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Georgette Review. PMHNP QUESTIONS- WITH COMPLETE
SOLUTIONS LATEST UPDATE GRADED A+2025.
What is dissemination? - ANSWERS-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? - ANSWERS-Moderate cognitive impairment What is Tegretol in the CYP450 system? - ANSWERS-Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? - ANSWERS-Inducer - will lower dose of Lamictal What is a Type I research error? - ANSWERS-There IS a difference but you say there isn't a difference. What is a Type II research error? - ANSWERS-There is NO difference but you say there is a difference. What is pseudo-dementia? - ANSWERS-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? - ANSWERS-Yes. What is a drug 1/2 life? - ANSWERS-The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? - ANSWERS-Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? - ANSWERS-Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? - ANSWERS-HLAB- When might you see toxic epidermal necrolysis? - ANSWERS-With worsening of SJS How many generations do you include for a genogram? - ANSWERS-1st degree - mother, father, siblings 2nd degree - grandparents & cousins
3rd degree - What does messenger RNA code for? - ANSWERS-Amino Acids What is epigenetics? - ANSWERS-Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? - ANSWERS-Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? - ANSWERS-Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? - ANSWERS-10-25 yo When do females typically present with schizophrenia? - ANSWERS-25-35 yo What does Erythromycin to trileptal? - ANSWERS-You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? - ANSWERS-Heart Failure HTN What are some psychiatric side effects seen with some asthma drugs - ANSWERS-Leukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol? - ANSWERS-Agranulocytosis and Hyponatremia What are the 3 CK muscle enzyme tests? - ANSWERS-CKBB, CKMM, CKMB Which one of the 3 muscle enzymes are related to cardiac muscle damage? - ANSWERS-CKMB What is the risk of a seriously elevated CKMB? - ANSWERS-Polymyositis Rhabdo What is a normal CKMB? - ANSWERS-0.3 mcg/L What psychoactives does Detrol interact with? - ANSWERS-Topamax KCL Zonegran What CN are you assessing when you have the patient shrug their shoulders? - ANSWERS-CN XI - Spinal
When do you assume informed consent? - ANSWERS-Unconscious Incompetent Life Threatening Situation What are the legal ramifications of treating w/o informed consent? - ANSWERS-Same as with informed consent Who can declare a patient incompetent and appoint a guardian? - ANSWERS-Only a court Does impaired judgment mean one is incompetent? - ANSWERS-No. Can an advanced directive ever be revoked? - ANSWERS-Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? - ANSWERS- Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? - ANSWERS-No. How do Asians see HC providers? - ANSWERS-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? - ANSWERS-SIgn of respect What is the evil eye? - ANSWERS-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? - ANSWERS-Red ribbon on an infant Amulet for adults How do you treat for evil eye? - ANSWERS-Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? - ANSWERS-Relationship What is a proximate cause? - ANSWERS-Connection between A + B. For there to be damages, what must exist first? - ANSWERS-Negligence What is an occurrence basis liability insurance? - ANSWERS-"occurred" during the policy period, no matter when the claim is brought against the insured What is a claims made/based liability insurance? - ANSWERS-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? - ANSWERS-Board of Nursing State What are the various controlled substance classes? - ANSWERS-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? - ANSWERS-Schedules III-V ONLY. Where does 50% of healthcare funds come from? - ANSWERS-The government Who is eligible for Medicare? - ANSWERS->65 or under 65 with diability, ANY age with renal disease. What is incident to billing? - ANSWERS-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? - ANSWERS-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? - ANSWERS-Yes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? - ANSWERS-Yes, <21 gets basic dental as part of the Medicaid plan.
Maintain passive position What is required for Medicare submission? - ANSWERS-ICD 10 and narrative or CPT What is the neurotransmitter problem in Schizophrenia? - ANSWERS-Excess dopamine in mesolimbic pathway. What is the neurotransmitter problem in ADHD? - ANSWERS-Dopamine, norepinephrine and serotonergic dysfunction What is the benefit of play therapy? - ANSWERS-Don't have to confront emotions head on. What neurotransmitters are involved in the bioamine hypothesis of depression? - ANSWERS- 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? - ANSWERS-Stick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? - ANSWERS-CN V - Trigeminal What are two important things to measure when using Zyprexa? - ANSWERS-Lipid level and abdominal circumference What is included in the mini-cognitive exam? - ANSWERS-Clock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? - ANSWERS-Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? - ANSWERS-Stop and repeat lab. Normal is 1500-8000 mm Can you take Buspar during pregnancy? - ANSWERS-Category B - ok if really needed. Can you take Klonopin during pregnancy? - ANSWERS-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? - ANSWERS-Both are CYP450 inducers of the other and therefore together will lower the level of both drugs. Can asthma medications cause depression? - ANSWERS-Yes.
