PMHNP Exam Reported Questions and answers

PMHNP Exam Reported Questions and answers 1. 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 2. What does a 17 on MMSE mean?: Moderate cognitive impairment 3. What is Tegretol in the CYP450 system?: Inducer --will lower dose of Lam- ictal and BCP's 4. What do BCP's do to Lamictal?: Inducer - will lower dose of Lamictal 5. What is a Type I research error?: There IS a difference but you say there isn't a difference. 6. What is a Type II research error?: There is NO difference but you say there is a difference. 7. What is pseudo-dementia?: Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve. 8. Is it normal for a 1 month old to have a palmar grasp?: Yes. 9. What is a drug 1/2 life?: The time it takes for 50% of a drug to be eliminated from the body. 10. What 3 atypicals can be used with teens?: Zyprexa, Abilify, Seroquel - low doses 11. What is a risk of using Tramadol?: Serotonin Syndrome as it is very seroton- ergic. 12. What is the allele seen in Asians that increase the risk of SJS?: - HLAB-1502 13. When might you see toxic epidermal necrolysis?: With worsening of SJS 14. How many generations do you include for a genogram?: 1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - 15. What does messenger RNA code for?: Amino Acids 16. What is epigenetics?: Factors that affect genes - environmental, smoking, stress, etc... 17. What part of the brain is involved with OCD?: Basal Ganglia Occipito-Frontal 18. What happens to the brain during adolescence?: Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well 19. When do males typically present with schizophrenia?: 10-25 yo 20. When do females typically present with schizophrenia?: 25-35 yo 21. What does Erythromycin to trileptal?: You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor 22. ACE Inhibitors are the drug of choice for what?: Heart Failure HTN 23. 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 24. What should you watch for with Tegretol?: Agranulocytosis and Hypona- tremia 25. What are the 3 CK muscle enzyme tests?: CKBB, CKMM, CKMB 26. Which one of the 3 muscle enzymes are related to cardiac muscle dam- age?: CKMB 27. What is the risk of a seriously elevated CKMB?: Polymyositis Rhabdo 28. What is a normal CKMB?: 0.3 mcg/L 29. What psychoactives does Detrol interact with?: Topamax KCL Zonegran 30. What CN are you assessing when you have the patient shrug their shoul- ders?: CN XI - Spinal Accessory 31. What do you see in labs with HIV & Dementia?: CD4 200 Viral Load is high 20% get it with antiretroviral treatment 32. 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 33. What is sensitivity?: Helps rule-out disease = True Positive = Snout 34. What is specificity?: Helps rule-in disease = True Negative = Spin 35. What does a sed rate measure?: Inflammation (ESR - Erythrocyte Sedimen- tation Rate) = distance in mm RBC's have descended in 1 hour. 36. What is a normal sed rate or ESR?: 0-22 males 0-29 females 37. What is a retic count?: Measures % of reticulocytes in blood (immature RBC's) Indicates whether enough RBC's are being produced by bone marrow. 38. What does a decreased retic count indicate?: Anemia - acute or chronic bleeding 39. What does an increased retic count indicate?: Bone marrow disorder or Vitamin Deficiency 40. What does an abnormal retic ount indicate in general?: Doesn't diagnose anything. First step is ID source of the issue. 41. What happens when you mix tegretol and macrolides?: Increase tegretol levels. 42. What happens if a pregnant women takes Accutane?: Birth defects. 43. 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. 44. Where does the NP Code of Ethics come from?: ANA 45. When do you assume informed consent?: Unconscious Incompetent Life Threatening Situation 46. What are the legal ramifications of treating w/o informed consent?: Same as with informed consent 47. Who can declare a patient incompetent and appoint a guardian?: Only a court 48. Does impaired judgment mean one is incompetent?: No. 49. Can an advanced directive ever be revoked?: Yes, at any time. 50. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact?: Nothing. They are all the same. 51. Does the de facto rule of proxy apply in same sex marriages?: No. 52. How do Asians see HC providers?: As in a position of authority. Expect to give instructions and help make decisions 53. What does it mean when an Asian patient does not make eye contact with the NP?: SIgn of respect 54. 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. 