PMHNP 1 Final Exam 246 Questions with Verified Answers
_______ is produced in the locus ceruleus of the pons - CORRECT ANSWER Norepinephrine
The
... [Show More] hallmark symptom in _______ is a disturbance of consciousness accompanied by changes in cognitive function - CORRECT ANSWER delirium
Disturbance of consciousness develops over a short time, usually hours to days is seen in _______ - CORRECT ANSWER delirium
How are Sleep-rest cycle different in patients with delirium? - CORRECT ANSWER clients are awake at night andsleep during the day.
Impaired _______ and ______ memory is seen in patients with delirium - CORRECT ANSWER recent and intermediate
Symptoms of delirium resolve within ? - CORRECT ANSWER 3 to 6 months
Delirium Mnemonic - CORRECT ANSWER D-Drugs
E-electrolyte abnormality
L-low oxygen saturation
I-infection
R-reduced sensory input
I-intracranial
U-urinary or renal retention
M-myocardial
What is the most common type of dementia? - CORRECT ANSWER Alzheimer's
__________ has a Gradual onset and progressive decline without focal neurological deficits - CORRECT ANSWER Dementia of Alzheimer's type (DAT)
What are the hallmark signs of Dementia of Alzheimer's type (DAT) - CORRECT ANSWER amyloid deposits and neurofibrillary tangles senile plaques
What changes in the brain are seen in DAT? - CORRECT ANSWER Diffuse cerebral atrophy and enlarged ventricles
Which neurotransmitters are decreased in DAT? - CORRECT ANSWER acetylcholine (ACh) and norepinephrine
___________is Often induced by traumatic experiences such as physical/sexual abuse, or betrayal by a trusted individual - CORRECT ANSWER Dissociative amnesia
Clinical features of _____________ includes An inability to recall important personal information, usually of a traumatic/stressful nature, that is inconsistent with ordinary forgetting - CORRECT ANSWER Dissociative amnesia
localized amnesia is the disruption of - CORRECT ANSWER an event or period of time
selective amnesia is the disruption of - CORRECT ANSWER Specific aspect of an event
generalized amnesia is the disruption of - CORRECT ANSWER Identity or life history
purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information - CORRECT ANSWER dissociative fugue
inability to learn new info - CORRECT ANSWER Anterograde amnesia
inability to recall previously remembered info - CORRECT ANSWER Retrograde amnesia
Which TCA is used in the treatment of OCD? - CORRECT ANSWER Clomipramine
Which substances may cause dementia? - CORRECT ANSWER Alcohol
• Heavy metals
• Carbon monoxide
•Pseudodementia r/t meds ( anticholinergics)
inhalants
Which SSRIs have a sedative effect? - CORRECT ANSWER Citalopram (Celexa)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Which TCAs have a sedative effect? - CORRECT ANSWER Amitriptyline (Elavil)
Doxepin (Sineqan)
Which other antidepressants may cause sedation? - CORRECT ANSWER Mirtazapine (Remeron)
Nefazodone (Serzone)
Trazodone
What are side effects of trazadone? - CORRECT ANSWER Sedation, nausea, headache, hypotension, priapism
Wellbutrin (NDRI) can be used to treat which disorders? - CORRECT ANSWER -Antidepressant (mood disorders, unipolar affective disorders and depressive disorders)
-attention deficit hyperactive disorder
-smoking cessation.
Wellbutrin is contraindicated in clients with - CORRECT ANSWER SZ disorder
eating disorder
What is Considered first-line agents for chronic anxiety disorders? - CORRECT ANSWER Selective serotonin reuptake inhibitors (SSRIs)
black box warning for SSRIs in children, adolescents, and young adults - CORRECT ANSWER increased risk for suicide
Which benzo have a short half life? - CORRECT ANSWER Alprazolam (Xanax)
Lorazepam (Ativan)
Which benzo have a long half life? - CORRECT ANSWER Clonazepam (Klonopin)
Diazepam (Valium)
Medications used to treat anxiety works on which system? - CORRECT ANSWER directly or indirectly on GABA
Benzodiazepines with short/long half life have More severe withdrawal and more rebound anxiety - CORRECT ANSWER short
Which non- benzo anxiolytics can be used to treat anxiety - CORRECT ANSWER Buspirone (Buspar)
Tiagabine (Gabitril)
Gabapentin(Neurontin)
Propranolol (Inderal)
Males greater than ______ yrs old are have a risk factor associated with suicide - CORRECT ANSWER 45 yr. old
females greater than ______ yrs old are have a risk factor associated with suicide - CORRECT ANSWER 55 yr.s old
Which Benzodiazepines or hypnotics used for insomnia is long acting and should be avoided in older adults - CORRECT ANSWER Flurazepam (Dalmane)
Pharmacological Management for insomnia include: - CORRECT ANSWER §Melatonin
§Benzodiazepines or hypnotics
Nonbenzodiazepine hypnotics
§Antidepressants
Classification?
