PMHNP Exam Prep: Comprehensive Guide for Nurse Practitioners, Exams of Nursing

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ANCC - PMHNP EXAM TEST

QUESTIONS AND ANSWERS

100 (A+ GRADE) NEWEST

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What is dissemination?

• 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?
• Moderate cognitive impairment What is Tegretol in the CYP450 system?
• Inducer → will lower dose of Lamictal and BCPs What do BCPs do to Lamictal?
• Inducer - will lower dose of Lamictal What is a Type I research error?
• There IS a difference, but you say there isn't. What is a Type II research error?
• There is NO difference, but you say there is. What is pseudo-dementia?
• 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?
• Yes. What is a drug 1/2 life?
• The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens?
• Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol?
• Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increases the risk of SJS?

What are some psychiatric side effects seen with some asthma drugs?

• Leukotriene receptor agonists (Singulair, Accolade, Zyflo) = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol?
• Agranulocytosis and Hyponatremia What are the 3 CK muscle enzyme tests?
• CKBB, CKMM, CKMB Which one of the 3 muscle enzymes is related to cardiac muscle damage?
• CKMB What is the risk of a seriously elevated CKMB?
• Polymyositis
• Rhabdo What is a normal CKMB?
• 0.3 mcg/L What psychoactives does Detrol interact with?
• Topamax
• KCL
• Zonegran What CN are you assessing when you have the patient shrug their shoulders?
• CN XI - Spinal Accessory What do you see in labs with HIV & Dementia?
• CD4 <
• Viral Load is high
• <20% get it with antiretroviral treatment What is the scoring with the Beck Depression Inventory?
• Self-Report: 0- 63 o 0 - 13 - minimal o 14 - 19 - mild

o 20 - 28 - moderate o 29 - 63 - severe What is sensitivity?

• Helps rule out disease = True Positive = Snout What is specificity?
• Helps rule in disease = True Negative = Spin What does a sed rate measure?
• Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in mm RBCs have descended in 1 hour. What is a normal sed rate or ESR?
• 0 - 22 males
• 0 - 29 females What is a retic count?
• Measures % of reticulocytes in blood (immature RBCs). Indicates whether enough RBCs are being produced by bone marrow. What does a decreased retic count indicate?
• Anemia - acute or chronic bleeding What does an increased retic count indicate?
• Bone marrow disorder or Vitamin Deficiency What happens when you mix Tegretol and Macrolides?
• Increase Tegretol levels. What happens if a pregnant woman takes Accutane?
• Birth defects. What labs do you get with RA?
• Sed rate, RF, ANA, C reactive protein, CBC, CMP
• CRP and ESR are both increased in RA but NOT in osteoarthritis. Where does the NP Code of Ethics come from?
• ANA When do you assume informed consent?

56. What are the legal ramifications of treating without informed consent? Same as with informed consent violations. 57. Who can declare a patient incompetent and appoint a guardian? Only a court. 58. Does impaired judgment mean one is incompetent? No. 59. Can an advanced directive ever be revoked? Yes, at any time. 60. What is the difference between a Healthcare Agent, Proxy, Surrogate, and Attorney-in-Fact? Nothing – they are all the same. 61. Does the de facto rule of proxy apply in same-sex marriages? No. 62. How do Asians see healthcare providers? As in a position of authority – they expect to be given instructions and help making decisions. 63. What does it mean when an Asian patient does not make eye contact with the NP? Sign of respect. 64. What is the evil eye? When a stronger or more powerful person looks at a weaker person (often an infant/child), resulting in a "hex" that presents as illness (e.g., headache, fever, diarrhea, disturbed sleep, increased fussiness). 65. How do you protect from the evil eye? - Red ribbon on an infant - Amulet for adults 66. How do you treat for the evil eye? Consult a traditional healer + traditional care. 67. For there to be a duty to a patient, what must exist? A provider-patient relationship. 68. What is a proximate cause? Connection between A (action) and B (harm). 69. For there to be damages, what must exist first? Negligence.

