Download Psychiatric Pharmacology Exam Questions and Answers and more Exams Nursing in PDF only on Docsity!
LMR GEORGETTE’S PMHNP FINAL
EXAM LATEST 2023 QUSTIONS
WITH ANSWERS NEW UPDATE
What drugs should be avoided with Kava Kava?ANS== Alprazolam CNS depressants (e.g., phenobarbital, zolpidem)
What is the normal range for TSH?ANS== 0.5 - 5.0 mu/L
What are lab values in HyperthyroidismANS== Decreased TSH Increased T4 and T
What are labs in Hypothyroidism?ANS== Increased TSH Decreased T4 and T
What are 5 primary symptoms of Hyperthyroidism?ANS== Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss
What are 4 primary symptoms of Hypothyroidism?ANS== Cold intolerance Lethargy Weight gain Decreased libido
Hypothyroidism mimics symptoms of what psychiatric disorder?ANS== Depression
Hyperthyroidism mimics symptoms of what psychiatric disorder?ANS== Mania
Valproic acid produces what teratogenic effect?ANS== Spina bifida (neural tube defect)
What is the primary organ where valproic acid is toxic?ANS== Liver (hepatoxicity)
Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue
What is the therapeutic range for valproic acid?ANS== 50-125 mcg/ml
What are 4 signs of hepatoxicity?ANS==
What is a toxic level of valproic acid?ANS== >150 mcg/ml
How are agitation and psychotic symptoms treated in delirium?ANS== Low dose Haldol (QTc check first)
16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action?ANS== Do UDS; chances are they may be abusing other substances
What 4 drugs can cause mania?ANS== "SAID" Steroids Antidepressants (in BPD) Isoniazid (INH) Disulfiram (Antabuse)
What 6 drugs can induce depression?ANS== "SIP BARB" Steroids Interferon, Progesterone
Beta blockers Accutane, (Isotretinoin) Retroviral drugs, Antineoplastic drugs Benzodiazepines
Steroids can induce what 3 psychiatric states?ANS== 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?ANS== reassure safety, provide environment of safety private area with door open/partially open
What is the therapeutic range for lithium?ANS== 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?ANS== 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?ANS== 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?ANS== fax; so the new provider has them for follow-up appointment
At what level do you monitor lithium closely (but not discontinue)?ANS== 1.3 -1.4 mEq/L or higher
With suspected lithium toxicity, what do you do first?ANS== D/C Li and draw Lithium level (not VS)
What is the appropriate action if lithium level is 1.5 mEq/L?ANS== 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 ?ANS== Dehydration Hyponatremia
Take extra water to avoid dehydration
What birth defect can lithium cause?ANS== 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 anANS== Ethical dilemma
When building a therapeutic alliance w/ adolescents, it is important to stressANS== 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?ANS== interview the teen w/o the parents; call CPS
What 3 neurotransmitters are associated with ADHD?ANS== DA, NE, 5HT aka serotonin -->(DNS)
The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder?ANS== ADHD
Inattentive Type ADHD demonstrates abnormalities in which part of the brain?ANS== Prefrontal cortex
What should be done before placing a patient on stimulants for ADHD (priority)?ANS== 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 isANS== GAD
if ADHD and tic both present, what is contraindicated?ANS== Stimulants
if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean?ANS== the medication has been cleared from the body
What are the lower age limits for stimulants for ADHD?ANS== AMPH = 3yrs MPH = 6yrs
When considering Clonidine or Guanfacine for a pt, the PMHNP knows?ANS== Clonidine is more sedating than Guanfacine; Guanfacine lasts longer than Clonidine
What does thought process assess?ANS== thoughts and ideas
A normal thought process is described asANS== Logical Linear Coherent Goal-oriented
Moving from thought to thought and never getting to the point is calledANS== Tangentiality ("goes on tangent")
Providing unnecessary detail but eventually getting to the point is calledANS== Circumstantiality ("goes in circles")
Themes that occupy a patient's thoughts and perceptual disturbances is calledANS== Thought content
Thought content includes 3 itemsANS== Suicidal ideation Homicidal ideation Hallucinations/Delusions
Asking a patient to count backward from 100 by seven (serial 7s), or anything going backwards measures what?ANS== Concentration Attention
Asking the year, season, date, month, and location measuresANS== Orientation
Asking a patient to repeat "bed, red, ball" measuresANS== Registration (ability to learn new material)
Asking a patient to repeat objects 5 minutes later measuresANS== Recall (memory)
Asking the patient who is the president of the US or governor of state is measuringANS== Fund of Knowledge
Skin rash SOB
In which ethnic group must you screen for the HLA-B1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary?ANS== Asians risk for SJS in Asians (+) for HLA-B1502 allele
Which 2 drugs have the highest likelihood of causing agranulocytosis?ANS== Clozaril Carbamazepine
