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PMHNP Certification "Purple Book" Chapter 8, question and answer
Originated by Sigmund Freud (1856-1939), who believed that behavior is determined by unconscious motivations and instinctual drives. Attends to past develo... [Show More] pmental and psychodynamic factors, which shape present behaviors. Psychoanalytical therapy Originate by Aaron Beck (born 1921), states that a person's expectations, perceptions, and interpretations of events cause anxiety. Allow clients to view reality more clearly through an examination of their central distorted cognitions. Goal is to change clients' irrational beliefs, faulty conceptions, and negative cognitive distortions. Cognitive Therapy Originated by Arnold Lazarus (born 1932), focuses on changing maladaptive behaviors by participating in active behavioral techniques such as exposure, relaxation, problem-solving, and role-playing. Behavioral therapy Originated by Marsha Linehan (born 1943), focuses on emotional regulation, tolerance for distress, self-management skills, interpersonal effectiveness, and mindfulness, with an emphasis on treating therapy-interfering behaviors. Dialectical behavior therapy Originated by Viktor Frankl (1905-1997), a philosophical approach in which reflection on life and self-confrontation is encouraged, "why am I here? What is my purpose?." Goals are to live authentically and to focus on the present and on personal responsiblity. Existential therapy Originated by Carl Rogers (1902-1987), aka person-centered therapy, concepts include self-directed growth and self-actualization; people are born with the capacity to direct themselves toward self-actualization. Humanistic theory Originated by Gerald L. Klerman (1928-1992) and Myrna M. Weissman (born 1940), evidence-based therapy with focus on interpersonal issues that are creating distress, time-limited, active, focused on the present and on interpersonal distress. Interpersonal therapy What does EMDR stand for? Eye movement desensitization and reprocessing Involves the use of bilateral stimulation—moving the eyes back and forth, alternating tapping on hand or knee, or sounds in ears, originated by Francine Shapiro (born 1948). Most commonly used for PTSD. EMDR The first person to put a theoretical perspective on group work and identified 10 therapeutic factors that differentiate group therapy from individual therapy. Irvin Yalom _________________ is based on the idea that one could not understand any family member (part) without understanding how all family members operate together (system). Family systems theory An ongoing feedback loop; a series of actions and reactions that maintain a problem. Individuals and emotional problems are best understood within the context of relationships and through assessing interactions within an entire family. Circular causality Originated by Salvador Minuchin (1913-1990), who placed emphasis on how, when, and to whom family members relate in order to understand and then change the family's structure. Structural family therapy Originated by Virginia Satir (1916-1988), behavior is determined by personal experience and not by external reality, focus is on being authentic, on freedom of choice, on human validation, and on experiencing the moment. Experiential therapy Originated by Jay Haley (1923-2007), symptoms are viewed as metaphors and reflect problems in the hierarchal structure. Symptoms are a way to communicate metaphorically within a family. Strategic therapy Originated by Steve deShazer (1940-2005), Bill O'Hanlon (born 1952), and Insoo Berg (1934-2007), focus is to rework for the present situation solutions that have worked previously. Techniques include the use of miracle questions, exception-finding questions, and scaling questions. Solution-focused therapy What does CAT stand for? Complementary, alternative, and integrative therapies Guided imagery, meditation, yoga, and biofeedback are all examples of? Mind-body interventions Herbal products, vitamins, supplements, and aromatherapy are all examples of? Biologically based therapies Acupressure and acupuncture, massage, and reflexology are all examples of? Body-based therapies Used for attention deficit hyperactivity disorder, dyslexia, cognitive impairment, dementia, cardiovascular disease, asthma, lupus, and rheumatoid arthritis. Interacts with warfarin (Coumadin), increasing anticoagulant effect (people cautioned to stop using before surgery). Omega-3 fatty acids Used for depression, osteoarthritis, and liver disease. May cause hypomania, hyperactive muscle movements, and possible serotonin syndrome. Sam-e Used for depression, obesity, insomnia, headaches, and fibromyalgia. Increased risk of serotonin syndrome with use of selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and St. John's wort. Tryptophan Used for enhancing the immune system and protecting cells against effects of free radicals. Used for neurological disorders, diabetes, and premenstrual syndrome. Interacts with warfarin, increasing anticoagulant effect; antiplatelet drugs; and statins, increasing additive effect and risk of rhabdomyolysis. Vitamin E Used for insomnia, jet lag, shift work, and cancer. Sets timing of circadian rhythms and regulates seasonal responses. Interacts with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), beta blockers, corticosteroids, valerian, kava kava, and alcohol. Can inhibit ovulation. Melatonin Used for bipolar disorder, hypertension, lowering triglycerides, and decreasing blood clotting. Interacts with warfarin, aspirin, NSAIDs, garlic, and ginkgo. May alter glucose regulation. Fish oil Used for menopausal symptoms, premenstrual syndrome, dysmenorrhea. Black cohosh CAM used for anxiety. Belladonna CAMs used for sedation. Valerian; catnip CAM used for sedation and anxiety. Chamomile CAM used for delirium, dementia, sexual dysfunction caused by SSRIs. Ginkgo CAM used for depression and fatigue. Ginseng [Show Less]
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Yellow PMHNP test questions Ch 10, question and answer with rated solutions
