PMHNP Boards Scientific Foundation and Advance Practice Skills 212 Questions with Verified Answers
Which of the following is a contraindication to
... [Show More] benzodiazepines?
a. Acute alcohol intoxication
b. Acute narrow angle glaucoma
c. Psychosis
d. All the above - CORRECT ANSWER 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 - CORRECT ANSWER 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. - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 How long before starting the MAOI should the Fluoxetine be withdrawn?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 - CORRECT ANSWER 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 - CORRECT ANSWER d. Tegretol
Which is considered the most sedating SSRI?
a. Paroxetine
b. Sertraline
c. Fluoxetine
d. Escitalopram Oxalate - CORRECT ANSWER a. Paroxetine (Paxil is EVIL)
Brain structure responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions - CORRECT ANSWER amygdala
Regulates memory and converts short-term memory into long-term memory - CORRECT ANSWER
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 - CORRECT ANSWER
Patient on lithium and cipro Cipro _____________ lithium level - CORRECT ANSWER
Patient on psych meds and dexamethasone will complain of what? - CORRECT ANSWER
Patient w/ schizophrenia, structural changes of the brain on CT - CORRECT ANSWER
Which lab is checked with clozaril? - CORRECT ANSWER ANC
Lobes of the Brain - Fred Tore his Pants Off - CORRECT ANSWER 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? - CORRECT ANSWER Cranial nerve 5 - TRIGEMINAL
What does the frontal lobe affect? (LIMP) - CORRECT ANSWER Executive functions:
Language
Intelligence (cognitive functoning)
Motor Function
Personality
What does temporal lobe affect? (LAME) - CORRECT ANSWER Language
Affective Component of speech
Memory
Emotion
In which lobe of the brain does the limbic system reside? - CORRECT ANSWER The temporal lobe
What is Wernicke's area responsible for and where does it reside in the brain? - CORRECT ANSWER Wernicke's area is responsible for receptive speech and it resides in the temporal lobe.
What is the first line drug for OCD? - CORRECT ANSWER SSRIs
What is the drug of choice for ADHD for 8 y.o and above? - CORRECT ANSWER Stimulants (specifically ritalin - methyphenidate)
If child develops tics, what do you prescribe? - CORRECT ANSWER Guanfacine
What does parietal lobe affect? (VAST) - CORRECT ANSWER Visual spatial processing
Association cortex
Symbolic recognition
Topographic sense
what is sterognosis? how do you test it? - CORRECT ANSWER Place objects in hand with closed eyes. Ability to differentiate items comes from parietal lobe
What does the occipital lobe affect? (VIP) - CORRECT ANSWER 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? - CORRECT ANSWER Cialis (tadalafil) or Viagra (sildenafil) phophodiasterase inhibitors
What is mechanism of action of phophodiasterase inhibitors? - CORRECT ANSWER Rapid absorption. They pull blood to corpus cavernosum.
What are the main functions of the limbic system? - CORRECT ANSWER 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? - CORRECT ANSWER Anterior cingulate gyrus (LIMBIC SYSTEM)
If a patient with OCD has failed on SSRIs, what should you switch to? - CORRECT ANSWER TCA - anafranil
Mood disorder is most associated with which neurotransmitters? - CORRECT ANSWER serotonin and norepinephrine
Serotonin DOMAINS - CORRECT ANSWER Depression
Obsessions
Migraines
Anxiety
Intestines
Nausea
Sexual and sleep
Where is serotonin produced? - CORRECT ANSWER The raphe nuclei (distributed near the midline of brainstem)
What are the symptoms of SEROTONIN SYNDROME? SHITS AND SHIVERS - CORRECT ANSWER SHITS (diarrhea)
Shivering
Hyperreflexia
Increased body temp
Vital sign instability
Encephalopathy
Restlessness
Sweating
What is the treatment for serotonin syndrome? - CORRECT ANSWER Cyproheptadine (PERIACTIN)
Patient has serotonin syndrome what are actions? - CORRECT ANSWER 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? - CORRECT ANSWER antipsychotics
Treatment for NMS is? - CORRECT ANSWER 1. dantrolene
2. Bromocriptine (parlodel)
If you are giving a patient Latuda and Geodon, what is the patient teaching? - CORRECT ANSWER 1. QT prolongation