55. How do you protect from the evil eye?: Red ribbon on an infant Amulet for adults 56. How do you treat for evil eye?: Access traditional healer + traditional care. 57. For there to be a duty to a patient, what must exist?: Relationship 58. What is a proximate cause?: Connection between A + B. 59. For there to be damages, what must exist first?: Negligence 60. What is an occurrence basis liability insurance?: "occurred" during the policy period, no matter when the claim is brought against the insured 61. 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. 62. Who sets the minimum requirements for NP's?: Board of Nursing State 63. 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 64. What classes of CS's is the NP approved to prescribe?: Schedules III-V ONLY. 65. Where does 50% of healthcare funds come from?: The government 66. Who is eligible for Medicare?: 65 or under 65 with diability, ANY age with renal disease. 67. 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%. 68. 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. 69. Can you have Medicare and Medicaid?: Yes, impoverished elderly but Med- icaid is always payor of last resort. 70. Is dental care included in Medicaid?: Yes, 21 gets basic dental as part of the Medicaid plan. 71. What is the purpose of HIPAA?: National standards for electronic HC trans- actions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. 72. What must be signed prior to any healthcare in the state: Notice of Privacy Practices Statement 73. What happens if a patient refuses to sign an ROI?: Can decline to treat Health plan may condition enrollment on provision of consent 74. When is HIPAA not required?: Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment 75. Is it ok to announce a patient's name in a waiting room?: Yes, no other way to give care. 76. Is it ok to leave a message on a patient's vm?: Yes, but should be limited. 77. What is the impact of steroid inhalers on children?: Slows bone growth and may decrease ultimate height. 78. What is the long-term impact of using steroid inhalers?: Cataracts, glau- coma, thinning of bones and skin 79. What is included in the treatment of fibromyalgia?: Sleeping meds Antidepressants Pain meds 80. What psychoactives are first line treatment for fibro?: Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's 81. What is the purpose of telepsychiatry?: Increase the ability to reach rural and underserved areas. 82. What is the purpose of Motivational Interviewing?: Explore ambiguity Maintain passive position 83. What is required for Medicare submission?: ICD 10 and narrative or CPT 84. What is the neurotransmitter problem in Schizophrenia?: Excess dopamine in mesolimbic pathway. 85. What is the neurotransmitter problem in ADHD?: Dopamine, norepineph- rine and serotonergic dysfunction 86. What is the benefit of play therapy?: Don't have to confront emotions head on. 87. What neurotransmitters are involved in the bioamine hypothesis of de- pression?: Noradrenaline Serotonin Dopamine MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse. 88. How do you test CN XII?: Stick out your tongue. 89. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles?: CN V - Trigeminal 90. What are two important things to measure when using Zyprexa?: Lipid level and abdominal circumference 91. What is included in the mini-cognitive exam?: Clock, memory questions from MSE. 92. What is HIV related dementia often mistaken for, especially at the begin- ning?: Depression 93. What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) 1000?: Stop and repeat lab. Normal is mm3 94. Can you take Buspar during pregnancy?: Category B - ok if really needed. 95. Can you take Klonopin during pregnancy?: Category C - avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms. 96. 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. 97. Can asthma medications cause depression?: Yes. 98. If a patient has muscle pain and red urine with an elevated leukocyte esterase. What lab do you order?: Microalbumin? 99. What is often common to patients with fibro?: Sexual abuse 100. How is telepsychiatry evaluated?: Outcome based - measure at intervals. 101. What happens with a patient taking Lithium and who gets dehydrated?- : Levels increase 102. What happens with a patient taking Lithium who decreases sodium intake?: Levels increase 103. What happens with a patient taking Lithium and drinks a lot of water?- : Levels decrease 104. If a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future?: Zyprexa 105. What happens when taking Lithium and NSAIDS?: NSAIDS can cause Lithium levels to increase and for the patient to become toxic! 106. 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. 107. Amgdyla: Fear, Anxiety, and Aggression 108. Neurotransmitter for Addiction: Dopamine and GABA 109. Neurotransmitter for Mood Disorder: Serotonin and norepinephrine 110. Which drug affects Carbamazepine/tegretol: Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol 111. Signs and Symptoms of stimulant abuse: insomnia and tremor 112. Depakote check: HCG levels 113. Depakote causes: Spinal bifida 114. 