin, steroids, and heparin. Values may increase with lithium. calcium 8.8-10.5. 99% found in bone. major cation for bones and teeth. higher in kids because of bone growth. sodium 135-148 magnesium 1.3-2.1. chloride 98-106 potassium 3.5-5.1. value decrease with lithium, diuretics. marijuana use can elevate K ALT 5-35. AST 5-40 GGT gamma glutamyl transpeptidase - 10-38. Used to evaluate alcohol abuse because levels rise after only a small ingestion of alcohol. teratogenic risks of benzodiazepines floppy baby, cleft palate teratogenic risks of tegretol neural tube defects teratogenic risks of lithium Epstein anomaly teratogenic risks of depakote neural tube defects such as spina bifida Rogers Humanistic theory: person centered therapy Beck CBT Lazarus Behavioral therapy Marsha Linehan DBT Frankle Existentialism: reflection on life and encouragement of self-confrontation. "Why am I here? What is my purpose?" Klerman and Weissman Interpersonal therapy: time limited, problem focused Shapiro EMDR: used to treat PTSD Yalom Group therapy: 10 guiding principles for group Bowen Family systems theory Minuchin Structured family therapy Satir Experiential therapy: behavior is determined by personal experience. Focus is on being authentic Haley Strategic therapy: symptoms are metaphors and reflect problems in the hierarchal structure deShazer, O'Hanlon, Berg Solution-focused therapy: miracle questions, exception finding questions, scaling questions PANDAS pediatric autoimmune neuropsychiatric disorders associated with strep: consider with children who have OCD symptoms schizophrenia excess dopamine in the mesolimbic pathway and decreased dopamine in the mesocoritcal pathway. Excess glutamate, decreased GABA, decreased serotonin atypical antipsychotics D2 and 5HT2a blockade: treat both positive and negative symptoms of schizophrenia Neuroleptic malignancy syndrome Elevated CPK, elevated WBC, elevated LFT. Autonomic instability. Bromocriptine (Parlodel) and dantrolene (Dantrium) Treatment for NMS DELIRIUM drugs, electrolytes, low 02 sat, infection, reduced sensory input, intracranial, urinary, myocardial Pick's Disease frontotemporal dementia: more common in men, personality/behavioral changes in early stages, cognitive changes later Kluver-Bucy syndrome hypersexuality, hyperorality, and placidity Creutzfeld-Jakob disease fatal, rapidly progressing, fatigue and flu like symptoms, cognitive impairment. Later aphasia, apraxia, emotional lability Huntington's disease subcortical type of dementia characterized by choreoathetoid movements Lewy body disease Lewy bodies in cortex, Parkinson's features, adverse reaction of antipsychoticsMeman BUN 6-20 creatinine 0.6-1.2 [Show Less]
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PMHNP Questions and Answers 2023
What is true of interprofessionality? All health professionals have individual professional competencies What is the significance of an experimenta... [Show More] l p-value of 0.05 There is a 5% chance of a similar result occurring by chance alone What percentage of children with oppositional defiance disorder will develop conduct disorder? 30% In the DSM-5, selective mutism is now considered what type of disorder? anxiety disorder Symptoms of selective mutism must persist for at least 1 month Common competencies overlap more than one health care professional, although not necessarily all health care professionals, and are competencies expected of all health care professionals Complementary competencies enhance the qualities of other professions in provision of care Collaborative competencies those that each individual profession must possess to work with others, including those who practice within different specialties within a profession. Interpersonal collaboration is _______ centered patient Cognitive therapy is recommended for patients that have negative cognitive distortions irrational beliefs faulty conceptions Humanistic Therapy focuses on assisting patients with self-actualization and self-directed growth Behavioral Therapy focuses on changing maladaptive behaviors through the use of behavioral modification techniques Existential therapy is for reflection on life confronting self 120 who got diarrhea ate lettuce. 80 with diarrhea did not eat lettuce. 40 without diarrhea ate lettuce. 160 without diarrhea ate lettuce. What is the odds ratio of eating lettuce and developing diarrhea? 6 ((120X160)/(80x40)) The New Freedom Commission on Mental Health (NFCMH) released a report that suggested implementation a national campaign to reduce the stigma of seeking care Focusing on promoting recovery and building resilience The efficacy of mental health treatments was found to be well documented in influential report issued by US Surgeon General in 1999 State of high negative emotion and pessimism neuroticism Commonly known as an optimistic outlook on life They are are outgoing, like social interaction, respond to external rewards, have more active dopamine networks, and are responsive to positive reinforcement. Extraversion (high levels protect from psychiatric illness) Introverts are more likely to be _______ motivated and more likely to respond to _______ reinforcement internally negative (more likely to interact with internal motivation/self-image) Interpersonal trait of cooperation, easy going nature. Tend to have smooth relationships often at the expense of self-assertion Agreeableness Associated with self-control and a focused, organized approach to life. Are achievement-oriented goal setters who can delay immediate gratification to obtain their long term desired outcome. They are considered responsible, reliable, and dependable. conscientiousness In behavioral couples therapy, the initial sessions are spent doing a functional analysis of behavior (FAB). What is true about FAB? FAB is concerned only with observable stimuli connected to operant behavior FAB is based on operant conditioning (identifying antecedent stimuli, operant behaviors, and consequent stimuli) The goal of FAB is modifying willful operant behavior Gestalt theory deals with _____, not _____ perceptual psychology behavior Medication that can delay ejaculation in patients with premature ejaculation Paroxetine (and other SSRIs) (others include: Topical anesthetic Tramadol Phosphodiesterase-5 inhibitors) First line treatment for lithium induced diabetes insipidus Amiloride (K potassium diuretic) in addition to dc lithium when possible. Ways to reduce polyuria associated with lithium toxicity reduce lithium dose to minimum effective dose take once daily at night (may be 5-30% lower than when given in divided doses over the day) Encourage adequate fluid intake What is true about ECT in Parkinson's disease it's more likely to cause transient delirium (worsened dyskinesias induced by l-dopa) Lithium effects with Parkison's disease may worsen tremor nonselective MAOIs decrease the efficacy of ______ and increase the risk of a __________ l-dopa products hypertensive crisis Selegiline is selective for MAO-B (after 10mg there is an increase in risk of serotonin syndrome if given with other meds that increase serotonin) SSRI's can _______ Parkinsonism tremor worsen (and decrease 'off time') Process describes the mechanism by which the hippocampus stores memories long-term potentiation loss of memory relating to a particular category of information (inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting) systematized amnesia Lack of memories from a circumscribed period of time, usually immediately following a traumatic event localized amnesia Person can recall some but not all of events from a particular time period selective amnesia Lack of memory of the patient's entire life generalized amnesia The drugs that are FDA approved for GAD Paroxetine Citalopram Escitalopram Venlafaxine Duloxetine Buspar A surrogate has the right to terminate pregnancy if the pregnancy threatens her health or life or she is a genetic parent If the surrogate receives both ovum and sperm from couple, she loses the right to determine whether or not child will be aborted (this is up to the couple) Which medication is most effective for treating social phobia/social anxiety disorder, especially when refractory? Phenelzine A 55-year-old female patient has Stg II HTN. On exam, she has trace pedal edema bilaterally, but her lungs are clear. Her ECG reveals 2nd degree heart block. Which of the following BP medications should be avoided? Calcium Channel Blockers 3 Contraindications to use a calcium channel blocker 1st or second degree heart block Bradycardia CHF 4 Side effects of calcium channel blockers Headache Lower extremity edema Bradycardia Heart Block An NP is evaluating a 78 year old female with depression. She suspects the patient may have Parkinson's disease. Which of the following is consistent with that diagnosis? Postural instability Pill-rolling tremor Shuffling Gait Difficulty initiating movement Mask-like facies (difficulty initiating movement) Writhing movements occur with Huntington's chorea 10 Non-motor manifestations of Parkinsons Autonomic dysfunction Gastrointestical dysfunction Rhinorrhea Sleep disturbance Fatigue Mood disorder Cognitive dysfunction Dementia Psychosis Hallucinations What type of therapy is most useful in depressed HIV positive outpatients? Interpersonal psychotherapy What type of therapy is most useful in patients with borderline personality disorder? Dialectical behavioral therapy The NP is caring for a patient dying of lymphoma. The pt's wife states that the pt has been mismanaged and that another practitioner must be assigned to the patient for him to improve. This NP suspects that this individual is in which stage of grief according to Elizabeth Kugler-Ross? Bargaining Involves resisting or refusing to remember information that has been supplied Denial Pica and spoon shaped nails are associated with Iron-deficiency anemia (microcytic) 2 common causes of microcytic anemia iron deficiency anemia of inflammation/chronic disease (TB, HIV, endocarditis, RA, Chrohn's DM, kidney disease, CA) (Other causes: lead toxicity, alcohol/drug use, zinc excess (copper deficiency)) Initial symptoms of B12 deficiency Generalized weakness Paresthesias Possible ataxia Late symptoms of B12 deficiency Memory impairment Depressed mood 5 P's of Vitamin B12 deficiency Pancytopenia (Peripheral and Posterior spinal cord) neuropathy Pyramidal tract signs Papillary atrophy of tongue (atrophic glossitis) 2 causes of megaloblastic macrocytic anemias Vitamin B12 deficiency Folate deficiency What neurotransmitter is thought to play the most significant role in social phobia? dopamine What neurotransmitter is thought to mediate social interest, gregariousness, confidence and sensitivity to rejection? dopamine According to Gonzalez-Jaimes and Turnbull-Plaza (2003, which type of therapy with psychocorporal, cognitive, and neurolinguistic components and a holistic focus is significantly more effective in patients diagnosed with adjustment disorder? mirror psychotherapy The ________ is part of the treatment to encourage a patient to accept his physical condition mirror Discussing medical diagnoses and the reaction to it, as well as treatment modalities medical conversation Therapy that emphasizes personal responsibility, focusing on the individual's experience at the present moment, the therapist-patient relationship, the context of the person's life, and adjustments people make as a result of their overall situation Gestalt Therapy PANDAs is associated with _________ infections and results in _______ symptoms Group A beta-hemolytic strep OCD After camping trip, pt began to have a petechial rash on her legs/trunk, parts of which are turning dark red and purple, temp 102.8, HR 1115, BP 88/50, mm pain, neck stiffness, severe HA. What is the dx? meningococcemia 1 mg of Xanax = _____ mg of Ativan 2 1mg of Xanax = ____mg of phenobarbital 30 1mg Xanax = ____ mg of Clonazepam (Klonopin) 1 1mg Xanax = ____ mg of chlordiazepoxide (Librium) 25 1mg of Xanax = ____ mg of diazepam (Valium) 10 Pt wanting something immediate and non-addictive for breakthrough anxiety Hydroxyzine How long do GAD symptoms need to occur to make the diagnosis? 6 months First lab test to check for Sjogren's Anti-nuclear antibody tests To diagnose Cyclothymic disorder, it must be present for _______ in adults 2 years To diagnose Cyclothymic disorder, it must be present for _______ in pediatrics 1 year 4 physiological disturbances that may explain some of the symptoms of panic impaired lactate metabolism abnormality of locus coeruleus (Ser, NE, GABA, Dop, cholecystokinin) carbon dioxide hypersensitivity (hyperventilation) A 45-year-old man presents to the ER for "panic attack". He appears agitated, confused, and dizzy. He became more agitated and combative with staff upon further questioning. He states he was prescribed Xanax 0.5mg 3x daily by outpatient psychiatrist. His vitals are WNL. What is most likely his dx Benzodiazepine intoxication [Show Less]
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PMHNP Questions and Answers 2022/2023
Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiery disorders? A. Increase levels ... [Show More] of CRF in amygdala, hippocampus and LC increase symptoms of anxiety. B. Decreaseing GABA in the Mesolimbic cortex diminishes symptoms of anxiery. C. Increasing serotoneric activity in the amygdala diminishes symptoms of anxiety. D. Decreasing NE in the LC diminishes symptoms of anxiety. A, C & D are all correct so the answer is B As a PMHNP, you know anti-psychotic meds have side effects. Which side effects of antipsychotic meds has an insidious delayed-onself of 1-2 after starting the medication? A. Dry Mouth B. Tardive Dyskinesia C. Wt gain D. Sedation We know that Dry mouth, drowsiness, dizziness, restlessness, wt gain, constipation & N/V are all SE but, Tardive Dyskinesia does not start for 1-2 years. My answer - B. Tardive Dyskinesia (TD) ** long standing blockage of DA2 in nigrostriatal pathway leads to TD Which Serotonin receptor antagonism makes an antipsychotic "atypical"? A. 5HT1A B. 5HT3A C. 5HT4A D. 5HT2A Atypical antipsychotic drugs such as clozapine, olanzapine, quetiapine, risperidone, sertindole, and ziprasidone are potent 5-HT2a receptor antagonists and relatively weaker dopamine D2 antagonists. Commonly Prescribed Typical and Atypical Antipsychotic Medications Typical antipsychotics include: Haldol (haloperidol); Loxitane (loxapine); Mellaril (thioridazine); Geodon (ziprasidone) Moban (molindone); Seroquel (quetiapine) Navane (thiothixene); Zyprexa (olanzapine) Prolixin (fluphenazine); Serentil (mesoridazine) Stelazine (trifluoperazine); Trilafon (perphenazine) Thorazine (chlorpromazine) Atypical antipsychotics include: Abilify (aripiprazole); Clozaril (clozapine) Geodon (ziprasidone); Seroquel (quetiapine) Zyprexa (olanzapine) Which medication inhibits both dopamine and norepinephrine? A. Venlafaxine (effexor) B. Duloxetine (Cymbalta) C. Buproprion (Wellbutrin) D. Imipramine (Tofranil) C. Buproprion (Wellbutrin) Bupropion inhibits the presynaptic reuptake of both dopamine (DA) and noradrenaline (NA), leading to increased levels of both of these neurotransmitters in the synaptic cleft Current understanding of Dopamine (DA) pathways & clinical symptoms in schizophrenia is reflected in which statement? A. Neg symptoms are related to DA deficit in meslimbic system and pos (+) symptoms are related to DA excess in the (SN) substanita nigra & (VTA) ventral tegmental area. B. (-) symptoms are related to DA excess in the CC cerebral cortex; + symptoms are related to DA in the (NA) nucleus accumbens and mesolimbic system C. (-) related to DA in (MS) mesolimbic system; + are related to DA deficit in the SN and VTA D. (-) related to DA deficit in the CC; (+) related to DA excess in the NA & MS ANS. D? In the case of schizophrenia and other psychological disorders, a positive symptom is one that adds a behavior, thought or feeling, whereas a negative symptom takes away a behavior, thought or feeling. Dopamine pathways Mesolimbic => pathway projections from VTA to the NA (nucleus accumbens in the limbic system; Increased dopamine in the Mesolimbic pathway mediates (+) symptoms. VTA => Mesocortical; Decreased DA in Mesocortical => (-)negative symptoms Nigrostriatal Pathway => (SN) Substantia nigra to the basal ganglia or striatum =>decreased DANigrostriatal (NS) Pathway (mediate motor movement)=> (SN) Substantia nigra to the basal ganglia or striatum =>decreased DA => dystonia, parkinsonian symp and akathsia. Hyperactivity of DA in NS pathway => hyper-movements disorders - tics, chorea (jerky movements) and dyskinesias (involuntary muscle movements). Tuberoinfundibular (TI) Pathway: projects from the hypothalamus to anterior pituitary TI pathway decreases prolactin release, increased DA=> positive symptoms (hyperprolactinemia, amenorrhea, galactorrhea & sexual dysfunction) What medication is recommended to be used in the treatment of NMS? Dantrolene (Dantrium) NE is a neuro transmitter that is implicated in alertness and Anxiety. What area of the brain has a large majority of NE neurons? A. Amygdala B. Hippocampus C. Nucleus Accumbens D. Locus Coeruleus Locus Coeruleus, located in the pons An inverse agonist produces which effect? A. Opposite of agonist, & causes the receptor to close the ion channel. B. Blocks the agonist from opening the channel, but does not activate the biological responw C. Does not fully activate the receptor and causes only limited actions D. Activates a biological response, and opens the ion channel A. Opposite of the agonist... An inverse agonist is a compound that binds to a receptor and produces a pharmacological response that is opposite to that of the corresponding agonist. An agonist increases the activity mediated by a receptor, an inverse agonist reduces it. In the presence of the agonist the inverse agonist acts as an antagonist. Adverse reactions from Antabuse (Disulfiram) Do not take disulfiram if you have consumed alcohol within the past 12 hours. Do not drink alcohol while taking disulfiram, and for up to 14 days after you stop taking this medicine. Disulfiram should never be given to a person without his or her knowledge of taking the medicine. does adding folic acid 0.8mg to lamictal and seroquel help Folic acid interaction Lamotrigine can inhibit folate metabolism, and it had been thought that adding folate would be useful. Until further data are gathered on folate augmentation in patients taking the combination of lamotrigine and quetiapine, Assessing an elderly patient who complains of tinnitus, what findings are associated with acoustic neuroma? A. Suppuration of the labyrinth B. Unilateral ringing in the ear C. Perforation of tympanic membrane D. Inflammation of middle ear B. Unilateral ringing in the ear The most common presenting feature of acoustic neuromas, occurring in 90 percent of patients, is unilateral hearing loss. ... Other symptoms of the acoustic neuroma include asymmetric tinnitus (ringing in the ear), dizziness and disequilibrium (difficulty with balance). Which of the following hematologic changes is associated with lithium? A. Anemia B. Agranulocytosis C. Leukocytosis D. Leukopenia ANS. => C. Leukosytosis Acute exposure to lithium can cause leukocytosis, whereas chronic exposure can produce aplastic anemia. Which mood-stabilizing drug has consistently been shown to decrease the risk of suicide for bipolar patients? ... Which mood-stabilizing drug is most associated with a life-threatening rash? A. Lamotrigine (Lamictal) B. Divalproex (Depakote) C. Carbamazepine (Tegretol) D. Lithium (Eskalith) A. Lamictal Which brain structure is activated in patients with extreme frea, panic and anxiety? A. Hippocampus B. Thalamus CCingulate gyrus D.Amygdala ANS =>amygdala The brain amygdala appears key in modulating fear and anxiety. Patients with anxiety disorders often show heightened amygdala response to anxiety cues. PMHNP would expect to see what when doing a physical exam on a patient with bulimia nervosa? A. Obesity B, Alopecia C Erosion of dental enamel D. Tachycardia17 C. Erosion of enamel Tooth Erosion Studies show that between 47 and 93 percent of bulimia nervosa patients who vomit exhibit damage to tooth enamel. ... Over time as the enamel is eroded by repeated exposure to gastric acid, teeth may lose their shine, break, turn yellow, wear down, chip, and look ragged. Which Serotonin receptor antagonism makes an antipsychotic "atypical"? A. 5HT1A B. 5HT3A C. 5HT4A D. 5HT2A D. 5HT2a Which antidepressant is associated with dose related adverse effects to cardiovascular system? (ie adhere to max recommended dose) A. Sertraline (Zoloft) B. Venlafaxine (Effexor) C. Mirtazapine (Remoran) D. Citalopram (Celexa) Answer: B. Venlafaxine (Effexor) Elderly patient presents for evaluation and is not able to correctly draw the face of the clock (MMSE), which area of the brain is likely to have compromised functioning? A. Right Hemisphere B. Left Hemisphere C. Wernicke's Area D. Corpus Callosum ? D. Corpus Callosum Changes in mental status, fever and rigidity are all symptoms of A. Serotonin Syndrom B. NMS C. Anticholinergic withdrawal syndrome D. EPS SE Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction. Pt, 62 yo female, bipolar I disorder is taking valproate & resperidone. Has shingles and is given corticosteroids. Adding corticosteroids may cause: A. Stevens-Johnson Syndrome B. a manic episode C. NMS D. hypertensive crisis A. Stevens-Johnson Syndrome PMHNP is evaluating a child. what features might raise concerns for genetic testing for Fragile X Syndrome? Long head, big ears, short stature and extension of joints. Which medication has a unique mechanism of action - both being dopamine and norepinephrine reuptake inhibitors? A. Venlafaxine (Effexor) B. Duloxetine (Cymbalta) C. Bupropion (Wellbutrin) D. Imipramine (Toframil) C. Bupropion (Wellbutrin) What screening tests has high sensitivity and specificity for identifying cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? A. Global deterioration Scale B. Dementia Rating Scale C. Clock Drawing Scale D. MMSE D. MMSE The information of SI, plan, or past attempt would be included in what part of the intake? H&P The Five A's for Health Behavior Change include the following: 5 A's elements (Assess, Advise, Agree, Assist, Arrange). What does the CAGE questionnaire stand for? Cut down (Ever feel you need to cut down on ___) Annoyed with others' comments about your drinking? Guilty (about your use) Eye opener (need to use in AM to function) When assessing a patient, what is the most important predictor of potential for violence? A. History of abuse B. History of SZ C. History of Head injury D. History of aggressive rage D. History of aggressive rage Why is general screening for dementia for the general population not recommended? Screening of apparently healthy individuals is only justified if there is an effective treatment for specific conditions identified. Screening of populations or groups before symptoms develop is clearly NOT justified at present as there is no drug that arrests clinically diagnosed dementia of the Alzheimer's type. MMSE is a brief standardized screening tool designed for use on what population? The Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the elderly; it includes tests of orientation, attention, memory, language and visual-spatial skills. 1. Alert Level: In general participant scoring below education-adjusted cut-off scores* on the MMSE may be cognitively impaired. An FNP colleague asks you, the PMHNP what antidepressant to start for a patient who scored a 15 on the PHQ9. Answer=> Score of 15 is moderate severity (MDD) give SSRI and refer to therapy. PHQ-9 Score Provisional Diagnosis Treatment RecommendationPatient Preferences should be considered5-9 Minimal Symptoms Support, educate to call if worse, return in one month10-14 Minor depression ++ Support, watchful waitingDysthymia Antidepressant or psychotherapyMajor Depression, mild Antidepressant or psychotherapy15-19 Major depression, moderately severe Antidepressant or psychotherapy>20 Major Depression, severe Antidepressant and psychotherapy(especially if not improved on monotherapy) PMHNP is evaluating the functional status of an elderly patient with depression. The Instrumental ADL scale tests which of the following activities? A. Toileting B. Telephone use C. Filing Taxes D Bathing Ans => Unsure if A or D => both are listed below Common ADLs include feeding ourselves, bathing, dressing, grooming, work, homemaking, cleaning oneself after defecating and leisure A middle aged male with a HX of schizophrenia is asked about his education level. Pt answers: tells you where he went to HS, his HS friends, activities he was involved in and his HS graduation. He then says, that was the end of my education. This is an example of what... A. Loosening of associations B. Tangentiality C. Perseveration D. Circumstantiality Ans => D. Circumstantiality Circumstantial speech (also referred to as circumstantiality) is a communication disorder in which the focus of a conversation drifts, but often comes back to the point. In circumstantiality, unnecessary details and irrelevant remarks cause a delay in getting to the point. PMHNP is a member of a crisis intervention team after a tornado destroyed over 100 home is the rural midwest. Which of the following statements is most appropriate at the initial encounter? A. "What is your biggest concern right now? I will help you as much as possible? B. "Tell me everything that happened. We'll sort through the next steps" C. "What medications were you taking? Let me work on that first" D. "You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK" A. what's your biggest... During an initial psychiatric eval, the patient reports ETOH and illicit drug use. This information whould be most appropriate in which part of the evaluation? A. Chief Complaint B. Mental Status Exam C. Review of systems D. Personal and social HX D. Personal and social history What is Clerambault syndrome Popularly called erotomania, the syndrome is characterized by the delusional idea, usually in a young woman, that a man whom she considers to be of higher social and/or professional standing is in love with her. What is Capgras syndrome? delusional belief that one or more individuals in the environement are imposters or doubles imitating someone else What is Fregoli phenomenon? The Fregoli delusion is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. ... This means that for any face that is similar to a recognizable face to the patient, the patient will recall that face as the person they know. What is displacement? transfer of feelings to a less threatening person What is rationalization? Making excuses for behaviors that are considered unacceptable Dissociation a split in consciousness, which allows some thoughts and behaviors to occur simultaneously with others Which medication for ADHD is FDA approved for a 3 yo? A. Fluoxetine B. Amphetamines C. Methylphenidate D. Bupropion ... [Show Less]
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ANCC PMHNP Questions and Answers!!