A 38 y/o male reports excessive daytime sleepiness for the last 2 weeks in the setting of restructuring at his job. He is unable to tell if he is having mo... [Show More] re trouble falling asleep or staying asleep. Sometimes he wakes up at 4 am and is unable to fall back asleep. what should the PMHNP do first? A. Prescribe zolpidem 10 mg at bedtime as needed B. Prescribe a mirtazapine 15 mg at bedtime C. Request the patient completes a sleep log D. Add an extra blanket to his bed covers C. Request the patient completes a sleep log A 45 y/o female reports that she has difficulty falling back asleep after she wakes up at 4 am. for the last month. She understand that it is better to get out of bed rather than lying in bed awake. She uses this time to catch up on her reading but as a result is very sleepy during the day. What should the PMHNP recommend? A. Intermezzo 1.75 mg when she awakes at 4 am B. Mop the kitchen floor as soon as she wakes up at 4 am C. Diphenhydramine 25 mg at bedtime D. Sleep diary for 2 weeks B. Mop the kitchen floor as soon as she wakes up at 4 am A 44 y/o male with type 2 diabetes is becoming increasingly irritable, inattentive, forgetful, and frequently falls asleep in front of his computer at work. he is worried he will get fired and lose his benefits which he needs to cover his diabetic supplies. he says, "I am so worried that my blood sugars are a high as 300 and on occasion have wet the bed". What should the PMHNP do during this visit? A. Provigil 100 mg daily B. Order a sleep study C. Mirtazapine 15 mg at bedtime D. Refer him back to primary care for glycemic control B. Order a sleep study A 25 y/o woman reports frequently falling asleep during the day for the last 6 months. This has been affecting her work as a computer help desk agent, noting she sometimes nods off during calls but also during times of high volume hours. When he head hits the back of the chair she wakes up and realizes what happened. She insists she consistently sleeps 8 hours each night. This is most consistent with which of the following? A. Narcolepsy B. Circadian rhythm sleep disorder C. Hypersomnia D. Night terrors A. Narcolepsy John is a 22 y/o RN who has started his first job in the cardiothoracic IVY. After his orientation he began his fulltime position working three 12-hour shifts per week. On his days off he reports excessive fatigue during the day with periods of falling asleep while driving. he also reports difficult staying awake at work his first night back to work. Which of the following is the most likely diagnosis? A. narcolepsy B. Circadian rhythm sleep disorder C. Hypersomnia D. Night terrors B. Circadian rhythm sleep disorder Ella is trying to help her 3 y/o son sleep through the night but reports recently he has had three episodes of waking up within 3 hours of falling asleep with inconsolable screaming and crying. He then falls back asleep on his own and has no memory of what happened. What would be the best intervention? A. Recommend diphenhydramine 12.5 mg at bedtime B. Create and maintain bedtime routine and reduce stimuli C. Order polysomnography and EEG D. Prescribe desmopressin nasal spray B. Create and maintain bedtime routine and reduce stimuli A 45 y/o man reports difficulty falling asleep and early morning awakening. He reports excessive daytime sleepiness as a result of his unrestful sleep. What should the PMHNP do first? A. Prescribe trazadone 100 mg at bedtime B. Administer Patient Health Questionnaire (PHQ)-9 C. Order a sleep study D. Have the patient complete a sleep diary B. Administer Patient Health Questionnaire (PHQ)-9 A 22 y/o male has been referred by the employee assistance program at his job for poor work performance. The patient reports that no matter how much coffee he drinks he remains sleepy throughout the day and will doze off at meetings. He notes that he will often awake when his head hits the back of his chair when at a meeting. On occasion he has dropped his cup of coffee in front of everyone and now he feels he is under constant scrutiny and thinks people are speculating he is using drugs. What is the most likely diagnosis? A. Primary hypersomnia B. Hypnagogic hallucinations C. Hypnopompic hallucinations D. Narcolepsy D. Narcolepsy A 48 y/o obese woman experiences excessive daytime sleepiness, fatigue, anhedonia, and apathy. Her husband reports that she snores loudly when sleeping, and often will wake up drenched in sweat. the patient has no prior psychiatric history and denies substance abuse. Which of the following is the most likely cause of her symptoms? A. Airway obstruction B. Major depression C. Perimenopause D. Narcolepsy A. Airway obstruction A 52 y/o obese man with type 2 diabetes reports dozing off while driving, watching TV, or reading, with increased apathy and fatigue. The PMHNP orders a sleep study which revealed 10 episodes of apnea lasting 15 to 20 seconds each per hour of sleep. Based on these findings what should the PMHNP prescribe for his condition? A. Antidepressant medication B. Referral to otolaryngology for uvuloplasty C. Referral to otolaryngology for rhinoplasty D. Continuous positive airway pressure D. Continuous positive airway pressure A father brings his 6 y/o son to you because he is worried about him. He states that the son sits up in bed shortly after falling asleep and screams. He says he is consolable and unable to be awakened during these episodes but eventually he falls back asleep. The father states he is not able to fall back asleep after those episodes and is exhausted and falling asleep at work during the day. The child is energetic and playful during the day and has no memory of the episodes. What is the most appropriate response? A. "Are you worried you are doing something wrong?" B. "I can see you're upset, but really you are overreacting" C. "I can see this is upsetting for you" D. "Tell me why you can't fall back asleep after your son does?" C. "I can see this is upsetting for you" The PMHNP is providing