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PMHNP FINAL EXAM WITH 200 QUESTIONS & CORRECT
ANSWERS A+ GRADES
What is dissemination? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Moderate cognitive impairment What is Tegretol in the CYP450 system? - CORRECT ANSWER >>> Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? - CORRECT ANSWER >>> Inducer - will lower dose of Lamictal What is a Type I research error? - CORRECT ANSWER >>> There IS a difference but you say there isn't a difference. What is a Type II research error? - CORRECT ANSWER >>> There is NO difference but you say there is a difference. What is pseudo-dementia? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Yes. What is a drug 1/2 life? - CORRECT ANSWER >>> The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? - CORRECT ANSWER >>> Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? - CORRECT ANSWER >>> Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? **- CORRECT ANSWER
** HLAB When might you see toxic epidermal necrolysis? - CORRECT ANSWER >>> With worsening of SJS How many generations do you include for a genogram? - CORRECT ANSWER >>> 1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - What does messenger RNA code for? - CORRECT ANSWER >>> Amino Acids What is epigenetics? - CORRECT ANSWER >>> Factors that affect genes - environmental, smoking, stress, etc...
Which one of the 3 muscle enzymes are related to cardiac muscle damage? **- CORRECT ANSWER
** CKMB What is the risk of a seriously elevated CKMB? - CORRECT ANSWER >>> Polymyositis Rhabdo What is a normal CKMB? - CORRECT ANSWER >>> 0.3 mcg/L What psychoactives does Detrol interact with? - CORRECT ANSWER >>> Topamax KCL Zonegran What CN are you assessing when you have the patient shrug their shoulders? - CORRECT ANSWER >>> CN XI - Spinal Accessory What do you see in labs with HIV & Dementia? - CORRECT ANSWER >>> CD4 < Viral Load is high <20% get it with antiretroviral treatment What is the scoring with the Beck Depression Inventory? - CORRECT ANSWER >>> Self-Report
- 0 - 63 0 - 13 - minimal 14 - 19 - mild 20 - 28 - moderate 29 - 63 - severe
What is sensitivity? - CORRECT ANSWER >>> Helps rule-out disease = True Positive = Snout What is specificity? - CORRECT ANSWER >>> Helps rule-in disease = True Negative = Spin What does a sed rate measure? - CORRECT ANSWER >>> Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour. What is a normal sed rate or ESR? - CORRECT ANSWER >>> 0 - 22 males 0 - 29 females What is a retic count? - CORRECT ANSWER >>> Measures % of reticulocytes in blood (immature RBC's) Indicates whether enough RBC's are being produced by bone marrow. What does a decreased retic count indicate? - CORRECT ANSWER >>> Anemia - acute or chronic bleeding What does an increased retic count indicate? - CORRECT ANSWER >>> Bone marrow disorder or Vitamin Deficiency What does an abnormal retic ount indicate in general? - CORRECT ANSWER >>> Doesn't diagnose anything. First step is ID source of the issue. What happens when you mix tegretol and macrolides? - CORRECT ANSWER >>> Increase tegretol levels. What happens if a pregnant women takes Accutane? - CORRECT ANSWER >>> Birth defects.
Expect to give instructions and help make decisions What does it mean when an Asian patient does not make eye contact with the NP? - CORRECT ANSWER >>> SIgn of respect What is the evil eye? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Red ribbon on an infant Amulet for adults How do you treat for evil eye? - CORRECT ANSWER >>> Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? - CORRECT ANSWER >>> Relationship What is a proximate cause? - CORRECT ANSWER >>> Connection between A + B. For there to be damages, what must exist first? - CORRECT ANSWER >>> Negligence What is an occurrence basis liability insurance? - CORRECT ANSWER >>> "occurred" during the policy period, no matter when the claim is brought against the insured What is a claims made/based liability insurance? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Board of Nursing State What are the various controlled substance classes? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Schedules III-V ONLY. Where does 50% of healthcare funds come from? - CORRECT ANSWER >>> The government Who is eligible for Medicare? - CORRECT ANSWER >>> >65 or under 65 with diability, ANY age with renal disease. What is incident to billing? - CORRECT ANSWER >>> 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%.