70. What is an occurrence-based liability insurance? Covers any incident that occurred during the policy period, no matter when the claim is filed. 71. What is a claims-made liability insurance? Provides coverage for a claim that is brought within the policy period, regardless of when the incident occurred. 72. Who sets the minimum requirements for NPs? Board of Nursing & the State. 73. What are the various controlled substance classes? - Schedule I – High abuse, no medical use (e.g., heroin, PCP, MDMA). - Schedule II – High abuse potential, medical use (e.g., morphine, methadone, methylphenidate). - Schedule III – Moderate abuse potential (e.g., hydrocodone, codeine). - Schedule IV – Low abuse potential (e.g., benzodiazepines, Ambien, phentermine). - Schedule V – Very low abuse potential (e.g., anti-tussives, Lomotil). 74. What classes of controlled substances can an NP prescribe? Schedules III-V ONLY. 75. Where does 50% of healthcare funding come from? The government. 76. Who is eligible for Medicare? - >65 years old - <65 years old with a disability - Any age with renal disease 77. What is incident-to billing? When an NP provides care under the supervision of a physician who initiates treatment, allowing the NP to bill at 100% reimbursement instead of 85%. 78. How are Medicaid benefits determined? - State determines qualification (partnership between State & Federal Government). - Must be impoverished. - Must be a U.S. resident with low or very low income.

• Pain meds 90. What psychoactives are first-line treatment for fibromyalgia?
• SNRIs – Cymbalta, Effexor
• TCAs – Elavil, Pamelor
• Anticonvulsants – Lyrica, Gabapentin
• Other – Ultram, Benzodiazepines 91. What is the purpose of telepsychiatry? Increase access to care in rural and underserved areas. 92. What is the purpose of Motivational Interviewing?
• Explore ambivalence
• **Maintain a passive position

93. What is required for Medicare submission?** ICD- 10 and narrative or CPT code. 94. What is the neurotransmitter problem in Schizophrenia? Excess dopamine in the mesolimbic pathway. 95. What is the neurotransmitter problem in ADHD? Dopamine, norepinephrine, and serotonergic dysfunction. 96. What is the benefit of play therapy? Allows children to express emotions without directly confronting them. 97. What neurotransmitters are involved in the bioamine hypothesis of depression?

• Noradrenaline
• Serotonin
• Dopamine 98. How do MAOIs work? Inhibit monoamine oxidase , which breaks down neurotransmitters , increasing their levels in the synapse. 99. How do you test CN XII (Hypoglossal nerve)? Have the patient stick out their tongue. 100. What CN are you testing when a patient clenches their jaw? CN V – Trigeminal nerve. 101. What are two important things to measure when using Zyprexa?

• Lipid levels
• **Abdominal circumference

102. What is included in the Mini-Cognitive Exam?**

• Clock drawing test
• **Memory questions from the MMSE

103. What is HIV-related dementia often mistaken for initially?** Depression. Part 2
104. What happens with a patient taking Lithium and who gets dehydrated? o Levels increase.
105. What happens with a patient taking Lithium who decreases sodium intake? o Levels increase.
106. What happens with a patient taking Lithium and drinks a lot of water? o Levels decrease.
107. If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? o Zyprexa.
108. What happens when taking Lithium and NSAIDS? o NSAIDS can cause Lithium levels to increase and for the patient to become toxic.
109. What medications are at risk to cause SJS in the Asian population? o HLAB-1502 Allele increases risks of SJS. o Trileptal, Tegretol, and other AEDs.
110. What is the role of the Amygdala? o Fear, Anxiety, and Aggression.
111. What neurotransmitter is associated with Addiction? o Dopamine and GABA.
112. What neurotransmitter is associated with Mood Disorders? o Serotonin and norepinephrine.
113. Which drug affects Carbamazepine/Tegretol? o Erythromycin will cause toxic levels. Decrease Carbamazepine/Tegretol.
114. What are the signs and symptoms of stimulant abuse? o Insomnia and tremor.
115. What should you check for a patient on Depakote? o HCG levels.
116. What does Depakote cause?

30. What should you do if a 5-year-old tells you his brother sodomized him? o Tell the mom, don’t leave him alone with the patient, and call CPS. Implement crisis intervention.
31. What is Just Culture? o A model that reconciles the need for no-blame and appropriate accountability by focusing on systems issues and individual accountability.
32. What should you do if a child reports sexual abuse? o Interview the young child and infants with the parent.
33. What is the first sign of Temporal Frontal Dementia? o Behavior and personality changes.
34. What are the two amines related to depression? o Serotonin and norepinephrine.
35. What tool would you need to show economic viability for starting a consulting firm? o Revenue and expenses.
36. What happens when a patient stops smoking (cessation)? o Decreased Zyprexa.
37. How do you promote resilience in schizophrenia for a patient who lives alone and is doing well? o Refer to peer support.
38. What is the Spirit Stick? o Teach staff about cultural competence.
39. What problems can occur in the parietal lobe? o Sensory-perceptual disturbances, agnosia, R-L confusion, difficulty writing (agraphia), aphasia.
40. What is the PDSA cycle? o Plan-Do-Study-Act. It describes how to test a change by trying it, observing the consequences, and learning from those consequences.
41. What is Appreciative Inquiry? o An organizational change strategy that focuses on the group’s potential and positive elements rather than problems.
42. What is the CIWA-Ar? o Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised. A 9- item symptom rating scale used to assess alcohol withdrawal.
43. What should you do for a Hispanic patient who lost his parent and complains of a stomach ache? o Validate his experience and provide culturally specific care.
44. What should you do if a Native American patient wants his healer present?

o Involve the mother of the patient and the healer.

