PMHNP Certification Exam KM 2022 (Actual test questions verified A+) 434 Questions with 100% Correct Answers

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PMHNP Certification Exam KM 2022 (Actual test questions verified A+) 434 Questions with 100% Correct Answers Which patient is at highest risk for SI A. 30y/o married AA female with previous SI att... empt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank *2 risk factors D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) - ✔✔D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors When interview teenagers (16 y/o) that arrive with their parents what should you do? - ✔✔interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. Which Ethnic group has the highest rate of suicide? - ✔✔Native Americans Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism C. Increased Lipids D. Metabolic Syndrome - ✔✔D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? - ✔✔Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFYWhich mood stabilizer have the least weight gain? - ✔✔Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a - ✔✔atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus - ✔✔Hypothalamus A, B, & D are all part of the limbic system so you can rule that out When a patient is hesitant to participate in treatment you should encourage? - ✔✔Bring a support person like a husband Thyroid-Stimulating hormone normal level - ✔✔0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis - ✔✔HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance - ✔✔Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis - ✔✔(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance - ✔✔HypothyroidismHyperthyroid can mimic - ✔✔Mania Hypothyroid can mimic - ✔✔Depression A patient on depakote complains of RUQ pain and has reddish/brown urine - ✔✔Hepatoxicity -Check LFTs Signs of Depakote toxicity - ✔✔Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? - ✔✔Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? - ✔✔Kava Kava When taking Kava Kava in combinations with other medications you should caution about - ✔✔Risk of Hepatoxicity and Sedation TCAs carry a risk of - ✔✔Hepatotoxicity Signs of Stevens-Johnson Syndrome - ✔✔-fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome - ✔✔lamictal and tegretol What nationality is most suseptible of getting steven johnson? - ✔✔Asians When treating asians with tegretal screen for? - ✔✔HLAB-1502 AlleleWhat two medications cause agranulocytosis? - ✔✔Clozaril & Tegretal Agranulocytosis when to discontinue medication - ✔✔Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? - ✔✔Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? - ✔✔HCG Which two medications may decrease the risk of suicide? - ✔✔clozaril and lithium Medications that increase lithium level - ✔✔NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? - ✔✔Heart Failure Certain medications are known to increase lithium level, but HOW? - ✔✔by reducing renal clearance When educating a patient about lithium teach them about - ✔✔Hyponatremia Dehydration-hot days, exercise Normal Lithium Level - ✔✔0.6-1.2 Lithium Toxicity - ✔✔1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 - ✔✔Monitor for toxicityLabs before starting lithium - ✔✔TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium - ✔✔4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects - ✔✔hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity Signs of lithium toxicity - ✔✔confusion, ataxia, GI upset, palpitation, tremor NMS - ✔✔muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot - ✔✔test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome - ✔✔With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Treatment for NMS - ✔✔Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer Treatment for Serotonin Syndrome - ✔✔Stop Med (1 or more SSRI, SSNRI, TCA, MOAI)-Cyproheptadine Triptans - ✔✔Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan - ✔✔-call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP How long do you wait when switching between an SSRI to an MAOI? - ✔✔2 weeks How long do you wait when switching between Prozac and MAOI? - ✔✔5-6 weeks wash out period What is the first line treatment for depression and why? - ✔✔SSRI-First line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? - ✔✔Treating with a medication with minimal drug/drug side effects like Lexapro Patient with depression worries about sexual dysfunction what would be the medication of choice? - ✔✔Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? - ✔✔Wellbutrin Wellbutrin is contraindicated in patients with - ✔✔Seizures and anorexia Which medications are best for neuropathic pain? - ✔✔SNRI Gabapentin TCASecondary to the black box warning providers caring for patients on antidepressants should assess for? - ✔✔Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome - ✔✔Those with short half lives such as zoloft Symptoms of serotonin withdrawal syndrome - ✔✔Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females - ✔✔-MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for - ✔✔SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia - ✔✔excessive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad) MRI or PET scan what is seen in schizophrenia - ✔✔EVERYTHING DECREASES EXCEPT VENTRICLES-You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter? - ✔✔Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) - ✔✔a form of rehabilitation post hospitalization, in home treatment What level of prevention is ACT? - ✔✔Tertiary What adjunctive treatment is important in schizophrenia - ✔✔-social skills training -Exercise Exercise for mental health patients can promote - ✔✔Cognition Quality of Life Long-term health ACT is ideal for patients with a history of - ✔✔Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality - ✔✔Antisocial In the MMSE how do you test for abstraction? - ✔✔proverb interpretation (everyone that lives in glass houses shouldn't throw stones) Are they able to think abstractly Thought Process-Tangential - ✔✔means that their response has nothing to do with the questionCircumstantial - ✔✔means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes - ✔✔SI/HI/AH/VH Another name for MMSE - ✔✔Folstein Scale How to assess concentration on MMSE - ✔✔Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material - ✔✔repeat 3 words after me Assess ability to recall - ✔✔repeat 3 words after 5 minutes Assess fund of knowledge - ✔✔Who is the president What is a quick and easy way to assess for neurological issues - ✔✔Clock drawing test If patient is unable to draw a clock this indicates - ✔✔Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway - ✔✔Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway - ✔✔-Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia Nigrostriatal Pathway - ✔✔-This pathway mediates motor movements-Dopamine blockade in this pathway can lead to increase acetylcholine levels -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter - ✔✔-Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to - ✔✔tardrive dyskinesia Tuberoinfundibular pathway - ✔✔-Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN Long-term hyperprolactinemia can be associated with what condition - ✔✔osteoporosis Normal Prolactin Level in Men - ✔✔level less than 20ng/ml Normal Prolactin Level in Women - ✔✔less than 25ng/ml Which medication is the highest offender for increasing prolactin - ✔✔Risperdal Acute Dystonia + Treatment - ✔✔neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment - ✔✔may mimic anxiety, restlessness, can't sit still, rocking, pacing-First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos Beta-Blockers such as Inderal are contraindicated with what type of asthma medication - ✔✔-DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment - ✔✔A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment - ✔✔caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN tardive dyskinesia + Treatment - ✔✔abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT Does Cogentin Treat TD - ✔✔COGENTIN MAKES TD WORSE Typical onset of TD - ✔✔OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO What non-psych med can cause TD? - ✔✔REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops InDucers CYP450 - ✔✔DECREASECarbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylureas Crap GPS Induces me to Madness! InhIbitors of CYP450 - ✔✔INCREASE Ciprofloxacin Ritonavir Amiodarone Cimetidine Ketoconazole Acute Etoh Macrolides INH Grapefruit Juice Omeprazole Crack Amigos Erythromycin and Clarithromycin can cause - ✔✔Increased tegretol levelsPatient started on Clozaril or Zyprexa and two months later starts smoking - ✔✔as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey - ✔✔as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania - ✔✔Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer Medications that cause depression - ✔✔steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone -may need to increase antidepressant Accutane (isotretinoin) - ✔✔Can cause depression and birth defects Flonase - ✔✔As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression Flonase can trigger mood instability but it can also cause an increase in - ✔✔Psychosis patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis -increase the dose of antipsychoticNeurotransmitters involved in Addiction - ✔✔Dopamine and GABA Symptoms of Stimulant Abuse - ✔✔1. agitation/aggression 2. impaired judgment 3. euphoria 4. elevated BP 5. tachycardia 6. dilated pupils 7. hallucinations 8. TREMORS 9. IMSOMNIA If an anorexic patient complains of pain or bloating after eating this may indicate - ✔✔delayed gastric emptying Medications that delay gastric emptying - ✔✔Omeprazole, ranitidine, famotidine Proton Pump Inhibitors (omeprazole & Protonix) - ✔✔Decrease absorption of antipsychotics & SSRI -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI When initiating an SSRI on an elderly patient you should advise about - ✔✔increased anxiety Paradoxical effect - ✔✔when meds cause the opposite effect than expected Apoptosis - ✔✔programmed cell death/neuronal loss At age 45 and above the patient displays mania for first time what should be ruled out - ✔✔MEDICAL CONDITIONPatient with bipolar disorder presents with depressed mood & emotional lability - ✔✔Give Depakote Hallmark sx of Borderline Personality - ✔✔Recurrent self harm Treatment for Borderline Personality - ✔✔DBT Creator of DBT - ✔✔Marsha Linehan What activity is helpful in making a diagnosis of borderline personality - ✔✔Journaling or diary keeping Conversion Disorder - ✔✔STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism Adjustment Disorder - ✔✔adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying) -Symptoms occur within 3 months of the stressor If question states recently moved, recent death....THINK ADJUSTMENT factitious disorder - ✔✔when patients introduce foreign substances into their body or contaminate their food -Faking illness but NO MOTIVE BEHIND IT Malingering - ✔✔Faking illness for financial gain Reactive Attachment - ✔✔common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiverODD - ✔✔They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting Conduct Disorder - ✔✔violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine Acute Stress Disorder - ✔✔similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH PTSD - ✔✔-OVER ONE MONTH -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT Panic attack vs Panic disorder (treatment) - ✔✔Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONICFeels like impending doom Tourette's Syndrome - ✔✔Criteria for diagnosis -TWO moto tics and ONE vocal tics -LASTS more than ONE YEAR -By age 18 **CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Child presents with one tic and the parent is worried - ✔✔**CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Neurotransmitters involved in Tourettes - ✔✔DNS: Dopamine, Norepinephrine, Serotonin Treatment for tourettes - ✔✔Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them - ✔✔Stimulants Neurotransmitters involved in mood disorders - ✔✔DNS: Dopamine, Norepinephrine, Serotonin + GABA Neurotransmitters involved in ADHD - ✔✔DNS: Dopamine, Norepinephrine, Serotonin part of brain implicated in ADHD - ✔✔prefrontal cortex basal ganglia reticular activating system ADHD inattentive type is caused in what part of the brain - ✔✔Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION dorsolateral p [Show More]

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