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PMHNP TEST LMR ACTUAL EXAM
350 QUESTIONS WITH VERIFIED
ANSWERS ALREADY GRADED A+
LATEST VERSION
"Bulimia presentation= - CORRECT ANSWER=> Weight usually within normal range (different from anorexia), Erosion of dental enamel, Russell's sign (calluses on hands), Hypertrophy of salivary glands, Rectal prolapse" "Bulimia TX - CORRECT ANSWER=> Fluoxetine is FDA-approved for bulimia nervosa, SSRIs and tricyclic antidepressants (TCAs) effective in reducing the frequency of binging and purging" "Anorexia Nervosa S/S - CORRECT ANSWER=> Low body mass index, Amenorrhea, Emaciation, Bradycardia, Hypotension, Electrocardiogram (ECG) changes (Inversion of T-waves, ST segment depression, Prolonged QT interval), Hypertrophy of the salivary glands, Russell's sign" "Anorexia TX - CORRECT ANSWER=> CBT (if medically stable, if not then send to hospital)" "Bupropion uses - CORRECT ANSWER=> NDRI used with depression with low energy/fatigue" "Bupropion do not use - CORRECT ANSWER=> Contraindicated with bulimia or seizures, increased risk for sz" "SNRI is goof for - CORRECT ANSWER=> depression with chronic neuropathic pain" "Enzyme inducers - CORRECT ANSWER=> can decrease the serum level of other drugs (tobacco is inducer of 1A2 will cause decreased med levels)" "Enzyme inhibitors can - CORRECT ANSWER=> increase the serum level of other drugs" "how does Liver disease affect medication - CORRECT ANSWER=> will affect liver enzyme activity and first-pass metabolism, possibly resulting in toxic plasma drug levels."
"Kidney disease or drugs that reduce renal clearance, such as nonsteroidal anti-inflammatory drugs (NSAIDs, HCTZ and ACE inhibitors) does what to medication - CORRECT ANSWER=> may increase serum concentration of drugs that are excreted by the kidneys (such as lithium)." "Older adults are more sensitive to - CORRECT ANSWER=> psychotropics because of their decreased intracellular water, protein binding, low muscle mass, decreased metabolism, and increased body fat concentration." "Clozapine smoking - CORRECT ANSWER=> and CYP450 1A2 (smoking induces), smoking causes lower serum levels" "what happens with a CYP inhibitor and inducer - CORRECT ANSWER=> Inhibitor takes preference if taking both (Tegretol and erythromycin, Tegretol inducer, eryth inhibitor, may need to decrease tegretol)" "Lithium levels can increase with what medications - CORRECT ANSWER=> - NSAID, thiazide diuretics, ACE inhibitors increase lithium level" "Older adults more sensitive to psychotropic meds because - CORRECT ANSWER=> • Decreased intracellular H2O
- Decreased protein binding
- Increased body fat concentration (only increase)
- Decreased muscle mass" "Dopamine: produced in the - CORRECT ANSWER=> substantia nigra, ventral tegmental area and nucleus accumbens" "Norepinephrine produced in - CORRECT ANSWER=> locus ceruleus and medullary reticular formation" "Serotonin produced in - CORRECT ANSWER=> raphe nuclei of brainstem" "Acetylcholine made in the - CORRECT ANSWER=> basal nucleus of meynert" "Serotonin controls - CORRECT ANSWER=> sleep and mood" "Decreased GABA causes - CORRECT ANSWER=> with anxiety"
"D2 Nigrostriatal pathway responsible for - CORRECT ANSWER=> motor movements (D2 blockade increases acetylcholine levels, responsible for EPS, acute dystonia, parkinsonism, akathisia) Long standing D2 blockade can lead to TD (Reglan can also cause TD)" "D2 Tuberofundibular path involved in - CORRECT ANSWER=> D2 blockade increases prolactin, causing amenorrhea, galactorrhea, gynecomastia, and sexual dysfunction. Long term hyperprolactinemia associated with osteoporosis." "Normal Prolactin levels - CORRECT ANSWER=> men <20, women <25" "EPS results from what neurotransmitter changes - CORRECT ANSWER=> when dopamine decreased and acetylcholine increased" "Acute dystonia - CORRECT ANSWER=> muscle spasm of face, neck, and tongue, painful grimace
