PMHNP Review Questions Set With Answers (Latest Update) 2022

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ANCC Review Questions (PMHNP IQ) Terms in this set (21) What direct-acting dopamine receptor agonist is recommended to be used in the treatments of neuroleptic malignant syndrome (NMS) fo help lowe... r the dopamine blockade? A) benzotropine (Cogentin) B) bromocriptine (Parlodel) C) dantrolene (Dantrium) D) trihexyphenidyl (Artane) A) Bromocriptine (Parlodel) is the recommended direct acting dopamine receptor agonist to help decrease the dopamine blockade. Danrolene (Dantrium) is a muscle relaxant. Benzotropine (Cogentin) and Trihexyphenidyl (Artane) are anticholinergic medications used for extrapyramidal side effects (EPS). Mr. Smith is a 56 year old white male who has been successfully treated on Selegiline for over 4 years. Mr. Smith is going in for elective surgical procedure. Which medication is strictly contraindicated with Selegiline? A) Non-steroidal anti-inflammatory drugs (NSAIDS) B) Codeine C) Morphine D) Meperidine D) Meperidine is strictly prohibited when a patient is treated on a monoamine oxidase inhibitor (MAOI) due to the risk of hypertensive crisis and death. A WBC of 4,000 in a patient taking Clozapine would prompt the PMHNP to take which of the following actions? A) Consult with hematologist to determine appropriate antibiotic regimen and monitor closely. B) Institute twice-weekly complete blood count with differentials and monitor closely. C) Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely. D) Institute daily complete blood count with differentials and monitor closely. B) Institute twice-weekly complete blood count with differentials and monitor closely. The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely compromised immune system. At a WBC of 4,000, the recommendation is to closely monitor CBC with differential twice a week while patient may continue clozapine in the absence of any other signs or symptoms. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia? A) Abilify (aripriprazole) B) Latuda (lurasidone) C) Invega (iloperidone) D) Clozaril (clozapine) D) Clozaril (clozapine) is the only known antipsychotic medication that had been shown to reduce the risk of suicide in patients diagnosed with schizophrenia. A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg po daily for the past 16 years, presents to the psychiatric mental health practitioner for an outpatient follow-up visit. During the visit she states that she has not been feeling well, reporting the flu. She also states she has not taken her medication in the last five days. Which of the following symptoms would she be describing if you suspect selective serotonin reputable inhibitors (SSRIs) discontinuation syndrome? A) Agitation, nausea, dysphoria, and diequilibrium B) Agitation, nausea, tremor, and ataxia. C) Restlessness, tremor, fever, and shivering. D) Restlessness, headache, increased heart rate, and diarrhea. A) Agitation; nausea, dysphoria, and disequilibrium The patient has SSRI discontinuation syndrome and would be presenting with flu-like symptoms. If the patient had serotonin syndrome, she would present with symptoms of autonomic instability. Which of the following statements reflect the current understanding of dopamine (DA) pathways and clinical symptoms in schizophrenia? A) Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. B) Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system. C) Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area. A) Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. Negative symptoms & cognitive impairment are thought to be related to hypoactivity of the mesocortical dopiminergic tract, which by its association with the prefrontal cortex and neocortex contributes to motivation, planning, sequencing of behaviors in time, attention, and social behavior. Positive symptoms (hallucination and delusions) are thought to be caused by dopamine hyperactivity in the mesolimbic tract, which regulates emotion. This hyperactivity could result in overactive modulation of nueurotransmission from the nucleus accumbens. Norepinephrine is a neurotransmitter that is implicated in alertness and anxiety. What area of the brain has a large majority of norepinephrine neurons? A) Amygdala B) Hippocampus C) Locus Coeruleus D) Nucleus Accumbens C) Locus coeruleus There are two areas in the brain that produce norepinephrine neurons, one is the locus coeruleus and the other is the medullary reticular formation. Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine? A) 1A2 B) 2D6 C) 2C9 D) 2C19 A) 1A2 When an individual is treated on clozapine and decreases tobacco use, the clozapine level with increase, as tobacco is an inducer to the clozapine, and the patient no longer needs the higher dose of clozapine. When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? A) Techniques to decrease arousal B) Clarification and close-ended questions C) Techniques to increase arousal D) Reflection and open-ended questions. C) Techniques to increase arousal Activation is needed to allow memories stored in the amygdala to be processed. The PMHNP knows that the ego is a part of the personality and is the logical/rational mind including defense mechanisms. What might this personality part say? A) "I should" B) "I want" C) "I evaluate" D) "I ought" C) "I evaluate" The ego is the logical and rational mind. The ego monitors the is and would say "I think. I evaluate." Mr. Jones, a 78 year old patient, presents to the PMHNP for a follow-up medication appointment. Mr. Jones' depression has been successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr Jones complains that in the last 2 or 3 weeks, he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. Which action would be most appropriate for Mr. Jones? A) Assess for other symptoms of hyponatremia and check a serum sodium level. B) Discuss SSRI discontinuation syndrome and stress importance of medication adherence. C) Discuss rates of relapse on a SSRI and increase his medication to citalopram 40 mg by mouth daily. D) Discuss rates of relapse on a SSRI and recommend switching his medication to a different class. A) Assess for other symptoms of hyponatremia and check serum sodium level. Hyponatremia can occur on SSRIs, and is more common in elderly patients. This patient is reporting symptoms of moderate hyponatremia and needs to be assessed, and his sodium levels need to be checked. Normal sodium level: 135-145 mEq/L The PMHNP mental health nurse practitioner treating a patient for schizophrenia on ziprasidone orders an electrocardiograph. Which QTc interval result places the patient at greatest risk for torsades de pointes? A) 100-200 milliseconds B) 160-260 milliseconds C) 300-500 milliseconds D) 500-700 milliseconds D) 500-700 milliseconds A patient with a QTc interval of 500-700 milliseconds is at a higher risk of developing torsades de pointes. Which lab test should be ordered to rule out a medical cause of dementia symptoms? A) Albumin B) thiamine C) Vitamin D3 D) Vitamin B12 D) Vitamin B12 Low vitamin B12 levels have been associated with the development of dementa- like symptoms, and when dementia is a differential diagnosis, a Vitamin B12 should be checked. Which of the following lab findings would raise the greatest concern when prescribing Lithium? A) BUN 20 mg/dL B) GFR 115 mL C) Serum Creatinine 3.0 mg/DL D) Serum Na+ 120 mEq/L C) Serum creatinine 3.0 mg/dL Normal serum creatinine is < 1.5 mg/dL. Elevated creatinine indicates decreased renal function. Lithium is excreted through the kidneys and decreased renal function can result in lithium toxicity. A 43-year-old male is treated for Bipolar 1 on lithium. Which of the following hematologic changes is associated with lithium? A) Agranulocytosis B) Anemia C) Leukocytosis D) Leukopenia C) Leukocytosis While the mechanism of action is not clear, the use of lithium can raise white blood cell counts and therefore, CBC should be monitored in patients treated on lithium. Which serotonin receptor antagonism makes an antipsychotic "atypical" A) 5HT2A B) 5HT1A C) 5HT3A D) 5HT4A A) 5HT2A The mechanism of action that makes an antipsychotic medication "atypical" is related to the 5HT2A receptor antagonism and D2 receptor antagonism. Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety. Sally's only other medical condition is exercise induced asthma, and she is treated on Albuterol. Sally states she was in CBT without relief and would like to try a medication. Which is the most suitable initial treatment for Sally? A) clonazepam (Klonopin) B) sertraline (Zoloft) C) inderal (Propanolol) D) risperidone (Risperidal) B) sertraline (Zoloft) is used to treat social anxiety disorder and the patient is on albuterol; therefore the betablocker inderal is contraindicated with albuterol due to the risk of increased CNS stimulation. When suspecting a patient with neuroleptic malignant syndrome (NMS), which lab values would help confirm diagnosis? A) Leukocytosis and elevated creatinine phosphokinase. B) Leukocytosis and thrombocytosis C) Leukopenia and decreased creatinine phosphokinase D) Leukocytosis and thrombocytopenia A) Leukocytosis and elevated creatinine phosphokinase. With NMS, a patient has an elevated creatinine phosphokinase (CPK) due to skeletal muscle breakdown and an elevated white blood cell count (WBC). In managing the maintenance phase for Bipolar I disorder, which of the following statements is not supported by current evidence in the literature? A) Both lamotrigine and lithium are superior to placebo in delaying onset of mood-related disorders. B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. C) Lamotrigine, but not lithium is superior to placebo in preventing a depressive episode. D) Lithium. but not lamotrigine, is superior to placebo in preventing a hypomanic, or mixed episode. B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. Extended-release formulation of carbamazepine has demonstrated preliminary efficacy in the tx of acute manic or mixed episodes, but is not currently indicated in maintenance phase tx for Bipolar I disorder. Side