PMHNP certification 2023 with 100% correct questions and answers

CAGE items responses are scored either 1 or 0. A score 2 or higher is considered clinically significant OCD obsessive thoughts interfere with your daily life -are you concern about things being contaminated, keeping things in perfect order -do you feel driven to perform certain acts over and over again? -have unwanted images or thought that you cant seem to get out of your head layman's explanation of mental illness Abnormal functioning of neurotransmitters. Neuroanatomical differences have been found in some cases. -can arise from multiple sources, not a single or consistent cause has been established biomedical psychiatry mental illness is conceptualized as a disorder of the brain circuit caused by a complex interplay of genetic and environmental factor state-dependent learning when a memory is formed a new neural pathway is created. If the memory was formed under specific chemical conditions (on a drug, manic), then the pathway will be primed to work most effectively under these circumstances. -state-dependent learning in bipolar. Bipolar individuals in a depressed episode may not be able to recall details of manic episodes. Corroboration is needed. Assessment tools to screen for cognitive impairment -folstein mini-mental: perfect score is 30. 24 impairment. If only 9th grade education 17 Abnormal sodium levels -increased: dehydration, methyldopa, -decreased: SIADH, heart failure, nephrotic syndrome, hepatic disease. Abnormal Potassium levels Increased: amiloride, spirolactone, lithium, propranolol. Decreased alpha 1 antagonists -vasodilator and used for hypertension -raynauds -PTSD and GAD -benign prostatic hyperplasia (tamsulosin) -agonism: vasoconstrictor -trazadone and many antipsychotics ESR-erythrocyte sedimentation rate high values indicate autoimmune, malignancies, infections absolute neurophil count calculations total WBC x percentage of neurophil in differential=ANC Calcium -increased: 10.8 caused by hyperparathyroidism from tumor of renal disease, lithium PET vs. fMRI measures brain activity by associated changes in blood flow. Relies on fact that cerebral blood flow and neuronal activity are coupled. -In addition, PET has the advantage of being able to identify specific receptors associated with neurotransmitter through its ability to image radioactive ligands ELISA testing -first screen with ELISA. ELISA tests for HIV antibodies. Vast majority of HIV positive people have detectable antibodies by 3 months after exposure. Splitting the individual segregates experiences in to all-good or all-bad, with no room for ambiguity or ambivalence. displacement separation of emotion from it object of discontent and redirected to a less threatening and intimidating --example: displaced aggression- If expressing or dismay to the source of the anger could lead to negative consequences, we may rather than express our angry to a person or object that pose no threat. introjecion a process whereby an individual unconsciously incorporates the qualities of another person into his or her ego structure Gestalt Therapy emphasizes personal responsibility. Cultivate a greater self-awareness and mindfulness. -greater self-awareness of mind and body -chair technique: a role-playing exercise. The client is asked to adopt one role in one chair, and another in the other chair (e.g. plays parent and then plays child) Hyperprolactinemia and Risperidone -prolactin levels peak the first 6 to 8 weeks -returns to normal range in 3 t0 5 months -hyperprolactinemia is dose-dependent -osteopenia, amenorrhea, galactorrhea, gynecomastia -get baseline, repeat in two months. ask about nipple discharge, menstruation, sexual dysfunction. If the patient has elevated prolactin after 2 months but no symptoms, repeat test in two months. Antipsychotics that cause the most hypotension olanzapine, risperidone, quetiapine Rett Syndrome -more common in females--the mutation arises from the X chromosome. -onset before first birthday -loss of skills already acquired: speech and purposeful hand movement -delayed head growth, scoliosis, ataxia Tourettes -tics must be present for at least a year before diagnosis -must have motor and vocal tic -abnormalities in the basal ganglia andd dopamine system are implicated -First use guanfascine or clonidine. if doesnt work then use risperidone autism appears before the age of 3. Difficulty with communication -pervasive failure to form social relationships -problems with communication -ritualistic behaviors -stereotyped behavior -circumscribed range of interests paranoid personality disorder -guarded with others. interprets actions of others as threatening and deceptive. -Suspicious that others are out to attack his character or reputation -uses projection as predominant defense mechanism -more common in families of schizophrenics schizoid personality -disinterested in close relationships -appears indifferent to the praise or criticism of