- Occulogyric crisis (acute dystonic reaction) prolonged upward look (stuck) bilateral eyes" "Acute dystonia TX - CORRECT ANSWER=> Stop agent
- Give benztropine" "Akathisia - CORRECT ANSWER=> • Restless, pacing, difficulty sitting still
- Commonly used rating scales: Barnes Akathisia Rating Scale and Extrapyramidal Symptoms Rating Scale
- Give beta-blocker, cogentin, or benzo" "Akinesia - CORRECT ANSWER=> absence of movement, lack of motivation (TX: cogentin)" "Pseudoparkinsonism - CORRECT ANSWER=> shuffled gait, pill rolling, mask like facial expression (confused, blunting, flattening)" "Tardive Dyskinesia - CORRECT ANSWER=> tongue rolling, smacking chewing
- Stop or decrease dose of offending medication
- Change to clozapine (may tx s/s of TD)
- Cogentin can worsen symptoms of TD
- TD can take 1-2 years to occur, or can be acute during medication initiation
- Reglan can cause TD" "Fetal Alcohol Syndrome - CORRECT ANSWER=> • Signs: low birth weight and height, microphthalmia, short palpebral fissure,
midface hypoplasia, smooth or short philtrum, thin upper lip
- Most structures underdeveloped" "Remember that citalopram causes - CORRECT ANSWER=> QT prolongation, esp in elderly, do not dose over 40mg" "Pharmacokinetics - CORRECT ANSWER=> Study of what the body does to drugs; includes absorption, distribution, metabolism, and excretion" "Pharmacodynamics - CORRECT ANSWER=> Study of what drugs do to the body; target sites for drug actions include receptors, ion channels, enzymes, and carrier proteins" "meds that cause Mania - CORRECT ANSWER=> steroids, antabuse, INH, antidepressant in persons with bipolar" "meds that cause Depression - CORRECT ANSWER=> steroids, beta blockers, interferon, accutane, some retroviral drugs, antineoplastic drugs, benzos, progesterone
- Note: steroids can cause psychosis" "accutane can cause - CORRECT ANSWER=> birth defects" "Fragile X Syndrome - CORRECT ANSWER=> • large, long head and ears, short stature, hyperextensive joints, large testes" "NMS labs - CORRECT ANSWER=> Elevated CPK (creatine phosphokinase, from muscle contraction/destruction), Elevated WBCs (white blood cell count), Elevated LFTs (liver function tests), myoglobinuria (think rhabdo)" "NMS Assess for symptoms known to occur first - CORRECT ANSWER=> Altered sensorium, Hyperthermia, Hyperreflexia, extreme muscle rigidity
- Assess for symptoms of autonomic instability: Hypotension, Extreme muscular rigidity, Hyperthermia, Tachycardia, Diaphoresis, Tachypnea, Coma and potentially death, mutism" "NMS TX - CORRECT ANSWER=> d/c antipsychotics, dantrolene (muscle relaxant for rigidity), bromocriptine (D2 agonist)" "Meds that cause NMS - CORRECT ANSWER=> antipsychotic"
"MSE Cognition - CORRECT ANSWER=> - abstraction (proverb interpretation, can they interpret common proverbs?) -MSE Serial 7's or backwards from 100 tests=- concentration/attention/calculation" "MSE Year, month, date tests - CORRECT ANSWER=> - orientation" "MSE Bed, bad, ball tests - CORRECT ANSWER=> - registration/ability to learn new material" "MSE Ask to recall items above after 5 min tests - CORRECT ANSWER=> - recall/memory" "MSE Who is president tests - CORRECT ANSWER=> - fund of knowledge" "Tools for Assessing cognitive impairment - CORRECT ANSWER=> • Moca, mini-cog, SLUMS" "Risk Factors for Suicide - CORRECT ANSWER=> • Ages 45 or older if male
- Ages 55 or older if female
- Divorced, single, or separated
- White
- Living alone
- Psychiatric disorder
- Physical illness
- Substance abuse
- Previous suicide attempt
- Family history of suicide
- Recent loss
- Male gender
- When comparing, count risk factors, when one person, previous suicide attempts" "CIWA-AR symptoms measures - CORRECT ANSWER=> N/V, tremor, sweating, anxiety, agitation, tactile disturbance, auditory disturbance, HA, orientation" "CIWA Score 8 or above - CORRECT ANSWER=> PRN eg. (clonidine)" "CIWA Score 15 or above - CORRECT ANSWER=> scheduled med" "ETOH withdrawl With liver disease, give - CORRECT ANSWER=> ativan due to short half-life"
