ANCC PMHNP Cert Exam Review
Questions
How do you assess cranial nerve V trigeminal? –
Tell patient to close eyes, take piece of cotton or other soft item and lightly touch
either one of both sides of each of the three divisions of the trigeminal.
How do you assess for cranial nerve VII facial? –
Observe the patient for nystagmus or twitching of the eye. This nerve controls
facial movements and expression, check for symmetry. Have the patient wrinkle
forehead, close eyes, smile, pucker lips, show teeth, and puff out cheeks.
primitive reflexes –
reflexes, controlled by "primitive" parts of the brain, that disappear during the
first year of life
Mororeflex –
Extending of limbs when they hear a loud noise (defend themselves)
rooting reflex –
a baby's tendency, when touched on the cheek, to turn toward the touch, open
the mouth, and search for the nipple
palmer grasp –
grasping with the whole hand
scope of practice –
The range of clinical procedures and activities that are allowed by law for a
profession
Quality Improvement (QI) –
an approach to the continuous study and improvement of the processes of
providing health care services to meet the needs of patients and others and
inform health care policy
PDSA model –
Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI)
Trendelenburg sign –
Occurs with severe subluxation of one hip
When the child stands on the good leg, the pelvis looks level. When the child
stands on the affected leg the pelvis drops toward the good side
,CYP450 inhibitors –
Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline
CYP450 inducers –
Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
St John's Wort
What is the adverse effect of Depakote on the liver? –
can cause liver damage, and the risk is more likely to occur during the first 6
months of taking the medication. Signs might include nausea or vomiting, loss of
appetite, abdominal pain, dark-colored urine, facial swelling, and yellowing of the
skin or white of eyes
What would you do for a patient on Depakote with +4 protein in the urine? –
Rule out UTI, no adjustment for medication is needed
What happens when you take carbamazepine (tegertal) and erythromycin together? –
It will decrease the effect of the antibiotic by inhibition
What happens when you take zyprexa and smoke? –
nicotine will increase the excretion of the drug thereby inhibiting it's effect
ICP in Infants S/S –
Bulging fontanels, high-pitch cry, irritability, restlessness
*ICP*
*CHILDREN* signs and symptoms - • Headache
• Vomiting (usually projectile)
• Seizures
• Diplopia (Dbl vision), blurred vision
Neuro cry –
high-pitched and very grating on the ears due to their neurological sxs being
overwhelmed
Neuroleptic Malignant Syndrome –
,Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and
mental status changes.
FEVER:
Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles
NMS treatment –
Dantrolene
D2 agonists (e.g., bromocriptine).
lead poisoning –
A medical condition caused by toxic levels of the metal lead in the blood
Lead poisoning treatment –
chelation therapy
Amygdala's role in emotion –
- Aggression center
- Role in storing implicit emotional memories
- Stimulation (+) anger/violence or fear/anxiety
- Damage (-) mellow; hyperorality; hypersexuality; dis-inhibited behavior
Amygdala role in aggression - Small volume increase aggression.
Frontal Lobe Atrophy –
As neurons die in the frontal and temporal regions, these lobes atrophy, or
shrink. Gradually, this damage causes difficulties in thinking and behaviors
normally controlled by these parts of the brain. ... Scientists think that FTLD
(frontal temporal lobe dementia) is the most common cause of dementia in people
younger than age 60
Four dopaminergic pathways –
mesocortical
mesolimbic
nigrostriatal
tuberoinfundibular
mesocortical pathway –
a path through which dopaminergic projections travel to reach the neocortex
mescolimbic pathway –
The mesolimbic pathway, sometimes referred to as the reward pathway, is a
dopaminergic pathway in the brain. The pathway connects the ventral tegmental
, area in the midbrain, to the ventral striatum of the basal ganglia in the forebrain.
The ventral striatum includes the nucleus accumbens and the olfactory tubercle.
Nigrostriatal pathway –
the dopaminergic tract from the substantia nigra to the striatum
Tuberoinfundibular pathway –
from hypothalamus to anterior pituitary -> DA released from these neurons inhibit
prolactin secretion -> when DA receptors here are blocked prolactin levels rise
cause galactorrhea)
primary prevention –
Efforts to prevent an injury or illness from ever occurring.
secondary prevention –
Efforts to limit the effects of an injury or illness that you cannot completely
prevent, screening exams.
tertiary prevention –
actions taken to contain damage once a disease or disability has progressed
beyond its early stages
menopause hormone therapy –
most effective therapy for moderate -severe vasomotor symptoms - use quality
of life scales to identify degree of vasomotor symptom severity
*should not be used for protection against CVD or dementia
congestive heart failure and depression –
MDD is highly prevalent in these patients
Thyroid levels while on lithium –
Because of the high incidence of thyroid dysfunction that occurs during lithium
treatment, patients should have a careful thyroid physical examination and
determination of serum thyroid-stimulating hormone (TSH) and antithyroid
peroxidase antibody titers before lithium treatment is begun. Patients with normal
thyroid function initially should be reevaluated every 6 to 12 months for several
years, and thyroid dysfunction should be treated if diagnosed. The development
of thyroid dysfunction does not typically require discontinuation of lithium. If
thyroid function is abnormal at the initial evaluation, lithium can still be given if
necessary, but the thyroid dysfunction should be treated.
SSRIs MOA –
block reuptake of serotonin by inhibiting the presynaptic reuptake
SNRIs mechanism –
Questions
How do you assess cranial nerve V trigeminal? –
Tell patient to close eyes, take piece of cotton or other soft item and lightly touch
either one of both sides of each of the three divisions of the trigeminal.