effects include dizziness, somnolence, nausea, vomiting, ataxia, blurred vision, dyspepsia, dry mouth, pruritus, and speech disorder. The other responses are supported by current evidence in literature. A new patient comes to you on a medication regimen of: Adderall XR, Seroquel, Mirtazepine, Diazepam, Zolpidem. In addition if initial dose dose not help the patient sleep. You confirm the medication regimen with the patient's past records. You diagnose with PTSD, alcohol use disorder moderate by history in recovery, depressive disorder, and ADD. You tx the patient and find that the patient is resistant to changing the past medication regimen. The pt wants you to rewrite the script so that the medication is available. In checking with the pharmacy, you find out the pt has potentially used 60 tablets of Zolpidem (Ambien) in a 20 day period. Your best action is to: A) Refill the order for the med as requested. The med has not harmed the pt so far. B) Discontinue the prescription for Zolpidem (Ambien). Talk to the pt about the overuse of Zolpidem (Ambien) and the danger it poses to his health and wellbeing. C) Give the order for the Zolpidem (Ambien). Talk with the pt about the danger of using too much sleeping medication. Then, discontinue the medication. D) Refill the order for the medication. Then, send the pt for the chemical dependency evaluation. The pt is on too many sedative-type meds and is harming himself. B) Discontinue the prescription for Zolpidem. Talk to the pt about the overuse of Zolpidem and the danger it poses to his health and wellbeing. Zolpidem (Ambien) is a hypnotic med for the short-term management of insomnia. It can be stopped abruptly without significant harm to the patient other than rebound insomnia. You are protecting your patient by stopping the dangerous misuse of a hypnotic medication. You must also discuss the ramifications of the misuse with the pt and attempt to help him by giving him a rationale for the discontinuation and a healthy plan for managing the insomnia. You are on call for your service. You arrive at the Emergency Dept to find a 22 year old male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 foot 7 inches tall. His weight is 140 lbs, and his labs are all normal range. He states he has been taking aripiprazole (Abilify) for the last 2 months for his bipolar 1 disorder. He had the dose raised 4 days ago to manage a manic episode. He states that one to three times a day for the past 2 days his eyes will roll upwards for 10-15 min and he will hav trouble seeing until they role back down. After examination you decide to: A) Discontinue to aripiprazole and begin the pt on a gradual regimen of Lamotigrine for 1 week. Have him return to his provider for further management of bipolar disorder. B) Continue the aripiproazole and give benzotropine mesylate. C) Discontinue the aripiprazole and give benzotropine mezylate (Congentin) 1 mg IM. D) Begin a cross titration downward of aripiprazole and upwards of haldol. PMHNP Exam Reported Questions - Terms in this set (341) 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 00:1801:36 What is Tegretol in the CYP450 system? Inducer -->will lower dose of Lamictal and BCP's What do BCP's 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 a difference. What is a Type II research error? There is NO difference but you say there is a difference. 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 increase the risk of SJS? HLAB-1502 00:0201:36 Upgrade to remove ads Only $35.99/year When might you see toxic epidermal necrolysis? With worsening of SJS How many generations do you include for a genogram? 1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - What does messenger RNA code for? Amino Acids What is epigenetics? Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? 10-25 yo When do females typically present with schizophrenia? 25-35 yo What does Erythromycin to trileptal? You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? Heart Failure HTN 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 are 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 <200 Viral Load is high <20% get it with antiretroviral treatment What is the scoring with the Beck Depression Inventory? Self-Report - 0-63 0-13 - minimal 14-19 - mild 20-28 - moderate 29-63 - severe Upgrade to remove ads Only $35.99/year 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 RBC's 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 RBC's) Indicates whether enough RBC's 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 does an abnormal retic ount indicate in general? Doesn't diagnose anything. First step is ID source of the issue. What happens when you mix tegretol and macrolides? Increase tegretol levels. What happens if a pregnant women takes Accutane? Birth defects. What labs do you get with RA? Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP - helps confirm diagnosis. 