A sudden fever, chills, a sore throat, and weakness are symptoms ofANS== Agranulocytosis
At what ANC should clozapine be stopped (even if asymptomatic)?ANS== <
What is neutropenia?ANS== <2000 PMNs or WBC <
What is agranulocytosis?ANS== <500 ANC
What does DIGFAST stand for?ANS== Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness
What neurological symptoms might one see in Conversion Disorder?ANS== Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures
When do symptoms typically begin with Conversion Disorder?ANS== After a stressful experience (suddenly)
What are 5 stressful events in a child's life that can cause adjustment disorder?ANS== Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness
A child with an Adjustment Disorder with disturbances of conduct may have what symptoms?ANS== Not going to school, destroying property, driving recklessly, or fighting
What are some key sx of Oppositional Defiant Disorder (ODD)?ANS== NOT aggressive (key difference vs CD) loses temper easily annoys others angry/resentful argues with authority easily annoyed blames others spiteful refuses to comply with rules/requests from authority figures
What is the mainstay treatment of Oppositional Defiant Disorder (ODD)?ANS== Therapy, individual and family
What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)?ANS== Child and parent problem-solving skills training, boundary setting
A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder if under age 18?ANS== Conduct Disorder
What are 3 "hallmark" characteristics of Conduct Disorder?ANS== aggression Destruction of property Lack of remorse
What 2 factors differentiate Conduct Disorder from ODD?ANS== Severity Aggression
What are 4 pharmacologic treatments for Conduct Disorder?ANS== Things to target mood and aggression --Antipsychotics --Mood stabilizers --SSRIs --Alpha agonists (Clon. and Guan)
What type of therapy is used in the treatment of Conduct Disorder?ANS== Behavioral therapy/ problem solving skills
What is the goal of multisystemic family therapy (MFT)?ANS== Reduce barriers to resources for youth with problematic behavior
What is Multisystemic family therapy?ANS== Home-based model for youth (12-17) with serious antisocial problematic bx and criminal offenses by empowering parents with resources and skills and reducing barriers to resources that prevent families from accessing services needed for effective management of youth helps to develop natural support systems
Just moderate 10-
What is the moderate range for COWS?ANS== 13-
If a patient's COWS score is between 5 - 12, what do you do?ANS== Administer clonidine (mild score)
If a patient's COWS score is between 13 - 24, what do you do?ANS== Administer buprenorphine (Suboxone) (moderate score)
When do you administer clonidine on the COWS?ANS== Definitely at score of >7; prior to that (scores 5-6) it can be given
When do you administer buprenorphine (Suboxone) on the COWS?ANS== moderate symptoms (13-24)
What is a moderate range on the CIWA?ANS== 16-
When do you administer prn meds such as benzodiazepine or for N/V/D on the CIWA?ANS== Mild symptoms (8 or greater)
When do you administer scheduled benzodiazepine +PRN's on the CIWA?ANS== moderate symptoms (15 or higher)
If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how do you treat it?ANS== Medication and/or therapy Assess for suicidal ideation
If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it?ANS== Medication and/or therapy
If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it?ANS== Therapy or nothing
If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat?ANS== Therapy or nothing
If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat?ANS== Medication and/or therapy
If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it?ANS== Medication and/or therapy
What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking?ANS== Prefrontal cortex Amygdala
Basal ganglia Hippocampus
Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms?ANS== Aggression Impulsivity Difficulty with abstract thinking
What are 6 symptoms of NMS?ANS== *Extreme muscular rigidity *Mutism *Elevated labs CPK (creatine phosphokinase), LFT's and WBC's Myoglobinuria autonomic instability vBP, ^HR/RR Fever *= top 3 ways to differ from SS
Elevated CPK (creatine phosphokinase) in NMS is caused fromANS== muscle contraction and destruction
What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome?ANS== Hyperreflexia Myoclonic jerks
S/S of serotonin syndrome include: what are the 4 most often seen (in bold)?ANS== "Shits and Shivers" § Diarrhea (shits) § Shivering, § Hyperreflexia/myoclonic jerks § Increased temperature § Vital sign instability § Encephalopathy § Restlessness/anxiety § Sweating
How do you treat NMS?ANS== DC offending agent Bromocriptine or Dantrolene
What does Dantrolene treat in NMS?ANS== Muscle rigidity
How do you treat Serotonin Syndrome?ANS== DC offending agent Cyproheptadine: H1 antihistamine that acts to block 5-HT1A and 5-HT2A receptors
What combination of medications increases the risk of Serotonin Syndrome? What herbal supplement also increases the risk?