If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? - ANSWERS-Microalbumin? What is often common to patients with fibro? - ANSWERS-Sexual abuse How is telepsychiatry evaluated? - ANSWERS-Outcome based - measure at intervals. What happens with a patient taking Lithium and who gets dehydrated? - ANSWERS-Levels increase What happens with a patient taking Lithium who decreases sodium intake? - ANSWERS-Levels increase What happens with a patient taking Lithium and drinks a lot of water? - ANSWERS-Levels decrease If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? - ANSWERS-Zyprexa What happens when taking Lithium and NSAIDS? - ANSWERS-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? - ANSWERS-HLAB-1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's. Amgdyla - ANSWERS-Fear, Anxiety, and Aggression Neurotransmitter for Addiction - ANSWERS-Dopamine and GABA Neurotransmitter for Mood Disorder - ANSWERS-Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol - ANSWERS-Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol Signs and Symptoms of stimulant abuse - ANSWERS-insomnia and tremor Depakote check - ANSWERS-HCG levels Depakote causes - ANSWERS-Spinal bifida Grasp reflex. - ANSWERS-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. - ANSWERS-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
DIGFAST for mania - ANSWERS-Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase 5 year old tells u his brother sodomized him - ANSWERS-Tell mom don't leave him alone with patient and call CPS implement crisis Just culture - ANSWERS-"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 - ANSWERS-Interview the young child and infants child with parent First sign of temprofrontal Dementia - ANSWERS-Behavior and personalty changes Tow amines related to depression - ANSWERS-Serotonin and norepinephrine Want to start an consulting firm what tool would be needed to show economic viability - ANSWERS- Revenue and expenses Patient stopped smoking (Cessation) - ANSWERS-Decreased Zyprexia Promote resilience in schizophrenia for a patient that lives alone and doing well - ANSWERS-Refer to peer support
Spirit stick - ANSWERS-Teach staff about culture competence Problems in the parietal lobe can lead - ANSWERS-Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) PDSA cycle - ANSWERS-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 - ANSWERS-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 - ANSWERS-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) - ANSWERS-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 - ANSWERS-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 - ANSWERS-Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised
A substance that speeds up a chemical reaction Inhibitor - ANSWERS-A substance that slows down or stops a chemical reaction cytochrome p450 inhibitors - ANSWERS-CRACK AMIGOS Cimetidine Ritonavir Acute Alcohol Ciprofloxacin Ketoconazole Amiodarone Macrolides Isoniazid Grapefruit juice Omeprazol Sulfonamides Carb and Barb - ANSWERS-decrease INR Deapkote and Disulfruram - ANSWERS-Increase INR GAL-Renall metabolized - ANSWERS-Gabapentin Acamprostate Lithium Grapefruit juice - ANSWERS-One glass can reduce absorption by 47% Blood levels will be Increased Trazodone (Desyrel) - ANSWERS-Get EKG. Trazodone (Desyrel) - ANSWERS-Get an eye exam can cause Glaucoma Grapefruit juice or grapefruit - ANSWERS-Increase trazodone PICOT - ANSWERS-Patient population of interest Intervention of interest Comparison of interest
Outcome Time limbic system - ANSWERS-A doughnut-shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus, amygdala, and hypothalamus. Amygdala - ANSWERS-A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression. PANDAS - ANSWERS-Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD Mental Health Parity Act 1996 - ANSWERS-ensure equal coverage for mental and physical illness equal life time and annual limits charge of DEA - ANSWERS-state and federal Stereogenesis - ANSWERS-identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object Sterogenesis abnormality in - ANSWERS-parietal lobe Clozaril (Clozapine) - ANSWERS-WBC- ANC LESS than 1000 (950) dc medication how treat child with depression - ANSWERS-Zoloft and therapy 3 year old masturbates, plays with self, says naught things - ANSWERS-normal for Piaget NMS treatment - ANSWERS-Dantrolene: MUSCLE RELAXTION D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable
0-7 Normal 14-18 Moderate
