PMHNP Actual Exam 2022/2023 Solved 100%

Autosomal Dominant - ANSWER Genetic inheritance, is more rare (i.e. Huntington's disease), is present in more than one generation. Autosomal Recessive - ANSWER Expressed in one generation, inherited from unaffected pa ...

Autosomal Dominant - ANSWER Genetic inheritance, is more rare (i.e. Huntington's disease), is present in more than one generation. Autosomal Recessive - ANSWER Expressed in one generation, inherited from unaffected parent, is more common. CAGE Questionnaire - ANSWER For substance abuse, Cut, Annoyed, Guilty, Eye opener Suicidal Risk Assessment - ANSWER SLAP: Social support, Lethality, Access to means, Plan and previous attempts, & family history Suicidal Risk Assessment #2 ISPATHWARM - ANSWER ISPATHWARM: Ideation, Substance abuse, Purpose for living, Anxiety/agitation, Trapped feeling, Hopelessness, Withdrawing from friends, Anger with rage, Reckless in behaviors, Mood changes Depression Assessment SIGECAPS - ANSWER SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor retardation, Suicidality Mania Assessment DIGFAST - ANSWER DIGFAST: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness Mental Status Exam Components (All Borderline Subjects Are Tough Troubled Characters) - ANSWER Appearance, Behavior, Speech, Affect, Thought Process, Thought Content, Cognitive Examination Hamilton Depression Rating (HDRS) for very severe depression - ANSWER more than 23 Hamilton Depression Rating (HDRS) for severe depression - ANSWER 19-23 Hamilton Depression Rating (HDRS) for moderate depression - ANSWER 14-18 Hamilton Depression Rating (HDRS) for mild depression - ANSWER 8-13 Hamilton Depression Rating (HDRS) for no depression - ANSWER 0-7 Hamilton Anxiety Rating for moderate to severe anxiety - ANSWER 25-30 Hamilton Anxiety Rating for mild to moderate anxiety - ANSWER 18-24 Hamilton Anxiety Rating mild anxiety - ANSWER <17 General screening labs - ANSWER CBC, Chem, Thyroid, Hepatic, b12, folate, drug levels Lithium labs - ANSWER evaluate thyroid function, check creatinine clearance regularly Depakote labs - ANSWER check hepatic function Olfactory Nerve (On) - ANSWER CN I: Sensory: (test by smell- coffee, tea, non astringent smells) Optic Nerve (Old) - ANSWER CN II: Sensory- visual acuity test (confrontation method to assess visual fields) Oculomotor (Olympus) - ANSWER CN III: Motor- eye movement (follow penlight through six fields of gaze, test OD, OS individually) Trochlear Nerve (Towering) - ANSWER CN IV: Motor- eye movement (superior oblique-same test as oculomotor) Trigeminal Nerve (Tops) - ANSWER CN V: Both- superficial and deep structures of head and face, mastification/corneal reflex (test by show teeth) Abducens Nerve (A) - ANSWER CN VI: Motor- specific eye movements (test same as oculomotor) Facial Nerve (Fin) - ANSWER CN VII: Both- taste of anterior 2/3 of tongue, sensation in ear canal, facial movement (use salt/sugar for taste, evaluate corneal reflex, raise eyebrows, keep eyes closed, and resist attempt to open, puff cheeks) Acoustic Nerve (And) - ANSWER CN VIII: Sensory- Hearing/tickling watch and whisper (tuning fork with Rinne- positive as normal, when air conduction persists twice as long as bone conduction) Glossopharyngeal Nerve (German) - ANSWER CN IX: Both- Swallow, taste of posterior 1/3 of tongue, pain, touch, and temp of mucosa and pharynx (check for deviation of uvula to unaffected side) Vagus Nerve (Viewed) - ANSWER CN X: Both- Elevation of the uvula (swallow, have patient say aaah and check uvula elevation, gag reflex, and ability to swallow water) Accessory Nerve (A) - ANSWER CN XI: Motor- Innervates trapezius and sternocleidomastoid (shrug shoulders against resistance, turn head against hand on cheek) Hypoglossal (Hop) - ANSWER CN XII: Motor- motor of the tongue (push tongue against the inside of cheek, stick out tongue and check for fasciculation) Lithium therapeutic levels (acute mania) - ANSWER 0.6-1.2 mEq/L Lithium therapeutic levels (maintenance) - ANSWER 0.8-1.0 mEq/L Lithium adverse effect level - ANSWER > 2 mEq/L >2.5 mEq/L = seizure, death Valproic acid therapeutic levels - ANSWER 50-120 ug/ml Sensitivity - ANSWER true positives (the degree to which those who have a disease screen positive) Specificity - ANSWER true negatives (the degree to which those who not have a disease test negative) Incidence - ANSWER frequency with which a disease appears in a population given the rate in which new cases occur during a specific time period Prevalence - ANSWER proportion of a population that is affected by a disease at a particular time Major cause of death for adolescents - ANSWER motor vehicle accident, suicide, accidents, homicide, malignancy, cv or congenital disease Major cause of death for young adults - ANSWER Motor vehicle accidents, homicide, suicide, injuries, heart disease, AIDS Major cause of death for middle age adult - ANSWER Heart disease, accidents, lung cancer, CVA, breast and colorectal cancer, COPD Major cause of death for elderly adults - ANSWER Heart disease, CVA, COPD, pneumonia and influenza Primary prevention - ANSWER measures to promote health prior to onset of problems (teaching) Secondary prevention - ANSWER focuses on early identification and treatment of existing problems (screening) Tertiary prevention - ANSWER rehabilitation and restoration of health Diagnosis of diabetes - ANSWER fasting BG > 126 on 2 separate occasions random BG of >200 with s/s of diabetes oral glucose tolerance test >200 Total cholesterol recommendations - ANSWER <200 LDL recommendation - ANSWER <100, <70 goal HDL recommendation - ANSWER >40 men >50 women Triglycerides recommendation - ANSWER <150 Mitral stenosis - ANSWER loud first heart sound (s1) murmur, low pitched, mid diastolic, apical crescendo rumble Mitral regurgitation - ANSWER third heart sound (S3) with systolic murmur at 5th intercostal space midclavicular line (apex), may radiate to base or left axilla, musical, blowing, or high pitched Aortic stenosis - ANSWER systolic, "blowing", rough harsh murmur at second right ICS usually radiating to the neck Aortic regurgitation - ANSWER diastolic, "blowing" murmur at second left ICS S1 - ANSWER mitral/tricuspid (AV) valves closure S2 - ANSWER aortic/pulmonic (semilunar) valves closure systole - ANSWER period between S1 and S2 diastole - ANSWER period between S2 and S1 S3 - ANSWER "Kentucky", increased fluid states (CHF, pregnancy) S4 - ANSWER "Tennesse", stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension) HIV window period - ANSWER immune system responding to viral presence in serum but virus hidden in lymphatic system Ego defense mechanisms - ANSWER compensation, denial, displacement, identification, intellectualization, introjection, isolation, projection, rationalization, regression, sublimation, suppression, undoing Transactional Analysis - ANSWER Eric Berne: description of what people do and say themselves and to each other Interpersonal Theory - ANSWER Harry Sack Sullivan, Peplau Interpersonal Theory: the bad me - ANSWER Develops in response to negative feedback, feelings of anxiety, discomfort, displeasure, and distress Interpersonal theory: the good me - ANSWER Develops in response to positive feedback, feelings, of pleasure, contentment, and gratification Interpersonal Theory: The not me - ANSWER Develops in response to intense anxiety, feelings of horror, dread, awe, loathing Gesalt Therapy - ANSWER Fredrick Perls: the whole is more important than the sum of it's parts (increased awareness of self and responsibility) Person-Centered Therapy - ANSWER Carl Rogers: Unconditional Positive Regard, genuineness, warmth accurate empathy, respect, permissiveness (development of self-direction) Behavioral Therapy - ANSWER Pavlov (, Skinner, Bandura, Wolpe Understanding human behavior, scientific method Applied Behavioral Analysis - ANSWER direct extension of BF Skinner's radical baaviorism, Operant conditioning- all behavior result of consequences Neobehavioristic Mediational Stimulus Response - ANSWER S-R Model. Classical conditioning, based on research of Pavlov , Guthrie. Model of mediating and intervening variables that create consequence and affect behaviors. Social Cognitive Theory - ANSWER Pavlov's classic dog study, external stimulus events, external reinforcement, cognitive mediational processes Rational Emotive Therapy - ANSWER Albert Ellis. Neurosis is irrational thinking and behaving, emotional disturbances are rooted in childhood but continue through re-indoctrination in the now Cognitive Behavioral Therapy - ANSWER Aaron Beck. How one thinks largely determines how one feels and behaves. Cognitive distortions created by certain pathologies like depression/anxiety crate systematic bias. Collaborative Empiricism - ANSWER Agreeing that something is the truth (therapist and client create collaboration to identify dysfunctional interpretations and try to modify them) Trauma Informed Care - ANSWER Goals are safety, awareness through mindfulness, managing physiological arousal. Narratives are constructed sometimes. Most commonly used: CBT and EMDR, and adjunctive body/energy work, group therapy. Avnet Report - ANSWER 1969: demonstrated efficacy of treatment with short-term therapy, paid for by commercial insurance (setting the foundation for 3rd party payment) Role of Psychiatric Nurse - ANSWER Peplau identified the 6 nursing sub-roles: mother-surrogate, technician, manager, socializing agent, health teacher, and counselor/psychotherapist Physical Conditions to Group Therapy - ANSWER no barriers between participants, 5-10 participants, either open-ended or close-ended depending on the focus of group Yalom Principles - ANSWER Universality, Hope, Altruism (helping others), imparting information (education) , Corrective recapitulation of the primary family experience, Development of socializing techniques, Imitative behavior, cohesiveness, existential factors (direction in life, responsibility), catharsis, interpersonal learning, self understanding Autocratic Leadership - ANSWER "This is how it is" type. Leader focused, memers encouraged to adopt leader's ideas, member participation limited, low individual creativity, low cohesiveness, low productivity Democratic Leadership - ANSWER Most effective type. Member focused, group problem solving, unlimited member participation, encouraged creativity, high cohesiveness, high productivity Laissez-Faire Leadership - ANSWER Undetermined focus, no defined strategy, inconsistent member participation, creativity not addressed, low cohesiveness, low productivity Family Systems Theory - ANSWER Bowen. Usually there is an identified patient (the symptom barer within the family). Goal: coach families to develop more solid self to stand against anxiety, triangles, goal is differentiation. Focus on relationships and not individuals, use "I think" rather than "I feel". Therapy can occur without family. present. Triangles - ANSWER Family Systems Theory: building blocks of any emotional system. A person focuses on a different object, idea or person to manage anxiety between him/her and another person in the family. De-triangulating allows increased differentiation of self and decreased emotional reactivity.