psychoeducation and anticipatory guidance to the concerned parent regarding night terrors. At which stage of sleep is this most likely to occur? A. Any stage of sleep B. Stage 1 C. Stage 2 D. Stage 3 to 4 D. Stage 3 to 4 Sam is 11 y/o without past psychiatric history. He was born by normal spontaneous vaginal delivery with normal APGAR scores. He has met all of his developmental milestones. He began sixth grade this year and has had increased trouble falling asleep. He has always had bedtime rituals but lately they are extending in complexity and length. Most of his time in the evening is spent checking that the lights are turned off and that the windows are locked. As a result, he is only getting 5 hours of sleep at night and now have excessive daytime sleepiness with decreased interest in socialization and failing grades. which of the following infectious diseases may contribute to this clinical presentation? A. Treponema B. Human immunodeficiency virus C. Streptococcus D. Congenital herpes simplex virus B. Human immunodeficiency virus The PMHNP is covering for the vacationing psychiatrist and is conducting a follow-up visit for a 24 y/o man diagnosed with major depressive disorder. Which type of sleep disturbance is most consistent with this diagnosis? A. Early morning awakening B. Sleeping too deeply C. Easily awakened sleeping to lightly D. Decreased effect of trazadone A. Early morning awakening [Show Less]
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PMHNP Boards - Scientific Foundation and Advance Practice Skills, latest updated
Which of the following is a contraindication to benzodiazepines? a. Acute alcohol intoxication b. Acute narrow angle glaucoma c. Psychosis d. All the a... [Show More] bove a. Acute alcohol intoxication In the pharmacological treatment of psychosis, when antipsychotics are administered, which block dopamine, a secondary effect is blocking in another tract, which causes potential prolactin problems, such as gynecomastia in males. This tract is the: a. mesolimbic b. tuberoinfundibular c. nigrostrial dopamine tract d. mesocortical b. tuberoinfundibular A six-year-old patient with autism spectrum disorder has not responded to six months of psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The psychiatric-mental health nurse practitioner prescribes: 1. carbamazepine (Tegretol) 200 mg once a day. 2. haloperidol (Haldol) 2 mg once a day. 3. risperidone (Risperdal) 0.25 mg once a day. 4. venlafaxine ER (Effexor XR) 37.5 mg once a day. 3. risperidone (Risperdal) 0.25 mg once a day. Which drug is likely to produce liver failure and hepatitis? 1. Lamotrigine 2. Gabapentin 3. Carbamazepine 4. Topiramate 3. Carbamazepine EPS arises from: a. D2 blockade in the nigrostriatial tract b. D2 blockade in the tuberoinfundibular tract c. D2 blockade in the alpha-1 adrenergic receptor blockade d. D2 blockade in the HPA axis a. D2 blockade in the nigrostriatial tract Which drug carries a higher risk of metabolic effects than the other second generation antipsychotics: weight gain, diabetes, dyslipidemia ? a. Clozaril b. Zyprexa c. Risperdal d. Geodon b. Zyprexa A patient has not had any relief of symptoms with Fluoxetine, and is going to be started on an MAOI. How long before starting the MAOI should the Fluoxetine be withdrawn? a. 2 weeks b. 3 weeks c. 4 weeks d. 5 weeks a. 2 weeks Which drug can produce serious side effect of rash in some Asians, and the FDA has mandated genetic testing before the administration of this drug? a. Dilantin b. Lamictal c. Depakote d. Tegretol d. Tegretol Which is considered the most sedating SSRI? a. Paroxetine b. Sertraline c. Fluoxetine d. Escitalopram Oxalate a. Paroxetine (Paxil is EVIL) Brain structure responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions amygdala Regulates memory and converts short-term memory into long-term memory ... Plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormonal regulation ... Patient on lithium and cipro Cipro _____________ lithium level ... Patient on psych meds and dexamethasone will complain of what? ... Patient w/ schizophrenia, structural changes of the brain on CT ... Which lab is checked with clozaril? ANC Lobes of the Brain - Fred Tore his Pants Off Frontal - executive fx, logical thinking Temporal (tempo) sound Occipital (optic) vision Parietal (pat) touch You ask a patient to clench her teeth, which cranial nerve are you testing? Cranial nerve 5 - TRIGEMINAL What does the frontal lobe affect? (LIMP) Executive functions: Language Intelligence (cognitive functoning) Motor Function Personality What does temporal lobe affect? (LAME) Language Affective Component of speech Memory Emotion In which lobe of the brain does the limbic system reside? The temporal lobe What is Wernicke's area responsible for and where does it reside in the brain? Wernicke's area is responsible for receptive speech and it resides in the temporal lobe. What is the first line drug for OCD? SSRIs What is the drug of choice for ADHD for 8 y.o and above? Stimulants (specifically ritalin - methyphenidate) If child develops tics, what do you prescribe? Guanfacine What does parietal lobe affect? (VAST) Visual spatial processing Association cortex Symbolic recognition Topographic sense what is sterognosis? how do you test it? Place objects in hand with closed eyes. Ability to differentiate items comes from parietal lobe What does the occipital lobe affect? (VIP) Visual integration Primary visual cortex Patient was prescribed paroxetine 1 month ago and had since developed ED, he is not a candidate for Wellbutrin because of a history of seizure disorder. What can you prescribe? Cialis (tadalafil) or Viagra (sildenafil) phophodiasterase inhibitors What is mechanism of action of phophodiasterase inhibitors? Rapid absorption. They pull blood to corpus cavernosum. What are the main functions of the limbic system? Regulation of emotion and memory Olfactory sense is combined with memories Hippocampus is located here - memory Where are affective domains (emotions, feelings) originating in the brain? Anterior cingulate gyrus (LIMBIC SYSTEM) If a patient with OCD has failed on SSRIs, what should you switch to? TCA - anafranil Mood disorder is most associated with which neurotransmitters? serotonin and norepinephrine Serotonin DOMAINS Depression Obsessions Migraines Anxiety Intestines Nausea Sexual and sleep Where is serotonin produced? The raphe nuclei (distributed near the midline of brainstem) What are the symptoms of SEROTONIN SYNDROME? SHITS AND SHIVERS SHITS (diarrhea) Shivering Hyperreflexia Increased body temp Vital sign instability Encephalopathy Restlessness Sweating What is the treatment for serotonin syndrome? Cyproheptadine (PERIACTIN) Patient has serotonin syndrome what are actions? 