Reflexes expected at 1 month Moro until 4 months, Palmer until 4 months, Plantar util 8 months, Babinski (2 years is disease) Signs of fetal alcoho... [Show More] l syndrome small head, shoey palpebral fissure, inner epicanthal folds. Do IEP and early intervention specialist Rhett Syndrome a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally unitl about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities EPS types Tardive dyskinesia happen after years (eps is a precursor). Acute dystonia (hours), Parkinsons (weeks), Akathisia (days) Where do EPS originate nigrostiatal tract. How does tegretol interact with cipro cipro and erythromycin are inhibitors. Cause increased level of Tegretol. Black box warning Tegretol side effects Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro nuchal rigidity stiffness in cervical neck area, meningitis ACE inhibitors -pril, CHF signs of serotonin syndrome -shivering -anxiety -diaphoresis -hyperthermia Shits and Shivers diarrhea, shivering, hyperreflexia/myoclonis, increased temperature, vital sign instability, encephalopathy, restlessness, sweating Serotonin Discontinuation Syndrome syndrome caused by abrupt withdrawal of an antidepressant drug, resulting in sensory disturbances, sleeping disturbances, disequilibrium, flu-like symptoms, dizzy, vertigo, paresthesia (brain zaps), nausea/vomiting, and gastrointestinal effects NMS neuroleptic malignant syndrome Severe fever Changing LOC Autonomic instability Rigidity Sweating and drooling FEVERS- fever, encephalopathy, vitals instability, elevated white blood cell count/cpk, rigidity Levels of Prevention Primary: prevent/promotion, classes, safety initiatives, education, classes, modifying environment Secondary: screen-early detection, crisis hotlines, disaster Tertiary: treat- to prevent further deterioration, rehab, restoration, day treatment, social skills Risk factors for serotonin syndrome more than 1 SSRI, st johns wart, tramadol, demerol, ultram, maperidone, 5HT Grade 2/5 hoarse systolic heart murmur aortic stenosis Woman with GAD advise on medication stop benzos because can cause floppy baby syndrome and cleft palate, cotinue buspar What to give to agitated pt in seclusion IM Geodon Labs for macrocytic anemia Folic acid, vitamin B12, ESR/CRP, HGB, MCV (liver) When to assess a patient in restraints for face/face 1 hour then 8 hours therapeutic communication open ended, 'tell me' Reluctant/silent patient open ended questions Patients husband shows up but not the patient both people need to be present, reschedule Abnormal Trendelenburg Test Hip disease, refer child out, assessed during head to toe Hamilton Depression Scale i. Severe 19- 23 (monitor for SI) ii. Moderate 14 - 18 iii. Mild 8 -13 0-7 normal GAD-7 scale More than 15 severe HAM-A Hamilton Anxiety Scale, most commonly used 14 domains, 14=mild, 18-24= moderate, 25-30=severe Anxiety 25/15 severe Scope of practice comes from the state, board of nursing/american nurse association Elderly patient with dementia how do you know id can give consent Able to repeat back risks and benefits elements= nature/pupose of tx, risks/benefits of tx, risks/benefits not doing tx, alternatives, diagnosis/prognosis Patient moving states, what do you do with medication? send enough medication is standard of practice just culture refers to an organization's commitment to accountability and a focus supporting universal safety in health care. Find out the error ad where went wrong 2 classes of medications that should not be used together? Ace inhibitors and ARBs together Keeping chronically mentally ill in the community? ACT model Law that makes sure people with mental health issues get the same financial treatment? Parity Laws Brother sexually abusing sister make sure that he is not left alone with her and call CPS, mandatory reporter, arrange crisis therapy Kleinfelter's Syndrome male with more than one X chromosome (XXY), little to no sperm, fertility treatment clozaril wbc+anc If less than 950 discontinue the medication and get a repeat level, 1000 is the cutoff 1.5-2 cbc biweekly 1-1.5 hold, cbc q dayx 3 weeks less than 1- Stop medication 12.5initial, target 300-900mg/d once or bid schizophenrenia/pscyhosis agranulocytosis, seizures, myocarditis (inflammed heart muscle -chest pain,diff breath) wg, increase lipids/glucose REMS pharmacy need clozaril registry to dispense to start: WBC must be >_3500 and ANC >_2000 WBC + ANC weekly q6months, then every 2w q6months, then monthly Labs for rheumatoid arthritis . ESR erythrocyte sedimentation rate elevation. Synovial fluid analysis. X ray of joints. Rheumatoid factor titer, CRP, Hgb PTSD nightmares prazosin adjustment disorder reaction to a specific life event (identified stressor), symtoms within 3 monhts but no more than 6 months. Think about a patient move Norepinephrine (NE) Synthesized in locus coeruleus arousal and other functions like mood, hunger, and sleep locus coeruleus a small nucleus in the reticular formation that is involved in directing attention 5HT raphe nucleus raphe nuclei a string of nuclei in the midline of the midbrain and brainstem that contain most of the serotonergic neurons of the brain substantia nigra midbrain structure where dopamine is produced; involved in control of movement dopamine production substantia nigra and ventral tegmental area ventral tegmental area (VTA) midbrain structure where dopamine is produced: associated with mood, reward, and addiction Acetylcholine (ACh) nucleus basalis of meynert Nucleus basalis of Meynert Alzheimer disease cognitive and memory function PICOT P: Population/problem I: Intervention/issue C: Comparison O: Outcome T: Time shrill cry Increased cranial pressure PANDAS Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. OCD- recent strep throat PTSD Acute stress disorder- less than 1 month PTSD- after 1 month Medicine that can cause mania steroids/prenisolone, antabuse, isoniazid, patient wakes up screaming at night ask family if anyone else has sleep problems pulling hair out OCD/trichotillomania how do you get paid for medicare CPT current procedural code patient in hospital with no family and failing cognitive test perform an MRI, labs to rule out substances Patient cold what labs to get? Check TSH. What medication to give for serotonin syndrome Cyproheptadine Medication for NMS? Dantrolene and bromocriptine Zung scale from 25-100, 25-49 is normal, 70+ is severe Beck Scales Eight, separate, self-report inventories designed to assess different areas. Scores from 0-63 over 30 is severe PHQ9 score 1-27, over 20 is severe zung, beck, PHQ9, HAM 70, 30, 20, 25 DEA regulation monitoring State and Federal, PMP Aggression in brain Stimulation of the amygdala results in augmented aggressive behavior hypothalamus, is believed to serve a regulatory role in aggression nurse attacked 3 weeks ago and now scared to go to work Acute Stress Disorder, as it happened less than 1 month ago masturbating 3 year old Phallic stage is normal 3-6 years old Elderly female with decreased sex drive check testosterone level OB/PMHNP in same clinic increased access to mental health access NMS -NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool NMS labs increased CPK, WBC Lithium level is 1.4 monitor for toxicity, toxicity=1.5, nausea, vomiting Lithium toxicity 1.5, 3 is an emergency, severe diarrhea/nausea/vomiting, metallic taste, tremor, slurred speech, number one intervention, give fluids, sweating give electrolytes too NSAIDs & ACE inhibitors effect can double lithium levels ibuprofen + lithium increases the serum level of lithium up to double Lab values concerning for patients on lithium 4+ protein in urine, Leukocytosis, creatinine, BUN, Na, Erythromycin and Tegretol Erythromycin is an inhibitor (H=high level). If on Tegretol and Erythromycin together would want to reduce the dose of Tegretol 14 year old with no axillary hair, has not gotten her period yet Normal tanner stage, start by 16 On Interferon and Lexapro Interferon can cause depression, increase Lexapro Accutane can cause depression and birth defects Patient on risperdal and elevated prolactin stop or decrease the medication, tubin tract Neurotransmitters involved in alcoholism dopamine and gaba Patient abusing stimulants, what does NP assess for Insomnia and tremor, irritability, weight loss, nervous, hypertension, tachycardia Anorexic teenager with pain when eating refeeding syndrome causes delayed gastric emptying Beck inventory score of 10? 0-63, over 30 severe, dont start medication just start therapy Treatment for ADHD stimulant and therapy together 65 year old started on a SSRI may experience an increase in anxiety in elderly, expect increased side effects, do an EKG What medication can alter absorption of antipsychotics? Antacids, can decrease antispsychotic effects Dark brown urine check LFT, Person with EPS will most likely experience what Tardive dyskinesia Apoptosis? neuron loss because of suffocation, enzyme breakdown Patient lost a friend now experiences paralysis conversion syndrome, repression of unconscious intrapsychic conflicts patient continues to say "I dont know" depression, not dementia MMSE scores 24-30 no cognitive impairment 18-23 mild cognitive impairment 0-17 severe cognitive impairment Early signs of aids dementia memory, inattention, concentration changes, worry over decreased cognition Frontal lobe dementia A form of dementia characterized by personality changes/social changes , Wandering, disoriented person on the streets for 2 days delirium The health care policy is access, cost and ____ quality Phases of policy making formulation, implementation, evaluation Flonase interacts with what mood stabilizer? Tegretol (inhibitor) Smoking cessation and antipsychotic decrease the level of Zyprexa, smoking is an inducer causing decreased levels of the medication. When stop smoking re-increase the medication Clenched teeth? CN 5 Trigeminal (masseter or masticatory muscle). Puff cheeks CN 7 facial (sensory and motor) Started on a medication then comes back in 2 weeks? Increase the dose after 1-2 weeks, therapeutic effects 4-6 weeks Zantac is for what? H2 inhibitor Best therapy for negative thinking CBT, all or nothing thinking catastrophic thinking Humanistic therapy-self Existential- reflection/self control/personal responsibility Patient is borderline and suicidal what therapy? DBT, goal to decrease emotional reactivity/crisis bxs and self validation. Tics what advise? fairly common in children and will often remit on its own, ADHD concomittant ODD child help the parents with positive reinforcement and parenting skills, limit setting, logical consequences, consistency, power stuggle/control issues problematic, parenting/family dysfunction exacerbates Fungus on toenial scrape toenail and sent for testing Age for schizophrenia female 25-35 bipolar not taking medication "tell me how the medication works in your body" patient has neuropathic pain, what medication will help? gabapentin not helping Alpha 2 delta, pregabalin- lyrica When opening independent practice consider cost and revenue, must calculate the time spent with patient vs time spent on risk called indirect vs direct processing Can disclose info to medicare /CMS without consent ... First line neuro-protective for bipolar lithium What to check in terms of depakote in young girl check HCG, blackbox for pregnancy, can cause spinal bifida-tetrogenic, also check LFTs, CBC assertive inquiry ... Appreciate Inquiry strengths and competencies. What is being done currently and assessment of strenghts, no problem focused, 3 steps are discovery, understanding, amplifying Np notices teen with DKA leaving without eval collaborate with ER to provide a psych assessment MMSE part for thought disorder proverb interpretation, abstract vs concrete interpretations Teen commits suicide, NP does presentation to teens in order to normalize the grieving process To reduce stigma among teens seeking mental health... educate friends/peers Experiencing irritability/depression/edginess? best assessment is mood questionnaire for bipolar, 7/13 bipolar likely Telemedicine asking a legal question?? Licensing jurisdiction for the np Adolescent with substance abuse and working out has muscle aches urine is red colored- hematuria, concerned for rhabdomyolysis (muscle breakdown), What are you looking at when you are assessing the function of an elderly individual ability to manage a checkbook, instrumental ADLs go first (meds, phone, drive, house week, balancing check book), then ADLs eating/dressing, Exec functions=judgement, planning, taxes First symptom of metabolic syndrome? large waist circumference Autistic child not responding to your verbal commands this is normal, repetitive patterns of bx, impaired social interactions, verbal/nonverbal communication common Women is anxious about administering medication to a child stop and address her anxiety Why would you be concerned about immature retuculocytes? tests looking at reticulocytes hep evaluate conditions affecting RBCs such as anemia, low reticulocytes may be seen with iron deficiency anemia, pernicious anemia, folic acid deficiency, aplastic anemia First line neuro-protective for bipolar lithium What medication can alter absorption of antipsychotics? ... 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ANCC PMHNP Exam Reviewed Questions and Answers
