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NURSING 706 PMHNP Certification Exam 2024/2025: Actual Test with Correct Detailed Answers, Exams of Pathophysiology

Massachusetts College of Pharmacy & Health Sciences (MCPHS)Pathophysiology

A comprehensive set of questions and answers for the nursing 706 pmhnp certification exam, covering key topics in psychiatric mental health nursing. It includes detailed explanations for each answer, making it a valuable resource for students preparing for the exam. A wide range of topics, including psychotropic medications, side effects, treatment guidelines, and common psychiatric diagnoses.

Typology: Exams

2024/2025

Available from 12/10/2024

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lOMoARcPSD|33689129

NURSING 706 PMHNP CERTIFICATION EXAM 2024/2025

ACTUAL TEST WITH CORRECT DETAILED ANSWERS/

VERIFIED AND GRADED A+

1. 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 confiden-

tial. Parents may be upset but remember you are advocating for the child.

2. Which Ethnic group has the highest rate of suicide?:

Native Americans

3. 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

an- tagonism

C. Increased Lipids

D.

Metabolic Syndrome:

Metabolic Syndrome (UMBRELLA ANSWER)

4. 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 ABILIFY

5. Which mood stabilizer have the least weight gain?:

Lamictal

-But remember all mood stabilizers cause some weight gain

6. When presented with a question about typical vs atypical

antipsychotic the answer is usually to start of a: atypical

Partial preview of the text

Download NURSING 706 PMHNP Certification Exam 2024/2025: Actual Test with Correct Detailed Answers and more Exams Pathophysiology in PDF only on Docsity!

lOMoAR cPSD| 33689129

NURSING 706 PMHNP CERTIFICATION EXAM 2024/

ACTUAL TEST WITH CORRECT DETAILED ANSWERS/

VERIFIED AND GRADED A+

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 confiden- tial. Parents may be upset but remember you are advocating for the child.

Which Ethnic group has the highest rate of suicide?: Native Americans 3. 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 an- tagonism C. Increased Lipids D. Metabolic Syndrome: 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 ABILIFY
Which 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

7. A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical 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 **8. Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *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 a patient is hesitant to participate in treatment you should encour- age?: 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: HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEATINTOLERANCE
Key symptoms of Heat Intolerance: Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis:

Signs of Stevens-Johnson Syndrome:

fever, mouth pain, swelling,burning eyes, blisters, skin pain 24. 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 Allele
What two medications cause agranulocytosis?: Clozaril & Tegretal
Agranulocytosis when to discontinue medication: Less than 1000 29. 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?: clozariland lithium
Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
Ace inhibitors are treatment of choice for?: Heart Failure 34. Certain medications are known to increase lithium level, but HOW? by reducing renal clearance 35. When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise
Normal Lithium Level: 0.6-1.
Lithium Toxicity: 1 .5 or aboveDiscontinue and re- order lithium level
Lithium level of 1.4: Monitor for toxicity
Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renalimpair- ment)à4+ protein in urine=MONITOR FOR TOXICITY

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 notstart antidepressant without talking to PCP 50. 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-Firstline treatment for depression due to less risk of injury from OVERDOSE 53. 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 4 / 38

57. Which medications are best for neuropathic pain?: SNRI Gabapentin TCA

Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERY appointment 59. 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, GIUPSET 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) 63. What increases the causes or increases the risk or schizophrenia: exces- sive 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 DECREAS-ES EXCEPT VENTRICLES

Assess ability to recall: repeat 3 words after 5 minutes
Assess fund of knowledge: Who is the president 81. 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 dysto- nia, parkinsonian symptoms and akathisia

Low Dopamine in the nigrostriatal pathway increases which neurotrans- mitter: - Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) 87. 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 89. 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 92. 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 AL- BUTERAL this combination can cause bronchospasm
akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness of movement

Macrolides INH Grapefruit Juice Omeprazole Crack Amigos

Erythromycin and Clarithromycin can cause: Increased tegretol levels
Patient 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, benzodi- azepines, 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 antipsychotic

Neurotransmitters involved in Addiction: Dopamine and GABA 113. Symptoms of Stimulant Abuse:

agitation/aggression
impaired judgment
euphoria
elevated BP
tachycardia
dilated pupils
hallucinations
TREMORS
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, famoti- dine
Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption of antipsychotics & SSRI

MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI 117. 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 CONDITION
Patient with bipolar disorder presents with depressed mood & emotion- al lability: Give Depakote
Hallmark sx of Borderline Personality: Recurrent self harm
Treatment for Borderline Personality: DBT
Creator of DBT: Marsha Linehan 125. 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

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 caregiver

ODD: 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 activ- ity, +AGGRESSION, NO REMORSE

May need meds and therapy
Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsy- chotics, 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, avoid- ance
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 CHRONIC Feels 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, Norepineph- rine, 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, Norepi- nephrine, 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 prefrontal cortex: Attention Executive Function Cognition Processing Working Memory Problem Solving
Deficit in the can lead to ADHD inattentive type: Prefrontal Cortex
Teacher reports that the stimulant only works for first few hours of class: medication has worn off too fast. Order multiple dosing throughout the day
When does the aftercare plan start: on admission

Parents may become anxious after a diagnosis of mental illness such as ADHD, stop teaching offer support because they will not absorb the education. Provide supportive therapy

Neurotransmitters involved in OCD: serotonin, dopamine, glutamate & GABA
A tic may also be a : Compulsion
Facts about OCD: Obsession/Compulsion

A tic may be a compulsion
If first order relative has OCD the child's risk of developing OCD is increased
Streptococcal infections increase risk of OCD
Treatment SSRI-prozac, Zoloft, if adult you may also use TCA such as clomipramine 153. If question asks if the patient has Tourette's vs OCD listen for mention of streptococcal treatment this will trigger you to think OCD:

DMDD: 6 - 17 years ONLY

Irritability for no reason, sad, depressed mood, tantrums, crying, moody, always mad

If patient presents with irritability or labile mood and you need help further delineating symptoms: Administer MOOD QUESTIONAIRE 7/13 Bipolar Diagnosis Likely
Sleep Disorders are often So what should you assess if a parent reports that a child is having night- mares: GENETIC ask if someone in the family has a similar issue with sleep...look for family patterns of sleep problems
GAD: Worry, apprehension, fear must LAST ATLEAST 6 MONTHS
Delirium: - ACUTE (within hours to days) onset of disturbance of LOC, COG- NITION, inattention

Urinary Tract Infections are common cause for DELIRIUM always check UA
Treatment is antipsychotics like HALDOL

Dementia: - Chronic and slow onset (months to years to develop)

Mental decline in cognition, irritability, personality changes
When asked questions they may try to answer or MAKE UP ANSWERS (confab- ulate)

Low levels of what labs may mimic dementia: Vit B12 and Folic Acid
Cortical Dementia: Language and memory (aphasia and amnesia)
Subcortical Dementia: Motor abnormalities/Mood issues like apathy, de- pression, irritability HIV Dementia is a type of subcortical dementia
Early signs of HIV dementia: subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordina- tion, unsteady gait
Treatment for HIV dementia: Antivirals
Pseudo Dementia: Depression causes the memory issues, common in older adults

Also assess onset of symptoms, pseudo dementia is more acute onset
When asked questions they often say "I DON'T KNOW"

Instruments to use to differentiate between dementia and pseudo de- mentia: - Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE 167. - Older individuals with depression may present with irritability and agitation If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present:
hallmark of lewy body dementia: visual hallucinations
Frontotemporal lobe Dementia: PICKs Disease

Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes
May see slurred speech or difficulty getting words out

What lobe is associated with ability to understand what others are saying (comprehending speech): Temporal Lobe
Neurotransmitters involved in Autism: GABA, Glutamate, Serotonin
Autism: a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement When play they often like to line up their toys, stack them in tidy rows

NURSING 706 PMHNP Certification Exam 2024/2025: Actual Test with Correct Detailed Answers, Exams of Pathophysiology

Related documents

Partial preview of the text

Download NURSING 706 PMHNP Certification Exam 2024/2025: Actual Test with Correct Detailed Answers and more Exams Pathophysiology in PDF only on Docsity!

NURSING 706 PMHNP CERTIFICATION EXAM 2024/

ACTUAL TEST WITH CORRECT DETAILED ANSWERS/

VERIFIED AND GRADED A+