PMHNP Exam Reported Questions and Answers images, with complete solution

DBT (dialectical behavior therapy) - ANSWER relaxation muscle prior to DBT Greatest patient at risk for Violence - ANSWER Substance abuse EMDR (eye movement desensitization and reprocessing) - ANSWER eye movement d ...

DBT (dialectical behavior therapy) - ANSWER relaxation muscle prior to DBT Greatest patient at risk for Violence - ANSWER Substance abuse EMDR (eye movement desensitization and reprocessing) - ANSWER eye movement desensitization and reprocessing What is dissemination? - ANSWER Getting the research information out to those who need to know it! Publication - highest level Presenting at National Conference Presenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? - ANSWER Moderate cognitive impairment What is Tegretol in the CYP450 system? - ANSWER Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? - ANSWER Inducer - will lower dose of Lamictal What is a Type I research error? - ANSWER There IS a difference but you say there isn't a difference. What is a Type II research error? - ANSWER There is NO difference but you say there is a difference. What is pseudo-dementia? - ANSWER 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? - ANSWER Yes. What is a drug 1/2 life? - ANSWER The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? - ANSWER Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? - ANSWER Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? - ANSWER HLAB-1502 When might you see toxic epidermal necrolysis? - ANSWER With worsening of SJS How many generations do you include for a genogram? - ANSWER 1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - What does messenger RNA code for? - ANSWER Amino Acids What is epigenetics? - ANSWER Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? - ANSWER Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? - ANSWER Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? - ANSWER 10-25 yo When do females typically present with schizophrenia? - ANSWER 25-35 yo What does Erythromycin to trileptal? - ANSWER You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? - ANSWER Heart Failure HTN What are some psychiatric side effects seen with some asthma drugs - ANSWER Leukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol? - ANSWER Agranulocytosis and Hyponatremia What are the 3 CK muscle enzyme tests? - ANSWER CKBB, CKMM, CKMB Which one of the 3 muscle enzymes are related to cardiac muscle damage? - ANSWER CKMB What is the risk of a seriously elevated CKMB? - ANSWER Polymyositis Rhabdo What is a normal CKMB? - ANSWER 0.3 mcg/L What psychoactives does Detrol interact with? - ANSWER Topamax KCL Zonegran What CN are you assessing when you have the patient shrug their shoulders? - ANSWER CN XI - Spinal Accessory What do you see in labs with HIV & Dementia? - ANSWER CD4 <200 Viral Load is high <20% get it with antiretroviral treatment What is the scoring with the Beck Depression Inventory? - ANSWER Self-Report - 0-63 0-13 - minimal 14-19 - mild 20-28 - moderate 29-63 - severe What is sensitivity? - ANSWER Helps rule-out disease = True Positive = Snout What is specificity? - ANSWER Helps rule-in disease = True Negative = Spin What does a sed rate measure? - ANSWER Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour. What is a normal sed rate or ESR? - ANSWER 0-22 males 0-29 females What is a retic count? - ANSWER 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? - ANSWER Anemia - acute or chronic bleeding What does an increased retic count indicate? - ANSWER Bone marrow disorder or Vitamin Deficiency What does an abnormal retic ount indicate in general? - ANSWER Doesn't diagnose anything. First step is ID source of the issue. What happens when you mix tegretol and macrolides? - ANSWER Increase tegretol levels. What happens if a pregnant women takes Accutane? - ANSWER Birth defects. What labs do you get with RA? - ANSWER 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? - ANSWER ANA When do you assume informed consent? - ANSWER Unconscious Incompetent Life Threatening Situation What are the legal ramifications of treating w/o informed consent? - ANSWER Same as with informed consent Who can declare a patient incompetent and appoint a guardian? - ANSWER Only a court Does impaired judgment mean one is incompetent? - ANSWER No. Can an advanced directive ever be revoked? - ANSWER Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? - ANSWER Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? - ANSWER No. How do Asians see HC providers? - ANSWER 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? - ANSWER SIgn of respect What is the evil eye? - ANSWER 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? - ANSWER Red ribbon on an infant Amulet for adults How do you treat for evil eye? - ANSWER Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? - ANSWER Relationship What is a proximate cause? - ANSWER Connection between A + B. For there to be damages, what