How do you assess cranial nerve V trigeminal? Tell patient to close eyes, take piece of cotton or other soft item and lightly touch either one of both sid... [Show More] es of each of the three divisions of the trigeminal. How do you assess for cranial nerve VII facial? Observe the patient for nystagmus or twitching of the eye. This nerve controls facial movements and expression, check for symmetry. Have the patient wrinkle forehead, close eyes, smile, pucker lips, show teeth, and puff out cheeks. primitive reflexes reflexes, controlled by "primitive" parts of the brain, that disappear during the first year of life Mororeflex Extending of limbs when they hear a loud noise (defend themselves) rooting reflex a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple palmer grasp grasping with the whole hand scope of practice The range of clinical procedures and activities that are allowed by law for a profession Quality Improvement (QI) an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy PDSA model Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI) Trendelenburg sign Occurs with severe subluxation of one hip When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side CYP450 inhibitors Fluvoxamine Fluoxetine Paroxetine Duloxetine Sertraline CYP450 inducers Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin St John's Wort What is the adverse effect of Depakote on the liver? can cause liver damage, and the risk is more likely to occur during the first 6 months of taking the medication. Signs might include nausea or vomiting, loss of appetite, abdominal pain, dark-colored urine, facial swelling, and yellowing of the skin or white of eyes What would you do for a patient on Depakote with +4 protein in the urine? Rule out UTI, no adjustment for medication is needed What happens when you take carbamazepine (tegertal) and erythromycin together? It will decrease the effect of the antibiotic by inhibition What happens when you take zyprexa and smoke? nicotine will increase the excretion of the drug thereby inhibiting it's effect ICP in Infants S/S Bulging fontanels, high-pitch cry, irritability, restlessness ICP CHILDREN signs and symptoms • Headache • Vomiting (usually projectile) • Seizures • Diplopia (Dbl vision), blurred vision Neuro cry high-pitched and very grating on the ears due to their neurological sxs being overwhelmed Neuroleptic Malignant Syndrome Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes. FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles NMS treatment Dantrolene D2 agonists (e.g., bromocriptine). lead poisoning A medical condition caused by toxic levels of the metal lead in the blood Lead poisoning treatment chelation therapy Amygdala's role in emotion - Aggression center - Role in storing implicit emotional memories - Stimulation (+) anger/violence or fear/anxiety - Damage (-) mellow; hyperorality; hypersexuality; dis-inhibited behavior Amygdala role in aggression Small volume increase aggression. Frontal Lobe Atrophy As neurons die in the frontal and temporal regions, these lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally controlled by these parts of the brain. ... Scientists think that FTLD (frontal temporal lobe dementia) is the most common cause of dementia in people younger than age 60 Four dopaminergic pathways mesocortical mesolimbic nigrostriatal tuberoinfundibular mesocortical pathway a path through which dopaminergic projections travel to reach the neocortex mescolimbic pathway The mesolimbic pathway, sometimes referred to as the reward pathway, is a dopaminergic pathway in the brain. The pathway connects the ventral tegmental area in the midbrain, to the ventral striatum of the basal ganglia in the forebrain. The ventral striatum includes the nucleus accumbens and the olfactory tubercle. Nigrostriatal pathway the dopaminergic tract from the substantia nigra to the striatum Tuberoinfundibular pathway from hypothalamus to anterior pituitary -> DA released from these neurons inhibit prolactin secretion -> when DA receptors here are blocked prolactin levels rise cause galactorrhea) primary prevention Efforts to prevent an injury or illness from ever occurring. secondary prevention Efforts to limit the effects of an injury or illness that you cannot completely prevent, screening exams. tertiary prevention actions taken to contain damage once a disease or disability has progressed beyond its early stages menopause hormone therapy most effective therapy for moderate -severe vasomotor symptoms - use quality of life scales to identify degree of vasomotor symptom severity *should not be used for protection against CVD or dementia congestive heart failure and depression MDD is highly prevalent in these patients Thyroid levels while on lithium Because of the high incidence of thyroid dysfunction that occurs during lithium treatment, patients should have a careful thyroid physical examination and determination of serum thyroid-stimulating hormone (TSH) and antithyroid peroxidase antibody titers before lithium treatment is begun. Patients with normal thyroid function initially should be reevaluated every 6 to 12 months for several years, and thyroid dysfunction should be treated if diagnosed. The development of thyroid dysfunction does not typically require discontinuation of lithium. If thyroid function is abnormal at the initial evaluation, lithium can still be given if necessary, but the thyroid dysfunction should be treated. SSRIs MOA block reuptake of serotonin by inhibiting the presynaptic reuptake SNRIs mechanism Inhibit 5-HT and norepinephrine reuptake. Lithium mechanism of action Not established, possibly related to inhibition of phosphoinosital cascade It inhibits excitatory neurotransmitters such as dopamine and glutamate, and promotes GABA-mediated neurotransmission. Carbamazepine mechanism Block voltage-dependent sodium channels Structural Therapy A therapeutic approach directed at changing or realigning the organization of a family to modify dysfunctional patterns and clarify boundaries. Developed by Salvador Minuchin. crisis intervention five-step problem-solving technique to promote adaptation and improve future coping Irvin Yalom A leading figure in contemporary group therapy, especially the interpersonal approach group therapy therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction boderline personality disorder impulsive actions, often with the potential for self-harm as well as mood instability and chaotic relationships DBT (dialectical behavior therapy) a form of therapy used to treat borderline personality disorder that combines elements of the behavioral and cognitive treatments with a mindfulness approach based on Eastern meditative practices eating disorder treatment -correct dangerous eating patterns -address psychological and situational factors that have led to / are maintaining the disorder -often requires family and friend participation When to admit for eating disorder? 75% below ideal body weight and/or electrolyte imbalances just culture culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action GERIATRIC ANEMIA lower than normal RBC that is common in seniors PHQ-9 scores 1-4 min depression 5-9 Mild depression 10-14 moderate depression 15-19 Moderately severe depression 20-17 Severe depression Beck Depression Inventory (BDI) 1-10 normal 11-16 Mild 17-20 Borderline depression 21-30 Moderate 31-40 Severe Over 40 Extreme HAM-D 0-7 normal 8-16 Mild 17-23 Moderate 24 (+) Severe HAM-A 17 or less indicates mild anxiety 18-24 mild to moderate anxiety GAD-7 1-4 minimal anxiety 5-9 Mild anxiety 10-14 Moderate anxiety 15-21 Severe anxiety Zung Self-Rating Depression Scale 50-69 indicates depression 70 (+) severe depression MoCA 26-30 normal 22.1 mild impairment 16.2 Alzheimer's Disease MMSE 24-30 normal 23-20 mild 19-10 middle-moderate Alzheimer's 9-0 Late stage-severe Alzheimer's Dementia a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes delirium an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech. Pediatric SSRIs fluoxetine (ages 8 and up) escitalopram (ages 12 and up) Pediatric OCD FDA medications clomipramine (anafranil) 10 years and up fluoxetine (prozac) 8 years and up fluvoxamine (luvox) 8 years and up sertraline (zoloft) 6 years and up galactorrhea abnormal flow of milk from the breasts Dopamine a neurotransmitter that regulates motor behavior, motivation, pleasure, and emotional arousal Serotonin A neurotransmitter that affects hunger,sleep, arousal, and mood. GABA An inhibitory neurotransmitter in the brain. Glutamate A major excitatory neurotransmitter; involved in memory Acetylcholine A neurotransmitter that enables learning and memory and also triggers muscle contraction Crisis training is proven to be effective in helping to deescalate situations to prevent the officer from using what? Lethal force Signs of child abuse Head injuries;bruises and welts in the shapes of objects;Burns;human bites;rope burn;fractures in different stages of healing AIDS dementia complex (ADC) Encephalitis, behavioral changes, decline in cognitive function Progressive slowing of motor functions Apoptosis process of programmed cell death Recovery (training principle) Holistic, person-centered approach to mental health care. Two premises: 1) It is possible to recover from a mental health condition; 2) The most effective recovery is patient-directed neuron death the stage of early nervous system development during which large numbers of neurons die, typically those that have not established effective synaptic contacts Mini-Cog Test ■ Quick method for assessing dementia. If abnormal, screen further with MMSE. ■ Use these two methods: the clock drawing test with word recall test (three unrelated words). ■ Instruct patient to draw a clock and mark it with the hands showing a certain time. ■ Example: Instruct patient to "Draw a clock that shows 20 minutes past 4." - Scoring clock test: Hands point to the correct time and numbers on clock are in correct sequence. meta-analysis a statistical technique that averages the results of two or more studies to see if the effect of an independent variable is reliable PTSD diagnostic criteria Three or more of the following should be present for more than 1 month: 1. Inability to recall an important aspect of the event 2. avoidance of activities, people, places that remind the patient of the event 3. attempts to avoid thinking or talking about the event 4. Feelings of detachment or estrangement from others 5. markedly decreased interest or anhedonia (inability to experience pleasure) 6. Restricted Range of Affect 7. Belief ones future has been foreshortened because of the event 8. Increased state of arousal characterized by insomnia, irritability, angry outbursts, poor concentration, hypervigilance, exaggerated startle response PTSD treatment MEDICATIONS: - Antidepressants (Zoloft, Paxil). - Anxiolytics. - If manifestations include nightmares or insomnia, Minipress has been prescribed. (Normally used to treat HTN, Minipress blocks the brain's response to NE and has been effective in suppressing nightmares.) THERAPY: - Cognitive Therapy - Exposure Therapy Zyprexa (olanzapine) monitor for metabolic syndrome Risperidone (Risperdal) monitor for prolactin level increases gastric emptying drugs Metoclopramide, Erythromycin, Domperidone, Cisapride oversupply linked to schizophrenia. undersupply linked to tremors and decreased mobility in Parkinson's disease Dopamine With Alzheimer's disease, ACh-producing neurons deteriorate. Acetylcholine undersupply of serotonin linked to depression Undersupply of norepinephrine. can depress mood undersupply of GABA linked to seizures, tremors, and insomnia [Show Less]
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ANCC PMHNP Questions with complete Answers!!!!
