PMHNP certification Exam 2022(Actual test Already Passed)

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PMHNP certification Exam 2022(Actual test Already Passed) 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 wit... h 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) Correct AnswerD. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors When interview teenagers (16 y/o) that arrive with their parents what should you do? Correct Answerinterview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. Which Ethnic group has the highest rate of suicide? Correct Answer-Native Americans 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 antagonism C. Increased Lipids D. Metabolic Syndrome Correct Answer-D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? Correct Answer-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? Correct Answer-Lamictal -But remember all mood stabilizers cause some weight gainWhen presented with a question about typical vs atypical antipsychotic the answer is usually to start of a Correct Answer-atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus Correct Answer-Hypothalamus A, B, & D are all part of the limbic system so you can rule that out When a patient is hesitant to participate in treatment you should encourage? Correct Answer-Bring a support person like a husband Thyroid-Stimulating hormone normal level Correct Answer-0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis Correct Answer-HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance Correct Answer-Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis Correct Answer-(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance Correct Answer-Hypothyroidism Hyperthyroid can mimic Correct Answer-Mania Hypothyroid can mimic Correct Answer-DepressionA patient on depakote complains of RUQ pain and has reddish/brown urine Correct Answer-Hepatoxicity -Check LFTs Signs of Depakote toxicity Correct Answer-Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? Correct Answer-Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? Correct Answer-Kava Kava When taking Kava Kava in combinations with other medications you should caution about Correct AnswerRisk of Hepatoxicity and Sedation TCAs carry a risk of Correct Answer-Hepatotoxicity Signs of Stevens-Johnson Syndrome Correct Answer--fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome Correct Answer-lamictal and tegretol What nationality is most suseptible of getting steven johnson? Correct Answer-Asians When treating asians with tegretal screen for? Correct Answer-HLAB-1502 Allele What two medications cause agranulocytosis? Correct Answer-Clozaril & Tegretal Agranulocytosis when to discontinue medication Correct Answer-Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? Correct Answer-Infection -Fever, sore throat, fatigue, chillsBefore starting any mood stabilizer in a female of childbearing age be sure to check? Correct Answer-HCG Which two medications may decrease the risk of suicide? Correct Answer-clozaril and lithium Medications that increase lithium level Correct Answer-NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? Correct Answer-Heart Failure Certain medications are known to increase lithium level, but HOW? Correct Answer-by reducing renal clearance When educating a patient about lithium teach them about Correct Answer-Hyponatremia Dehydration-hot days, exercise Normal Lithium Level Correct Answer-0.6-1.2 Lithium Toxicity Correct Answer-1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 Correct Answer-Monitor for toxicity Labs before starting lithium Correct Answer-TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium Correct Answer-4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITYLithium side effects Correct Answer-hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity Signs of lithium toxicity Correct Answer-confusion, ataxia, GI upset, palpitation, tremor NMS Correct Answer-muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot Correct Answer-test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome Correct Answer-With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Treatment for NMS Correct Answer-Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer Treatment for Serotonin Syndrome Correct Answer-Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine Triptans Correct Answer-Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan Correct Answer--call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCPHow long do you wait when switching between an SSRI to an MAOI? Correct Answer-2 weeks How long do you wait when switching between Prozac and MAOI? Correct Answer-5-6 weeks wash out period What is the first line treatment for depression and why? Correct Answer-SSRI-First line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? Correct Answer-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? Correct Answer-Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? Correct Answer-Wellbutrin Wellbutrin is contraindicated in patients with Correct Answer-Seizures and anorexia Which medications are best for neuropathic pain? Correct Answer-SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? Correct Answer-Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome Correct Answer-Those with short