PMHNP ANCC EXAM REVIEW QUESTION BANK 2024, OVER 500 QUESTIONS AND CORRECT ANSWERS.

PMHNP ANCC EXAM REVIEW QUESTION BANK 2024, OVER 500 QUESTIONS AND CORRECT ANSWERS. What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania Valproic acid produces what teratogenic effect? Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? Liver (hepatoxicity) What are 4 signs of hepatoxicity? Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? 150 mcg/ml What are 4 signs of valproic acid toxicity? Disorientation Lethargy Respiratory depression Nausea/vomiting A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do? Hepatotoxicity; hold med, draw LFT's (priority), DVP level With suspected toxicity with valproic acid, what steps/labs should be drawn? D/C drug Check drug level Obtain LFTs Obtain ammonia level A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd? Accutane (used for acne; Causes birth Defects!!!) What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava? Kava Kava liver damage What are 5 symptoms of Stephen's Johnson Syndrome? Fever -Key sx to suspect SJS; high yield (HY) burning of mouth/eyes -HY Body aches Severe red rash Peeling skin Facial and tongue swelling Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add? Aripiprazole (least sedating) What are 2 hallmark symptoms of delirium? Acute onset disturbance of LOC impaired cognition inattention How are agitation and psychotic symptoms treated in delirium? Low dose Haldol (QTc check first) 16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action? Do UDS; chances are they may be abusing other substances What 4 drugs can cause mania? "SAID" Steroids Antidepressants (in BPD) Isoniazid (INH) Disulfiram (Antabuse) What 6 drugs can induce depression? "SIP BARB" Steroids Interferon, Progesterone Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines Steroids can induce what 3 psychiatric states? Mania Depression Psychosis REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is_____. What is the best environment to interview this pt in? reassure safety, provide environment of safety private area with door open/partially open What is the therapeutic range for lithium? 0.6-1.2 mEq/L Many postpartum women have SI after delivery, yet they don't have psych evals before leaving the hospital, what could a possible solution be? collaborating care between psych and OBGYN to provide the best care for that pt If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does/does not] apply? Does not, ie pt will need to sign consent for labs/ chart to be sent When discharging from inpatient you want [to fax/print off-give to pt.] labs for the outpatient provider before pt discharge? fax; so the new provider has them for follow-up appointment Before referring a pt out or discharging them, it is good to ask yourself what question? is there something that I could do for this patient first? What 3 things are MUST KNOWS about Lithium? has neuroprotective effect for bipolar disorder the gold standard for treating manic episodes the mood stabilizer w/ anti-suicidal effects What mood stabilizer has anti-suicidal effects? Lithium What 5 labs should be drawn with lithium? Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SerumCr range? 0.6-1.2 mg/dL What is the normal range for BUN? 10-20 mg/dL When should you suspect kidney disease with a urinalysis? 4+ protein; if pt on Lithium--monitor closely toxicity What are 7 side effects of lithium? Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Bold =must knows Which 3 drugs can increase lithium levels by decreasing renal clearance? NSAIDs (ibuprofen, indomethacin) Thiazides ACE-I What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? 1.3 -1.4 mEq/L or higher With suspected lithium toxicity, what do you do first? D/C Li and draw Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? D/C lithium Check lithium level What 2 conditions can increase lithium levels? If this pt is going on a hike, what would you recommend ? Dehydration Hyponatremia Take extra water to avoid dehydration What birth defect can lithium cause? Ebstein anomaly (congenital heart defect) When working with adolescents, parents often feel they have a right to know what is going on with their child, but the teen has a right to confidentiality. This can create an Ethical dilemma When building a therapeutic alliance w/ adolescents, it is important to stress confidentiality; what they say remains confidential unless they are wanting to harm self/ someone else, [or they are in a relationship with someone much older (like 14 y/o seeing a 30 y/o)] if an adolescent C/O abuse, even if they make the claim in the presence of the parents, what should you do? interview the teen w/o the parents; call CPS What 3 neurotransmitters are associated with ADHD? DA, NE, 5HT aka serotonin --(DNS) The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is GAD if ADHD and tic both present, what is contraindicated? Stimulants if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean? the medication has been cleared from the body What are the lower age limits for stimulants for ADHD? AMPH = 3yrs MPH = 6yrs When considering Clonidine or Guanfacine for a pt, the PMHNP knows? Clonidine is more sedating than Guanfacine; Guanfacine lasts longer than Clonidine What does thought process assess? thoughts and ideas A normal thought process is described as Logical Linear Coherent Goal-oriented Moving from thought to thought and never getting to the point is called Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called Thought content Thought content includes 3 items Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s), or anything going backwards measures what? Concentration Attention Asking the year, season, date, month, and location measures Orientation Asking a patient to repeat "bed, red, ball" measures Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures Recall (memory) Asking the patient who is the president of the US or governor of state is measuring Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway to the dorsolateral prefrontal cortex (DLPFC) modulates positive psychotic symptoms The safest drug switch strategy is to have a "washout period" of _______ half-lives between cessation of old med and the introduction of the new med. 5 1/2 Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? Negative symptoms: affect, anhedonia, asociality, alogia, apathy, avolition, Depressive symptoms The nigrostriatal pathway modulates motor movements Dopamine has what type of relationship with acetycholine Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? Acute dystonia: stiff neck, muscle spasms neck/back, painful Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking DA in the tuberoinfundibular pathway leads to Increased prolactin What are 5 symptoms of hyperprolactinemia?