Purpose of Dopamine Inhibition of prolactin production Sleep Learning Attention Pleasure and reward Movement Memory Mood What term best desc... [Show More] ribes the reelationship between an individual's health and a number of other variables, including the amoutn of healthcare consumed? Health production function- math expression that shows the relationship between an individual's health and a number of other variables. How much time should you allow for Celexa to provide its initial therapeutic effect and the patient to see an improvement in symptoms? 4-6 weeks Clients have what rights? Right to privacy and confidentiality Right to least restrictive treatment measures Right to consent and withdraw consent at any given time Which inferential statistic determines whether the means of 2 groups are statistically different from each other? t-test enables one to reach conclusions that extend beyond the immediate data alone (ANOVA tests the difference among 3 or more groups, Pearson's r correlation- tests the relationship between 2 variables, probability-likelihood, p value- probability of a particular result occurring by chance) What symptoms would a patient exhibit if they were experiencing an excess serotonin? Restlessness, agitation, myoclonus, vital sign abnormalilties What term descries a colletion of individuals who coordinate lobbying efforts around a common interest and seek to influence policymakers? Special interest group. What are 3 phases of a therapeutic relationship between NP and pt? 1. Intro 2. Working- 3. Termination The following describes what stage of a therapeutic relationship? Clarifying patient expectations, ID goals, treatment plan, preventative healthcare, measuring outcomes of care, reprioritizing plan Working phase Which type of family therapy uses genograms, structural mapping, emphasizes understanding to produce change in the family structure. Structural family therapy Symptoms of exess GABA excess sleepiness, increased blood pressure, shallow breathing Symptoms of insufficient GABA Sz, trouble concentrating, insomnia, depression, anxiety A Hamilton Anxiety score of 14-17 indicates what? Mild Anxiety A Hamilton Anxiety score of 18-24 indicates what? Moderate Anxiety A Hamilton Anxiety score of 25-30 indicates what? Severe Anxiety When would you not use seclusion and restraint? Extremely unstable medical or psychiatric conditions Delirious or demented patients unable to tolerate decreased stimulation Overtly suicidal patients When should you use seclusions and restraint? Prevent significant disruption to treatment program or physical surroundings Decrease sensory overstimulation What is the difference between pharmacokinetics, and pharmaodynamics? pharmacokinetics is whatthe body does to drugs, pharmacodynamics is what the drug does to the body Problems with the frontal lobe could lead to what personality changes problems with the temporal lobe can lead to aphasia and amnesia problems with the occipital lobe can lead to visual field defects problems with the parietal lobe can lead to densory perceptual disturbances and agnosia This type of advanced nurse evaluates, diagnoses, and treats a wide range of medical conditions nurse practitioner This type of advanced practice nurse consults researches educates and coordinates care Clinical nurse specialist This type of advnaced practice nurse provides well-woman gyno care, management pregnancy, child birth, antipartum post partum. Nurse midwife According to Piaget wat what cognitive stage do children develop object permanence? sensorimotor Occurs when a patient is unabe to see others as somethimes good sometimes bad splitting what is the therapeautic dose of riseridone for an adolescent? 3 mg What core comopetency is the NP demonstrating when she evaluates the appropriate use of seclusion and restraints? NP core competency: Quality What core competency is the NP demonstrating when participating in a special interest group? NP core competency: Policy By whom and where was the first NP role introduced? Loretta C. Ford, Henry Silver; University of Colorado What factors constrain the growth of the NP role? Increased concerns over reinbursement fraud and abuse, reinbursement struggles, need for formal supervisory or collaborative relationships with physicians, overlapping scope of practice What regulatory or statutory dimension provides different rules and regulations for each state? Statutory law What regulatory or statutory dimension forms a process by which an agency of state government grants permission to persons to engage in the practice of that profession? Licensure What regulatory or statutory dimension forms a process used to protect the public by ensuring a minimum level of professional competence. Credentialing What regulatory or statutory dimension determines the scope of practice and assures the public that a person has mastery of a specified body of knowledge. Certification HITECH(health information technology for economic and clinical health Act) meaningful use incentive charting system for physician order set Incentive payment for sharing specific electronic health record(EHR) Basic criteria for involuntary admission danger to self or others unable to care for self poor nutritional intake What are the four main components of HIPPA To be educated, have access, the ability to request amendments and permission for disclosure Voluntary Commitment entails Admission, Client of all civils liberties, client consents to confinement What is the communication process between the provider and the client that results in acceptance or rejection of the the proposed treatment Informed Consent Promoting well-being and doing good Beneficence Doing no harm Nonmaleficence Being true and loyal fidelity Doing for self Autonomy Telling the truth Veracity A male client approached the NP for a date. The NP went out on one date with the client, but ended the relationship due to this element of negligence Breach of duty What Act of 2009 requires incentive if payments, is a part of the meaningful use and can improve health outcomes HITECH ( Heath Information Technology for economic health record) Durable power of attorney contracts are or are not legally binding in all 50 states Are legally binding in all 50 states Living wills are or are not legally binding in all 50 states Are not legally binding in all 50 states All of the following are Cluster A personality disorders Schizoid, Schizotypal Paranoid What is another name for durable POA a healthcare proxy All of the following are Cluster B personality disorders Histrionic, Borderline, Narcissistic, Antisocial All of the following are Cluster C personality disorders OCD, Dependent, Avoidant Cluster A personality disorders can best be described as what? Odd and eccentric Cluster B personality disorders can best be described as what? Dramatic and Erratic Cluster C personality disorders can best be described as what? Fearful and anxious · No: Ibuprofen increases plasma levels of lithium Would you give Ibuprofen to a patient receiving lithium? What are the two main types of a Systematic Review? · Meta- Analysis: Statistically analysis quantitative studies · Meta Synthesis: Statistically analysis Qualitative Studies What are the different types of Validity in research? · External Validity: When the sample is representative of the population and the results can be generalized. · Internal validity: When the independent variable causes a change in, he dependent variable. · Probability: The likelihood of an event occurring · Standard Deviation: Indication of possible deviation from the mean. What is the most used legal substance? ETOH ... See pg 296 of the purple book! Highest in the African American Population What is the difference between Certification and Credentialing · Certification is a process by which a professional organization certifies that an individual has net certain predetermines standards. · Credentialing is a process that is used to protect the public by ensuring a minimum level of professional competence. · Licensure: is a process by which an agency of state government grants permission to individuals to engage in practice Different types of Therapy · Klerman and Weissman created interpersonal Therapy. · Sigmund Freud created Psychoanalytic Therapy. · Anna Freud and Melanie Klein contribution sin Psychoanalytic Child Theory · Aaron Beck- Created Cognitive Therapy · Carl Rogers: Humanistic Therapy (Person Centered) Murray Bowen: Family Therapy Antidepressants that do not depend on the CYP2D6 for Metabolism. Lexapro, Zoloft and Remeron Medicare vs Medicaid -Medicare - Over 65, Younger individuals with disabilities, individuals with End stage Renal Disease. Individuals in he need of a kidney transplant, individuals receiving social security for a disability of amyotrophic lateral sclerosis. -Medicaid- Low-income children, Low income pregnant women, elderly and disabled individuals who qualify for the supplemental security income program -If a woman is taking tamoxifen for Breast Cancer do not RX: Paxil, Prozac, or Wellbutrin Valerian Root is considered a psychoactive herbal substance to treat insomnia, anxiety and restless. Risk factor for developing a somatic disorder Female Lower Socioeconomic Unemployed Olde age Fewer years of education Recent stressful life events Negative affectivity Childhood sexual abuse Comorbid psych condition Perceived illness benefits Sensitization of pain Heighted attention to body sensation -The difference between culture and ethnicity Culture is learned behaviors, socially inherited characteristic. Ethnicity: self-identified race, tribe, or nation -Family Vs Community: Family is defined as a group of adults and children who are usually related and carry out the essential functions of life. Community; group of families sharing the same race, tribe, or culture. Family Vs Community: Family is defined as a group of adults and children who are usually related and carry out the essential functions of life. Community; group of families sharing the same race, tribe, or culture. Competency to be executed was established in the supreme Court Ford Vs Wainwright -Depolarization- Influx of sodium and calcium into the cell Repolarization -Kt leaving the cell or Chloride entering the body. Therapeutic Relationship: Introduction: Boundaries, Agreed time frame Working: Measuring, reprioritizing Termination: long term plan of self-management, Reemergence of symptoms Countertransference delt with Peer to Peer Abilify has the lowest risk of sedation of all Antipsychotics the homeless population has a co-occurring Mental Health Issue and Substance Abuse. What Percent 50% the most widely used psychoactive drug in the US. Cannabis i The first step in hearing your patient say they will kill someone; you must notify the person that they are in danger and then call the police. - Stages of Psychosexual Development (Freud) - Oral- birth to 0-18 - Anal -12-18 to 3 years - Phallic- 3to 5-6 years - Latency- 5-6 to adolescence - Genital- adolescence to adulthood Stages of Erick Erikson see image Normal Labs Kt and NA see results Normal TSH 2-10mu/I see page 87 Normal lithium levels 0.5-1.2 Tests for Lithium -Cardiac: ECG, especially in patients at risk of unmasking Brugada syndrome; cardiac function at baseline and at regular intervals thereafter-Endocrine: Thyroid function at baseline and at regular intervals thereafter-Metabolic: Lithium levels at baseline and at regular intervals thereafter-Renal: Renal function tests (e.g., urinalysis, urine specific gravity, serum creatinine, creatinine clearance), especially in patients who develop polyuria and/or polydipsia And Pregnancy Test Deferential Vs Inferential Statistics see image What is the assessment for ETOH Detox CIWA What is the assessment for Opioids Detox COWS ETOH Screening Test for Geriatrics S-MAST /Known as the Alcohol Screening Test for Geriatric What antidepressant can give false positive for Methamphetamines' Wellbutrin What antidepressants can give a false positive for Benzo Zoloft What Benzo can give a false positive for ETOH Valium Nyquil can give a false positive for what methadone Assessment for Benzo withdrawal CNSDP What area of the body if dysregulated can result in anxiety and panic Vestibular Dysfunction What developmental phase, if not accomplished, can result in Conversion disorder Initiative vs guilt Culture explanations labels, attributes or features of a culturally recognized etiology for distress Culture bound syndromes Clusters of symptoms that tend to occur in or among individuals in a certain culture Culture idioms terms that are used to describe ways of sharing their experience of suffering Norepinephrine attention, focus, memory and learning (AFML)Apples falls more than leaves Dopamine Thinking, fine muscle action, reward ( TFR) Troy found Renee GABA Reduces Arousal Aggression and Anxiety ( AAA) Triple A Adam Asks Alison ( Two A's in GABA) Serotonin Regulates: Sleep, Mood, pain, and temp (SMPD) Basil Ganglia Somatic Motor Activity: initiates complex motor function and maintains tone posture and common reflexes A common psyhoactive herbal supplement used to treat insomnia Valerian root Patient was previously accepting of treatment but now appears agitated. Presents with personality changes over the past year, memory impairment, asterixis, palmar erythema, peripheral edema, and a large ecchymotic area left elbow. Why? Hepatic encephalopathy; the loss of brain function when a damaged liver does not remove toxins from the blood. This patient has presented with at least four mood episodes in the past year. What additional specifier will the practitioner add to the diagnosis of depression? Rapid cycling Which theorist believed that humans develop through learning, cmprehending, and cognition. Child's development is shaped through native endowment and factors. Jean Piaget Which statement most acurately describes grassroots lobbying When nonpaid individuals contact their legislators to influence policy Restless leg syndrome can be associated with compromised levels of what blood protein ferritin Anxiety and depression an be assoiated with compromised levels of what blood protein? folic acid What are the common with drawal symptoms assessed on the CIWA scale n&v, tremors, paroxysmal sweats, agitation, tactile disturbances, ha, altered sensorium Which theorist was the first person to develop specific phases of group Irvin Yalom Theoretical group phases developed by the first theorist to develop specific phases of group Pregroup, forming, storming, norming, performing, adjourning What vitamin is used in treating neurological disorders, diabetes, and premenstraul syndrome? Vitamin E What vitamin plays important roles in maintaining calcium absorption Vitamin D Acupuncture and acupressure aid in the activity of endorphins by manipulating point of energy flow in the body What vitamin plays important roles in the repair of tissue and enzymatic production of certain neurotransmitters Vitamin C What vitamin plays important roles in cell metabolism Vitamin B Biofeedback Teaches a patient to control their own physiological responses Massage Increases blood circulation, lymph flow and enhances musculoskeletal tone Aromatherapy simulates the olfactory system to elicit feeling and memories Technology Informatics Guiding Education Reform (TIGER) A 10-year plan Nursing path toward computer and information technology Literacy A Behavior Report Card commonly used to treat ADHD( Bridges the gap between school, therapy and home) schizophreniform disorder Psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months. 1-6 months schizoaffective disorder Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder. delusional disorder a psychotic disorder in which the primary symptom is one or more delusions brief psychotic disorder brief episodes (lasting a month or less) of otherwise uncomplicated delusional thinking Mental status of Autism Little or no eye contact flat or blunted affect lack of emotional reciprocity Stereotyped or repetitive motor mannerisms medical care Describes goods and services that maintain, improve or restore an individuals physicals; social or mental well-being Same-e Treats depression osteoarthritis and liver disease omega-3 fatty acids polyunsaturated fatty acids commonly found in fish oils that are beneficial to cardiovascular health Tryptophan Aiding in nitrogen balance, which is essential in creating serotonin Pheochromocytoma a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine Should be a differential for panic disorder Shingles Vaccine 50 and over even if you have had or have not had the chicken pox Vestibulocochlear hearing and balance 8th Cranial Nerve studies estimate 15-24% of those incarcerated have a mental health disorder Trochlear eye muscle movement family systems therapy psychotherapy that focuses on the family, rather than the individual, as the source of problems; family therapists challenge communication styles, disrupt pathological family dynamics, and challenge defensive conceptions in order to harmonize relationships among all members and within each member Retinal Pigmentation Thioridazine side effect voyeuristic ACTS ARE THE MOST COMMON POTENTIALLY LAW BREAKING SEXUAL BEHAVIOR cyclothymic disorder Chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes. bipolar disorder 1 full blown episodes of mania. MAY EXPEREINCE DEPPRSSION Bipolar 2 hypomania and depression. EXPEREINCE AT LEAST ONE Team Leadership Model Decision 1 Should the leader monitor the team or take action? Team Leadership Model Decision 2 Should the leader intervene to meet the task or relational need? Team Leadership Model Decision 3 Shoul the leader intervene internally or externally? Harmless mentally ill patients cannot be confined against their will if they can survive outside case? O'Conner vs Donaldson Patients have the right to refuse any treatment and use an appeal process Rennie vs Klein This case is know for originating the insanity defense Durham vs US [Show Less]