Zaleplon (Sonata)
•Zolpidem (Ambien)
•Eszopiclone (Lunesta) - CORRECT ANSWER Nonbenzodiazepine hypnotics used for insomnia
•Classification?
Flurazepam (Dalmane)
•Temazepam (Restoril)
•Triazolam (Halcion) - CORRECT ANSWER Benzodiazepines or hypnotics used for insomnia
Which antidepressant use to treat insomnia should be avoided in older adults? - CORRECT ANSWER Doxepin (Sinequan)
Classification?
•Amitriptyline (Elavil), Doxepin (Sinequan)
•Mirtazapine (Remeron), Desyrel (Trazadone) - CORRECT ANSWER Antidepressants used for insomnia
Pharmacological Management for Hypersomnolence/Narcolepsy/OSA - CORRECT ANSWER Armodafinil (Nuvigil)
Modafinil (Provigil)
Amphetamines
Second-line treatment for Hypersomnolence/Narcolepsy/OSA - CORRECT ANSWER Traditional psychostimulants- Amphetamines
Benzodiazepines should NEVER be used in which sleep disorder? - CORRECT ANSWER OSA
Pharmacological Management for nightmare disorder? - CORRECT ANSWER Prazosin (Minipress)
Pharmacological Management for Restless Leg Syndrome - CORRECT ANSWER Dopaminergic agonists
Levodopa
Benzodiazepines
Antiepileptics
Which Dopaminergic agonists are used to treat RLS? - CORRECT ANSWER Pramipexole (Mirapex)
Ropinirole (Requip)
Which Nonbenzodiazepine hypnotics has an Ultra-short half-life makes this drug particularly useful for initial or middle phase
insomnia? - CORRECT ANSWER Zaleplon (Sonata)
Which Nonbenzodiazepine hypnotics is a Melatonin receptor agonist? - CORRECT ANSWER Rozerem
What is the classic sign of ETOH withdrawal? - CORRECT ANSWER tremulousness
Pharmacological management for Tremulousness/agitation r/t alcohol intoxication and withdrawal - CORRECT ANSWER chlordiazepoxide (Librium)
Pharmacological management for Withdrawal seizures/delirium tremens r/t alcohol intoxication and withdrawal - CORRECT ANSWER diazepam/Valium; lorazepam/Ativan
What is the aversion treatment for ETOH abuse? - CORRECT ANSWER Disulfiram (Antabuse)
Detox agents for ETOH withdrawal? - CORRECT ANSWER Ativan, Librium, Valium, oxazepam/ Serax
SSRIs used in ETOH withdrawal? - CORRECT ANSWER citalopram/ Celexa
Anti-seizure medication used in ETOH withdrawal? - CORRECT ANSWER carbamazepine/ Tegretol
Anti-craving medications used in ETOH withdrawal? - CORRECT ANSWER naltrexone/ Revia; acamprosate/ Campral
Which Adrenergic medications -to lower blood pressure and pulse rate associated with ETOH withdrawal - CORRECT ANSWER catapres/ Clonidine
Dysphoria, lethargy, fatigue, anxiety, headache, muscle/stomach cramps, anxiety, tremulousness, nightmares, bradycardia are associated with ____________ withdrawal? - CORRECT ANSWER Amphetamine
________ is a atypical antipsychotic injectable give IM monthly (39-324mg) with S/E that include Orthostatic Hypotension, Hypoprolactinemia, GI upset, dizziness and headache - CORRECT ANSWER Invega Sustenna
________ is a atypical antipsychotic injectable given IM every 2 weeks (25-50mg) with S/E that include Hypotension, Galactorrhea, nausea and insomnia. - CORRECT ANSWER Risperdal Consta
Doses _________ of Risperdal Consta associated with a higher incidence of extrapyramidal symptoms - CORRECT ANSWER >6mg
Which atypical antipsychotic has the greatest prolactin elevation? - CORRECT ANSWER Risperdal Consta
A increase in which neurotransmitter is responsible for EPS? - CORRECT ANSWER ACh
EPS is caused by - CORRECT ANSWER D2 receptor antagonism
what type of drugs are used for treatment of EPS? - CORRECT ANSWER Anti-Parkinson (benztropine, diphenhydramine, Artane, Symmetrel, Inderal, Catapres)
Potentially irreversible movement disorder that may occur in people who are treated for more than 1 year with typical antipsychotics - CORRECT ANSWER EPS
Symptoms of ________ consist of abnormal, involuntary movements such as lip smacking, chewing, tongue protrusion, or twisting movements of the trunk or limbs - CORRECT ANSWER EPS
What movements are most common in EPS? - CORRECT ANSWER Perioral