45. What should you do if a 16-year-old shows up with their mother for the first therapy session? o Keep the session confidential. The mom sits in the lobby.
46. What should you do if a patient acts out due to missing a session? o Relate it to childhood abandonment and talk about it with the patient.
47. How do you assess the competency of a medical procedure? o Identify a pen and recall 3 words.
48. What is the diagnosis if a patient thinks someone has infiltrated the church because he watched it on TV 2 years ago? o Delusional disorder.
49. What are the signs and symptoms of increased ICP? o Baby’s neuro cry.
50. What is the treatment for a menopausal woman? o Hormone therapy and replacement.
51. What should you do if a patient on antidepressants for 3 weeks attempts suicide? o Stop medication immediately.
52. Who is considered the primary change agent if you want to decrease seclusion on your unit? o Unit staff.
53. How would you go about implementing change as a lead NP over other NPs in a rural setting? o Make an online form and have them vote on it.
54. What should you do if a 16-year-old refuses treatment? o Send to a psych specialist for acting-out kids.
55. What is a Positive Trendelenburg Sign? o Refer to Ortho/specialist. Pelvis drops when the patient raises one foot off the floor.
56. What drug affects Flonase? o Zantac (Histamine 2 Blocker Antagonist).
57. What kind of therapy would you suggest for a little boy who wets his sheets? o Behavior therapy.
58. What does DDVAP do? o Acts in much the same manner as antidiuretic hormone. Makes less urine.
59. What are you concerned with if a patient has a Lithium level of 1.2u? o 4+ Ketones.
60. What does Depakote do to Lamictal?

o WBC-2500. ANC less than 1000 (950). Discontinue medication.

77. How do you treat a child with depression? o Zoloft and therapy.
78. What is normal for a 3-year-old who masturbates, plays with self, and says naughty things? o Normal for Piaget.
79. What is the treatment for NMS? o Dantrolene: Muscle relaxation. D2 agonists (e.g., bromocriptine).
80. What are the positive symptoms of schizophrenia due to? o High dopamine in the mesolimbic system.
81. What are the negative symptoms of schizophrenia? o The absence of appropriate behaviors (expressionless faces, rigid bodies).
82. What is the mesocortical pathway? o VTA to prefrontal cortex. Negative symptoms.
83. What is the nigrostriatal pathway? o EPS due to low dopamine in this area.
84. What is the PDSA model? o Plan-Do-Study-Act.
85. What are Tanner's stages? o Stages of physical development during puberty.
86. What is the MMSE (Mini Mental State Examination)? o A screening tool for cognitive impairment. Scores: 25-30 Normal, 21- 24 Mild/Early, 10-21 Moderate, 0-9 Severe.
87. What should you do if a patient states that she has been raped? o Ensure safety.
88. What does a Hamilton D score of 28 indicate? o Assess for suicide.
89. What is the Hamilton Depression Rating Scale? o A 17-21 question scale used to assess depression severity.
90. What is the Beck Depression Inventory (BDI)? o A self-report questionnaire used to assess depression severity.
91. What is the Patient Health Questionnaire (PHQ-9)? o A 9-item self-report questionnaire used to assess depression severity.
92. What is the Hamilton Anxiety Rating Scale (HAM-A)? o A scale used to assess anxiety severity.
93. What is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)? o A scale used to assess OCD severity.
94. What is the treatment for PTSD? o EMDR (Eye Movement Desensitization and Reprocessing).

95. What are the signs of stimulant intoxication? o Dilated pupils.
96. What are the signs of opioid intoxication? o Constricted (pinpoint) pupils.
97. What are the signs of Phencyclidine intoxication? o Nystagmus.
98. What are the signs of Marijuana intoxication? o Conjunctival injection, munchies (super hungry), psychomotor slowness.
99. What should you do if a boy states that he wishes to be a girl and tells you not to tell his parents? o Don’t tell.
100. What should you do to prevent ODD from becoming Conduct Disorder?

- Therapy to target mood and aggression.