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. 115. 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. 116. pincer grasp: 9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios. 117. Pt has MI looses his job stable on psych medications: Provide brief supportive therapy 118. Latida and Geodon: Take with food 119. Moro reflex absent: Do xray 120. Health Care Policy Model: Access, Cost, Quality 121. Pt wants to stop medications: explore reason for stopping Its their right 122. 16 year old falls with the wrong crowd: Conduct disorder 123. change agent: the person formally in charge of guiding a change effort Administrator 124. 14 year old girl clenching her teeth: Cranial Nerve V-Trigeminal nerve 125. Infant dying: Give child to parents and comfort parents 126. borderline personality disorder Treatment: dialectical behavior therapy 127. Aggressive patient give: IM geodon 128. *SIGECAPS* of Depression: Sleep Interest Guilt Energy Concentration Appetite psychomotor retardation Suicide 129. DIGFAST for mania: Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talking increase 130. 5 year old tells u his brother sodomized him: Tell mom don't leave him alone with patient and call CPS implement crisis 131. 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 estab- lishing 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. 132. Child reports Sexual Abuse: Interview the young child and infants child with parent 133. First sign of temprofrontal Dementia: Behavior and personalty changes 134. Tow amines related to depression: Serotonin and norepinephrine 135. Want to start an consulting firm what tool would be needed to show economic viability: Revenue and expenses 136. Patient stopped smoking (Cessation): Decreased Zyprexia ces, and then 137. Promote resilience in schizophrenia for a patient that lives alone and doing well: Refer to peer support 138. Spirit stick: Teach staff about culture competence 139. 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) 140. PDSA cycle: For Plan-Do-Study-Act. Describes how to test a change: by trying it, observing the consequen learning from those consequences. 141. 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 142. 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 143. 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) 144. 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) cale, Revised ntervention 145. CIWA-Ar: Clinical Institute Withdrawal Assessment of Alcohol S 9 item symptom rating scale, max score 67; 10 does not warrant i 146. 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 147. Native American wants his healer present: Involve mother of the patient and healer, mom was cleared for you to involve her 148. 16 year old shows up with mother for first therapy is: confidential mom sits in lobby 149. Patient acts out due to missing session what do you do: You relate to childhood abandonment and talk about it with the patient 150. How do you assess the competency of a medical procedure: Identify a pen and recall 3 words 151. Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis: Delusional disorder 152. Increase ICP (signs and symptoms): Baby Neuro cry 153. Menopausal woman: Hormone therapy and replacement 154. Patient on antidepressants for 3 weeks and attempted Suicide: Stop medication immediately 155. You want to decrease seclusion on your unit who considered the prima- ry change agent: Unit staff 156. 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 157. 16 year old refuse treatment: Send to psych specialist for acting out kids 158. Positive Trendelenburg Sign: Refer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor. 159. Drug affects Flonase: Zantac (Histamine 2 Blocker) Antagonist 160. Little boy wet his sheets, What kind of therapy would you suggest: Be- havior therapy 161. DDVAP acts in much the same manner as antidiuretic hormone.: Makes less urine arba- 162. Lithium level 1.2u what are you concerned with: 4+ Ketones 163. What does depakote do to Lamictal: Increase laminate 200% 164. Inducers of Cytochrome P450 (CYP450): Barbiturates, phenytoin, mazepine, rifampin, St. John's Wort A substance that speeds up a chemical reaction 165. Inhibitor: A substance that slows down or stops a chemical reaction 166. cytochrome p450 inhibitors: CRACK AMIGOS Cimetidine Ritonavir Acute Alcohol Ciprofloxacin Ketoconazole Amiodarone Macrolides Isoniazid Grapefruit juice Omeprazol Sulfonamides 167. Carb and Barb: decrease INR 168. Deapkote and Disulfruram: Increase INR 169. GAL-Renall metabolized: Gabapentin Acamprostate Lithium 170. Grapefruit juice: One glass can reduce absorption by 47% Blood levels will be Increased 171. Trazodone (Desyrel): Get EKG. 172. Trazodone (Desyrel): Get an eye exam can cause Glaucoma 173. Grapefruit juice or grapefruit: Increase trazodone 174. PICOT: Patient population of interest Intervention of interest Comparison of interest Outcome Time 175. 