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PMHNP ANCC FINAL EXAM COMPLETE QUESTIONS &
CORRECT ANSWERS ALREADY GRADED A +
Descriptive Vividness - CORRECT ANSWER >>> The researcher describes the data gathering process in sufficient detail that the reader can personally experience it. The data collected, often in the form of personal statements, should be quoted directly and extensively, because this is the raw data from the study. Methodological Congruence - CORRECT ANSWER >>> The researcher presents the philosophical and methodological approach used and cites references to support their approach. The subjects, sampling method, data-gathering and data-analysis strategies, and processes for informed consent are clearly and concisely described. Theoretical Conectedness - CORRECT ANSWER >>> Any theory developed from the study is clearly stated, logically consistent, reflective of the data, and in accord with other available knowledge. Analytical Precision - CORRECT ANSWER >>> Is not concerned with statistics and instruments. If refers to the decision-making process by which the researchers synthesize concrete data (words of the subjects) into an abstract that clarifies the meaning and the importance of the study. The last of the 5 criteria is Heuristic Relevance - The researcher clarifies the significance of the study, its applicability to public health or community nursing, and its likely influence o the future research. Phenelzine - CORRECT ANSWER >>> An MAOI that patients with atypical depression respond particularly well to. Atomoxetine - CORRECT ANSWER >>> A norepinephrine reuptake inhibitor approved for the treatment of ADHD.
Loxapine - CORRECT ANSWER >>> A typical, tetracyclic antipsychotic with antidepressant properties. Its active metabolite is amoxapine, which is a secondary amine tricyclic antidepressant. HITECH - CORRECT ANSWER >>> Implementation of EHR for information exchanges and improving population health. This was done by Obama and the ARRA. Suppression - CORRECT ANSWER >>> The intentional or conscious exclusion of painful or disturbing thoughts or emotions from awareness. A healthy defense mechanism because the client channels conflicting energies into growthpromoting activities. Medications that can induce depression - CORRECT ANSWER >>> beta blockers, steroids, interferon, Accutane, benzodiazepines, progesterone, some antivirals, and antineoplasmics. Medications that can induce mania - CORRECT ANSWER >>> Steroids, Isoniazid, antidepressants (in people who already have bipolar disorder), and Antabuse. Medigap Insurance Policies - CORRECT ANSWER >>> Private insurance policies purchased by elderly individuals to cover some or all of their medical expenses not paid for by Medicare. Medicare Advantage Plan - CORRECT ANSWER >>> Formerly Medicare + Choice, this created regional Preferred Provider Organizations (PPOs) and gave Medicare enrollees the option of enrolling in private insurance plans. Medicare + Choice - CORRECT ANSWER >>> Was a part of the Balanced Budget Act of 1997 that significantly increase the number of managed care insurance plans available to recipients. This was replaced with the Medicare Advantage Plan in 200.
Irritability Nausea Imbalance/instability/incoordination/dizzy (motor) Sensory disturbances Headache, hyperarousal (anxiety/agitation) Signs of NMS (Neuroleptic Malignant Syndrome) - CORRECT ANSWER >>> Initial Symptoms: altered sensorium, hyperreflexia, fever Then signs of autonomic instability: extreme muscle rigidity, hypotension, tachycardia, diaphoresis, tachypnea, hyperthermia, coma, death. Check for increased WBCs (leukocytosis)/LFTs/CPK Signs of Lithium toxicity - CORRECT ANSWER >>> Confusion, diplopia, nausea/diarrhea, ataxia, lethargy, fatigue, clumsiness, weakness, muscle cramping, severe tremor, blurred vision, nystagmus, increased DTRs, altered mental status, cardiac dysrhythmias Signs of Serotonin Snydrome - CORRECT ANSWER >>> agitation, restlessness, rapid heart rate, blood pressure elevation, headache, sweating, shivering, goose bumps, myoclonic jerking and loss of coordination, confusion, fevers, unconsciousness, seizures Medications that can increase lithium level - CORRECT ANSWER >>> NSAIDs, ACE Inhibitors (prils), ARBs (-sartans), tetracyclines, metronidazole Medications that can decrease lithium level - CORRECT ANSWER >>> potassium-sparing diuretics, thiazide diuretics, theophylline Clozaril - monitoring considerations - CORRECT ANSWER >>> Monitor ANC (absolute neutrophil count); pt needs an ANC of at least 1500 to start clozaril therapy; watch for Benign Ethnic