1. stop SSRIs/other meds that are contributing 2. Give Cyproheptadine(PERIACTIN) 3. Cooling/Fluids If a patient develops NMS on risperidone, what drug class will be avoided in the future? antipsychotics Treatment for NMS is? 1. dantrolene 2. Bromocriptine (parlodel) If you are giving a patient Latuda and Geodon, what is the patient teaching? 1. QT prolongation 2. Metabolic syndrome 3. Eat with a meal!!!! For pediatric panic disorder, what do you prescribe? Clonidine or guanfacine A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increase waist circumference B. Extrapyramidal side effects (not usual because serotonin antagonism - 5HT2A) C. Increase lipids D. Metabolic syndrome D. Metabolic syndrome [Show Less]
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ANCC Review Questions (PMHNP IQ) latest updated,100% correct
What direct-acting dopamine receptor agonist is recommended to be used in the treatments of neuroleptic malignant syndrome (NMS) fo help lower the dopamine... [Show More] blockade? A) benzotropine (Cogentin) B) bromocriptine (Parlodel) C) dantrolene (Dantrium) D) trihexyphenidyl (Artane) A) Bromocriptine (Parlodel) is the recommended direct acting dopamine receptor agonist to help decrease the dopamine blockade. Danrolene (Dantrium) is a muscle relaxant. Benzotropine (Cogentin) and Trihexyphenidyl (Artane) are anticholinergic medications used for extrapyramidal side effects (EPS). Mr. Smith is a 56 year old white male who has been successfully treated on Selegiline for over 4 years. Mr. Smith is going in for elective surgical procedure. Which medication is strictly contraindicated with Selegiline? A) Non-steroidal anti-inflammatory drugs (NSAIDS) B) Codeine C) Morphine D) Meperidine D) Meperidine is strictly prohibited when a patient is treated on a monoamine oxidase inhibitor (MAOI) due to the risk of hypertensive crisis and death. A WBC of 4,000 in a patient taking Clozapine would prompt the PMHNP to take which of the following actions? A) Consult with hematologist to determine appropriate antibiotic regimen and monitor closely. B) Institute twice-weekly complete blood count with differentials and monitor closely. C) Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely. D) Institute daily complete blood count with differentials and monitor closely. B) Institute twice-weekly complete blood count with differentials and monitor closely. The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely compromised immune system. At a WBC of 4,000, the recommendation is to closely monitor CBC with differential twice a week while patient may continue clozapine in the absence of any other signs or symptoms. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia? A) Abilify (aripriprazole) B) Latuda (lurasidone) C) Invega (iloperidone) D) Clozaril (clozapine) D) Clozaril (clozapine) is the only known antipsychotic medication that had been shown to reduce the risk of suicide in patients diagnosed with schizophrenia. A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg po daily for the past 16 years, presents to the psychiatric mental health practitioner for an outpatient follow-up visit. During the visit she states that she has not been feeling well, reporting the flu. She also states she has not taken her medication in the last five days. Which of the following symptoms would she be describing if you suspect selective serotonin reputable inhibitors (SSRIs) discontinuation syndrome? A) Agitation, nausea, dysphoria, and diequilibrium B) Agitation, nausea, tremor, and ataxia. C) Restlessness, tremor, fever, and shivering. D) Restlessness, headache, increased heart rate, and diarrhea. A) Agitation; nausea, dysphoria, and disequilibrium The patient has SSRI discontinuation syndrome and would be presenting with flu-like symptoms. If the patient had serotonin syndrome, she would present with symptoms of autonomic instability. Which of the following statements reflect the current understanding of dopamine (DA) pathways and clinical symptoms in schizophrenia? A) Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. B) Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system. C) Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area. A) Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. Negative symptoms & cognitive impairment are thought to be related to hypoactivity of the mesocortical dopiminergic tract, which by its association with the prefrontal cortex and neocortex contributes to motivation, planning, sequencing of behaviors in time, attention, and social behavior. Positive symptoms (hallucination and delusions) are thought to be caused by dopamine hyperactivity in the mesolimbic tract, which regulates emotion. This hyperactivity could result in overactive modulation of nueurotransmission from the nucleus accumbens. Norepinephrine is a neurotransmitter that is implicated in alertness and anxiety. What area of the brain has a large majority of norepinephrine neurons? A) Amygdala B) Hippocampus C) Locus Coeruleus D) Nucleus Accumbens C) Locus coeruleus There are two areas in the brain that produce norepinephrine neurons, one is the locus coeruleus and the other is the medullary reticular formation. Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine? A) 1A2 B) 2D6 C) 2C9 D) 2C19 A) 1A2 When an individual is treated on clozapine and decreases tobacco use, the clozapine level with increase, as tobacco is an inducer to the clozapine, and the patient no longer needs the higher dose of clozapine. When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? A) Techniques to decrease arousal B) Clarification and close-ended questions C) Techniques to increase arousal D) Reflection and open-ended questions. C) Techniques to increase arousal Activation is needed to allow memories stored in the amygdala to be processed. The PMHNP knows that the ego is a part of the personality and is the logical/rational mind including defense mechanisms. What might this personality part say? A) "I should" B) "I want" C) "I evaluate" D) "I ought" C) "I evaluate" The ego is the logical and rational mind. The ego monitors the is and would say "I think. I evaluate." Mr. Jones, a 78 year old patient, presents to the PMHNP for a follow-up medication appointment. Mr. Jones' depression has been successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr Jones complains that in the last 2 or 3 weeks, he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. Which action would be most appropriate for Mr. Jones? A) Assess for other symptoms of hyponatremia and check a serum sodium level. B) Discuss SSRI discontinuation syndrome and stress importance of medication adherence. C) Discuss rates of relapse on a SSRI and increase his medication to citalopram 40 mg by mouth daily. D) Discuss rates of relapse on a SSRI and recommend switching his medication to a different class. A) Assess for other symptoms of hyponatremia and check serum sodium level. Hyponatremia can occur on SSRIs, and is more common in elderly patients. This patient is reporting symptoms of moderate hyponatremia and needs to be assessed, and his sodium levels need to be checked. Normal sodium level: 135-145 mEq/L The PMHNP mental health nurse practitioner treating a patient for schizophrenia on ziprasidone orders an electrocardiograph. Which QTc interval result places the patient at greatest risk for torsades de pointes? A) 100-200 milliseconds B) 160-260 milliseconds C) 300-500 milliseconds D) 500-700 milliseconds D) 500-700 milliseconds A patient with a QTc interval of 500-700 milliseconds is at a higher risk of developing torsades de pointes. Which lab test should be ordered to rule out a medical cause of dementia symptoms? A) Albumin B) thiamine C) Vitamin D3 D) Vitamin B12 D) Vitamin B12 Low vitamin B12 levels have been associated with the development of dementa- like symptoms, and when dementia is a differential diagnosis, a Vitamin B12 should be checked. Which of the following lab findings would raise the greatest concern when prescribing Lithium? A) BUN 20 mg/dL B) GFR 115 mL C) Serum Creatinine 3.0 mg/DL D) Serum Na+ 120 mEq/L C) Serum creatinine 3.0 mg/dL Normal serum creatinine is < 1.5 mg/dL. Elevated creatinine indicates decreased renal function. Lithium is excreted through the kidneys and decreased renal function can result in lithium toxicity. A 43-year-old male is treated for Bipolar 1 on lithium. Which of the following hematologic changes is associated with lithium? A) Agranulocytosis B) Anemia C) Leukocytosis D) Leukopenia C) Leukocytosis While the mechanism of action is not clear, the use of lithium can raise white blood cell counts and therefore, CBC should be monitored in patients treated on lithium. Which serotonin receptor antagonism makes an antipsychotic "atypical" A) 5HT2A B) 5HT1A C) 5HT3A D) 5HT4A A) 5HT2A The mechanism of action that makes an antipsychotic medication "atypical" is related to the 5HT2A receptor antagonism and D2 receptor antagonism. Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety. Sally's only other medical condition is exercise induced asthma, and she is treated on Albuterol. Sally states she was in CBT without relief and would like to try a medication. Which is the most suitable initial treatment for Sally? A) clonazepam (Klonopin) B) sertraline (Zoloft) C) inderal (Propanolol) D) risperidone (Risperidal) B) sertraline (Zoloft) is used to treat social anxiety disorder and the patient is on albuterol; therefore the betablocker inderal is contraindicated with albuterol due to the risk of increased CNS stimulation. When suspecting a patient with neuroleptic malignant syndrome (NMS), which lab values would help confirm diagnosis? A) Leukocytosis and elevated creatinine phosphokinase. B) Leukocytosis and thrombocytosis C) Leukopenia and decreased creatinine phosphokinase D) Leukocytosis and thrombocytopenia A) Leukocytosis and elevated creatinine phosphokinase. With NMS, a patient has an elevated creatinine phosphokinase (CPK) due to skeletal muscle breakdown and an elevated white blood cell count (WBC). In managing the maintenance phase for Bipolar I disorder, which of the following statements is not supported by current evidence in the literature? A) Both lamotrigine and lithium are superior to placebo in delaying onset of mood-related disorders. B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. C) Lamotrigine, but not lithium is superior to placebo in preventing a depressive episode. D) Lithium. but not lamotrigine, is superior to placebo in preventing a hypomanic, or mixed episode. B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. Extended-release formulation of carbamazepine has demonstrated preliminary efficacy in the tx of acute manic or mixed episodes, but is not currently indicated in maintenance phase tx for Bipolar I disorder. Side effects include dizziness, somnolence, nausea, vomiting, ataxia, blurred vision, dyspepsia, dry mouth, pruritus, and speech disorder. The other responses are supported by current evidence in literature. A new patient comes to you on a medication regimen of: Adderall XR, Seroquel, Mirtazepine, Diazepam, Zolpidem. In addition if initial dose dose not help the patient sleep. You confirm the medication regimen with the patient's past records. You diagnose with PTSD, alcohol use disorder moderate by history in recovery, depressive disorder, and ADD. You tx