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ANCC PMHNP Exams Questions and Answers 2023
Your patient, whose wife died a few months ago, appears to be very unkempt and apathetic. Although several months have passed since his wife's death he has... [Show More] not progressed at all through his grieving. You assess this condition as which of the following? disenfranchised grief panic disorder complicated grief physiologic grief Correct Answer: complicated grief A person has uncomplicated grief when he or she has normal physical, psychological, cognitive and spiritual responses to the death of a significant other. But when the person shows persistent maladaptive behaviors such as not taking care of personal hygiene and/or appearance and does not progress through the mourning process, this is complicated grief. If a patient has had a myocardial infarction, which of the following atypical antidepressants should not be prescribed within the recovery phase? Trazodone Duloxetine Bupropion Desvenlafaxine Correct Answer: Trazodone If a patient has had a myocardial infarction, during the recovery phase, the patient should not be prescribed this medication. Trazodone (Desyrel) can cause the patient to develop orthostatic hypotension and priapism. To get your teaching ideas and concepts across to a poor reader which of the following would be most appropriate? Use longer sentences. Use abstract concepts. Discourage questioning. Use examples and review. Correct Answer: Use examples and review. To get the idea across to a poor reader use examples and review. The other choices are not helpful. You should use short sentences and easy to read layouts; be concrete rather than abstract; and teach them how to ask questions about their health. Also, tell context first and use visual, use common words and examples, and explain meaning. A 21-year old woman presents with complaints of milky discharge from her breasts. She doesn't have any other symptoms and is not pregnant, nor has been before. She tells the nurse about each medication that she takes. Which of these drugs may be implicated as the cause of the symptom? aspirin Lamotrigine Risperidone sertraline Correct Answer: Risperidone Risperidone can cause the greatest prolactin elevation among atypical psychotics. A milky white discharge known as galactorrhea could be a sign of an underlying condition. The fact that the woman takes Risperidone, an atypical antipsychotic, would likely point to the cause and should be switched with one less likely to have that same side effect. Which of the following would be considered one of the main things that is responsible for about 2/3 of psychiatric hospital readmissions? Not sufficient care. Medication noncompliance Biophysical assessments None of the above Correct Answer: Medication noncompliance Medication noncompliance is a major problem with the psychiatric mental health patients. The home health nurses assists by helping the patients to see the relationship between their compliance with their medication regimen and control of their symptoms. Which of the following would be considered an important form of communication that can help to promote consistency in the care of the patient at the same time that it justifies their stay in the hospital? Review of care. Documentation Verbal reporting None of the above Correct Answer: Documentation The other 3 options above are incorrect. One of the most important aspects of nursing is documentation. Documentation can promote consistency in the care of the patient and is also used to help justify the patient remaining in the hospital. Effects of an overdose of LSD (Lysergic acid diethylamide) can include all of the following except? Vomiting Respiratory failure Hypertensive crisis Seizures Correct Answer: Hypertensive crisis Hypertensive crisis would be considered a symptom of PCP overdose. Vomiting, respiratory failure and seizures would be considered an effect of LSD overdose. Symptoms of serotonin syndrome include all of the following EXCEPT: insomnia nausea loss of coordination sweating or shivering with goose bumps Correct Answer: nausea Symptoms of serotonin syndrome can present in patients that have drug combinations that are contraindicated. They can vary from restlessness and agitation to tremors, chills, headaches, and insomnia as well as loss of coordination. Nausea has not been implicated in serotonin syndrome. What is the rate of suicide attempts for patients having dissociative identity disorder? 30% 45% 70% 60% Correct Answer: 70% People with dissociative identity disorder have one of the highest risks for suicide. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),more than 70% of outpatients with DID have attempted suicide, and multiple suicide attempts are common. Of the following, which would not be considered a phase of schizophrenia treatment? Maintenance Acute Cognitive Stabilization Correct Answer: Cognitive Cognitive is not one of the three phases of schizophrenia treatment. The three phases are: Phase 1: acute Phase 2: stabilization Phase 3: maintenance The patient should be monitored for effects of psychotropic medications which can impact cardiac rhythms. Which of the following could be a potential cardiac side effect? A prolonged QT interval Narrowing of the QRS Both A and B None of the above Correct Answer: A prolonged QT interval With antipsychotic drugs, the triclyclic action can cause problems. These medications can cause a widening of the QRS or a prolonged QT interval. This is a measure of the ventricular repolarization. Sullivan described three developmental cognitive modes of experience and believed that mental disorders are related to the persistence of one of the early modes. The mode that begins in early childhood as the child begins to connect experiences in sequence is which of the following? prototaxic mode parataxic mode syntaxic mode composite mode Correct Answer: parataxic mode The parataxic mode begins in early childhood. The child may not make logical sense of the experiences and may see them as coincidence or chance events. The child seeks to relieve anxiety by repeating familiar experiences, although he or she may not understand what he or she is doing. Which of the following acts have provided the greatest protection for the individual not to lose or be denied health insurance coverage? Patient Protection and Affordable Care Act OSHA ISPN None of the above Correct Answer: Patient Protection and Affordable Care Act The other 3 options above are incorrect. For several decades now, the ANA (American Nurses Association) has been working and advocating for reforms that will help to guarantee the access of high-quality health care. This act has helped millions of people, but ANA recognizes the fact that this debate is far from being over. The ANA is dedicated to educating the nursing public about the changing systems and their impacts on people's lives and the nursing profession. Which of the following is an example of Western alternative medical systems? TCM (traditional Chinese medicine) naturopathy ayurveda acupuncture Correct answer: naturopathy Naturopathy and homeopathy are examples of Western alternative medical systems. Naturopathy emphasizes health restoration rather than disease treatment and combines nutrition, homeopathy, therapeutic counseling and other therapies. The underlying belief is that the individual assumes responsibility for his or her recovery. What is NOT a sign of alcohol intoxication? Nystagmus Mood lability The face has pale skin. Aggressive impulses Correct Answer: The face has pale skin. A flushed face is a sign of alcohol intoxication. Other signs include disinhibition of sexual impulses, impaired judgment, and impaired occupational functioning. In terms of styles of leadership in therapeutic groups, which type of leader encourages individual creativity and group cohesiveness? autocratic democratic laissez-faire psychotherapeutic Correct Answer: democratic There are three main styles of group leadership: autocratic, democratic, and laissez-faire. A democratic leadership style focuses on the members of the group. Members are encouraged to participate fully in problem-solving of issues that relate to the group. This type of leader encourages individual creativity and group cohesiveness. All of the following are considered to be types of family structures except? Nuclear family Behavioral family Blended family Extended family Correct Answer: Behavioral family The major types of family structures are: Nuclear family Blended family Extended family Single-parent family Other familial systems What would NOT be an appropriate way to deal with a patient in the psychiatric unit who is prone to protracted angry outbursts? Using reassuring touch Determining the source of the patient's anger Remaining calm Setting verbal limits on behavior Correct answer: Using reassuring touch This would not be appropriate for interacting with an angry patient. When coping with an angry patient, don't shout or argue with the client and avoid touching the client or invading the client's space. This can escalate the anger. Touching the client can be threatening and make them feel cornered. This may result in retaliation. N-STAT is an ANA program that does which of the following? unifies nurses' political voices recommends nursing health policies assures a safe workplace for nurses evaluates Medicare and Medicaid reforms Correct Answer: unifies nurses' political voices Nurses are the largest group among the health care disciplines The Nurses Strategic Action Team (N-STAT) is an ANA program that unifies nurses' political voices across the country to enact measures to benefit health care for everyone. Examples of DSM-V diagnostic criteria for schizophrenia include all of the following EXCEPT: hallucinations thought insertion disorganized speech delusions Correct Answer: thought insertion DSM-V diagnostic criteria for schizophrenia include delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms. Abraham Maslow established that human needs are hierarchical, with lower level (most basic) needs being critical to survival. Which of the following is the highest level of needs in Maslow's hierarchy? esteem and recognition self-actualization love and belonging safety Correct Answer: self-actualization Abraham Maslow's hierarchy of needs from lowest to highest are: physiologic, safety, love and belonging, esteem and recognition, and self-actualization. Self-actualization is the fulfillment of a person's unique potential. How well a drug passes through natural body barriers such as the skin or stomach is known as the drug's: diffusion metabolism bioavailability absorption Correct Answer: absorption A drug's absorption is how well it passes through natural body barriers such as the skin, stomach, intestines, blood-brain barrier and other membranous tissues. Some considerations include whether the barrier is a lipid base or not. Antidepressant medications are known to work by increasing the concentration of which of the following in the body? Serotonin Dopamine Norephinephrine All of the above Correct Answer: All of the above These actions occur because the brain blocks the reuptake of these neurotransmitters by the neurons. In addition, the enzyme monoamine oxidase can inactive these at various sites in the nervous system. Which of the following would more than likely be included in treatment of the patient with depression? Cognitive therapy Psychopharmacology Individual therapy All of the above Correct Answer: All of the above Treatment of depression can include: Cognitive therapy Psychopharmacology Individual therapy Group/family therapy Electroconvulsive therapy Light therapy Transcranial magnetic stimulation Which of the following individuals would be the most likely to be homeless? 16 year old white male. 67 year old Hispanic female 49 year old female Native American 19 year old Asian male Correct Answer: 16 year old white male. Studies have shown that approximately 39 percent of the homeless are under the age of 18. Studies have shown that more males are homeless then females. Studies have shown that 39 percent of the homeless are white. What test should be administered for a patient who is taking lithium, and it is suspected has arrhythmia? ACH EKG ABG EEG Correct answer: EKG Arrhythmia is a side effect of lithium. The patient needs to be monitored for risky side effects. An EKG or electrocardiogram would be used. Akathisia, akinesia, dystonia, and tardive dyskinesia are all side effects considered to affect which system: lymphatic skeletal endocrine muscular Correct Answer: muscular The muscular system is responsible for extrapyramidal side effects. The best way to prevent involuntary muscular movements that could be irreversible is to monitor carefully. If symptoms are present, it can be treated by reducing the current dose, or changing the patient to an atypical agent. The gathering and interpretation of data based on valid observed and patient-reported information, in addition to research-derived evidence, is known as which of the following? Interventions Managed care Evidence-based Crisis intervention Correct Answer: Evidence-based Evidence-based practice is typically used in the nursing process. The best available evidence is applied in order to improve the quality of clinical judgments. Preventative factors are those that protect the individual from a disorder. Which of the following would be considered a social preventative factor? healthy nutritional status good self-esteem healthy ego defenses higher level of education Correct answer: higher level of education Preventative factors are those that protect the individual from a disorder. They are coping mechanisms or resources that facilitate a healthy response to stress. Social preventative factors include: low-stress occupations; higher socioeconomic status; and a higher level of education. Which of the following would probably not be considered as having a partnership with community-based mental health care? Crisis centers Insurance companies Group homes Shelters Correct Answer: Insurance companies Insurance companies would not be the typical partner with mental health care. Such places could include: Crisis centers Group homes Shelters Patient homes Work sites Mental health clinics Senior centers Schools/colleges Clinics for the homeless What action would be