Neutropenia (BED); Monitor ANC weekly x6 months, every 2 weeks x6 months, then monthly if ANC is at least 1500. Substances that can cause a false + drug test for PCP & methadone **- CORRECT ANSWER
** Niquil, OTC cough meds Substances that can cause a false + drug test for heroin & morphine **- CORRECT ANSWER ** rifampin, fluoroquniolones Substances that can cause a false + drug test for cocaine - CORRECT ANSWER >>> NSAIDs, amoxicillin, most antibiotics Substances that can cause a false + drug test for amphetamines - CORRECT ANSWER >>> Prozac, Wellbutrin, Trazodone, Nefazodone, Sudafed, OTC decongestants. Schizophrenia Prevalence: Non-twin siblings of a schizophrenic parent Dizygotic twins of a schizophrenic parent Monozygotic twins of a schizophrenic parent - CORRECT ANSWER >>> 8% 12% 47% Birth defects caused by benzodiazepines - CORRECT ANSWER >>> Cleft palate, floppy baby syndrome Birth defects caused by carbamazepine - CORRECT ANSWER >>> Neural tube defects
Normal Plate Count - CORRECT ANSWER >>> 140,000-340, Normal hemoglobin value for males and females - CORRECT ANSWER >>> Males: 13.5- 18 Females: 12.5- 14 Normal MCV (mean corpuscular volume) value - CORRECT ANSWER >>> 78 - 100 Normal TSH Range - CORRECT ANSWER >>> 0.4- 4 Normal Free T4 range - CORRECT ANSWER >>> 10 - 27 Substances that can cause a false + drug test for codeine - CORRECT ANSWER >>> poppy seeds Substances that can cause a false + drug test for benzodiazepines - CORRECT ANSWER >>> Zoloft Gamma glutamyl transpeptidase (GGT) normal range - CORRECT ANSWER >>> 10 - 38 Drug Category A and examples - CORRECT ANSWER >>> Controlled studies show no risk Vitamins within RDA, insulin, thyroxine Drug Category B and examples - CORRECT ANSWER >>> No evidence of risk in humans Buspirone, zolpidem, clozapine, lurasidone Beta-lactam antimicrobials (PCNs, cephalosporins, select macrocodes,azithromycin, erythromycin), acetaminophen, ibuprofen (1st & 2nd trimesters)
Drug Category C and examples - CORRECT ANSWER >>> Risk cannot be ruled out bupropion, lamotrigine, SSRIs (except paroxetine), TCAs, duloxetine, mirtazapine, trazodone, venlafaxine, aripiprazole, Haldol, ziprasidone, risperidone Drug Category D and examples - CORRECT ANSWER >>> Positive evidence of risk paroxetine, valproate, carbamazepine, lithium alprazolam, chlordiazepoxide, clonazepam, diazepam, lorazepam, oxazepam ACE Inhibitors (-prils), ARBs (-sartans), ibuprofen (3rd trimester), tetracyclines Drug Category X and examples - CORRECT ANSWER >>> Absolutely Contraindicated in pregnancy Accutane, misoprostol, thalidomide, flurazepam, temazepam, triazolam Types of inferential statistics - CORRECT ANSWER >>> p-value, Pearson's r correlation, ttest,ANOVA T-test - CORRECT ANSWER >>> Compares whether the means of two groups are statistically different ANOVA - CORRECT ANSWER >>> tests the differences of 3 or more groups Pearson's r correlation - CORRECT ANSWER >>> tests the relationship between 2 variables HLB- B*1502 - CORRECT ANSWER >>> Allele that some asian's have which makes them unable to metabolize carbamazepine, increasing their risk for Steven's-Johnson syndrome which can lead to toxic epithelial necrolysis. Asians must be tests for this gene prior to beginning therapy. TIGER - CORRECT ANSWER >>> technology competencies for NPs to improve access to quality & patient experience
20 - 28: moderate depression 29 - 63: severe depression Edinburgh Postnatal Depression Scale (EPDS) - CORRECT ANSWER >>> 10 questions. > or = possible depression SLUMS (St. Louis University Mental Status Exam) - CORRECT ANSWER >>> HS Education: Normal: 27- 30 MCI: 20- 27 Dementia: 1- 19 Less than HS education: Normal: 20- 30 MCI: 14- 19 Dementia: 1- 14 CIWA - CORRECT ANSWER >>> Very mild: 0- 9 Mild: 10- 15 Moderate: 16- 20 Severe: 21- 26 PHQ-9 (Patient Health Questionnaire 9) - CORRECT ANSWER >>> 9 questions 1 - 4 minimal depression 5 - 9 mild depression 10 - 14 moderate depression 15 - 19 moderately severe depression