"FDA approved alcohol use disorder meds - CORRECT ANSWER=> • Acamprosate (not metabolized by liver), disulfiram, and naltrexone" "Antabuse may potentially induce - CORRECT ANSWER=> mania in people with BP disorder." "Signs/symptoms of alcohol withdrawal - CORRECT ANSWER=> CIWA assesses: Nausea and vomiting, Tremors, Paroxysmal sweats, Anxiety, Agitation, Tactile disturbances, Auditory disturbances, Visual disturbances, Headaches, Altered sensorium" "Use COWS scale for - CORRECT ANSWER=> opiate withdrawal" "Cows Components - CORRECT ANSWER=> pulse, sweating, restlessness, pupil size, bone aches, runny nose, tearing, GI upset, yawning tremors, anxiety/irritability, gooseflesh skin. Dilated pupils (not pinpoint as seen in intoxication)" "Signs/symptoms of opiate withdrawal - CORRECT ANSWER=> • Yawning
- Anxiety
- Pupil dilation (pinpoint pupils with intoxication)
- NVD
- piloerection" "SBIRT - CORRECT ANSWER=> SCreening brief intervention referral for treatment
- Screen for substance use disorder" "Delirium - CORRECT ANSWER=> • Acute onset
- Altered LOC
- Inattention
- Changes in cognition/concentration
- Poor prognosis
- Management (pg 276) Haldol then atypicals. Don't give benzos since they prolong delirium
- UTI's in older females can cause delirium" "Dementia - CORRECT ANSWER=> • Slow progressive onset, chronic mental decline, can lead to personality changes and irritability
- gradual development of multiple cognitive deficits: Impaired executive functioning, Impaired global intellect with preservation of level of consciousness, Impaired problem-solving, Impaired organizational skills
- Cortical affects language and memory
- Disorganized
- Avoids attention requiring tasks
- Loses things
- Distractible
- Forgetful" "ADHD Hyperactive/impulsive - CORRECT ANSWER=> • Fidget
- Leaves seat
- runs/climbs
- Cant do quite time
- "On the go"
- Hyperverbal
- Blurts out answers
- Cant wait their turn
- Interrupts others" "ADHD brain - CORRECT ANSWER=> Neurotransmitters- DOPAMINE AND NOREPI and serotonin Fronto-subcortical path
- frontal cortex
- Basal ganglia
- Abnormal reticular activating system Inattentive symptoms in prefrontal cortex Executive function and attention in dorsolateral PFC" "ADHD meds - CORRECT ANSWER=> 1st line AMPHETAMINES age 3+ Methylphenidate 6+ Nonstimulants Guanfacine, clonidine (6" "Signs of stimulant abuse/withdrawal - CORRECT ANSWER=> agitation, anxiety, irritability, mood swings, elevated mood, insomnia, tremors" "Non-med TX for ADHD - CORRECT ANSWER=> • Behavioral therapy
- Pt and parent CBT
- Psycheducation
- Treat learning D/O
- Family therapy/education Monitor Progress overtime, and growth and development Scales-
Conners-copyrighted Vanderbult-free" "Borderline PD - CORRECT ANSWER=> BLACK AND WHITE RELATIONSHIPS, people are all good or all bad
- Impulsivity and self damaging behavior
- Recurrent SI/and self harm
- Frantic Efforts to avoid real or imagined abandonment
- Pattern of intense unstable relationships
- Identity disturbance
- Chronic feelings of emptiness
- Inappropriate intense affect (anger/sadness)
- May have transient psychosis (paranoia/ dissociation)" "Borderline TX - CORRECT ANSWER=> DBT (Linehan). If depressed mood/emotional lability can give Depakote. no meds approved, treat affective and impulsive symptoms as needed" "DMDD - CORRECT ANSWER=> BP presentation but in Kids 6-18 (prebipolar) Childhood depressive disorder
- Moody
- Temper tantrums
- Irritability
- anger" "DMDD TX - CORRECT ANSWER=> -tx symptoms, SSRI, mood stabilizers, antipsychotics, possible stimulants Individual, group and family therapy" "Risk factors for SI (Pt with more risk factors is at higher risk) - CORRECT ANSWER=> • M 45
- F 55
- Divorced/ single/ separated
- White
- Lives alone
- Psych D/O
- Physical illness
- Substance abuse
- Previous attempt
- Fam HX of suicide
• HA
- Slow and clumsy" "Hyperthyroid- can mimic - CORRECT ANSWER=> mania" "hyperthyroid symptoms - CORRECT ANSWER=> • Sensitive to heat
- Irritability
- Agitation