half lives such as zoloftSymptoms of serotonin withdrawal syndrome Correct Answer-Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females Correct Answer--MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for Correct Answer-SUICIDE *HIGH RISK OF SI in SCHIZOPHRENIA* Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia Correct Answer-excessive 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 Correct Answer-EVERYTHING DECREASES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter? Correct Answer-Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) Correct Answer-a form of rehabilitation post hospitalization, in home treatmentWhat level of prevention is ACT? Correct Answer-Tertiary What adjunctive treatment is important in schizophrenia Correct Answer--social skills training -Exercise Exercise for mental health patients can promote Correct Answer-Cognition Quality of Life Long-term health ACT is ideal for patients with a history of Correct Answer-Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality Correct Answer-Antisocial In the MMSE how do you test for abstraction? Correct Answer-proverb interpretation (everyone that lives in glass houses shouldn't throw stones) Are they able to think abstractly Thought Process-Tangential Correct Answer-means that their response has nothing to do with the question Circumstantial Correct Answer-means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes Correct Answer-SI/HI/AH/VH Another name for MMSE Correct Answer-Folstein Scale How to assess concentration on MMSE Correct Answer-Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material Correct Answer-repeat 3 words after meAssess ability to recall Correct Answer-repeat 3 words after 5 minutes Assess fund of knowledge Correct Answer-Who is the president What is a quick and easy way to assess for neurological issues Correct Answer-Clock drawing test If patient is unable to draw a clock this indicates Correct Answer-Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway Correct Answer-Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway Correct Answer--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 Correct Answer--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 dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter Correct Answer--Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to Correct Answer-tardrive dyskinesia Tuberoinfundibular pathway Correct Answer--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 Long-term hyperprolactinemia can be associated with what condition Correct Answer-osteoporosis Normal Prolactin Level in Men Correct Answer-level less than 20ng/ml Normal Prolactin Level in Women Correct Answer-less than 25ng/ml Which medication is the highest offender for increasing prolactin Correct Answer-Risperdal Acute Dystonia + Treatment Correct Answer-neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment Correct Answer-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 Correct Answer-- DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment Correct Answer-A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment Correct Answer-caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing-Treatment COGENTIN tardive dyskinesia + Treatment Correct Answer-abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT Does Cogentin Treat TD Correct Answer-COGENTIN MAKES TD WORSE Typical onset of TD Correct Answer-OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO What non-psych med can cause TD? Correct Answer-REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops InDucers CYP450 Correct Answer-DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylureas Crap GPS Induces me to Madness! InhIbitors of CYP450 Correct Answer-INCREASE CiprofloxacinRitonavir Amiodarone Cimetidine Ketoconazole Acute Etoh Macrolides INH Grapefruit Juice Omeprazole Crack Amigos Erythromycin and Clarithromycin can cause Correct Answer-Increased tegretol levels Patient started on Clozaril or Zyprexa and two months later starts smoking Correct Answer-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 Correct Answer-as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania Correct Answer-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 Correct Answer-steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone -may need to increase antidepressantAccutane (isotretinoin) Correct Answer-Can cause depression and birth defects Flonase Correct Answer-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 Correct Answer-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 Correct Answer-Dopamine and GABA Symptoms of Stimulant Abuse Correct Answer-1. agitation/aggression 2. impaired judgment 3. euphoria 4. elevated BP 5. tachycardia 6. dilated pupils 7. hallucinations 8. TREMORS 9. IMSOMNIA If an anorexic patient complains of pain or bloating after eating this may indicate Correct Answer-delayed gastric emptying Medications that delay gastric emptying Correct Answer-Omeprazole, ranitidine, famotidine Proton Pump Inhibitors (omeprazole & Protonix) Correct Answer-Decrease absorption of antipsychotics & SSRI-MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI When initiating an SSRI on an elderly patient you should advise about Correct Answer-increased anxiety Paradoxical effect