2. Metabolic syndrome
3. Eat with a meal!!!!
For pediatric panic disorder, what do you prescribe? - CORRECT ANSWER 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 - CORRECT ANSWER D. Metabolic syndrome
What is a normal lab value range for lithium? - CORRECT ANSWER 0.6 - 1.2
Which mood stabilizer is the gold standard for a manic episode? - CORRECT ANSWER lithium
Which mood stabilizer has evidence of anti-suicidal effects? - CORRECT ANSWER lthium
Before starting lithium, the serum creatinine of a patient was 1.8 and the BUN was 24, should you start the medicaton?
A) Yes, the level is normal.
B) No, the level is not normal - CORRECT ANSWER B) not the level is not normal. Normal serum creatinine is 0.6 - 1.2, like with lithium and BUN should be 10-20.
What labs should be done before starting lithium for safety? - CORRECT ANSWER Thyroid panel
Serum creatinine (0.6 - 1.2mg/dL)
Blood urea nitrogen (BUN) (10 - 20 mg/dL)
Pregnancy test (HCG)
ECG for clients older than 50
What are early signs of lithium toxicity? - CORRECT ANSWER Gi distress - diarrhea
What are late signs of lithium toxicity? - CORRECT ANSWER seizures and arrythmia
What would be a sign that lithium had become nephrotoxic? - CORRECT ANSWER Proteinuria
Which brain structure correlates to the development of anxiety disorder?
A) pons
B) Amygdala
C) Occipital cortex
D) hippocampus - CORRECT ANSWER A) pons - no connects medulla with cerebellum
B) Amygdala - yes, anxiety
C) Occipital cortex - no, optic
D) hippocampus - no, part of the limbic system and has several functions regarding forming new memories, learning and emotions . Damage of the hippocampus is involved in Alzheimer's disease.
What are primary side effects of lithium? - CORRECT ANSWER Hypothyroidism
Fine hand tremors
Fatigue
Mental cloudiness
Headaches
Coarse Hand tremors occur with toxicity
Nystagmus Dermatological
Maculopapular rash
Pruritus
Acne
Diarrhea
Vomiting
Cramps
Anorexia
Diabetes insipidus
Edema
Microscopic tubular changes
Cardiac T-wave inversions
Dysrhythmia
Leukocytosis (Increased WBC)
Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is affecting his ECG. How do you respond?
A. Lithium can prolong the QT interval
B. Lithium has no effect on his ECG
C. Lithium can invert the T -wave
D. Lithium can shorten the PR interval - CORRECT ANSWER C. Lithium can invert the T -wave
HTN crisis occurs when MAOIs are taken in conjunction with foods containing tyramine. What are foods to avoid when taking MAOIs? - CORRECT ANSWER Beer, red wine, sherry and liqueurs
Strong and aged cheeses
Cured, smoked, processed meats
Pickled and fermented foods
Dried fruits
Snow peas, fava beans, soybeans and soybean products
Sauces - soy, miso, teriyaki
HTN crisis can occur when MAOIs are taken with certain medications - CORRECT ANSWER meperidine
decongestants
TCAs
Atypical antipsychotics
St John's wort
L-tryptophan
Stimulants and other sympathomimetics
Asthma medication
What are symptoms of HTN crisis with MAOIs? - CORRECT ANSWER Elevated BP
Sudden, explosive-like headache, usually in occipital region
Facial flushing
Palpitations
Pupillary dilation
Diaphoresis
Fever
What is the treatment for HTN crisis with MAOIs? - CORRECT ANSWER 1. DC the offending agent
2. Administer phentolamine (alpha blocker)
What are the symptoms of metabolic syndrome? - CORRECT ANSWER 1. increased waist circumference
2. high triglycerides
3. low HDL
4. hypertension
5. hyperglycemia (fasting)
If you see "initially" in the stem of the question, what step in the evaluation process should you refer back to in order to answer the question? - CORRECT ANSWER The assessment/intervention phase
In addition to foods with tyramine, which medications can cause a HTN crisis if taken with MAOIs? - CORRECT ANSWER meperidine
stimulants and other sympathomimetics
TCAs
Atypical antipsychotics
decongestants
asthma medication
St John's Wort
L-tryptophan
What are symptoms of a MAOI related HTN crisis? - CORRECT ANSWER 1. Elevated BP
2. Sudden explosive-like HA, usually in occipital region
3. Facial flushing
4. Palpitations
5. Pupillary dilation
6. Diaphoresis
7. Fever
Name the FDA-approved MAOIs to treat depression. - CORRECT ANSWER 1. Isocarboxazid (Marplan)
2. Phenelzine (Nardil)
3. Selegiline (Emsam)
4. Tranylcypromine (Parnate)
A patient has been taking isocarboxazid (Marplan) for 6 years. Which medication is contraindicated with isocarboxazid?