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. 176. Amygdala: A limbic system structure involved in memory and emotion, anx- iety, particularly fear and aggression. 177. PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD 178. Mental Health Parity Act 1996: ensure equal coverage for mental and phys- ical illness equal life time and annual limits 179. charge of DEA: state and federal 180. Stereogenesis: identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object 181. Sterogenesis abnormality in: parietal lobe 182. Clozaril (Clozapine): WBC-2500 ANC LESS than 1000 (950) dc medication 183. how treat child with depression: Zoloft and therapy 184. 3 year old masturbates, plays with self, says naught things: normal for Piaget 185. NMS treatment: Dantrolene: MUSCLE RELAXTION D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles 186. mesolimbic system: POSITIVE symptoms of schizophrenia due to high dopamine 187. negative symptoms of schizophrenia: the absence of appropriate behav- iors (expressionless faces, rigid bodies) 188. negative symptoms of schizophrenia: mesocorticol pathway 189. mesocortical pathway: VTA to prefrontal cortex negative symptoms 190. Nigrostriatal pathway: EPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + puta- men) of the BG via DA; used to initiate movement 191. PDSA model: PLAN- Do-carry out Study -examine results Act-decide what action 192. Tanner's stages: 193. Tanner stages: 194. MMSE (Mini Mental State Examination)-: Stage May be Normal 25-30 Mild/Early 21-24 Moderate 10-21 Severe 0-9 195. A pt states that she has been raped. What do you do: ensure safety 196. Hamilton D score of 28: Assess for Suicide 197. Hamilton Depression Rating Scale: 17-21 questions 0-7 Normal 14-18 Moderate 20 Severe Depression 198. Beck Depression Inventory (BDI): 0-13 Minimal depression 14-19 Mild Depression ty 20-28 Moderate Depression 29-63 Severe Depression 199. 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. 200. Hamilton Anxiety Rating Scale (HAM-A): 14-17 Mild Anxie 18-24 Moderate Anxiety 25-30 Severe Anxiety 201. Yale-Brown Obsessive Compulsive Scale (Y-BOCS): OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme 202. PTSD (Post Traumatic Stress Disorder): EMDR 203. EMDR (eye movement desensitization and reprocessing): eye movement desensitization and reprocessing 204. Dilated pupils: Stimulant intoxication 205. constricted (pinpoint) pupils: Opiods 206. nystagmus: Phencyclidine 207. conjuctival injection, muchies (super hungry), psychomotor slowness?- : Marijuana 208. Marijuana: a drug, often smoked, whose effects include euphoria, impair- ment of judgment and concentration and occasionally hallucinations; rarely report- ed as addictive 209. Boy states that he wishes to be a girl and tells you not to tell his parent s: Don't tell 210. ODD what will you do to prevent it from becoming Conduct disorder: - Therapy to target mood and aggression 211. Herpes rooster 3 weeks later sleep difficulties and sad mood: Depression 212. Schizophrenia in males: 18-25 years old 213. Schizophrenia in Women: 25-35 years old 214. signs of amphetamine intoxication: Tears, Runny nose, restlessness, HTN, Tremors, Insomnia 215. Co-morbidities of bipolar: Anxiety, alcohol and substance abuse 216. Big Freaking Problems: Bupropion Fluoxetine Paxil 217. Medicare: A federal program of health insurance for persons 65 years of age and older 218. 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 219. Medicare A, B, C, D: A: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs 220. WATCHERS for GAD 3 of these *** for 6 months: worry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep trouble 221. Transtheoretical Model of Change: 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance perimental han randomly 222. Man working at the Gym and his urine is Cherry color: order myoglobin- uria 223. Latino women wanting prenatal class: Consult with cultural group in com- munity 224. Anorexia: Set up family therapy 225. quasi-experimental design: Research method similar to an ex design except that it makes use of naturally occurring groups rather t assigning subjects to groups. 226. The ventricle enlargement observed in clients with: schizophrenia is most often accompanied by 227. Encopresis Treatment: Behavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation Counseling 228. Medication that contradicts albuterol: Adderall (amphetamine / dextroam- phetamine) 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, En- docodone, 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) 229. t-tests: statistical measure: test means of 2 independent samples, significant- ly different? 