houses built in 1970's (lead was in the paint)
A child with developmental delay who eats things (such as paint chips) may haveANS== Lead poisoning
What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain?ANS== BMI Hip-to-waist ratio (waist circumference) Glucose Lipid panel
Where is norepinephrine produced?ANS== Locus coeruleus Medullary reticular formation
Serotonin is produced inANS== raphe nuclei in the brainstem
What 3 areas of the brain is dopamine produced?ANS== Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens
Where is acetylcholine synthesized?ANS== Basal nucleus of Meynert
What is the function of the amygdala?ANS== Emotional memories (aggression, fear, anxiety, rage [think amygdala], stress)
What are 5 functions of the hippocampus?ANS== Emotions Stress Learning Motivation Memory conversion ST to LT BOLD =HY
What disorder is associated with persistent deficits in social communication and social interactions across multiple settings?ANS== Autism Spectrum Disorder
A child who likes to line up, stack, or organize objects and toys in tidy rows, little or no eye contact and does not respond when called by name may haveANS== Autism
What theory claims that dysfunction of a particular neuron system may be a cause of the poor social interaction and cognition in autism?ANS== Broken Mirror Theory
What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder?ANS== tics appeared before age 18 yrs
What is the pharmacological treatment of Tourette's Disorder?ANS== Antipsychotic (haloperidol, pimozide, aripiprazole*)
What are the 3 primary neurotransmitters involved in Tourette's Disorder? What is special about DA?ANS== DA, NE, 5HT or (DNS) hyperactivity of DA can lead to tourettes
What are 11 risk factors for suicide?ANS== Previous suicide attempt
45 and older ( > 55 for women) Male gender Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss bold (must knows)
What are 5 physical characteristics of Anorexia Nervosa?ANS== Low BMI (below 18. is underweight) Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension
What is the BMI in a patient with Bulimia NervosaANS== Normal range (18.5-24.9)
Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder?ANS== Acute Stress Disorder
What are the 3 hallmark symptoms of PTSD?ANS== Intrusive re-experiencing of the trauma Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma
What are 3 pharmacological treatments for PTSDANS== SSRIs TCAs Prazosin for nightmares
What 2 nonpharmacologic treatments for PTSD?ANS== EMDR CBT
What are the 12 components/symptoms of the COWS?ANS== Pulse Sweating Restlessness
Act
Process, Policy reform, Policy environment, and Policy makers are the 4 components ofANS== Health Policy
Changes in programs and practices in Health Policy is calledANS== Policy Reform
What is the "policy environment" component of Health Policy?ANS== The arena the process takes place in (government, media, public)
What is the "policy makers" component of Health Policy?ANS== Key players and stake holders
What is the first action when developing Health Policy?ANS== Assess/address organizational barriers and facilitators
A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is calledANS== Recovery Model
What are 3 characteristics of the Recovery Model?ANS== Nonlinear recovery, continual growth and occasional setbacks; Learning from experience (e.g. relapse) Self-directed -pt is not told what to do Individualized and Person-Centered-pt is the center of the therapy
What is the SBIRT, and what is it used for?ANS== Screening Brief Intervention Referral Treatment Screens for Substance Use Disorders
What is the Tarasoff PrincipleANS== Duty to warn victim of imminent danger of homicidal patients...varies by state
What is the Rennie vs Klein Court case? "Rennie's Right to Refuse and appeal"ANS== An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications
What is the Donaldson vs. O'Connor court case? "You can't confine Donald"ANS== You cannot confine (commit a person involuntarily) who is not imminently dangerous to self or others
What are 4 key components of Strategic Therapy?ANS== Problem and Symptom focused Paradoxical directive/intervention (reverse psychology) when pt non-compliant
Straight forward directive- when pt compliant Reframe belief system
Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy?ANS== Solution-Focused therapy
Which therapy uses triangles/triangulation, and self-differentiation?ANS== Family Systems Therapy
The paradoxical directive, a technique to be used with caution, is used in which therapy?ANS== Strategic Therapy
Hierarchies, Boundaries, and Genograms are characteristics of what therapy?ANS== Structural Family Therapy
Genograms are used in which 2 family therapies?ANS== Family system therapy Structural therapy
What type of therapy should be performed when a patient presents with a cultural syndrome?ANS== Brief supportive therapy
What type of therapy should be used in a patient who has just lost their job?ANS== Brief supportive therapy
What is the most important concept in working with patients from different cultues?ANS== Respect
What should you teach a patient interested in meditation?ANS== muscle relaxation
Which ethnic group views mental illness as an imbalance between an individuals' relationship with world?ANS== Native American
Which ethnic group has the highest incidence of suicidal attempt and completion?ANS== Native American
A culturally expected response to a stressor is calledANS== Cultural Syndrome
How does the PMHNP perform health promotion education in a community setting with different ethnicitiesANS== provide multi-cultural teaching/education by using ethno- specific assessment parameters
If a patient is regularly taking Kava, what lab should you get?ANS== LFTs
Releasing information to a traditional healerANS== is okay after you get clearance for informed consent