20 - 27 severe depression MADRS (Montgomery Asberg Depression Rating Scale) - CORRECT ANSWER >>> 10 questions 44= very severe 31= severe 25= moderate 15= mild 7= recovered Mini-cog - CORRECT ANSWER >>> Screens for cognitive impairment. 3-item recall with a clock- drawing test (CDT). 0/3 word recall=cognitive impairment 1 - 2 word recall and abnormal CDT=cognitive impairment 1 - 2 word recall and normal CDT= no cognitive impairment 3/3 word recall= negative screen for dementia MMSE (Mini mental status exam) - CORRECT ANSWER >>> Screens for cognitive impairment and used to follow cognitive function over time. High education may score falsely high. 30-point questionnaire: Intact 25- 30 Mild 21- 24 Moderate 10- 20 Severe < or = MoCA (Montreal Cognitive Assessment) - CORRECT ANSWER >>> Screens for mild cognitive decline. 30-point questionnaire. > or = 26 considered normal
Schedule V Drugs - CORRECT ANSWER >>> buprenorphine, cheritussin (Robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil) Role of hypothalamus - CORRECT ANSWER >>> homeostasis; basic needs (eating drinking, temperature regulation, sleep-wake cycle). Braine stem reponsibility and parts - CORRECT ANSWER >>> Pons, Midbrain, medulla oblongata Regulates BP, respirations, level of arousal, and digestions. Relays information to the cerebellum Thalamus - CORRECT ANSWER >>> transmits sensory information to the cerebrum. influences affect, mood, and body movements associated with strong emotions. Kohlberg - CORRECT ANSWER >>> Stages of Moral Development 6 Domains in Diagnosing Neurocognitive Disorders - CORRECT ANSWER >>> 1. Complex Attention
- Executive Function
- Learning Memory
- Language
- Perceptual Motor Ability
- Social cognition Mesolimbic Pathway - CORRECT ANSWER >>> Responsible for POSITIVE symptoms of schizophrenia all antipsychotics block DA receptors (specifically D2) in this pathway Excess DA in this pathway leads to + symptoms (psychosis) Reward-oriented Associated with mood disorders, psychoses, and drug abuse
Mesocortical Pathway - CORRECT ANSWER >>> Responsible for NEGATIVE symptoms of schizophrenia, cognition, planning and behavior. Nigrostriatal Pathways - CORRECT ANSWER >>> Responsible for voluntary and involuntary movements. Insufficient DA in this pathway is implicated in Parkinson's disease. Tuberoinfundibular Pathway - CORRECT ANSWER >>> Responsible for prolactin production. Extends to the pituitary gland where prolactin is regulated. Otto Kernberg - CORRECT ANSWER >>> Psychoanalytic therapy with antisocial and borderline personality disorders. Carl Rogers - CORRECT ANSWER >>> Humanistic approach; unconditional positive regard; described the individual as an energy field existing within the universe 4 focuses of IPT (interpersonal therapy) - CORRECT ANSWER >>> 1. Complicated bereavement
- Role Dispute
- Role Transition
- Interpersonal Deficits Maslow's Hierarchy - CORRECT ANSWER >>> 1. Physiologic Needs (food, water, warmth, rest) 2.Safety/security
- Belongingness and love
- Esteem
- Self-actualization (achieving one's full potential)
- Self-transcendence Erikson's Stages of Development - CORRECT ANSWER >>> 1. Trust vs Mistrust
Failure: identity confusion, poor self-identification in group settings Intimacy vs Isolation - CORRECT ANSWER >>> Age: 20- 35 Mastery: committed relationships, capacity to love Failure: Emotional isolation, and egocentrism Generativity vs Stagnation - CORRECT ANSWER >>> Age: 35- 65 Mastery: ability to give time and talents to others and ability to care for others Failure: self-absorption, inability to grow-change as a person, inability to care for others Integrity vs Despair - CORRECT ANSWER >>> age 65+ Mastery: fulfillment and comfort with life, willingness to face heath, insight and balanced perspective on life's events Failure: biternes, sense of dissatisfaction with life, despair over impending death. Piaget Stages - CORRECT ANSWER >>> 1. Sensorimotor
- Pre-operational
- Concrete Operational
- Formal Operational Sensorimotor Stage - CORRECT ANSWER >>> 0 - 2 years Infants develop object permanence (the realization that people exist even when they cannot be seen) Pre-operational - CORRECT ANSWER >>> 3 - 6 years Egocentrism prominent during this stage. Children develop language, symbolic thinking.