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? Unconscious Incompetent Life Threatening Situation What are the legal ramifications of treating w/o informed consent? Same as with informed consent Who can declare a patient incompetent and appoint a guardian? Only a court Does impaired judgment mean one is incompetent? No. Can an advanced directive ever be revoked? Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? No. How do Asians see HC providers? 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? SIgn of respect What is the evil eye? 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? Red ribbon on an infant Amulet for adults How do you treat for evil eye? Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? Relationship What is a proximate cause? Connection between A + B. For there to be damages, what must exist first? Negligence What is an occurrence basis liability insurance? "occurred" during the policy period, no matter when the claim is brought against the insured What is a claims made/based liability insurance? 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? Board of Nursing State Upgrade to remove ads Only $35.99/year What are the various controlled substance classes? 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? Schedules III-V ONLY. Where does 50% of healthcare funds come from? The government Who is eligible for Medicare? >65 or under 65 with diability, ANY age with renal disease. What is incident to billing? 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? 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? Yes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? Yes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? National standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? Can decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment Is it ok to announce a patient's name in a waiting room? Yes, no other way to give care. Is it ok to leave a message on a patient's vm? Yes, but should be limited. What is the impact of steroid inhalers on children? Slows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? Cataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? Sleeping meds Antidepressants Pain meds What psychoactives are first line treatment for fibro? Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's What is the purpose of telepsychiatry? Increase the ability to reach rural and underserved areas. What is the purpose of Motivational Interviewing? Explore ambiguity Maintain passive position What is required for Medicare submission? ICD 10 and narrative or CPT What is the neurotransmitter problem in Schizophrenia? Excess dopamine in mesolimbic pathway. What is the neurotransmitter problem in ADHD? Dopamine, norepinephrine and serotonergic dysfunction What is the benefit of play therapy? Don't have to confront emotions head on. What neurotransmitters are involved in the bioamine hypothesis of depression? 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? Stick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? CN V - Trigeminal What are two important things to measure when using Zyprexa? Lipid level and abdominal circumference What is included in the mini-cognitive exam? Clock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000? Stop and repeat lab. Normal is 1500-8000 mm3 Can you take Buspar during pregnancy? Category B - ok if really needed. Can you take Klonopin during pregnancy? 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? Both are CYP450 inducers of the other and therefore together will lower the level of both drugs. Can asthma medications cause depression? Yes. If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order? Microalbumin? What is often common to patients with fibro? Sexual abuse How is telepsychiatry evaluated? Outcome based - measure at intervals. What happens with a patient taking Lithium and who gets dehydrated? Levels increase What happens with a patient taking Lithium who decreases sodium intake? Levels increase What happens with a patient taking Lithium and drinks a lot of water? Levels decrease If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future? Zyprexa What happens when taking Lithium and NSAIDS? 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? HLAB-1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's. Amgdyla Fear, Anxiety, and Aggression Neurotransmitter for Addiction Dopamine and GABA Neurotransmitter for Mood Disorder Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol Signs and Symptoms of stimulant abuse insomnia and tremor Depakote check HCG levels Depakote causes Spinal bifida Grasp reflex. 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. 