- Restless
- Emotional lability" "Lab finding in ETOH abuse - CORRECT ANSWER=> Normal AST 5-40, normal ALT 5-35, with damage, ALT can be up to 50x
- AST/ALT ratio >2" "ETOH abuse labs Elevated - CORRECT ANSWER=> glutamyltransferase, mean corpuscular volume, prothrombin time, uric acid, total cholesterol, and triglycerides" "ETOH labs Decreased - CORRECT ANSWER=> magnesium, calcium, potassium, blood urea nitrogen, hemoglobin, hematocrit, platelet count and albumin" "ODD - CORRECT ANSWER=> lasting more than 6 months, 4 symptoms
- angry/ irritable
- Defiant vindictive
- Bad temper
- Easily annoyed
- Resentful
- Argues
- Defies authority
- Blames others
- Deliberately annoys others
- Spiteful
- NO aggression"
"ODD TX - CORRECT ANSWER=> - no meds approved, treat symptoms PRN Therapy- family, parenting skills, positive reinforcement, boundary setting EBP TX- child and parent problem solving skills training
- ATP (adolescent transition program)- (individual/family/group)
- Parent child interaction (individual/family)
- Incredible years (group)" "Conduct D/O - CORRECT ANSWER=> - more severe than ODD, precursor to AS PD, present for 12 months COMMON in children of parents with ASPD, substance abuse, BP, Schizophrenias
- Violates rights of others or social norms/ rules
- AGGRESSION to people or animals
- Bullys, threatens others
- May use weapons
- Harms others
- Destroys property
- deceit/ theft
- NO REMORSE" "Conduct DO TX - CORRECT ANSWER=> - no specific meds, treat symptoms, antipsychotics and mood stabilizers, SSRI's, alpha agonists (clonidine/ guanfacine) (target mood and aggression) TX- Behavior therapy- individual and family, and multimodality treatment programs" "Conversion D/O - CORRECT ANSWER=> • Mental condition with neuro symptoms not explained by medical state
- Eg- blindness, paralysis
- Occurs after an identifiable stressor, eg death of loved one TX- Therapy" "Adjustment D/O - CORRECT ANSWER=> within 3 months of identifiable stressor (pg 170
- Unable to adjust to change in life within 3 months of it happening
- If can identify stressor that precipitated depressive symptoms then likely adjustment disorder versus MDD
- Mixed disturbance of emotions and conduct are common in children (sx: crying, insomnia, peer conflict)
- Identifiable stressor
- Emotional or behavioral response to stressor"
"Tourette's TX - CORRECT ANSWER=> atypical antipsychotics. FDA: Haldol, Pimozide, Abilify. clonidine and guanfacine for behavior, antidepressants such as Fluoxetine can control sadness, anxiety or OCD" "Variance - CORRECT ANSWER=> an event that alters PT progress towards outcomes Eg- provider behavior/ competency, severity of illness, or practice patterns" "Schizophrenia age male - CORRECT ANSWER=> Age 18-25 in M" "schizophrenia age in females - CORRECT ANSWER=> 25-35 in F, more common in MEN" "Schizophrenia has increased risk of - CORRECT ANSWER=> Increased thoughts of self harm" "Amygdala - CORRECT ANSWER=> fear, anxiety, aggression, emotion" "Hippocampus - CORRECT ANSWER=> memory, stress, emotion, learning" "Mesolimbic path - CORRECT ANSWER=> Positive symptoms- caused by increased D in this area" "Mesocortical path - CORRECT ANSWER=> Negative symptoms caused by decreased D in this area" "Nigrostriatal - CORRECT ANSWER=> decreased D from meds causes EPS, DIP, TD" "Tuberoinfundibular - CORRECT ANSWER=> decreased dopamine from meds= increased prolactin" "Brain structure in schizophrenia - CORRECT ANSWER=> • Key point- EVERYTHING DECREASES in size except
- The ventricles INCREASE" "Schizophrenia NT - CORRECT ANSWER=> Dopamine paths involvement and
- Excess glutamate
- Decreased GABA
- Decreased Serotonin"
"antipsychotic Monitoring - CORRECT ANSWER=> • Glucose, lipid panel, wt, BMI, waist to hip ratio
- ASSESS for METABOLIC SYNDROME when on meds
- Monitor movement AIMS Q 6months" "schizophrenia TX - CORRECT ANSWER=> Meds primary TX, most require lifelong TX
- 1st line atypical antipsychotics D2 and 5HT2A blockade