appropriate for documenting a patient's care? Charting opinions Charting in ink Charting events before they happen Charting generalizations Correct Answer: Charting in ink This is the only appropriate charting action. You would not chart the following: opinions that are not supported by facts or defame patients, chart events before they happen, chart generalizations, suppositions or pat phrases, obliterate, erase, alter or destroy a record, or leave blank spaces. If an incident report is filed, do not note it in the chart. Relationships between people are each unique. However, all relationships can be categorized into three major types. They are: social, intimate, and therapeutic social, intimate, and empathetic social, warm, and empathetic public, private, and therapeutic Correct Answer: social, intimate, and therapeutic The three categories of relationship types are: social, intimate, and therapeutic. Social relationships are primarily for friendship. Intimate relationships involve two people who are emotionally committed to each other. The therapeutic relationship focuses on the needs, experiences, feelings, and ideas of the client only. If the client cannot organize his or her thoughts, or has difficulty answering open-ended questions, the nurse should do which of the following? continue to ask the open-ended questions until the client can answer stop questioning the client altogether ask more direct questions focused on one specific behavior or symptom ask general multiple choice questions Correct Answer: ask more direct questions focused on one specific behavior or symptom If the client cannot organize his or her thoughts, or has difficulty answering open-ended questions, the nurse should use more direct questions to obtain information. Questions need to be clear simple, and focused on one specific behavior or symptom; they should not cause the client to remember several things at once. The study of the distribution, incidence, prevalence, and duration of a disease is known by which of the following terms? pharmacokinetics etiology epidemiology pathogenesis Correct Answer: epidemiology Epidemiology is the study of the distribution, incidence, prevalence, and duration of a disease. Etiology refers to cause or origination of a disease. Pathogenesis is the manner of development of the disease. Pharmacokinetics refers to the movement of the drug into, through and out of the body. Which of the following would not be considered a common side effect of paroxetine? Somnolence GI upset Headache Hypokalemia Correct Answer: Hypokalemia Some of the more common side effects of paroxetine would be considered: Somnolence GI upset Headache Dizziness Insomnia Which of the following physical conditions could potentially cause a patient to exhibit potential psychiatric symptoms such as confusion? Urinary tract infections Chest pain Thyroid disorders Both A and C Correct Answer: Both A and C When a patient is having an admission assessment, there should be a physical examination performed prior to the psychiatric assessment. Such problems as urinary tract infections, especially with the older adults can cause the patient to exhibit symptoms of confusion, among other things. Which of the following does the nurse typically work with to help determine the potential outcomes and goals for the patient? Family Housekeeping Members of the interdisciplinary team Both A and C Correct Answer: Both A and C Housekeeping is not typically included. The nurse typically communicates with the: Family significant others Members of the interdisciplinary team Patient What is the best course of action to be taken for a patient who insists on taking Gingko Biloba for anxiety? Explain that it is dangerous Respect preference Refuse to give consent Try to dissuade the patient Correct answer: Respect preference Gingko Biloba is shown to have some effect in treating anxiety. The patient preference needs to be respected in care. Herbal remedies need to be considered when prescribing other medications. Neurobiological defects found in schizophrenia are suspected to have abnormalities in chemical neuronal signal transmission. Which of the following is not a neuronal signal transmission found in people with schizophrenia? excess dopamine in mesolimbic pathway decreased norepinephrine decreased GABA decreased dopamine in the mesocortical pathway Correct Answer: decreased norepinephrine Impaired neuronal communication is suspected to lead to the abnormalities in the brain. Excess glutamate and dopamine in the mesolimbic pathway; decreased dopamine in the mesocortical pathway, and in GABA and serotonin are implicated in people affected by schizophrenia. Decreased norepinephrine is implicated in depression. What is the risk for a 50 year old patient taking NSAIDs while taking SSRIs? Seizures Arrhythmia Serotonin syndrome Gastrointestinal bleeding Correct Answer: Gastrointestinal bleeding Patient medications need to be monitored for possible interactions. There are different risks with different medications. Gastrointestinal bleeding is a risk that will increase if a patient takes both SSRIs and NSAIDs. When the registered nurse is making the decision about delegating any care to an unlicensed person, which of the following statements would not be correct? If the task is to be performed under the nurses scope of practice, then do not delegate it. If the outcome is not one that is reasonably predictable, then do not delegate it. If the task cannot be safely performed according to clear directions, then it is all right to delegate it. If there are any specific laws against delegation of the task, do not delegate it. The other 3 options above would be correct examples of when not to delegate a task to an unlicensed person. If the task cannot be safely performed according to clear directions, then it would not be all right to delegate it. Attention deficit hyperactivity disorder (ADHD) is divided into three subtypes that specify the dominant associated behaviors. They include all but which of the following? hyperactive-impulsive type manic type inattentive type combined type Correct Answer: manic type There is no manic type of ADHD. ADHD is among the most common of childhood psychiatric conditions. It is characterized by symptoms of inattention, impulsivity, and overactivity that occur in at least two different settings, with significant impairment in functioning. Typically, which type of mental health care involves a minimum of about 3 months and is reserved for patients that have been transferred from acute care setting that are at a chronic risk for harming themselves or others because of mental illness? Community-based care Primary care Long-term care Residential services Correct Answer: Long-term care This type care can be referred to as intermediate or long-term care. They can admit a patient directly, but typically the patients are transferred there from an acute care setting. Which of the following would be an example of a secondary prevention measure for psychiatric practice? disaster response day treatment programs social skills training case management for vocational needs Correct answer: disaster response Disaster response would be a secondary prevention measure that is aimed at decreasing the prevalence of mental disorders. The other three choices are tertiary prevention measures that are aimed at decreasing the disability and severity of a mental disorder. What is used to delineate the responsibilities and authority at all levels for the various activities in the organization? Mission statement Policy Philosophy statement Procedures Correct answer: Policy The governing body of an organization establishes broad policies for regulating the relations, operations, and outcomes in a health care enterprise. Policies are needed to guide actions in given sets of circumstances. They serve to delineate responsibilities and authority at all levels and for various activities in the organization. What activity is least likely to reduce role conflict and ambiguity of role? Discouraging freedom in the role Use of the chain of command Personal development Adaptation to change Correct answer: Discouraging freedom in the role This is least likely to reduce role conflict and ambiguity of role. Toleration of freedom is more likely to reduce role conflict and ambiguity. Other activities to reduce role conflict and ambiguity include increased need fulfillment, structure and standards, and facilitation of teamwork. Of the following statements about involuntary admission to a psychiatric facility, which is the least accurate? Involuntary admission requires that the patient retain freedom from unreasonable bodily restraints. Those patients who have been involuntarily admitted no longer have the right to refuse medications. Patients have the right to legal counsel and to take their cases before a judge who may order release. Forced treatment raises ethical dilemmas regarding autonomy versus paternalism. Correct answer: Those patients who have been involuntarily admitted no longer have the right to refuse medications. This statement is least accurate. Involuntary admission requires that the patient retain the right to refuse medications. This refusal can include psychotropic or antipsychotic medications. Managed care is used by whom? Stake holders. High Management. Purchasers of health services. Insurance companies. Correct Answer: Purchasers of health services. Managed care is used or employed by purchasers of health services. These people will make decisions about different services so that quality and costs can be monitored. In this type of program, people will get health care based on their needs. 75 year old male is suffering from an altered mental status. What is happening to him? The memory is overloaded. There are changes to the brain's normal functions. The patient is dying. There is no change to the patient's brain activity. Correct Answer: There are changes to the brain's normal functions Patients suffering from an altered mental status suffer general changes to the brain's normal functions. Symptoms that are associated with this state are confusion, loss of orientation, amnesia, and poor regulation of emotions. In order to provide health care, a health care professional must be assertive. This would include all of the following attributes EXCEPT: confidence in the necessary competencies and skills direct and effective communication acting as an advocate and consultant to the client pressuring a client to accept treatment Correct Answer: pressuring a client to accept treatment A client has the right to accept or refuse treatment. Being assertive does not mean that the nurse can impose his or her opinions on the client. What term best describes a nurse's ability to best determine the end result? Expected outcome. Evaluation. Competency. Autonomy. Correct Answer: Expected outcome. An expected outcome occurs when you can determine the end results of a patient's care. Mental health nurses can make an educated assumption on what the outcome of their patient's health will be based on patient cooperation, assessments, tests, observations, and the diagnosis. All details related to the patient's health are considered, and used to determine the expect outcome. What might be a cause for a member of the collaborative team to receive complaints concerning his communication skills? Poor eye contact Sitting too close Professional dress Gestures that accompany words Correct Answer: Sitting too close Body language is an important communicator. Sitting too close to people invades their personal space. This results in negative communication. When a nurse structures the relationship with a client to focus on the client and facilitates expression of problems and feelings, this is part of which phase of the nurse-client relationship? identification orientation exploitation resolution Correct Answer: identification The phases of a nurse-client relationship are (in sequence): orientation, identification, exploitation, and resolution. In the identification phase the nurse structures the relationship to focus on the client and facilitates the expression of problems and feelings. The nurse avoids fostering unnecessary dependency and encourages self-care. Most malpractice suits are filed under which of the following areas of law? tort law criminal law administrative law contract law Correct Answer: tort law Most malpractice suits are filed under tort law. Torts are private civil wrongs committed by one individual against another for which money damages are collected by the injured party from the wrongdoer. Conflict among members of a particular group is classified as which of the following? intrapersonal interpersonal intergroup intragroup Correct Answer: intragroup Conflict among members of a particular group is intragroup conflict. Conflict among members of two or more groups is known as intergroup conflict. Human development is what? The ability of disease to live inside of the body. The process of dying. The process of growing to maturity. The growth rate of humans. Correct Answer: The process of growing to maturity The process of growing to maturity is referred to as human development. It is based upon the theory that humans are born, grow, age, and then die. The NP sees a 12-year-old male who was referred to her because of disruptive behavior and physical aggression against his peers. He is generally hostile in temperament and easily irritated. The child is also failing academically. This child most likely suffers from which of the following disorders? attention deficit hyperactivity disorder oppositional defiant disorder posttraumatic stress disorder autistic disorder Correct answer: oppositional defiant disorder This child would most likely be diagnosed with oppositional defiant disorder (ODD). Children with ODD are disruptive, argumentative, hostile and irritable. They have social problems with peers and adults and impaired academic functioning. Under what category would employee vacation pay, sick leave, and education be listed? Non productive time Productive cost Long term plan Productive time Correct answer: Non productive time Non productive time must be considered. This includes benefits and pay that employees receive that are not provided for work that has been accomplished. Vacation and sick time are included in the Non productive budget. The neuroendocrine system contains all of the following EXCEPT: hippocampus hypothalamus gonads pancreas Correct answer: hippocampus The hippocampus is not a part of the neuroendocrine system. It is a part of the brain located in the medial temporal lobe. It is an important site for the formation and storage of immediate and recent memories. The neuroendocrine system contains the hypothalamus, pituitary gland, thyroid gland, adrenal glands, gonads, and pancreas. In which stage of the standards of practice for psychiatric nursing would the nurse document measurable goals? assessment implementation planning outcomes identification Correct Answer: outcomes identification Outcomes identification includes documenting expected outcomes as measurable goals. It also includes identifying attainable and culturally expected outcomes and including time estimate for expected outcomes. The type of hospital admission to a psychiatric inpatient setting that does not require a written application is which of the following? voluntary admission involuntary admission temporary admission informal admission Correct Answer: informal admission Informal admission is one type of voluntary admission that is similar to any general hospital admission in which there is no formal or written application. An informal admission is sought by the patient. The normal doctor-patient relationship exists, and the patient is free to stay or leave, even against medical advice. Which of the following is NOT a drug associated with date rape? Risperidone GHB Rohypnol Ketamine Correct answer: Risperidone Risperidone is not a drug associated with date rape. It is an antipsychotic. Date rape drugs may render a woman incapable of resisting a rape and are purported to facilitate acquaintance rape. Once the drugs are ingested, victims lose their ability to ward off attackers, develop amnesia and become unreliable witnesses. What is the term used for the study of ethical problems resulting from scientific advances? Medical ethics Ethical acculturation Bioethics Deontology Correct Answer: Bioethics Nursing ethics is part of a broader system known as bioethics. New questions surface as science and technology produce new ways of knowing. Bioethics is the term used for the study of ethical problems resulting from scientific advances. The responsibilities of the nurse leader in using change management include all but which of the following? using change theory serving as a change agent supporting staff during times of difficult transitions having a rigid leadership style Correct Answer: having a rigid leadership style Having a rigid leadership style is not part of good change management. Adapting leadership style to situational needs is more effective. The responsibilities of the nurse leader in using change management include all of the first three choices. They also include: recognizing one's own reaction to change and striving to remain open to new ideas and approaches. The NP asks a patient with schizophrenia what the saying, "people in glass houses shouldn't throw stones" means to him. The patient replies that "the glass might break." This is an example of the patients inability to process which of the following? concrete thinking abstract thinking delusion echolalia Correct Answer: abstract thinking This patient is not able to process abstraction. Concreteness is often assessed through the patient's interpretation of proverbs. Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time. If you teach a client how to navigate through the complexities of the health care delivery system to receive prompt treatment this is a form of: primary prevention secondary prevention tertiary prevention enabling Correct Answer: secondary prevention You should develop teaching programs that coincide with the level of prevention needed by the client. Because primary prevention is not possible in all cases, a significant share of your time is spent teaching at the secondary or tertiary level. What is the best course of action to be taken if a peer arrives at work hung over, therefore it is necessary to act quickly to prevent patient injury? Respect their privacy. Report the individual. Ignore the incident. Discuss the incident with coworkers. Correct answer: Report the individual Employees and peers have the right to expect personal privacy. This right however, does not protect unethical conduct. The individual placed others in danger and should be reported. What step of the nursing process, is the diagnoses, outcome and care revised if needed? Evaluation. Diagnosis. Planning. Implementation. Correct Answer: Evaluation The nursing process is a problem solving approach. There are 6 steps in the nursing process. They include: diagnosis, outcome identification, planning, implementation, evaluation, and reassessment. During evaluation, the diagnoses, outcome and care revised if needed. Which of the following drugs is NOT one of the "Z-hypnotics" that have sedative effects without the antianxiety, anticonvulsant, or muscle relaxant effects of benzodiazepines? Ambien BuSpar Lunesta Sonata Correct answer: BuSpar Buspirone (BuSpar) is a drug that reduces anxiety without having strong sedative-hypnotic properties. Because this drug does not leave the patient sleepy or sluggish, it is often much better tolerated than benzodiazepines. It is not a CNS depressant. All of the other choices are one of the "Z-hypnotics." A 58 year old woman is dealing with symptoms of vasomotor instability, sleep disturbances, hot flashes, urinary frequency, and dyspareunia. What is the likely cause of her symptoms? High cholesterol. Estrogen deficiency. Estrogen surplus. Testosterone surplus. Correct Answer: Estrogen deficiency Menopause upsets the balance of estrogen in the body. There are many symptoms associated with menopause, and they are all commonly because of an estrogen deficiency. Defamation of a person in written form is which of the following? breach of contract slander fraud libel Correct Answer: libel Defamation is defined as an oral or written communication to a third party about another party that is false and that tends to injure the other party's reputation. Libel is defamation in written form; slander is oral defamation. What leaders do or how they conduct themselves is the basis of what theory of leadership? trait theory contingency theory behavioral theory contemporary theory Correct Answer: behavioral theory What leaders do, or how the behave, is the focus of behavioral theorists. For example, impoverished leaders have a low concern for both people and production, while the team leaders show high concern in both of these dimensions. A psychiatric mental health nurse will work how? In a restricted environment. Alone and as a team player. Alone only. As a team only. Correct Answer: Alone and as a team player. Registered nurses need to know how to work by themselves or as team players. Working as a team is an integral part of the nursing process. If nurses can collaborate, they can provide better care to patients. What would be the first action to be taken if a patient who has been diagnosed with PTSD because she was a witness to her brother being killed and is now staying in a psychiatric unit is having trouble sleeping, thinks she hears people trying to get into her room, and at times having nightmares? Listen to the patient's story of what has been happening to her. Assess the risk of suicide. Have the patient talk about the traumatic event. Encourage her to talk to others who have had similar experiences. Correct answer: Assess the risk of suicide. A patient with post traumatic stress syndrome (PTSD) has experienced a traumatic event that has affected their life severely. The patient will be experiencing a high level of anxiety and as a result, the possibility of self-destructive behavior is present. This should be the first concern to be addressed. What statement concerning conduct disorder in children is accurate? Conduct disorder is more common in children of parents with antisocial personality disorder than in the general population. Conduct disorder affects more girls than boys. Onset is earlier for girls than boys. The child must have one or more symptoms of the disorder in the past year to be diagnosed with conduct disorder. Correct answer: Conduct disorder is more common in children of parents with antisocial personality disorder than in the general population. This is the accurate statement. It is also more common in children of parents with alcohol dependence, mood disorders, or schizophrenia rather than in the general population. Conduct disorder affects more boys than girls. Its onset is earlier for boys than girls. The child must have three or more symptoms of the disorder in the past year and at least one symptom in the past 6 months to be diagnosed with conduct disorder. What atypical antipsychotic is preferred for adolescent patients? Haldol Haloperidol Zyprexa ASA Correct Answer: Zyprexa Zyprexa is an atypical antipsychotic. This medication is preferred for patients between the ages of 13 and 17. There are multiple formulations for specific needs. In terms of complementary and alternative medicine which of the following would be classified as a whole medical system? chiropractic therapy meditation naturopathy herbal therapy Correct Answer: naturopathy Naturopathy is a whole medical system. It focuses on enhancing the natural healing responses of the body. Interventions include nutrition, herbology, hydrotherapy, acupuncture, physical therapies, and counseling. What term is used to describe the failure to exercise the standard of care that another would issue in the same situation? Negligence. Attention. Disregard. Heed. Correct Answer: Negligence Negligence is the failure to exercise the standard of care that another would issue in the same situation. Negligence also describes any conduct that falls below the legal standard that protects patients from risk of harm. What is a characteristic of dementia, but is not characteristic of delirium? Duration of hours to days Gradual change in mental status Change in psychomotor activity, either hyperactive or hypoactive Perceptual disturbances Correct answer: Gradual change in mental status This is a characteristic of dementia. The other choices are all characteristic of delirium. Dementia has a gradual and insidious onset. Delirium does not have an insidious onset; its onset is abrupt. It can usually be noted at a precise date as a rapidly progressive change in mental status. There are how many conditions that allow NPs to challenge a patient's refusal of treatment after informed consent? 3 . 4 . 5 . 6 . Correct Answer: 5 . There are five conditions that allow NPs to challenge a patient's refusal to treatment. They include: when a patient is mentally incompetent, when refusing treatment causes danger to the life/health of another, in an emergency situation, when the patient is a child, and in the case of therapeutic privilege. When would a patient's informed consent not be necessary? The patient has dementia. The patient has delusional thoughts. The patient is exhibiting violent ideation. The patient has bipolar disorder. Correct answer: The patient is exhibiting violent ideation. Informed consent is not always necessary. Exceptions are made in an effort to preserve life. A patient who is experiencing violent ideation and is a threat to others may be treated without informed consent. According to studies, which group of people with bipolar I is more likely to experience rapid cycling? Older people Men Young people Women Correct answer: Women According to evidence, female patients are more likely to experience rapid cycling. Male patients have a higher risk of manic episodes. Long-term involuntary admission to a psychiatric inpatient setting is for extended care and treatment of the mentally ill. The patient can be admitted for this type of admission through which of the following means? medical certification judicial review administrative action all of the above Correct answer: all of the above Long-term involuntary admission has as its primary purpose extended care and treatment of the mentally ill. Those who undergo extended involuntary hospitalization are admitted through medical certification, judicial review, or administrative actions. This type of involuntary hospitalization generally lasts 60 to 180 days, but may also be for an indeterminate period. If there is an absence of state statutes, what is used as the basis of liability for injuries related to negligence? Federal law. Common law. Administrative law. Criminal law. Correct Answer: Common law If there is an absence of state statutes, common law is used as the basis of liability for injuries related to negligence. Common law is also used for malpractice as well, if there is an absence of state statutes. What key principle of ethical decision making is defined as the right of self-determination, independence, and freedom? Autonomy Justice Fidelity Beneficence Correct answer: Autonomy Autonomy is the right of self-determination, independence, and freedom. Autonomy in the healthcare setting involves the healthcare provider's willingness to respect patients' rights to make decisions for themselves, even if the provider does not agree with those decisions. A client who is alert at the time of an event which he then forgets along with other successive events as they occur suffers from which of the following types of amnesia? localized generalized continuous selective Correct Answer: continuous A client with continuous amnesia forgets successive events as they occur, but is alert at the time of the event. Localized amnesia is for a short time period; generalized amnesia pertains to a whole lifetime of experiences; and selective amnesia occurs for some, but not all events. Which of the following statements about mood disorders is least accurate? The most common mood disorder is major depressive disorder. Mood disorders are diseases. The signs and symptoms of mood disorders tend to recur, often in periodic or cyclical fashion. Mood disorders are caused by a complex interplay of biological and psychological factors. Correct Answer: Mood disorders are diseases. Mood disorders are not diseases; they are syndromes. They consist of signs and symptoms that present a deviation from a person's normal functioning and are sustained over a period of weeks to months. A patient with schizoaffective disorder and a substance abuse disorder experiences auditory hallucinations causing anxiety. What condition needs to be addressed first? Substance abuse Schizoaffective disorder Anxiety Delusions Correct Answer: Substance abuse When there are comorbid conditions in a crisis situation determinations must be made. The substance abuse will compound the psychiatric condition. Interventions need to be made to address the substance abuse first. In what situation would a psychiatric nurse provide forced treatment? When court mandated When the patient has Alzheimer's When referred by a physician Never Correct Answer: When court mandated Psychiatric nurses have an ethical responsibility to balance patient's rights with necessary forced treatment for safety. Forced treatment is done when court mandated. Which of the following medications is a cholinesterase inhibitor used to treat clients with dementia? Cognex Zyprexa Seroquel Zoloft Correct Answer: Cognex Cognex (tacrine) is a cholinesterase inhibitor for treatment of cognitive impairment in clients with dementia. The daily dosage range is 40 - 160 mg. Side effects include dizziness, headache, GI upset, and elevated transaminase. Zyprexa and Seroquel are both antipsychotic drugs; Zoloft is an antidepressant (SSRI). What would be the reason for hallucinations and delusions if a patient does not meet the criteria for schizoaffective disorder or bipolar disorder and exhibits no symptoms of a physical illness or drug abuse? Paranoia Delusional disorder Bipolar I Schizophreniform disorder Correct Answer: Schizophreniform disorder Schizophreniform disorder is diagnosed after ruling out illness, drug use, schizoaffective disorder or bipolar disorder. Hallucinations and delusions are signs of schizophreniform disorder. Disorganized speech, negative symptoms, and catatonic behavior are also included in the diagnostic criteria. Which of the following medications would decrease seizure activity in ECT? fluoxetine lithium propofol anesthetic bupropion Correct Answer: propofol anesthetic Propofol anesthetic would decrease seizure activity in ECT. Other medications with this same effect include: benzodiazepines, barbiturate anesthetic, and anticonvulsants. All of the other choices would increase seizure activity in ECT. You are interviewing a woman who has unexplained bruises. You know that in interviewing this woman you should do all of the following EXCEPT: Conduct the interview in private. Be understanding. Inform the patient if a referral to protective services must be made. Probe for answers that the patient is not willing to give. Correct Answer: Probe for answers that the patient is not willing to give. The interview should be non-threatening and supportive. Probing for answers that the patient is not willing to give is something that you must not do. Also you should not try to prove abuse by accusations, display disapproval of the perpetrator or the situation, place blame or make judgments. Which of the following best defines the term "values clarification"? the science that deals with the rightness and wrongness of actions conduct that results from serious critical thinking about how individuals ought to treat others a process of self-exploration through which individuals identify and rank their own ideals and concepts that give meaning to their lives a valid, legally recognized claim or entitlement Correct answer: a process of self-exploration through which individuals identify and rank their own ideals and concepts that give meaning to their lives [Show Less]
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