the patient and find that the patient is resistant to changing the past medication regimen. The pt wants you to rewrite the script so that the medication is available. In checking with the pharmacy, you find out the pt has potentially used 60 tablets of Zolpidem (Ambien) in a 20 day period. Your best action is to: A) Refill the order for the med as requested. The med has not harmed the pt so far. B) Discontinue the prescription for Zolpidem (Ambien). Talk to the pt about the overuse of Zolpidem (Ambien) and the danger it poses to his health and wellbeing. C) Give the order for the Zolpidem (Ambien). Talk with the pt about the danger of using too much sleeping medication. Then, discontinue the medication. D) Refill the order for the medication. Then, send the pt for the chemical dependency evaluation. The pt is on too many sedative-type meds and is harming himself. B) Discontinue the prescription for Zolpidem. Talk to the pt about the overuse of Zolpidem and the danger it poses to his health and wellbeing. Zolpidem (Ambien) is a hypnotic med for the short-term management of insomnia. It can be stopped abruptly without significant harm to the patient other than rebound insomnia. You are protecting your patient by stopping the dangerous misuse of a hypnotic medication. You must also discuss the ramifications of the misuse with the pt and attempt to help him by giving him a rationale for the discontinuation and a healthy plan for managing the insomnia. You are on call for your service. You arrive at the Emergency Dept to find a 22 year old male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 foot 7 inches tall. His weight is 140 lbs, and his labs are all normal range. He states he has been taking aripiprazole (Abilify) for the last 2 months for his bipolar 1 disorder. He had the dose raised 4 days ago to manage a manic episode. He states that one to three times a day for the past 2 days his eyes will roll upwards for 10-15 min and he will hav trouble seeing until they role back down. After examination you decide to: A) Discontinue to aripiprazole and begin the pt on a gradual regimen of Lamotigrine for 1 week. Have him return to his provider for further management of bipolar disorder. B) Continue the aripiproazole and give benzotropine mesylate. C) Discontinue the aripiprazole and give benzotropine mezylate (Congentin) 1 mg IM. D) Begin a cross titration downward of aripiprazole and upwards of haldol. C) Discontinue the aripiprazole and give benzotropine mezylate (Congentin) 1 mg IM. This is an aripiprazole-induced oculogyric crisis (acute dystonia) [Show Less]
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Sample Test Questions ANCC – PMHNP, question and answer, 100% correct
A patient with borderline personality disorder experiences intense anxiety when an adult psychiatric and mental health nurse practitioner goes on vacation.... [Show More] The best explanation for this reaction is that the patient: A. has failed to develop clear ego boundaries. B. has failed to master object constancy. C. is employing primitive idealization. D. is employing projective identification. B. has failed to master object constancy 2. A patient has been taking escitalopram (Lexapro) 10 mg daily for four weeks. Initially, the patient reported depression and suicidal thoughts. The patient's sleep, appetite, energy, and appearance have now begun to improve. Which statement applies to this patient? A. The medication should be discontinued. B. The medication should be increased. C. The patient's risk for suicide is not a concern. D. The patient's suicide potential is increased. D. The patient's suicide potential is increased. 3. Which behavior reflects existentially oriented therapy? A. Attempting to understand a patient's subjective world B. Challenging a patient's irrational beliefs C. Developing specific plans for change D. Establishing general group goals A. Attempting to understand a patient's subjective world 4. Serving as a member on a crisis team, an adult psychiatric and mental health nurse practitioner provides crisis intervention to the survivors of a plane crash. Forty-eight hours after the accident, the survivors describe vivid flashbacks, startle reactions, and disrupted sleep patterns. The nurse practitioner responds by: A. advising the survivors to consider using a hypnotic medication for a brief period. B. educating the survivors about prodromal symptoms of posttraumatic stress disorder. C. encouraging the survivors to rest during the day. D. suggesting that the survivors join a posttrauma support group. B. educating the survivors about prodromal symptoms of posttraumatic stress disorder. 5. An adult psychiatric and mental health nurse practitioner uses the interpersonal therapy model with a patient to establish a therapeutic alliance based upon empathy and trust. The nurse practitioner recognizes the patient's readiness to terminate therapy when the patient demonstrates: A. an understanding that leaving a significant other may be painful, but also presents an opportunity for growth. B. breathing and muscle relaxation exercises that decrease muscle tension and anxiety. C. free association, and considers the nurse practitioner's interpretation of the patient's dreams. D. new adaptive skills and responses after completing "homework assignments." A. an understanding that leaving a significant other may be painful, but also presents an opportunity for growth. 6. An Hispanic patient informs an adult psychiatric and mental health nurse practitioner during a wellness visit that he or she occasionally uses hot chili juice to relieve a "nervous condition." The patient denies any complaints related to this practice. The nurse practitioner's response is to: A. actively discourage the patient from continuing this treatment. B. offer a medication to treat the nervous condition. C. suggest an alternative food to relieve the nervous condition. D. view this as a self-care ritual that needs to be preserved. D. view this as a self-care ritual that needs to be preserved. 