Concrete Operational - CORRECT ANSWER >>> 7 - 11 years Development of logical thought, but it is still more concrete than abstract. Developing the understanding of the concept of conservation. Formal Operational - CORRECT ANSWER >>> 12+ years Development of hypothetical-deductive reasoning, may have an imaginary audience, personal fable, propositional thinking Freud Stages - CORRECT ANSWER >>> 1. Oral 0-18 months
- Anal 18 mos-2 years
- Phallic 3-6 years
- Latency 7-11 years
- Genital 12+ years Oral Stage - CORRECT ANSWER >>> Age: 0-18 mos Activities: put everything in their mouth. sucking, chewing, feeding, crying Failure: schizophrenia, paranoia, substance abuse Anal Stage - CORRECT ANSWER >>> Age: 18 mos - 2 years Activities: fixated on toilet training and sphincter control, activities of expulsion and retention Failure: depressive disorders Phallic Stage - CORRECT ANSWER >>> Age: 3-6 years
Ford vs Wainwright (1986) - CORRECT ANSWER >>> Established a person's competence to be executed. :
- Person must understand retributive element of punishment
- Person must be in the best place to make peace with his or her religion. Cranial Nerve I - CORRECT ANSWER >>> Olfactory Sensory Smell; tested by having patient smell common things like coffee ground through each nare while occluding the opposite nare (eyes must be closed) Cranial Nerve II - CORRECT ANSWER >>> Optic Sensory Sight; tested using Snellen chart. Also, examiner views optic disc with ophthalmoscope, peripheral vision with confrontation test Cranial Nerve III - CORRECT ANSWER >>> Oculomotor Motor Extraocular movements, tested with CNs IV and VII. Pupils and corneal light reflex. Check for PERRLA Cranial Nerve IV - CORRECT ANSWER >>> Trochlear Motor Extraocular movements, tested with CNs III and VII. Innervates superior oblique muscle, turns eyes down and laterally (out) Cranial Nerve V - CORRECT ANSWER >>> Trigeminal Both
Sensation of touch and pain on the face. Movement of facial muscles (chewing). Specifically, have patient clench down and palpate the master muscle for tone. Cotton wisp test, and poke with pins with eyes closed on face. Cranial Nerve VI - CORRECT ANSWER >>> Abducens Motor Extraocular movements, tested with CNs III and IV. Turns eyes laterally (outwards) Cranial Nerve VII - CORRECT ANSWER >>> Facial Both Facial expressions. Sensation on face. Saliva and tears secretion. Taste (identify sugar, vinegar, and salt with eyes closed). Movement of facial muscles: frown, smile, raise eyebrows, puff out cheeks Cranial Nerve VIII - CORRECT ANSWER >>> Acoustic (vestibulocochlear) Sensory Hearing: Weber and Rinne test, Whisper Test. Audiometer. Equilibrium, sensation. Cranial Nerve IX - CORRECT ANSWER >>> Glossopharyngeal Both Taste on anterior 2/3 tongue. Tongue movement. Test with vagus nerve. Cranial Nerve X - CORRECT ANSWER >>> Vagus Both Carotid blood pressure regulation, lower HR, gag reflex (put tongue depressor on back of tongue), taste, stimulated digestive organs. Test with glossopharyngeal nerve). Check for elevation of uvula by having pt open mouth, say "ahh".