After stopping the offending medication in EPS, what type of medication should the prescribe next? - CORRECT ANSWER Start a atypical antipsychotic
AIMS= - CORRECT ANSWER Abnormal Involuntary Muscle Movement Screening (AIMS)
How frequently should AIMS be assed in patients taking typical antipsychotics? - CORRECT ANSWER every 6 months
Cogentin Benztropine is used to treat which disorder? - CORRECT ANSWER EPS
Artane (Trihexyphenidyl) is used to treat which disorder? - CORRECT ANSWER EPS
Symmetrel (Amantadine is used to treat which disorder? - CORRECT ANSWER EPS
Inderal (Propranolol) is used to treat which disorder? - CORRECT ANSWER EPS
Catapres (clonidine) is used to treat which disorder? - CORRECT ANSWER EPS
•Oculogyric crises•Tongue protrusion•Trismus•Torticollis•Laryngeal-pharyngeal dystonia•Dystonic postures of the limbs and trunk are all examples of medication induced _______ ________ - CORRECT ANSWER acute dystonia
Administration of which IM anticholinergic can be used to treat acute dystonia? - CORRECT ANSWER Benadryl 50 mg IM
•Prophylaxis with _________ or related drugs usually prevents dystonia - CORRECT ANSWER anticholinergics
Acute dystonia is common with ________ doses of high potency antipsychotics but can occur with any antipsychotics? - CORRECT ANSWER IM
•Subjective feeling of restlessness, objective restlessness, or both•Sense of anxiety•Inability to relax•Jittery•Pacing•Rocking motions while sitting•Rapid alternation of sitting and standing is called - CORRECT ANSWER acute akathisia
Which population is at increased risk of akathisia? - CORRECT ANSWER middle aged women
What is the most effective treatment for acute akathisia? - CORRECT ANSWER B-adrenergic receptor antagonists
B-adrenergic receptor antagonists is the most effective treatment for acute akathisia, which other classification of medications may help? - CORRECT ANSWER anticholinergics and benzodiazepines
which medication induced movement disorder usually occurs after 6 months of treatment? - CORRECT ANSWER Tardive dyskinesia
•Consist of abnormal, involuntary, choreoathetoid movements of the muscles of the head, limbs, and trunk•Facial grimacing•Lip puckering•Lateral jaw movements•Finger movements and hand clenching•Torticollis, retrocollis, trunk twisting, and pelvic thrusting occur in severe cases are S/S of which movement disorder? - CORRECT ANSWER Tardive dyskinesia
Which medication(s) can the provider switch to if a patient is experiencing Tardive dyskinesia? - CORRECT ANSWER Clozapine or newer psychotropic
presence of symptoms of parkinson's disease produced by D2 blockade; which includes shuffling gait, motor slowing, mask-like facial expressive, pill-rolling, tremors and muscle rigidity. ****Note: Mask-like facial expression often confused as affective blunting or flattening. - CORRECT ANSWER Pseudo-parkinson'
________ defense mechanism is avoidance of unpleasant realities by unconsciously ignoring their existence - CORRECT ANSWER denial
________ defense mechanism is unconscious rejection of emotionally unacceptable personal attributes, beliefs, or actions by attributing them to other people, situations or events. - CORRECT ANSWER projection
________ defense mechanism is to return to more comfortable thoughts, behaviors or feelings used in earlier stages of development in response to current conflict, stress or threat - CORRECT ANSWER Regression
________ defense mechanism is often called overcompensation; unacceptable feelings, thoughts, or behaviors are pushed from conscious awareness by displaying and acting on the opposite feeling, thought or behavior - CORRECT ANSWER Reaction formation
________ defense mechanism is unconscious exclusion of unwanted, disturbing emotions, thoughts, or impulses from conscious awareness - CORRECT ANSWER repression
________ defense mechanism is the justification of illogical, unreasonable ideas, feelings or actions by developing an acceptable explanation that satisfies