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 head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months. pincer grasp 9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios. Pt has MI looses his job stable on psych medications Provide brief supportive therapy Latida and Geodon Take with food Moro reflex absent Do xray Health Care Policy Model Access, Cost, Quality Pt wants to stop medications explore reason for stopping Its their right 16 year old falls with the wrong crowd Conduct disorder change agent the person formally in charge of guiding a change effort Administrator 14 year old girl clenching her teeth Cranial Nerve V-Trigeminal nerve Infant dying Give child to parents and comfort parents borderline personality disorder Treatment dialectical behavior therapy Aggressive patient give IM geodon SIGECAPS of Depression Sleep Interest Guilt Energy Concentration Appetite psychomotor retardation Suicide DIGFAST for mania Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase 5 year old tells u his brother sodomized him Tell mom don't leave him alone with patient and call CPS implement crisis Just culture "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 Interview the young child and infants child with parent First sign of temprofrontal Dementia Behavior and personalty changes Tow amines related to depression Serotonin and norepinephrine Want to start an consulting firm what tool would be needed to show economic viability Revenue and expenses Patient stopped smoking (Cessation) Decreased Zyprexia Promote resilience in schizophrenia for a patient that lives alone and doing well Refer to peer support Spirit stick Teach staff about culture competence Problems in the parietal lobe can lead Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) PDSA cycle 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 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 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) 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 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 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 Validate his experience and provide care in a culturally specific way to that patient Native American wants his healer present 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 confidential mom sits in lobby Patient acts out due to missing session what do you do You relate to childhood abandonment and talk about it with the patient How do you assess the competency of a medical procedure 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 Delusional disorder Increase ICP (signs and symptoms) Baby Neuro cry Menopausal woman Hormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide Stop medication immediately You want to decrease seclusion on your unit who considered the primary change agent Unit staff You are a lead NP over other NPs in a rural setting how would you go about the change Make online form and have them vote on it 16 year old refuse treatment Send to psych specialist for acting out kids Positive Trendelenburg Sign Refer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor. Drug affects Flonase Zantac (Histamine 2 Blocker) Antagonist Little boy wet his sheets, What kind of therapy would you suggest Behavior therapy DDVAP acts in much the same manner as antidiuretic hormone. Makes less urine Lithium level 1.2u what are you concerned with 4+ Ketones What does depakote do to Lamictal Increase laminate 200% Inducers of Cytochrome P450 (CYP450) Barbiturates, phenytoin, carbamazepine, rifampin, St. John's Wort A substance that speeds up a chemical reaction Inhibitor A substance that slows down or stops a chemical reaction cytochrome p450 inhibitors CRACK AMIGOS Cimetidine Ritonavir Acute Alcohol Ciprofloxacin Ketoconazole Amiodarone Macrolides Isoniazid Grapefruit juice Omeprazol Sulfonamides Carb and Barb decrease INR Deapkote and Disulfruram Increase INR GAL-Renall metabolized Gabapentin Acamprostate Lithium Grapefruit juice One glass can reduce absorption by 47% Blood levels will be Increased Trazodone (Desyrel) Get EKG. Trazodone (Desyrel) Get an eye exam can cause Glaucoma Grapefruit juice or grapefruit Increase trazodone PICOT Patient population of interest Intervention of interest Comparison of interest Outcome Time limbic system 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 A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression. PANDAS Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD Mental Health Parity Act 1996 ensure equal coverage for mental and physical illness equal life time and annual limits charge of DEA state and federal Stereogenesis identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object Sterogenesis abnormality in parietal lobe Clozaril (Clozapine) WBC-2500 ANC LESS than 1000 (950) dc medication how treat child with depression Zoloft and therapy 3 year old masturbates, plays with self, says naught things normal for Piaget NMS treatment Dantrolene: MUSCLE RELAXTION D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles mesolimbic system POSITIVE symptoms of schizophrenia due to high dopamine negative symptoms of schizophrenia the absence of appropriate behaviors (expressionless faces, rigid bodies) negative symptoms of schizophrenia mesocorticol pathway mesocortical pathway VTA to prefrontal cortex negative symptoms Nigrostriatal pathway EPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA; used to initiate movement PDSA model PLANDo-carry out Study -examine results Act-decide what action Tanner's stages Tanner stages 44 MMSE (Mini Mental State Examination)- Stage May be Normal 25-30 