PMHNP certification Exam 22 Questions and Answers correct

PMHNP certification Exam 22 Questions and Answers correct 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 with 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) D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors COWS scale components · Opioid W/D Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (gooseflesh skin), insomnia What does COWS stand for? Clinical Opiate Withdrawal Scale What does CIWA stand for? Clinical Institute Withdrawal Assessment What does CIWA assess for? --used to determine likelihood of ETOH withdrawal or DTs --usually occur within the first 24-72 hours after cessation o used to determine when to administer medications for ETOH withdrawal What does CIWA NOT test for? Alcohol Use Disorder What are the CIWA scale components? · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, H/A, orientation Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)-4 (disoriented) Score: 10: Very mild Start PRN meds at score of 8 10 to 15: Mild scheduled + PRN meds 16 to 20: Moderate 21: Severe Diazepam, Librium, Ativan When interview teenagers (16 y/o) that arrive with their parents what should you do? interview 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? 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 D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? 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? Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a 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 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? Bring a support person like a husband Thyroid-Stimulating hormone normal level 0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance Hypothyroidism Hyperthyroid can mimic Mania Hypothyroid can mimic Depression A patient on depakote complains of RUQ pain and has reddish/brown urine Hepatoxicity -Check LFTs Signs of Depakote toxicity Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? Kava Kava When taking Kava Kava in combinations with other medications you should caution about Risk of Hepatoxicity and Sedation TCAs carry a risk of Hepatotoxicity Signs of Stevens-Johnson Syndrome -fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome lamictal and tegretol What nationality is most suseptible of getting steven johnson? Asians When treating asians with tegretol screen for? HLAB-1502 Allele What two medications cause agranulocytosis? Clozaril & Tegretol Agranulocytosis when to discontinue medication Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? HCG Which two medications may decrease the risk of suicide? clozaril and lithium Medications that increase lithium level NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? Heart Failure Certain medications are known to increase lithium level, but HOW? by reducing renal clearance When educating a patient about lithium teach them about Hyponatremia Dehydration-hot days, exercise Normal Lithium Level 0.6-1.2 per Quie Lithium Toxicity 1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 Monitor for toxicity Labs before starting lithium TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment) 4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects "LITHIUM GI" L-Leukocytosis I-inverted t-waves T-tremors of the hand (fine)/teratogenic Ebstein's H-hypothroidism IU-Increased Urination M-maculopapular rash GI- GI upset (nausea, vomiting, anorexia) Signs of lithium toxicity confusion, ataxia, severe GI upset, palpitation, coarse hand tremor, slurred speech, metallic taste in mouth NMS is caused by "think 'Antipsychotics'"; usually Atypicals NMS “NMS is like S&M” o First Sx: -You get a lil crazy (altered LOC) -you get hot (hyperpyrexia) and stiff (extreme muscle rigidity) o Then: -You get sweaty (diaphoresis) -Your BP goes up or down, and your pulse and respirations go up (Autonomic instability) -You’re speechless (mutism) & -you start to drool increased CPK (caused by muscle contraction and muscle destruction), increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome is caused by "think 'antidepressants'" anything that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) to excess levels Treatment for NMS Stop Offending Medication -Dantrolene (Mr Dan the relaxed muscle man) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for….dopamine agonist vs muscle relaxer Serotonin Syndrome s/s most common sx : SAD AF-shivering -anxiety/restless-diaphoretic -Agitation-Fever “Shits and Shivers” -Diarrhea (shits) -Shivering, -Hyperreflexia/myoclonus -Increased temperature -Vital sign instability -Encephalopathy (agitation/restlessness/anxious/SZ) -Restlessness -Sweating Treatment for Serotonin Syndrome Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine (5-HT2 receptor antagonist). Triptans Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan -call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP How long do you wait when switching between an SSRI to an MAOI? 2 weeks How long do you wait when switching between Prozac and MAOI? 5-6 weeks wash out period What is the first line treatment for depression and why? SSRI-First line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? 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? Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? Wellbutrin Wellbutrin is contraindicated in patients with Seizures and anorexia (bulimia also) Which medications are best for neuropathic pain? SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome Those with short half lives such as Zoloft; TCA's Symptoms of discontinuation syndrome flu like symptoms (fatigue, lethargy, myalgia, decreased concentration), n/v, impaired memory, paresthesia, irritability, anxiety, insomnia, crying w/o reason, dizziness, and vertigo Tx w/periactin Ages of onset for schizophrenia in males vs females -MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for 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 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 EVERYTHING DECREASES EXCEPT VENTRICLES enlarged ventricles, decreased activity in the frontal cortex, decreased Gaba and glutamate decrease total brain volume. Stimulants can potentiate the release of what neurotransmitter? Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) a form of rehabilitation post hospitalization, in home treatment - for people w/ serious mental illness ACT is provided once they d/c from hospital -Primary goal: to help people become independent -Secondary Goal: reduce the reliance on hospitals - Treatment is centered around the patient’s personal strengths, needs, and desires for the future What level of prevention is ACT? Tertiary What adjunctive treatment is important in schizophrenia -social skills training -Exercise Exercise for mental health patients can promote Cognition Quality of Life Long-term health ACT is ideal for patients with a history of Treatment non-compliance -Think about making the treatment convenient for them--bringing it to their home What diagnosis has the highest risk of Homicidality Antisocial In the MMSE how do you test for abstraction? proverb interpretation (everyone that lives in glass houses shouldn’t throw stones) Are they able to think abstractly Thought Process-Tangential means that their response has nothing to do with the question Circumstantial means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes SI/HI/AH/VH Another name for MMSE Folstein Scale How to assess concentration on MMSE Serial 7s or perform an activity backwards i.e list the days of the week backwards