20 Severe Depression Beck Depression Inventory (BDI) - ANSWERS-0-13 Minimal depression 14-19 Mild Depression 20-28 Moderate Depression 29-63 Severe Depression Patient Health Questionnaire (PHQ-9) - ANSWERS-1-4 minimal 5-9 Mild depression 10-14 Moderate Depression 15-19 Moderate Severe Depression 20-27 Severe Depression A brief 9-item self-report questionnaire used as a screening tool to assess severity of depression; widely used by health care providers, in validity is well established, particularly for identifying severe depression. Hamilton Anxiety Rating Scale (HAM-A) - ANSWERS-14-17 Mild Anxiety 18-24 Moderate Anxiety 25-30 Severe Anxiety Yale-Brown Obsessive Compulsive Scale (Y-BOCS) - ANSWERS-OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme PTSD (Post Traumatic Stress Disorder) - ANSWERS-EMDR
EMDR (eye movement desensitization and reprocessing) - ANSWERS-eye movement desensitization and reprocessing Dilated pupils - ANSWERS-Stimulant intoxication constricted (pinpoint) pupils - ANSWERS-Opiods nystagmus - ANSWERS-Phencyclidine conjuctival injection, muchies (super hungry), psychomotor slowness? - ANSWERS-Marijuana Marijuana - ANSWERS-a drug, often smoked, whose effects include euphoria, impairment of judgment and concentration and occasionally hallucinations; rarely reported as addictive Boy states that he wishes to be a girl and tells you not to tell his parent s - ANSWERS-Don't tell ODD what will you do to prevent it from becoming Conduct disorder - ANSWERS-Therapy to target mood and aggression Herpes rooster 3 weeks later sleep difficulties and sad mood - ANSWERS-Depression Schizophrenia in males - ANSWERS-18-25 years old Schizophrenia in Women - ANSWERS-25-35 years old signs of amphetamine intoxication - ANSWERS-Tears, Runny nose, restlessness, HTN, Tremors, Insomnia Co-morbidities of bipolar - ANSWERS-Anxiety, alcohol and substance abuse Big Freaking Problems - ANSWERS-Bupropion Fluoxetine Paxil Medicare - ANSWERS-A federal program of health insurance for persons 65 years of age and older Medicare Advantage - ANSWERS-a program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrollee Medicare A, B, C, D - ANSWERS-A: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs WATCHERS for GAD 3 of these *** for 6 months - ANSWERS-worry
Atrovent (ipratropium) azithromycin (Zithromax, Azithromycin Dose Pack, Z-Pak, Zmax) Benadryl (diphenhydramine) caffeine Flonase (fluticasone nasal) ibuprofen ipratropium (Atrovent, Ipratropium Inhalation Solution, Atrovent HFA, Ipratropium Inhalation Aerosol) Lasix (furosemide) metoprolol (Metoprolol Succinate ER, Metoprolol Tartrate, Lopressor, Toprol-XL, Kapspargo Sprinkle) Mucinex (guaifenesin) oxycodone (OxyContin, Roxicodone, Xtampza ER, OxyIR, Oxaydo, Dazidox, Oxyfast, Oxecta, RoxyBond, Oxydose, Percolone, M-Oxy, ETH-Oxydose, Endocodone, Roxicodone Intensol) prednisone (Deltasone, Rayos, Sterapred, Prednicot, Sterapred DS, Liquid Pred, Meticorten, Orasone, Prednicen-M) Singulair (montelukast) Spiriva (tiotropium) Symbicort (budesonide / formoterol) Tylenol (acetaminophen) Vitamin B12 (cyanocobalamin) Vitamin D3 (cholecalciferol) Zyrtec (cetirizine) t-tests - ANSWERS-statistical measure: test means of 2 independent samples, significantly different? ANOVA (analysis of variance) - ANSWERS-3 OR MORE an inferential statistical test for comparing the means of three or more groups Pearson's r - ANSWERS-a statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scale p-value - ANSWERS-The probability of results of the experiment being attributed to chance. LEVEL OF
SIGNGNIFICANCE
Early onset of HIV dementia - ANSWERS-Apathy Lack of Interest Abnormal of MRI-SLow But cognitive," functions such as memory, reasoning, judgment, concentration, and problem solving. Other common symptoms are changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance. show brain atrophy (shrinkage) Yalom - ANSWERS-Universality: Members recognize that other members share similar feelings, thoughts and problems Altruism: Members gain a boost to self concept through extending help to other group members Instillation of hope: Member recognizes that other members' success can be helpful and they develop optimism for their own improvement Imparting information: Education or advice provided by the therapist or group members Corrective:Opportunity to reenact critical family dynamics with group members in a corrective manner Development of socializing techniques: The group provides members with an environment that fosters adaptive and effective communication Imitative behavior: Members expand their personal knowledge and skills through the observation of Group members' self-exploration, working through and personal development Cohesiveness: Feelings of trust, belonging and togetherness experienced by the group members