Correct Answer-when meds cause the opposite effect than expected Apoptosis Correct Answer-programmed cell death/neuronal loss At age 45 and above the patient displays mania for first time what should be ruled out Correct AnswerMEDICAL CONDITION Patient with bipolar disorder presents with depressed mood & emotional lability Correct Answer-Give Depakote Hallmark sx of Borderline Personality Correct Answer-Recurrent self harm Treatment for Borderline Personality Correct Answer-DBT Creator of DBT Correct Answer-Marsha Linehan What activity is helpful in making a diagnosis of borderline personality Correct Answer-Journaling or diary keeping Conversion Disorder Correct Answer-STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism Adjustment Disorder Correct Answer-adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying) -Symptoms occur within 3 months of the stressorIf question states recently moved, recent death....THINK ADJUSTMENT factitious disorder Correct Answer-when patients introduce foreign substances into their body or contaminate their food -Faking illness but NO MOTIVE BEHIND IT Malingering Correct Answer-Faking illness for financial gain Reactive Attachment Correct Answer-common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver ODD Correct Answer-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 Correct Answer-violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine Acute Stress Disorder Correct Answer-similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks -LESS THAN ONE MONTH PTSD Correct Answer--OVER ONE MONTH -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBTPanic attack vs Panic disorder (treatment) Correct Answer-Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom Tourette's Syndrome Correct Answer-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 Correct Answer-**CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL** Neurotransmitters involved in Tourettes Correct Answer-DNS: Dopamine, Norepinephrine, Serotonin Treatment for tourettes Correct Answer-Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them Correct Answer-Stimulants Neurotransmitters involved in mood disorders Correct Answer-DNS: Dopamine, Norepinephrine, Serotonin + GABA Neurotransmitters involved in ADHD Correct Answer-DNS: Dopamine, Norepinephrine, Serotonin part of brain implicated in ADHD Correct Answer-prefrontal cortex basal ganglia reticular activating systemADHD inattentive type is caused in what part of the brain Correct Answer-Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION dorsolateral prefrontal cortex Correct Answer-Attention Executive Function Cognition Processing Working Memory Problem Solving Deficit in the _____ can lead to ADHD inattentive type Correct Answer-Prefrontal Cortex Teacher reports that the stimulant only works for first few hours of class Correct Answer-medication has worn off too fast. Order multiple dosing throughout the day When does the aftercare plan start Correct Answer-on admission If parents become anxious while you are educating about a new diagnosis what should you do Correct Answer--Provide patient and parents information immediately don't wait till discharge -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 Correct Answer-serotonin, dopamine, glutamate & GABA A tic may also be a ___ Correct Answer-Compulsion Facts about OCD Correct Answer-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 clomipramineIf question asks if the patient has Tourette's vs OCD listen for mention of streptococcal treatment this will trigger you to think OCD Correct AnswerDMDD Correct Answer-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 Correct Answer-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 nightmares Correct Answer-GENETIC ask if someone in the family has a similar issue with sleep...look for family patterns of sleep problems GAD Correct Answer-Worry, apprehension, fear must LAST ATLEAST 6 MONTHS Delirium Correct Answer--ACUTE (within hours to days) onset of disturbance of LOC, COGNITION, inattention -Urinary Tract Infections are common cause for DELIRIUM always check UA -Treatment is antipsychotics like HALDOL Dementia Correct Answer--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 (confabulate) Low levels of what labs may mimic dementia Correct Answer-Vit B12 and Folic Acid Cortical Dementia Correct Answer-Language and memory (aphasia and amnesia) Subcortical Dementia Correct Answer-Motor abnormalities/Mood issues like apathy, depression, irritabilityHIV Dementia is a type of subcortical dementia Early signs of HIV dementia Correct Answer-subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordination, unsteady gait Treatment for HIV dementia Correct Answer-Antivirals Pseudo Dementia Correct Answer-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 dementia Correct Answer--Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE -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 Correct Answerhallmark of lewy body dementia Correct Answer-visual hallucinations Frontotemporal lobe Dementia Correct Answer-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) Correct Answer-Temporal Lobe Neurotransmitters involved in Autism Correct Answer-GABA, Glutamate, Serotoni [Show More]

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