must exist first? - ANSWER Negligence What is an occurrence basis liability insurance? - ANSWER "occurred" during the policy period, no matter when the claim is brought against the insured What is a claims made/based liability insurance? - ANSWER 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? - ANSWER Board of Nursing State What are the various controlled substance classes? - ANSWER 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? - ANSWER Schedules III-V ONLY. Where does 50% of healthcare funds come from? - ANSWER The government Who is eligible for Medicare? - ANSWER >65 or under 65 with diability, ANY age with renal disease. What is incident to billing? - ANSWER 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? - ANSWER 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? - ANSWER Yes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? - ANSWER Yes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? - ANSWER 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 - ANSWER Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? - ANSWER Can decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? - ANSWER Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment Is it ok to announce a patient's name in a waiting room? - ANSWER Yes, no other way to give care. Is it ok to leave a message on a patient's vm? - ANSWER Yes, but should be limited. What is the impact of steroid inhalers on children? - ANSWER Slows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? - ANSWER Cataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? - ANSWER Sleeping meds Antidepressants Pain meds What psychoactives are first line treatment for fibro? - ANSWER Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's What is the purpose of telepsychiatry? - ANSWER Increase the ability to reach rural and underserved areas. What is the purpose of Motivational Interviewing? - ANSWER Explore ambiguity Maintain passive position What is required for Medicare submission? - ANSWER ICD 10 and narrative or CPT What is the neurotransmitter problem in Schizophrenia? - ANSWER Excess dopamine in mesolimbic pathway. What is the neurotransmitter problem in ADHD? - ANSWER Dopamine, norepinephrine and serotonergic dysfunction What is the benefit of play therapy? - ANSWER Don't have to confront emotions head on. What neurotransmitters are involved in the bioamine hypothesis of depression? - ANSWER 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? - ANSWER Stick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? - ANSWER CN V - Trigeminal What are two important things to measure when using Zyprexa? - ANSWER Lipid level and abdominal circumference What is included in the mini-cognitive exam? - ANSWER Clock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? - ANSWER Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? - ANSWER Stop and repeat lab. Normal is 1500-8000 mm3 Can you take Buspar during pregnancy? - ANSWER Category B - ok if really needed. Can you take Klonopin during pregnancy? - ANSWER Category C - avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms. What is the concern when prescribing Lamictal with Depakote? - ANSWER Both are CYP450 inducers of the other and therefore together will lower the level of both drugs. Can asthma medications cause depression? - ANSWER Yes. If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? - ANSWER Microalbumin? What is often common to patients with fibro? - ANSWER Sexual abuse How is telepsychiatry evaluated? - ANSWER Outcome based - measure at intervals. What happens with a patient taking Lithium and who gets dehydrated? - ANSWER Levels increase What happens with a patient taking Lithium who decreases sodium intake? - ANSWER Levels increase What happens with a patient taking Lithium and drinks a lot of water? - ANSWER Levels decrease If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? - ANSWER Zyprexa What happens when taking Lithium and NSAIDS? - ANSWER NSAIDS can cause Lithium levels to increase and for the patient to become toxic! What medications are at risk to cause SJS in the Asian population? - ANSWER HLAB-1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's. Amgdyla - ANSWER Fear, Anxiety, and Aggression Neurotransmitter for Addiction - ANSWER Dopamine and GABA Neurotransmitter for Mood Disorder - ANSWER Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol - ANSWER Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol Signs and Symptoms of stimulant abuse - ANSWER insomnia and tremor Depakote check - ANSWER HCG levels Depakote causes - ANSWER Spinal bifida Grasp reflex. - ANSWER an infantile reflex in which an infant closes her hand into a fist when her palm is touched Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until about 5 to 6 months of age. Moro reflex. - ANSWER The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months. pincer grasp - ANSWER 9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios. Pt has MI looses his job stable on