the person - CORRECT ANSWER rationalization
________ defense mechanism is behaviors that attempt to make up for or undo an unacceptable action, feeling or impulse - CORRECT ANSWER undoing
________ defense mechanism is the attempt to master current stressors or conflict by expansion of knowledge, explanation or understanding - CORRECT ANSWER intellectualization
________ defense mechanism is conscious analog of repression; conscious denial of a disturbing situation or feeling, or event - CORRECT ANSWER Suppression
________ defense mechanism is the unconscious process of substitution of socially acceptable, constructive activity for strong unacceptable impulse - CORRECT ANSWER sublimation
________ defense mechanism is meeting the needs of others in order to discharge drives, conflict or stressors - CORRECT ANSWER altruism
"How can I help you"? is what type of assessment question? - CORRECT ANSWER Open-ended
"Tell me about your family situation" is what type of assessment question? - CORRECT ANSWER Gentle commands
"How have you been sleeping"? is what type of assessment question? - CORRECT ANSWER Qualitative questions
"You say you just want to stay in bed all the time"? is what type of assessment question? - CORRECT ANSWER Statements of inquiry
"That is very frustrating". is what type of assessment question? - CORRECT ANSWER Empathetic statements
"Go on" is what type of assessment question? - CORRECT ANSWER Facilitating statements
"How many drinks did you have"? is what type of assessment question? - CORRECT ANSWER Close ended questions
"You can sit down here" is what type of assessment question? - CORRECT ANSWER Closed ended statements
What is a Unpleasant and overriding mental tension that has no apparent identifiable cause and is accompanied by physical distress and disruption of activities of daily living? - CORRECT ANSWER anxiety
What is A pathologic state characterized by a feeling of dread and accompanied by somatic signs indicative of hyperactive autonomic nervous system, differentiated from fear which has a known cause - CORRECT ANSWER anxiety
What is the standardized rating scale used for anxiety? - CORRECT ANSWER Hamilton Rating Scale for Anxiety (HAM-A; Hamilton, 1959)
What is the first line agent for chronic anxiety disorder? - CORRECT ANSWER SSRI
§ Normative level, can be motivating
§ Normal vital signs
§ Perceptual field broadened
§ Heightened awareness of environment - CORRECT ANSWER mild anxiety
§ Normative level, response to extreme stressor
§ Mild increase in heart rate, slight increase in muscle tone
§ Subjective feeling of tension or worry
§ Narrowed perceptions - CORRECT ANSWER Moderate anxiety
§ Pathological level
§ Fight-or-flight response, increased vital signs, diaphoresis, diarrhea, urinary frequency, dilated pupils
§ Perception field narrowed
§ Difficulty problem solving
§ Selective inattention - CORRECT ANSWER severe anxiety
§ Pathological level
§ Severe symptoms markedly increased, poor eye-hand coordination, dizziness, shortness of breath, decrease in hearing
§ Scattered perceptions
§ Unable to pay attention to environmental stimuli
Illogical thinking - CORRECT ANSWER Panic
Drug with mixed dopamine agonist/antagonist properties? - CORRECT ANSWER Thorazine (Chlorpromazine)
__________ is a defense mechanism that protects a person from overwhelming anxiety by emotionally separating. - CORRECT ANSWER Dissociation
An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is more than forgetfulness - CORRECT ANSWER Dissociative amnesia
•Disruption of identity characterized by two or more distinct personality states - CORRECT ANSWER Dissociative Identity Disorder
Patients with _________ will have Recurrent gaps in the recall of everyday events, important personal information and/or traumatic events that inconsistent with ordinary forgetting - CORRECT ANSWER Dissociative Identity Disorder