A. Morphine
B. NSAIDS
C. Methyphenidate
D. Acetaminophen - CORRECT ANSWER C. Methylphenidate
What are the teratogenic risks associated with benzodiazepines during pregnancy? - CORRECT ANSWER 1. Cleft palate
2. Floppy baby syndrome
What are the teratogenic risks associated with carbamazepine (Tegretol) during pregnancy? - CORRECT ANSWER Neural tube defect
What are the teratogenic risks associated with Lithium during pregnancy? - CORRECT ANSWER Epstein anomaly (avoid in 1st trimester)
What are the teratogenic risks associated with depakote during pregnancy? - CORRECT ANSWER 1. Neural tube defects
2. Spina bifida
What is the most dangerous side effect of lamotrigine (Lamictal)? - CORRECT ANSWER Steven Johnson's Syndrome
What are signs and symptoms of Steven Johnson's Syndrome? - CORRECT ANSWER 1. Fever
2. Sore throat
3. Facial swelling
4. Macules, papules, and "burning" confluent erythematic rash
5. Skin sloughing
6. Prodromal HA, malaise, arthralgia, and painful mucous membranes may occur before rash occurs.
Which ethic group is most at risk for Steven Johnson's syndrome when taking carbamazepine (Tegretol)? What can you screen for before initiating? - CORRECT ANSWER Asians. Screen for HLAB 1502 allele for initiating.
What are the common, serious side effects of carbamazepine (Trileptal)? - CORRECT ANSWER 1. SJS, especially in Asians
2. Agranulocytosis (decreased WBCs)
Which lab is monitored closely with both carbamazepine and clozaril? At what level would you discontinue use? - CORRECT ANSWER Absolute neutrophil count (ANC). Discontinue if ANC is less than 1000 mm.
What should you monitor for with decreased ANC (less than 1000 mm)? - CORRECT ANSWER Signs of infection (sudden fever, chills, sore throat, weakness)
What type of anemia can develop with initiation of carbamazepine (Tegretol)? What are SXS? - CORRECT ANSWER Aplastic anemia. SXS are pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash SOB)
You want to start a 30 y.o. woman on carbamazepine (Tegretol). What lab do you you need to check first and what should the result be? - CORRECT ANSWER HcG - negative.
Why is folic acid so important for women to take during pregnancy? How much folic acid is recommended? - CORRECT ANSWER Folic acid supports neural tube development during the first month a woman is pregnant. It is recommended they take 0.4-0.8 mg of folic acid daily.
What lab is closely monitored with clozapine (Clozaril)? - CORRECT ANSWER Absolute neutrophil count (ANC).
A schizophrenic client is being treated with clozapine. Which lab values indicate the client needs to discontinue treatment?
A. WBC count less than 1800 and ANC less than 1200
B. ANC less than 1000
C. WBC less than 1200
D. ANC less than 200 - CORRECT ANSWER B. ANC less than 1000
If given during pregnancy sodium valproate can cause which of the following:
A. Steven Johnson syndrome
B. Epstein's anomaly
C. Spina bifida
D. Cleft palate - CORRECT ANSWER Sodium valproate (Depakote) can cause spina bifida. Lithium can cause Epstein's anomaly, especially during first trimester. Benzodiazepines can cause cleft palate and floppy baby syndrome.
Which mood stabilizer can have a life-threatening side effect in Asian population?