230. ANOVA (analysis of variance): 3 OR MORE an inferential statistical test for comparing the means of three or more groups 231. 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 232. p-value: The probability of results of the experiment being attributed to chance. LEVEL OF SIGNGNIFICANCE 233. 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 prob- lems, and motor (movement) problems such as clumsiness and poor balance. show brain atrophy (shrinkage) 234. 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 interper- sonal impact through feedback provided from other members Interpersonal learning- output Members provide an environment that allows mem- bers to interact in a more adaptive manner Self-understanding: m embers gain insight into psychological motivation underly- ing behavior and emotional reactions 235. Metobolic syndrome: group of signs and symptoms including insulin resis- tance, obesity characterized by excessive fat around the waist and abdomen, hypertension, hyperglycemia, elevated triglycerides, and low levels of HDL 236. NAMI: national alliance on mental illness help families of mentally ill: education, support groups 237. 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 238. health literacy: Man taking insulin asking him to read blood glucose level 239. inferential statistics: numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population 240. Mood Disorder Questionnaire (MDQ)-SCREENING: Mood Disorder Ques- tionnaire 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 concen- trating 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 241. Patient comes with vague symptoms depression irritability: BECK De- pression scale 242. DISSEMINATED ENCEPHALOMYELITIS: Assess for asymmetry of extrem- ities Along with this pattern, the patients usually get neurological symptoms which may include: Confusion, drowsiness, and even coma Unsteadiness and falling th a score that a Visual blurring or double vision (occasionally) Trouble swallowing Weakness of the arms or legs Fever HA 243. CBT (cognitive behavioral therapy): Anxiety popular integrative therapy that combines cognitive (thinking) and behavior therapy 244. Impulsivity (ADHD): Pre-Frontal Cortex Involves hasty actions taken without consideration of possible negative conse- quences to self or others; it often shows up as a kind of social intrusiveness, such as excessively interrupting others. 245. Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis: Hypogylcemia 246. NSAIDS: Lithium toxicity 247. Interferon: Causes depression 248. Beck Depression Inventory (BDI): Intimate therapy for a child wi of 10 a questionnaire useful for determining the level of depressive symptoms person is reporting 249. Zantac (ranitidine): affects Flonase 250. Greatest patient at risk for Violence: Substance abuse 251. DBT (dialectical behavior therapy): relaxation muscle prior to DBT 252. Pt on Lithium: Prescribe Synthroid 253. Zantac (ranitidine): H2 antagonist H2 BLOCKER 254. Tegretol (carbamazepine): INDUCES Flonase 255. primary prevention: Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuse. 256. Secondary prevention examples: - Implement blood pressure and choles- terol 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 cer- vical 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) 257. Collab with OB NP questions: wants to establish a relationship so Mental Health can be reached by more people 258. anorexia nervosa: BMI less than 18.5 an eating disorder in which an irrational fear of weight gain leads people to starve themselves 259. 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). 260. Culture question: A man injects himself: "tell me more about the medica- tions" 261. 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 262. Scope of Practice in Nursing: State 263. Standards of Practice: ANA 264. ADPIE - Nursing Process: Assessment Diagnosis Planning Implementation Evaluation 265. Adult panic disorder: Buspar 266. Kids panic disorder: Clonidine Guafacine 267. OCD (Obsessive Compulsive Disorder): TCA Clomipramical 268. Clomipramine (Anafranil): OCD, depression (tricyclic) 269. agoraphobia: fear of open spaces 270. 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 271. social anxiety disorder: BetaBlocker Propanolol 272. Tourette syndrome: involuntary, spasmodic, twitching movements; uncon- trollable vocal sounds; and inappropriate words TICS for 1 year Has to occur by 18 years old Usually occurs by 3-9 years old 273. Steroids: Cause mania 274. 