Mild/Early 21-24 Moderate 10-21 Severe 0-9 A pt states that she has been raped. What do you do ensure safety Hamilton D score of 28 Assess for Suicide Hamilton Depression Rating Scale 17-21 questions 0-7 Normal 14-18 Moderate > 20 Severe Depression Beck Depression Inventory (BDI) 0-13 Minimal depression 14-19 Mild Depression 20-28 Moderate Depression 29-63 Severe Depression Patient Health Questionnaire (PHQ-9) 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) 14-17 Mild Anxiety 18-24 Moderate Anxiety 25-30 Severe Anxiety Yale-Brown Obsessive Compulsive Scale (Y-BOCS) OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme PTSD (Post Traumatic Stress Disorder) EMDR EMDR (eye movement desensitization and reprocessing) eye movement desensitization and reprocessing Dilated pupils Stimulant intoxication constricted (pinpoint) pupils Opiods nystagmus Phencyclidine conjuctival injection, muchies (super hungry), psychomotor slowness? Marijuana Marijuana 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 Don't tell ODD what will you do to prevent it from becoming Conduct disorder Therapy to target mood and aggression Herpes rooster 3 weeks later sleep difficulties and sad mood Depression Schizophrenia in males 18-25 years old Schizophrenia in Women 25-35 years old signs of amphetamine intoxication Tears, Runny nose, restlessness, HTN, Tremors, Insomnia Co-morbidities of bipolar Anxiety, alcohol and substance abuse Big Freaking Problems Bupropion Fluoxetine Paxil Medicare A federal program of health insurance for persons 65 years of age and older Medicare Advantage 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 A: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs WATCHERS for GAD 3 of these *** for 6 months worry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep trouble Transtheoretical Model of Change 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance Man working at the Gym and his urine is Cherry color order myoglobinuria Latino women wanting prenatal class Consult with cultural group in community Anorexia Set up family therapy quasi-experimental design Research method similar to an experimental design except that it makes use of naturally occurring groups rather than randomly assigning subjects to groups. The ventricle enlargement observed in clients with schizophrenia is most often accompanied by Encopresis Treatment Behavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation Counseling Medication that contradicts albuterol Adderall (amphetamine / dextroamphetamine) Advair Diskus (fluticasone / salmeterol) amoxicillin (Amoxil, Trimox, Apo-Amoxi, Moxatag, Amoxicot, DisperMox, Biomox, Moxilin, Wymox) Ativan (lorazepam) 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 statistical measure: test means of 2 independent samples, significantly different? ANOVA (analysis of variance) 3 OR MORE an inferential statistical test for comparing the means of three or more groups Pearson's r 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 The probability of results of the experiment being attributed to chance. LEVEL OF SIGNGNIFICANCE Early onset of HIV dementia 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 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 Existential factors: Members accept responsibility for life decisions Catharsis: Members release of strong feelings about past or present experiences Interpersonal learning- input Members gain personal insight about their interpersonal impact through feedback provided from other members Interpersonal learning- output Members provide an environment that allows members to interact in a more adaptive manner Self-understanding: m embers gain insight into psychological motivation underlying behavior and emotional reactions Metobolic syndrome group of signs and symptoms including insulin resistance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDL NAMI national alliance on mental illness help families of mentally ill: education, support groups health literacy a person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness health literacy Man taking insulin asking him to read blood glucose level inferential statistics numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population Mood Disorder Questionnaire (MDQ)-SCREENING Mood Disorder Questionnaire Patient Name ______________________________________ Date of Visit ________________ Please answer each question to the best of your ability 1. Has there ever been a period of time when you were not your usual self and... ...you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble? ...you were so irritable that you shouted at people or started fights or arguments? ...you felt much more self-confident than usual? ...you got much less sleep than usual and found that you didn't really miss it? ...you were more talkative or spoke much faster than usual? ...thoughts raced through your head or you couldn't slow your mind down? ...you were so easily distracted by things around you that you had trouble concentrating or staying on track? ...you had more energy than usual? ...you were much more active or did many more things than usual? ...you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? ...you were much more interested in sex than usual? ...