Experiences of unreality, detachment, or being an outside observer to one's thoughts, feelings, and actions is called _________ - CORRECT ANSWER Depersonalization
Experiences of unreality or detachment with respect to surroundings (individuals and objects seem unreal, dreamlike, foggy, or distorted) is called - CORRECT ANSWER Derealization
During the depersonalization or derealization experiences, reality testing remains _________ - CORRECT ANSWER intact
Lithium therapeutic range - CORRECT ANSWER 0.6-1.2
What are the side effects of lithium? - CORRECT ANSWER (LMNOP)
Lithium Movement, nephrotoxic, hypOthyroidisim, pregnancy problems: Epstein's anomaly
nausea, fine hand tremors, increased urination, thirst,
S/S of lithium toxicity includes: - CORRECT ANSWER slurred speech, confusion, severe gi effect
Which medications should be avoided when on lithium because it can cause the levels to double? - CORRECT ANSWER NSAIDS/ACEI
Lithium pregnancy category - CORRECT ANSWER D- Dont do it
Carbamazepine (Tegretol) Therapeutic window: _______ mcg/ml - CORRECT ANSWER 6-12
Which mood stabilizer has a Black box warning of Agranulocytosis and Aplastic anemia? - CORRECT ANSWER Carbamazepine (Tegretol)
increased LFTs and SJS can be seen in which mood stabilizer - CORRECT ANSWER Valproic Acid (Depakote)
When should lithium therapeutic index be checked? - CORRECT ANSWER 12 hours after last dose
Carbamazepine (Tegretol) has a black box warning of _________ - CORRECT ANSWER Agranulocytosis and Aplastic anemia
◦Common side effects of which mood stabilizer includes nausea, dizziness, sedation, headache, dry mouth, constipation, skin rash - CORRECT ANSWER Carbamazepine (Tegretol)
Carbamazepine (Tegretol) is pregnancy category _______ - CORRECT ANSWER D
Which medication reaction is common particularly in Asians when taking Carbamazepine (Tegretol)? - CORRECT ANSWER Steven Johnson Syndrome
Which labs should be monitored when taking Carbamazepine (Tegretol)? - CORRECT ANSWER LFTs
Why is it important to titrate Lamotrigine (Lamictal) very slowly? - CORRECT ANSWER decreases the risk of Steven Johnson Syndrome
Common side effects of Depakote include: - CORRECT ANSWER Nausea, diarrhea, abdominal cramps, sedation, tremor
Which lab should the NP monitor when a patient is taking Depakote - CORRECT ANSWER Liver enzymes
Depakote is effective for ________ and _________ - CORRECT ANSWER rapid cycling and mixed bipolar
What lab is important to monitor when a patient is on lithium? - CORRECT ANSWER Kidney function
Pregnant patients with bipolar can be treated safely with which medication? - CORRECT ANSWER Lamotrigine
Which mood stabilizers should be avoided in women on BC r/t decreased efficacy? - CORRECT ANSWER Carbamazepine
Lamotrigine
Divalproex
Sedation, weight gain, orthostatic hypotension are side effects of which Atypical Antipsychotics - CORRECT ANSWER Quetiapine (Seroquel and Seroquel XR)
Which Atypical Antipsychotics should the NP monitor for cataract development? - CORRECT ANSWER Quetiapine (Seroquel and Seroquel XR)
Which Atypical Antipsychotics should the NP monitor for weight, BMI, and waist circumference ? - CORRECT ANSWER Quetiapine (Seroquel and Seroquel XR)
Which lab levels should be monitored in patients taking Quetiapine (Seroquel and Seroquel XR) - CORRECT ANSWER serum lipids and glucose
Sedation, weight gain, hyperlipidemia, elevated glucose, elevated LFTs are side effects of which atypical antipsychotic - CORRECT ANSWER Olanzapine (Zyprexa)
which atypical antipsychotic has the greatest increase of prolactin? - CORRECT ANSWER Risperidone (Risperdal)
Hypotenision, galactorrhea, nausea, insomnia are side effect of which atypical antipsychotic? - CORRECT ANSWER Risperidone (Risperdal)
Orthostatic hypotension, hyperprolactinemia, GI upset, dizziness, headache are side effect of which atypical antipsychotic? - CORRECT ANSWER Paliperidone (Invega)
which atypical antipsychotic requires QTc monitoring? - CORRECT ANSWER Ziprasidone (Geodon) [Show Less]