A. Carbamazepine
B. Depakote
C. Lithium
D. Lamictal - CORRECT ANSWER A. Carbamazepine
What is a normal BMI range?
A. Below 18.5
B. 18.5-24.9
C. 25-29.9
D. 30 and above - CORRECT ANSWER B. 18.5-24.9 (normal)
A. Below 18.5 (underweight)
C. 25-29.9 (overweight)
D. 30 and above (obese)
What BMI range do people with bulimia nervosa have? - CORRECT ANSWER Normal (18.5-24.9)
What are SXS of bulimia nervosa? - CORRECT ANSWER 1. erosion of dental enamel
2. Russel's sign (scarring or calluses on dorsum of hand secondary to self-induced vomiting)
3. Hypertrophy of salivary glands
4. Rectal prolapse
What specific medication is FDA approved for bulimia nervosa? - CORRECT ANSWER fluoxetine (Prozac)
Which drug classes are helpful in reducing bingeing and purging episodes in bulimia nervosa? - CORRECT ANSWER SSRIs and TCAs
What are examples of TCAs? - CORRECT ANSWER Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Imipramine (Tofranil)
What are SXS of anorexia nervosa? - CORRECT ANSWER 1. Underweight (BMI less than 18.5)
2. amenorrhea
3. hypertrophy of salivary glands
4. Russell's sign (scarring or calluses on dorsum of hand secondary to self-induced vomiting)
5. Emaciation
6. Bradycardia
7. HTN
8. Inversion of t-waves
9. Prolonged QT interval
What is the primary therapy for anorexia nervosa? - CORRECT ANSWER Therapy
The PMHNP would expect to see which of the following during a physical exam for a patient with anorexia nervosa?
A. Russel's sign
B. Underweight (BMI less than 18.5)
C. Erosion of dental enamel
D. Hypertrophy of salivary glands - CORRECT ANSWER B. Underweight (BMI less than 18.5)
What class of drug is bupropion (Wellbutrin)? - CORRECT ANSWER Norepinephrine-Dopamine Reuptake inhibitor
Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor (NDRI)?
A. duloxetine (Cymbalta)
B. sertraline (Zoloft)
C. bupropion (Wellbutrin)
D. clomipramine (Anafranil) - CORRECT ANSWER C. bupropion (Wellbutrin) is a NDRI
A. duloxetine (Cymbalta) is a SNRI
B. sertraline (Zoloft) is a SSRI
D. clomipramine (Anafranil) is a TCA
Which enzyme metabolizes clozapine? - CORRECT ANSWER P450 enzyme CYP1A2
How do enzyme inducers work? - CORRECT ANSWER INDUCE=DOWN. Enzyme inducers can decrease the serum level of other drugs that are substrates of that enzyme, thus possibly causing subtherapeutic drug levels.
How do enzyme inhibitors work? - CORRECT ANSWER INHIBITOR=HIGH. Enzyme inhibitors can increase the serum level of other drugs that are substrates of that enzyme, thus possibly causing toxic levels.
Are cigarettes an inducer or an inhibitor? - CORRECT ANSWER Cigarettes are an inducer. INDUCER=DOWN. Clients who smoke may need higher dose and if they stop smoking levels will need to be lowered.
Name the inducers. BULLSHIT - Crap GPS INDUCES my rage. - CORRECT ANSWER BULL - Barbituates (drugs w/ BARB in the name)
SHIT - St. Johns Wort
C - carbamazepine (Tegretol)
R - rifampin (TB treatment)
A - alcohol (Chronic use)
P- phenytoin (Dilantin)
G - griseofulvin (antifungal)
P - Phenobarbital (BARB)
S - sulfonylureas (diabetic drugs - glipizide, glyburide, glimepiride)
PLUS CIGARETTES AND ORAL CONTRACEPTIVES
Name the common inhibitors. SICKFACES.COM - CORRECT ANSWER Sodium valproate (depakote)
Isoniazid (TB treatment)
Cimetidine (Tagamet - acid reducer)
Ketoconazole (antifungal)
F is a filler
Alcohol (chronic)
Chloramphenicol - antibiotic (banned in US)
Erythromycin - antibiotic
Sulfonamides - antibiotic (ex: sulfameth-trimeth)
Ciprofloxacin - antibiotic
Omeprazole - acid reducer
Metronidazole - antibiotic
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated with clozapine?