7. Before an older adult patient initiates pharmacotherapy with a medication that is cleared by the kidneys, an adult psychiatric and mental health nurse practitioner assesses the patient's: A. blood urea nitrogen level. B. creatinine clearance. C. specific gravity. D. urinary sediment. B. creatinine clearance. 8. An adult psychiatric and mental health nurse practitioner uses a cognitive-behavioral approach to help an adolescent patient change self-defeating behaviors. After identifying the initial stressor that is causing the inappropriate behavior, the therapeutic intervention is to identify: A. alternative positive responses to the stressor. B. negative consequences of the behavioral response to the stressor. C. possible outcomes of alternative responses. D. rational and irrational beliefs about the stressor. D. rational and irrational beliefs about the stressor. 9. Which characteristic of fluoxetine (Prozac) provides the greatest degree of safety for patients who have severe depression? A. Greater efficacy than tricyclic antidepressants B. Less potential for drug interaction C. Less potential for injury with intentional overdose D. Less potential for suicidal thinking C. Less potential for injury with intentional overdose 10. When lobbying a local congressional representative to include nurse practitioners in reimbursement for services in all areas of the country, an adult psychiatric and mental health nurse practitioner emphasizes the: A. ability of nurse practitioners to provide health care that patients need. B. fact that nurse practitioners are caring in their patient care delivery. C. importance of broadening the scope of nursing practice. D. necessity of offering equivalent services both to urban and rural patients. A. ability of nurse practitioners to provide health care that patients need. 11. For 12 years, a 65-year-old patient with bipolar affective disorder has been treated with lithium (Eskalith) 900 mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0 mEq/L. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia. B. hyponatremia. C. increased renal clearance of lithium. D. reduced renal clearance of lithium. D. reduced renal clearance of lithium. 12. Which statement by a male patient who has posttraumatic stress disorder (PTSD) and chronic persistent suicidal ideation indicates a need for hospital assessment? A. "I feel so bad all the time. I wish I were dead." B. "My wife is so scared that she has taken all my guns out of the house." C. "My wife just left with the children. I have no one left and no future." D. "Those medications you gave me make me feel worse. I stopped taking them." C. "My wife just left with the children. I have no one left and no future." 13. A male patient informs an adult psychiatric and mental health nurse practitioner that he has not slept in three days, has poor concentration, and denies fatigue. The patient's diagnosis is: A. attention-deficit hyperactivity disorder. B. bipolar disorder. C. panic disorder. D. primary insomnia. B. bipolar disorder. 14. During patient education about sertraline (Zoloft), an adult psychiatric and mental health nurse practitioner focuses upon the potential side effect of: A. agranulocytosis. B. hypernatremia. C. sexual dysfunction. D. weight loss. C. sexual dysfunction 15. The neurochemical pathophysiology of Tourette disorder involves: A. decreased levels of gamma-aminobutyric acid and increased levels of glutamate in the brain. B. deficits in the prefrontal cortex-mediated executive functions of the brain. C. imbalances in dopaminergic, serotonergic, and noradrenergic systems in multiple regions of the brain. D. overstimulation of noradrenergic activity located in the locus coeruleus of the brain. C. imbalances in dopaminergic, serotonergic, and noradrenergic systems in multiple regions of the brain. 16. Before implementing evidence-based practice changes, an adult psychiatric and mental health nurse practitioner's initial action is to: A. brainstorm with stakeholders and draft a detailed problem list. B. compare data with internal and external benchmarks, and coordinate ongoing education. C. facilitate a collaborative multidisciplinary group to synthesize evidence and compare key themes. D. identify potential barriers and facilitators that reflect patients' values and expectations. D. identify potential barriers and facilitators that reflect patients' values and expectations. 17. Symptoms of anxiety and panic are associated with a low level of which neurotransmitter? A. Cortisol B. Dopamine C. Gamma-aminobutyric acid D. Glutamate C. Gamma-aminobutyric acid [Show Less]
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PMHNP Exam Reported Questions -with complete top solution
What is dissemination? Getting the research information out to those who need to know it! Publication - highest level Presenting at National Conferenc... [Show More] e Presenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? Moderate cognitive impairment What is Tegretol in the CYP450 system? Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? Inducer - will lower dose of Lamictal What is a Type I research error? There IS a difference but you say there isn't a difference. What is a Type II research error? There is NO difference but you say there is a difference. What is pseudo-dementia? Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve. Is it normal for a 1 month old to have a palmar grasp? Yes. What is a drug 1/2 life? The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? HLAB-1502 When might you see toxic epidermal necrolysis? With worsening of SJS How many generations do you include for a genogram? 1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - What does messenger RNA code for? Amino Acids What is epigenetics? Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? 10-25 yo When do females typically present with schizophrenia? 