psych medications - ANSWER Provide brief supportive therapy Latida and Geodon - ANSWER Take with food Moro reflex absent - ANSWER Do xray Health Care Policy Model - ANSWER Access, Cost, Quality Pt wants to stop medications - ANSWER explore reason for stopping Its their right 16 year old falls with the wrong crowd - ANSWER Conduct disorder change agent - ANSWER the person formally in charge of guiding a change effort Administrator 14 year old girl clenching her teeth - ANSWER Cranial Nerve V-Trigeminal nerve Infant dying - ANSWER Give child to parents and comfort parents borderline personality disorder Treatment - ANSWER dialectical behavior therapy Aggressive patient give - ANSWER IM geodon *SIGECAPS* of Depression - ANSWER Sleep Interest Guilt Energy Concentration Appetite psychomotor retardation Suicide DIGFAST for mania - ANSWER Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase 5 year old tells u his brother sodomized him - ANSWER Tell mom don't leave him alone with patient and call CPS implement crisis Just culture - ANSWER "Just culture" model: proposed to reconcile the twin needs for no-blame and appropriate accountability The focus is on identifying and addressing systems issues that lead individuals to engage in unsafe behaviors while maintaining individual accountability by establishing zero tolerance for reckless behavior. Distinguishes between Human error (e.g. slips), At-risk behavior (e.g. taking shortcuts), Reckless behavior (e.g. ignoring required safety steps). In a just culture, the response to an error or near-miss is predicated on the type of behavior associated with the error, not the severity of the event. Child reports Sexual Abuse - ANSWER Interview the young child and infants child with parent First sign of temprofrontal Dementia - ANSWER Behavior and personalty changes Tow amines related to depression - ANSWER Serotonin and norepinephrine Want to start an consulting firm what tool would be needed to show economic viability - ANSWER Revenue and expenses Patient stopped smoking (Cessation) - ANSWER Decreased Zyprexia Promote resilience in schizophrenia for a patient that lives alone and doing well - ANSWER Refer to peer support Spirit stick - ANSWER Teach staff about culture competence Problems in the parietal lobe can lead - ANSWER Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) PDSA cycle - ANSWER For Plan-Do-Study-Act. Describes how to test a change: by trying it, observing the consequences, and then learning from those consequences. Appreciative Inquiry - ANSWER an organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements Appreciative Inquiry - ANSWER an organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work Appreciative Inquiry (AI) - ANSWER Identify the problem Analyze the problem Generate Solutions Implement Best Solutions Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) Appreciative Inquiry - ANSWER Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) CIWA-Ar - ANSWER Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do - ANSWER Validate his experience and provide care in a culturally specific way to that patient Native American wants his healer present - ANSWER Involve mother of the patient and healer, mom was cleared for you to involve her 16 year old shows up with mother for first therapy is - ANSWER confidential mom sits in lobby Patient acts out due to missing session what do you do - ANSWER You relate to childhood abandonment and talk about it with the patient How do you assess the competency of a medical procedure - ANSWER Identify a pen and recall 3 words Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis - ANSWER Delusional disorder Increase ICP (signs and symptoms) - ANSWER Baby Neuro cry Menopausal woman - ANSWER Hormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide - ANSWER Stop medication immediately You want to decrease seclusion on your unit who considered the primary change agent - ANSWER Unit staff You are a lead NP over other NPs in a rural setting how would you go about the change - ANSWER Make online form and have them vote on it 16 year old refuse treatment - ANSWER Send to psych specialist for acting out kids Positive Trendelenburg Sign - ANSWER Refer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor. Drug affects Flonase - ANSWER Zantac (Histamine 2 Blocker) Antagonist Little boy wet his sheets, What kind of therapy would you suggest - ANSWER Behavior therapy DDVAP acts in much the same manner as antidiuretic hormone. - ANSWER Makes less urine Lithium level 1.2u what are you concerned with - ANSWER 4+ Ketones What does depakote do to Lamictal - ANSWER Increase laminate 200% Inducers of Cytochrome P450 (CYP450) - ANSWER Barbiturates, phenytoin, carbamazepine, rifampin, St. John's Wort A substance that speeds up a chemical reaction Inhibitor - ANSWER A substance that slows down or stops a chemical reaction cytochrome p450 inhibitors - ANSWER CRACK AMIGOS Cimetidine Ritonavir Acute Alcohol Ciprofloxacin Ketoconazole