others schizotypical personality -More likely to have a positive family history of schizophrenia -magical thinking, ideas of reference. -10% commit suicide Identity diffusion Poorly integrated concept of self. Individuals experience chronic emptiness and contradictory self-perceptions -common in borderline personality projective identification individual possesses a quality he considers intolerable and grapples with this by attributing it to someone else; then the individual dominates and molds the person to acquiring the projected quality. -common in borderline personality Kubler-Ross stages of grief -shock/denial -anger -bargaining -depression -acceptance risk factors for suicide -previous attempts -alcohol abuse -cocaine abuse -diminished concentration -global insomnia -divorced or widowed -substance abusers are 2o times more likely to die by suicide than the general population Narcan (Naloxone) has a shorter duration of action than most opiates and must be re-administered Alcohol withdrawal treatment 100mg Thiamine PO for 5 days -multivitamin that includes folate -1st day-- q6hr librium 50mg -for the next two days-- q6hr librium 25mg. OR -1st day--Q6hr lorazepam 2-4mg -for the next two days-Q6hr lorazepam 1-2 mg labs for monitoring alcohol withdrawal -megaloblastic anemia is observed in people with alcoholism because of a dietary deficiency in B12 and folate. Increased MCV! -Low BUN--suspect liver dysfunction. -hypomagnesium Structural family therapy the goals: to identify dysfunctional structures; to create clear and flexible boundaries between family members. -structure: the patterns of behaviors that form implicit expectations for each other. Clinical Institute Withdrawal Assessment of Alcohol (CIWA-AR) Recommended in early alcohol withdrawal as a tool to aid in the recognition of escalating symptom severity or development of delirium tremens. -15 indicates immediate need for pharmacological intervention. -8 to 14 consider pharmacological intervention. Delirium Tremens -Alcohol withdrawal manifested as altered mental status, autonomic overdrive which can progress to cardiovascular collapse. -Lack of gaba-a stimulation with a resultant reduction in chloride influx is associated with tremors, diaphoresis, tachycardia, anxiety, seizures. -hallucinations 24-72 hours after last drink. seizures occur 24-48 hours after last drink not the best SSRI for people with cardiovascular disease -paroxetine, duloxetine, bupropion not ideal in cardiac condition since they have the potential to interact with several cardiac drugs -they are all inhibitors of the CYP 2D6 -do not concomitmently administer atomoxetine concussion -amnesia, headache, ataxia, mental status changes, disorientation, blurred vision, irritability, light sensitivity Neuroplasticity -the ability of the nervous system to reorganize to create new neural pathways based on new experiences. -involves neurogenesis and neuronal death, strengthening of current neural pathways -abnormalities in the organization of neural networks may underlie mood disorders -stabilization of an active synapse is mediated by the environment just as the branching an the outline of a tree is shaped by light. -adverse environmental effects from early childhood predispose one to mental illness in later life ( MDD ppl with AEE early life have reduce hippocampal volume whereas MDD pll without AEE hippocamus is normal) -stress influences neuroplasticity. Stress reduces hippocampal volume and compromises synaptic transmission in critical neuronal pathways in the hippocampus. -stress reduces brain derived neurotrophic factor Total iron binding capacity -Drawing blood and measuring the maximum amount of iron it can carry, which indirectly measures transferrin. -transferrin: protein that transports iron to the cell -TIBC is high in iron deficiency anemia. percentage of transferrin saturation is low. - Treatment of withdrawal -substituting the drug with a long-acting agent and gradually tapering its doses -benzos are effective with alcohol withdrawal probably because of the cross-tolerance at the type A GABA receptor -OPIOID: uses MU receptor agonists. NALTREXONE and buprenorphine (suboxone). Use sublingual buprenorphine is preferred. Carbamazepine -Tegretol can be used for alcohol withdrawal -Obtain CBC, thyroid function panel, kidney and liver panel. First 3 months CBC every month. After first 6 months collect CBC, thyroid, liver, and kidney every 6 months. -monitor for Stevens-Johnson Syndrome: red macules, eye erythema and edema, fever, pain, weakness guanfacine motor tics, tourettes, ADHD, impulsivity -agonist for alpha2A receptor -Intuniv ER- 1mg QHS. After week can increase by 1mg -abrupt discontinuation can cause rebound hypertension within 2 to 4 days -take an hour after eating -metabolized by the cyp450 3A4. May INCREASE valprorate. Complex-partial seizure -often preceded by an aura (macroscopia, microscopia, depersonalization). -caused by excessive and synchronous electrical