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky? ...spending money got you or your family in trouble? 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? 3. How much of a problem did any of these cause you - like being unable to work; having family, money or legal troubles; getting into arguments or fights? No problems Minor problem Moderate problem Serious problem This instrument is designed for screening purposes only and not to be used as a diagnostic tool. Permission for use granted by RMA Hirschfeld, MD YES NO Patient comes with vague symptoms depression irritability BECK Depression scale DISSEMINATED ENCEPHALOMYELITIS Assess for asymmetry of extremities Along with this pattern, the patients usually get neurological symptoms which may include: Confusion, drowsiness, and even coma Unsteadiness and falling Visual blurring or double vision (occasionally) Trouble swallowing Weakness of the arms or legs Fever HA CBT (cognitive behavioral therapy) Anxiety popular integrative therapy that combines cognitive (thinking) and behavior therapy Impulsivity (ADHD) Pre-Frontal Cortex Involves hasty actions taken without consideration of possible negative consequences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others. Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis Hypogylcemia NSAIDS Lithium toxicity Interferon Causes depression Beck Depression Inventory (BDI) Intimate therapy for a child with a score of 10 a questionnaire useful for determining the level of depressive symptoms that a person is reporting Zantac (ranitidine) affects Flonase Greatest patient at risk for Violence Substance abuse DBT (dialectical behavior therapy) relaxation muscle prior to DBT Pt on Lithium Prescribe Synthroid Zantac (ranitidine) H2 antagonist H2 BLOCKER Tegretol (carbamazepine) INDUCES Flonase primary prevention Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse. Secondary prevention examples - Implement blood pressure and cholesterol screening; give a treadmill stress test. - Health screenings - Skin screenings for cancer - teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets. - mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes - Provide mental health interventions after stressful events. - The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides. - Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center. - Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care. - Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health. - Assess disaster victims and triage for care. - Investigate an outbreak of flulike illness in a local school. - Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems. - Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the facility at which the skin test was administered. - To prevent the spread of disease - Notify partners and trace contacts (HIV) Collab with OB NP questions wants to establish a relationship so Mental Health can be reached by more people anorexia nervosa BMI less than 18.5 an eating disorder in which an irrational fear of weight gain leads people to starve themselves Anorexia admission Criteria for hospitalization includes: weight loss over 30% over 6 months, severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm Hg, and hypokalemia (less than 3 mEq/L). Culture question: A man injects himself "tell me more about the medications" Acute Stress Disorder (ASD) can be 2-4 weeks a disorder resulting from exposure to a major stressor, with symptoms of anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to "relive" the event in dreams and flashbacks for as long as 1 month following the event Scope of Practice in Nursing State Standards of Practice ANA ADPIE - Nursing Process Assessment Diagnosis Planning Implementation Evaluation Adult panic disorder Buspar Kids panic disorder Clonidine Guafacine OCD (Obsessive Compulsive Disorder) TCA Clomipramical Clomipramine (Anafranil) OCD, depression (tricyclic) agoraphobia fear of open spaces Agoraphobia treatment BZDs - short term symptom relief SSRIs - long-term maintenance fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) SNRIs - long-term maintenance venlafaxine (Effexor) TCAs - long-term maintenance imipramine social anxiety disorder BetaBlocker Propanolol Tourette syndrome involuntary, spasmodic, twitching movements; uncontrollable vocal sounds; and inappropriate words TICS for 1 year Has to occur by 18 years old Usually occurs by 3-9 years old Steroids Cause mania Assertive Question (2) Use "I want", "I need" or "I feel" to convey basic assertions and get your point across firmly. For example, "I feel strongly that we need to bring in a third party to mediate this disagreement." For example, you might say "Dave, your request has caught me off guard. I'll get back to you within the half hour." Testing for fungal infections shavings of toes Pt on Lithium with temp, right flank pain, brown colored