25-35 yo What does Erythromycin to trileptal? You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? Heart Failure HTN What are some psychiatric side effects seen with some asthma drugs Leukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol? Agranulocytosis and Hyponatremia What are the 3 CK muscle enzyme tests? CKBB, CKMM, CKMB Which one of the 3 muscle enzymes are related to cardiac muscle damage? CKMB What is the risk of a seriously elevated CKMB? Polymyositis Rhabdo What is a normal CKMB? 0.3 mcg/L What psychoactives does Detrol interact with? Topamax KCL Zonegran What CN are you assessing when you have the patient shrug their shoulders? CN XI - Spinal Accessory What do you see in labs with HIV & Dementia? CD4 <200 Viral Load is high <20% get it with antiretroviral treatment What is the scoring with the Beck Depression Inventory? Self-Report - 0-63 0-13 - minimal 14-19 - mild 20-28 - moderate 29-63 - severe What is sensitivity? Helps rule-out disease = True Positive = Snout What is specificity? Helps rule-in disease = True Negative = Spin What does a sed rate measure? Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour. What is a normal sed rate or ESR? 0-22 males 0-29 females What is a retic count? Measures % of reticulocytes in blood (immature RBC's) Indicates whether enough RBC's are being produced by bone marrow. What does a decreased retic count indicate? Anemia - acute or chronic bleeding What does an increased retic count indicate? Bone marrow disorder or Vitamin Deficiency What does an abnormal retic ount indicate in general? Doesn't diagnose anything. First step is ID source of the issue. What happens when you mix tegretol and macrolides? Increase tegretol levels. What happens if a pregnant women takes Accutane? Birth defects. What labs do you get with RA? Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP - helps confirm diagnosis. CRP and ESR are both increased in RA but NOT in osteoarthritis. Where does the NP Code of Ethics come from? ANA When do you assume informed consent? Unconscious Incompetent Life Threatening Situation What are the legal ramifications of treating w/o informed consent? Same as with informed consent Who can declare a patient incompetent and appoint a guardian? Only a court Does impaired judgment mean one is incompetent? No. Can an advanced directive ever be revoked? Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? No. How do Asians see HC providers? As in a position of authority. Expect to give instructions and help make decisions What does it mean when an Asian patient does not make eye contact with the NP? SIgn of respect What is the evil eye? When a stronger or more powerful person looks at a weaker person - often infant/child resulting in a hex which presents in illness such as HA, fever, diarrhea, disturbed sleep, increased fussiness. How do you protect from the evil eye? Red ribbon on an infant Amulet for adults How do you treat for evil eye? Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? Relationship What is a proximate cause? Connection between A + B. For there to be damages, what must exist first? Negligence What is an occurrence basis liability insurance? "occurred" during the policy period, no matter when the claim is brought against the insured What is a claims made/based liability insurance? provides coverage for a claim that is brought within the policy period, no matter when the loss occurred. Who sets the minimum requirements for NP's? Board of Nursing State What are the various controlled substance classes? Schedule I - nobody has these - not good for health - heroin, PCP, MDMA, researchers can get it sometimes. Schedule II - Significant Abuse Potential - morphine, methadone, methyphenidate Schedule III - Moderate Abuse Potential - hydrocodone, codeine Schedule IV - Low Abuse Potential - benzo's, ambien, phentermine Schedule V - Very low abuse potential - anti-tussives, lomotil What classes of CS's is the NP approved to prescribe? Schedules III-V ONLY. Where does 50% of healthcare funds come from? The government Who is eligible for Medicare? >65 or under 65 with diability, ANY age with renal disease. What is incident to billing? Means MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD. Allows NP to get reimbursed at 100% rather than 85%. How are Medicaid benefits determined? State determines qualification - Partnership between State and Fed Govt. Must be impoverished Must be US resident and low or very low income. Can you have Medicare and Medicaid? Yes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? Yes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? National standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? Can decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment Is it ok to announce a patient's name in a waiting room? Yes, no other way to give care. Is it ok to leave a message on a patient's vm? Yes, but should be limited. What is the impact of steroid inhalers on children? Slows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? Cataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? Sleeping meds Antidepressants Pain meds What psychoactives are first line treatment for fibro? Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's What is the purpose of telepsychiatry? Increase the ability to reach rural and underserved areas. What is the purpose of Motivational Interviewing? Explore ambiguity Maintain passive position What is required for Medicare submission? ICD 10 and narrative or CPT What is the neurotransmitter problem in Schizophrenia? Excess dopamine in mesolimbic pathway. What is the neurotransmitter problem in ADHD? Dopamine, norepinephrine and serotonergic dysfunction What is the benefit of play therapy? Don't have to confront emotions head on. What neurotransmitters are involved in the bioamine hypothesis of depression? Noradrenaline Serotonin Dopamine MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse. How do you test CN XII? Stick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? CN V - Trigeminal What are two important things to measure when using Zyprexa? Lipid level and abdominal circumference [Show Less]
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