brain activity. -May display automatisms -cause impaired consciousness and unresponsive -commonly arise from the mesial temporal lobe Criteria for psych disorders -Major depressive disorder: must be present for 2 weeks. Must have 5 symptoms. -ADHD must be prior to the age of seven -Mania: must have symptoms for 1 week. Must have 3 symptoms (four if mood is only irritable). lamotrigine Stevens-johnson syndrome more common in child than adults. Probably not a good idea to prescribe it to kids. -blocks sodium channels -may reduce folate levels so don't give in pregnancy -valproate doubles the eliminate half-life of lamotrigine. Increases serum levels of lamotrigine by inhibiting its metabolism Latuda -good for bipolar depression -take it with meals Gabapentin -may increase Gaba synthesis. -inhibits calcium influx at voltage-sensitive calcium channels -negligible drug-drug interactions -AVOID IN RENAL DISEASE Isomer molecules with the same chemical formula but different chemical structures. Same number of atoms but have different arrangement of atoms in space. Lithium -propranolol for tremors -do not administer if history of arrhythmia -relatively slow onset of action so may have to temporarily take neuroleptic as well. -monitor for hypercalcemia caused by hyperparathyroidism: may have to d/c lithium -Lithium is known to affect renal concentrating abilities. monitor for polydispsia and polyuria--nephrogenic diabetes insipidus. -start at 300 bid. can increase to 1800 mg -check renal, thyroid, electrolytes twice in first 6 months. -monitor lithium levels frequently until reaching stable dose. IM injection -ventrogluteal up to 3ml of fluid -1 inch to 1.5 inch needle. 25 gauge (18 for very viscous) Omega 3 -polyunsaturated fatty acid types of omega 3: EPA and DHA. EPA better for depression -incorporated into the cell membrane. regulate dopaminergic and serotonin transmission. Important in mood regulation by targeting the arachidonic cascade and reducing synthesis of prostaglandin (high progtaglandin levels can cause somatic symptoms of depression). -will take up to four weeks before response is seen Progesterone precursor to other steroid hormones. Progesterone plus Estrogen--inhibition of the gonadotropin axis--inhibition of androgen production in the ovaries and adrenal glands. -with estrogen, it will enhance sex hormone binding globulin and thus result in reduced serum levels of free testosterone autism pharmacology -greater sensitivity or idiosyncratic effects from medication -do not use anticonvusants Sleep disorders -hypersomnia: excessive sleepiness -parasomnias: strange behaviors during sleep -nocturnal movement disorders: RLS sleep apnea characterized by prolonged pauses in breathing during sleep. -polysomnogram required for diagnosis -obstructive: caused by a physical block in air flow despite respiratory effort -central: is caused by lack of respiratory effort bulimia Laboratory finding -induced vomiting may cause metabolic alkalosis: elevated bicarbonate, hypochloremia, hypokalemia -Increased BUN indicates dehydration Eating disorder -fluoxetine found to be especially helpful in bulimia -Consequences of anorexia: osteoporosis, cortical gray matter loss, Nurse Practice Act the state guide that governs nursing practice. Defines scope of practice, grounds for disciplinary action HIPPA four guaranteed rights: 1. the right to be educated about HIPPA privacy 2. the right to access their protected health records 3. the right to request amendments to their PHR 4. the right to require their permission to disclose health records. Drug clearance Consider genetic polymorphisms, concurrent diseases, age-related changes, other drugs that are being administered Paliperidone palmitate -half-life: 25 to 49 days. -first dose is 234mg. 7 days later 156mg. -maintenance dose: 39 to 234mg -first two doses should be in the deltoid olanzapine pamoate 210-300mg every 2 weeks -monitor for post-injection delirium. patient must be observed by healthcare professional for at least 3 hours aripiprazole long acting -maximum concentration is achieved 5 to 7 days after injection -starting dose is 400mg -continue oral abilify 10 to 20mg for 14 days -administered in the gluteal muscle Sertraline -start 50mg in the morning with meals. after two weeks may increase in increments of 50mgs. -maximum dose is 200mg -good choice for people with cardiac disease. age-associated changes in pharmacodynamics and pharmacokinetics -distribution: more adipose tissue; less water -SSRI can induce hyponatriemia -more sensitive to the effects of benzodiazepines -decreased dopamine and acetylcholine synthesis in elderly and thus they are more sensitive to D2 antagonists and antimuscarinics. Locus of control -the extent to which one believes that they have control over their life circumstances -strong internal locus of control: individuals who believe that events derived primarily from their actions. Tend to attribute outcomes to actions that they took.