urine, What do you? LFT Medication Management By state and federal Kid with night mares screaming out doesn't remember the next morning what do you do Ask about sleep disorder in family PT taking a breathing treatment albuterol/proventil Do not take MAOI or TCA Pt in with Sob, Fatigue. When you assess the thinnest part of the skin , you notice s/s ... Sensitivity Sensitivity = TP / (TP + FN) Specifity TN peer consultation Mutual Benefit Critical and Supportive Shared discussion and accountability The regular engagement of two or more colleagues to give and receive feedback Tegretol (carbamazepine) ANC/WBC Paplau what nurses do WITH pts not TO pts - nurse as a therapeutic tool - therapeutic use of self - care for the person as well as the illness - think exclusively of patients as persons, not as a dx phases: 1. orientation 2. working 3. termination roles of the nurse - stranger - resource person - teacher - leader - surrogate - conselor Paplau's Interpersonal Theory Process recording Give Ativan For Alcoholic with Liver problems detailed physical exam Pt states that God did this to me Assess spiritual needs Mini-Cog is another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT) women in military and she saw her friend die PTSD Man had appt, wife came and he didnt Tell wife to reschedule appt Tagement (Cimetidine) ^ Benzo ^ Coumadin Erythromycin ^ Xanax levels Disulfiram ^ Coumadin Pt with Eating disorder states getting full Bloating delayed Gastric emptying Realiability consistency Biggest Concern with EHR Confidentiality Qualiatative Measures in natural setting i.e ?, observation Quantitative Data that is in numbers internal validity Was research done right? extent to which we can draw cause-and-effect inferences from a study I don't know answers pseudo dementia interferon decrease Wellbutrin ^ prolactin stop prolactin EPS ^ risk for TD Assess when someone ready to quit drinking See what stage they in Ask when ready to start tx To check for Dementia Have the patient tell you risk/benefits test capacity dairy log CBT treating a 6 y/o pt WHO HAS dx with Luekemia 1 month ago. What do you expect He would think he is being punished fro doing something wrong antidepressant takes 5 weeks 13 year old want to smoke ask him of his plan to stop smoking placement of chronically mental ill ACT Assertive Community Treatment Assertive Community Treatment (ACT) community-based programs that provide many of the services that are necessary for successful community living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basis BRUISE on the padded part of his arms Say I see you have bruises on your arm Ask what happened medication errors on a new floor when NP starts working. educate the staff on policies on how to handle med errors. ECT THERAPY GET CERTIFIED lesion in frontal cortex Impaired cogitate functions child in foster homer 5 years poor eye contact, isolated self, eat without difficulty autism A man states his wife was so good if he could only be like her. what is this Intellectualization or deflecting rare complication of anorexia nervosa binge/purge subtype that results from gastrointestinal abnormalities, including decreased gastric motility and delayed gastric emptying. Early diagnosis and intervention is critical since delay may result in gastric necrosis, perforation, shock, and death. decreased gastric motility check measure the stomach Tagement (Cimetidine) Prevents acid from backing up into the esophagus and causing heartburn Pt moving to another state Give enough meds Pt on Zoloft BMI 26 BMI Sildenafil (Viagra) 1 hour prior to sex Tadalafil (Cialis) 45 minutes prior to sex Vardenafil (Levitra) 45 minutes prior to sex Avanafil (Stendra) 15 minutes prior to sex Alprostadil (PGE1) • Ductal-dependent Congenital Heart Disease (all forms) • 0.05-0.1 µg/kg/min IV/IO infusion initially, then 0.01-0.05 µg/kg/min IV/IO Females more likely to become an alcoholic than man due to hormones Apoptosis cell death in aging/elderly solution therapy conducted through direct observation of clients' responses to a series of precisely constructed questions. Np wants to implement a certain policy in nursing. start with nurse manager Turner Syndrome A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. delayed puberty, short id, 10-16 years old amenorrhea web neck, osteoporosis, lymphemeda, poor social skills Prozac causes what? increased anxiety in elderly Prazosin (Minipress) nightmares ACE inhibitors HTN Recovery Model A model that is patient/consumer-centered, is hopeful and empowering, and emphasizes the person and the future rather than the illness and the present. Recovery Model Intervention motivational interviewing a collaborative, person-centered form of guiding to elicit and strengthen motivation for change MOTIVATIONAL INTERVIEWING MAY WE TALK ABOUT YOUR TEST SHOWS YOU ARE VERY COURAGEOUS YOU WANT TO CHANGE, BUT LETS SEE IF I GOT IT KIDS receive to many calories ue to staff letting him eat food Meet with dietiacan , discuss with manager [Show More]

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