How do you assess for cranial nerve VII facial? –
Observe the patient for nystagmus or twitching of the eye. This nerve controls
facial movements and expression, check for symmetry. Have the patient wrinkle
forehead, close eyes, smile, pucker lips, show teeth, and puff out cheeks.
primitive reflexes –
reflexes, controlled by "primitive" parts of the brain, that disappear during the
first year of life
Mororeflex –
Extending of limbs when they hear a loud noise (defend themselves)
rooting reflex –
a baby's tendency, when touched on the cheek, to turn toward the touch, open
the mouth, and search for the nipple
palmer grasp –
grasping with the whole hand
scope of practice –
The range of clinical procedures and activities that are allowed by law for a
profession
Quality Improvement (QI) –
an approach to the continuous study and improvement of the processes of
providing health care services to meet the needs of patients and others and
inform health care policy
PDSA model –
Plan-Do-Study-Act Model from the Institute for Healthcare Improvement (IHI)
Trendelenburg sign –
Occurs with severe subluxation of one hip
When the child stands on the good leg, the pelvis looks level. When the child
stands on the affected leg the pelvis drops toward the good side
,CYP450 inhibitors –
Fluvoxamine
Fluoxetine
Paroxetine
Duloxetine
Sertraline
CYP450 inducers –
Carbamazepine
Phenobarbital
Phenytoin
Rifampin
Griseofulvin
St John's Wort
What is the adverse effect of Depakote on the liver? –
can cause liver damage, and the risk is more likely to occur during the first 6
months of taking the medication. Signs might include nausea or vomiting, loss of
appetite, abdominal pain, dark-colored urine, facial swelling, and yellowing of the
skin or white of eyes
What would you do for a patient on Depakote with +4 protein in the urine? –
Rule out UTI, no adjustment for medication is needed
What happens when you take carbamazepine (tegertal) and erythromycin together? –
It will decrease the effect of the antibiotic by inhibition
What happens when you take zyprexa and smoke? –
nicotine will increase the excretion of the drug thereby inhibiting it's effect
ICP in Infants S/S –
Bulging fontanels, high-pitch cry, irritability, restlessness
*ICP*
*CHILDREN* signs and symptoms - • Headache
• Vomiting (usually projectile)
• Seizures
• Diplopia (Dbl vision), blurred vision
Neuro cry –
high-pitched and very grating on the ears due to their neurological sxs being
overwhelmed
Neuroleptic Malignant Syndrome –
,Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and
mental status changes.
FEVER:
Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles
NMS treatment –
Dantrolene
D2 agonists (e.g., bromocriptine).
lead poisoning –
A medical condition caused by toxic levels of the metal lead in the blood
Lead poisoning treatment –
chelation therapy
Amygdala's role in emotion –
- Aggression center
- Role in storing implicit emotional memories
- Stimulation (+) anger/violence or fear/anxiety
- Damage (-) mellow; hyperorality; hypersexuality; dis-inhibited behavior
Amygdala role in aggression - Small volume increase aggression.
Frontal Lobe Atrophy –
As neurons die in the frontal and temporal regions, these lobes atrophy, or
shrink. Gradually, this damage causes difficulties in thinking and behaviors
normally controlled by these parts of the brain. ... Scientists think that FTLD
(frontal temporal lobe dementia) is the most common cause of dementia in people
younger than age 60
Four dopaminergic pathways –
mesocortical
mesolimbic
nigrostriatal
tuberoinfundibular
mesocortical pathway –
a path through which dopaminergic projections travel to reach the neocortex
mescolimbic pathway –
The mesolimbic pathway, sometimes referred to as the reward pathway, is a
dopaminergic pathway in the brain. The pathway connects the ventral tegmental
, area in the midbrain, to the ventral striatum of the basal ganglia in the forebrain.
The ventral striatum includes the nucleus accumbens and the olfactory tubercle.
Nigrostriatal pathway –
the dopaminergic tract from the substantia nigra to the striatum
Tuberoinfundibular pathway –
from hypothalamus to anterior pituitary -> DA released from these neurons inhibit
prolactin secretion -> when DA receptors here are blocked prolactin levels rise
cause galactorrhea)
primary prevention –
Efforts to prevent an injury or illness from ever occurring.
secondary prevention –
Efforts to limit the effects of an injury or illness that you cannot completely
prevent, screening exams.
tertiary prevention –
actions taken to contain damage once a disease or disability has progressed
beyond its early stages
menopause hormone therapy –
most effective therapy for moderate -severe vasomotor symptoms - use quality
of life scales to identify degree of vasomotor symptom severity
*should not be used for protection against CVD or dementia
congestive heart failure and depression –
MDD is highly prevalent in these patients
Thyroid levels while on lithium –
Because of the high incidence of thyroid dysfunction that occurs during lithium
treatment, patients should have a careful thyroid physical examination and
determination of serum thyroid-stimulating hormone (TSH) and antithyroid
peroxidase antibody titers before lithium treatment is begun. Patients with normal
thyroid function initially should be reevaluated every 6 to 12 months for several
years, and thyroid dysfunction should be treated if diagnosed. The development
of thyroid dysfunction does not typically require discontinuation of lithium. If
thyroid function is abnormal at the initial evaluation, lithium can still be given if
necessary, but the thyroid dysfunction should be treated.
SSRIs MOA –
block reuptake of serotonin by inhibiting the presynaptic reuptake
SNRIs mechanism –