Is it ok to announce a patient's name in a waiting room? - CORRECT ANSWER >>> Yes, no other way to give care. Is it ok to leave a message on a patient's vm? - CORRECT ANSWER >>> Yes, but should be limited. What is the impact of steroid inhalers on children? - CORRECT ANSWER >>> Slows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? - CORRECT ANSWER >>> Cataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? - CORRECT ANSWER >>> Sleeping meds Antidepressants Pain meds What psychoactives are first line treatment for fibro? - CORRECT ANSWER >>> Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's What is the purpose of telepsychiatry? - CORRECT ANSWER >>> Increase the ability to reach rural and underserved areas. What is the purpose of Motivational Interviewing? - CORRECT ANSWER >>> Explore ambiguity Maintain passive position
What is HIV related dementia often mistaken for, especially at the beginning? - CORRECT ANSWER >>> Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? - CORRECT ANSWER >>> Stop and repeat lab. Normal is 1500-8000 mm Can you take Buspar during pregnancy? - CORRECT ANSWER >>> Category B - ok if really needed. Can you take Klonopin during pregnancy? - CORRECT ANSWER >>> 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? - CORRECT ANSWER >>> Both are CYP450 inducers of the other and therefore together will lower the level of both drugs. Can asthma medications cause depression? - CORRECT ANSWER >>> Yes. If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? - CORRECT ANSWER >>> Microalbumin? What is often common to patients with fibro? - CORRECT ANSWER >>> Sexual abuse How is telepsychiatry evaluated? - CORRECT ANSWER >>> Outcome based - measure at intervals. What happens with a patient taking Lithium and who gets dehydrated? **- CORRECT ANSWER
** Levels increase
What happens with a patient taking Lithium who decreases sodium intake? **- CORRECT ANSWER
** Levels increase What happens with a patient taking Lithium and drinks a lot of water? **- CORRECT ANSWER ** Levels decrease If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? - CORRECT ANSWER >>> Zyprexa What happens when taking Lithium and NSAIDS? - CORRECT ANSWER >>> 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? **- CORRECT ANSWER ** HLAB-1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's. Amgdyla - CORRECT ANSWER >>> Fear, Anxiety, and Aggression Neurotransmitter for Addiction - CORRECT ANSWER >>> Dopamine and GABA Neurotransmitter for Mood Disorder - CORRECT ANSWER >>> Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol - CORRECT ANSWER >>> Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol Signs and Symptoms of stimulant abuse - CORRECT ANSWER >>> insomnia and tremor
Pt wants to stop medications - CORRECT ANSWER >>> explore reason for stopping Its their right 16 year old falls with the wrong crowd - CORRECT ANSWER >>> Conduct disorder change agent - CORRECT ANSWER >>> the person formally in charge of guiding a change effort Administrator 14 year old girl clenching her teeth - CORRECT ANSWER >>> Cranial Nerve V-Trigeminal nerve Infant dying - CORRECT ANSWER >>> Give child to parents and comfort parents borderline personality disorder Treatment - CORRECT ANSWER >>> dialectical behavior therapy Aggressive patient give - CORRECT ANSWER >>> IM geodon SIGECAPS of Depression - CORRECT ANSWER >>> Sleep Interest Guilt Energy Concentration Appetite psychomotor retardation Suicide
DIGFAST for mania - CORRECT ANSWER >>> Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase 5 year old tells u his brother sodomized him - CORRECT ANSWER >>> Tell mom don't leave him alone with patient and call CPS implement crisis Just culture - CORRECT ANSWER >>> "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 - CORRECT ANSWER >>> Interview the young child and infants child with parent
Appreciative Inquiry - CORRECT ANSWER >>> 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 - CORRECT ANSWER >>> 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) - CORRECT ANSWER >>> 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 - CORRECT ANSWER >>> 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 - CORRECT ANSWER >>> Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention
Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do - CORRECT ANSWER >>> Validate his experience and provide care in a culturally specific way to that patient Native American wants his healer present - CORRECT ANSWER >>> Involve mother of the patient and healer, mom was cleared for you to involve her 16 year old shows up with mother for first therapy is - CORRECT ANSWER >>> confidential mom sits in lobby Patient acts out due to missing session what do you do - CORRECT ANSWER >>> You relate to childhood abandonment and talk about it with the patient How do you assess the competency of a medical procedure - CORRECT ANSWER >>> Identify a pen and recall 3 words Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis - CORRECT ANSWER >>> Delusional disorder Increase ICP (signs and symptoms) - CORRECT ANSWER >>> Baby Neuro cry Menopausal woman - CORRECT ANSWER >>> Hormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide - CORRECT ANSWER >>> Stop medication immediately You want to decrease seclusion on your unit who considered the primary change agent -