A. 2D6
B. 1A2
C. 2C19
D. 2C9 - CORRECT ANSWER B. 1A2 is implicated as tobacco inducer with clozapine. Other
A. 2D6
C. 2C19
D. 2C9
Besides inhibitor and inducer interactions, liver disease can also affect enzyme activity and first-pass metabolism. Which labs should monitor for this and what are the levels? - CORRECT ANSWER AST 8-48 (U/L)
ALT 7-55 (U/L)
Albumin 3.5-5.0 grams per deciliter (g/dl)
Total protein 6.3-7.9 (g/dl)
Bilirubin - 0.1 - 1.2 (mg/dl)
Gamma-glutamyltransferase (GGT)- 8-61 (U/L)
If a client has kidney disease or takes drugs that reduce renal clearance, what can result? - CORRECT ANSWER Increased serum concentration of drugs that are excreted by the kidneys such as lithium.
What are drugs you must advise a client to avoid if taking lithium because of reduced renal clearance? - CORRECT ANSWER NSAIDs, thiazides, and ACE inhibitors (-pril).
Older adults are more sensitive to psychotropics because of: - CORRECT ANSWER 1. decreased intracellular water
2. Decreased protein binding (more active drugs remains in body - leads to toxicity)
3. Low muscle mass
4. Decreased metabolism
5. Increased body fat concentration
When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons?
1. decreased body fat
2. increased liver capacity
3. decreased protein binding
4. increased muscle concentration - CORRECT ANSWER 3. decreased protein binding
1. decreased body fat - no, body fat is increased
2. increased liver capacity - no it's decreased
4. increased muscle concentration - no, it's decreased
For 12 years, a 65 y.o. patient with bipolar affective disorder has been treated with lithium 900mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for HTN, 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. hyponatermia
C. increased renal clearance of lithium
D. decreased renal clearance of lithium - CORRECT ANSWER D. decreased renal clearance of lithium
Where is norepinephrine produced in the brain? - CORRECT ANSWER Norepinephrine is produced in the LOCUS COERULEUS (located in the PONS) and the MEDULLARY RETICULAR FORMATION (located in the BRAINSTEM extend from upper part of the midbrain to the lower part of the medulla oblongata)
Where is serotonin produced in the brain? - CORRECT ANSWER Serotonin is produced in the RAPHE NUCLEI (located near the midline of the brainstem along its entire rostro-caudal extension)
Where is dopamine produced in the brain? - CORRECT ANSWER substantia nigra and ventral tegmental area (VTA)
Where is acetylcholine produced in the brain? - CORRECT ANSWER Synthesized by the nucleus of Meynert (located at the basal forebrain)
Which psych symptom would increase if GABA was decreased? - CORRECT ANSWER Increased anxiety
Which psych symptom presents if GLUTAMATE is increased? - CORRECT ANSWER increased anxiety
Which psych symptom presents if there is an increased level of corticotropin releasing hormone in the amygdala, hippocampus, and locus coeruleus? - CORRECT ANSWER Increased anxiety
Name 3 screening tools for autism. - CORRECT ANSWER Modified checklist for Autism in toddlers.
(M-CHAT)
Autism Diagnostic Observation Schedule - generic (ADOS-G)
Ages and Stages Questionnaire (ASQ)
What is the first line medication for autism-related tantrum, aggression, self-injury, hyperactivity, and repetitive, stereotyped behaviors? - CORRECT ANSWER Risperidone
What are the risk factors for ASD? - CORRECT ANSWER Male gender
Intellectual disability
Genetic loading
What is the largest part of the brain? - CORRECT ANSWER cerebrum
How is the cerebrum organized? - CORRECT ANSWER into left and right cerebral hemispheres
Which hemisphere dominant for most people and controls the right side of the body? - CORRECT ANSWER left hemisphere
Which hemisphere controls the left side of the body? - CORRECT ANSWER Right hemisphere
Which structure connects the right and left hemispheres so they can communicate? - CORRECT ANSWER Corpus callosum [Show Less]