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." 275. Testing for fungal infections: shavings of toes 276. Pt on Lithium with temp, right flank pain, brown colored urine, What do you?: LFT 277. Medication Management: By state and federal 278. Kid with night mares screaming out doesn't remember the next morning what do you do: Ask about sleep disorder in family 279. PT taking a breathing treatment albuterol/proventil: Do not take MAOI or TCA 280. Pt in with Sob, Fatigue. When you assess the thinnest part of the skin , you notice s/s: 281. Sensitivity: Sensitivity = TP / (TP + FN) 282. Specifity: TN 283. peer consultation: Mutual Benefit Critical and Supportive Shared discussion and accountability The regular engagement of two or more colleagues to give and receive feedback 284. Tegretol (carbamazepine): ANC/WBC 285. 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 286. Paplau's Interpersonal Theory: Process recording 287. Give Ativan: For Alcoholic with Liver problems 288. detailed physical exam: 289. Pt states that God did this to me: Assess spiritual needs 290. 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) 291. women in military and she saw her friend die: PTSD 292. Man had appt, wife came and he didnt: Tell wife to reschedule appt 293. Tagement (Cimetidine): ^ Benzo ^ Coumadin 294. Erythromycin: ^ Xanax levels 295. Disulfiram: ^ Coumadin 296. Pt with Eating disorder states getting full: Bloating delayed Gastric emp- tying 297. Realiability: consistency 298. Biggest Concern with EHR: Confidentiality 299. Qualiatative: Measures in natural setting i.e ?, observation 300. Quantitative: Data that is in numbers 301. internal validity: Was research done right? extent to which we can draw cause-and-effect inferences from a study 302. I don't know answers: pseudo dementia 303. interferon: decrease Wellbutrin 304. ^ prolactin: stop prolactin 305. EPS: ^ risk for TD 306. Assess when someone ready to quit drinking: See what stage they in Ask when ready to start tx 307. To check for Dementia: Have the patient tell you risk/benefits test capacity 308. dairy log: CBT 309. 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 310. antidepressant takes: 5 weeks 311. 13 year old want to smoke: ask him of his plan to stop smoking 312. placement of chronically mental ill: ACT Assertive Community Treatment 313. 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, teach- ing on a 24/7 basis 314. BRUISE on the padded part of his arms: Say I see you have bruises on your arm Ask what happened 315. medication errors on a new floor when NP starts working.: educate the staff on policies on how to handle med errors. 316. ECT THERAPY: GET CERTIFIED 317. lesion in frontal cortex: Impaired cogitate functions 318. child in foster homer 5 years poor eye contact, isolated self, eat without difficulty: autism 319. A man states his wife was so good if he could only be like her. what is this: Intellectualization or deflecting 320. 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.: de- creased gastric motility check measure the stomach 321. Tagement (Cimetidine): Prevents acid from backing up into the esophagus and causing heartburn 322. Pt moving to another state: Give enough meds 323. Pt on Zoloft BMI 26: BMI 324. Sildenafil (Viagra): 1 hour prior to sex 325. Tadalafil (Cialis): 45 minutes prior to sex 326. Vardenafil (Levitra): 45 minutes prior to sex 327. Avanafil (Stendra): 15 minutes prior to sex 328. 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 329. Females more likely to become an alcoholic than man: due to hormones 330. Apoptosis: cell death in aging/elderly 331. solution therapy: conducted through direct observation of clients' responses to a series of precisely constructed questions. 332. Np wants to implement a certain policy in nursing.: start with nurse manager of one X s hopeful and he illness and 333. Turner Syndrome: A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part chromosome is deleted. delayed puberty, short id, 10-16 years old amenorrhea web neck, osteoporosis, lymphemeda, poor social skills 334. Prozac causes what?: increased anxiety in elderly 335. Prazosin (Minipress): nightmares 336. ACE inhibitors: HTN 337. Recovery Model: A model that is patient/consumer-centered, i empowering, and emphasizes the person and the future rather than t the present. 338. Recovery Model Intervention: rm of guiding 339. motivational interviewing: a collaborative, person-centered fo to elicit and strengthen motivation for change 340. MOTIVATIONAL INTERVIEWING: MAY WE TALK ABOUT YOUR TEST SHOWS YOU ARE VERY COURAGEOUS YOU WANT TO CHANGE, BUT LETS SEE IF I GOT IT 341. KIDS receive to many calories ue to staff letting him eat food: Meet with dietiacan , discuss with manager