- Not recommended to give stimulants since it will potentiate DA which is already high in schizophrenia" "schizophrenia NON-meds - CORRECT ANSWER=> • Individual therapy- supportive
- Group therapy- problem solving
- Crisis management
- ACT (assertive community training) team- case management
- Social skills training (tertiary level of prevention)
- Aerobic exercise: increases cognition, quality of life, long term health
- Client and family education" "Switching from oral Haldol to IM - CORRECT ANSWER=> never want to give more than 100mg IM at one time. Use 20x the daily oral dose to equal the IM dose for the first month. (picture)" "Aripiprazole least - CORRECT ANSWER=> sedating" "Lowest WT gain, generally WT neutral antipsychotics - CORRECT ANSWER=> o Ziprasidone o Lurasidone o Aripiprazole" "Stage1: Trust vs mistrust - CORRECT ANSWER=> (birth -1. Infancy) Ability to form meaningful relationships, hope" "Unfavorable outcome: suspicion, fear of the future, poor relationships - CORRECT ANSWER=> trust vs mistrust" "Stage 2: Autonomy vs shame/doubt - CORRECT ANSWER=> (1-3. Early childhood) Self control, self esteem, willpower, sense of adequacy" "Unfavorable outcome: feelings of shame/doubt, poor self control, low self esteem, lack independence - CORRECT ANSWER=> Autonomy vs shame/doubt"
"Unfavorable outcome: dissatisfaction with life, despair over impending death, bitterness - CORRECT ANSWER=> Integrity vs despair" "(0-2) Object permanency and object constancy. Permanence - objects exist even though they can't be seen or heard (peek-a-boo) Constance - trust that the bond with those close to us will remain even if they aren't around (separation anxiety) - CORRECT ANSWER=> Sensorimotor:" "(2-7) Uses magical thinking, symbols to represent objects but does not reason logically. Ability to pretend. - CORRECT ANSWER=> Preoperational:" "(7-11) conservation and reversibility. Can think logically about concrete objects. Reversibility - one thing can turn into another and back again (water and ice) Conservation - although shape of object may change, it will still maintain its characteristics (clay)
- CORRECT ANSWER=> Concrete operational" "(11-adult) able to use logic, test a hypothesis (science project), abstract thinking (algebra) - CORRECT ANSWER=> Formal operational:" "Oral stage: - CORRECT ANSWER=> (birth - 1) sucking, chewing, feeding, crying Disorder linked to failed stage: schizophrenia, substance abuse, paranoia" "Anal stage: - CORRECT ANSWER=> (1-3) sphincter control, acitivites of expulsion and retention Disorders: depressive" "Phallic: - CORRECT ANSWER=> (3-6) exhibition, masturbation, Oedipal complex, erogenous zones/genitals (normal behavior to play with genitals in this phase) Disorders: sexual idendity disorders" "Latent: - CORRECT ANSWER=> (6-puberty) peer relationships with same sex, learning, motor development, socialization Disorder: inability to form social relationships" "Genital: - CORRECT ANSWER=> (puberty forward) attracted to opposite sex, primary genital based sexuality Disorders: sexual perversion disorder" "Motivational interviewing - CORRECT ANSWER=> • Focused goal directed therapy
- Builds on transtheoretical model of change
- Motivation elicited from client
- Non confrontational
- Ask open ended questions
- Listen with patient centered empathetic approach
- Empower patient. Patient is in control of his actions and changes
- Affirmation of patients positive traits
- Reflective listening technique" "Precontemplation: - CORRECT ANSWER=> no intention to change, not aware behavior is a problem Action: don't tell people what to do. Provide info to raise awareness" "Contemplation: - CORRECT ANSWER=> know behavior is a problem but doesn't want to change Action: Help the person see the benefits of changing and the consequences of not changing" "Preparation: - CORRECT ANSWER=> made a decision to change, ready for action. Action: help find change strategy that is realistic, acceptable, accessible, appropriate, effective" "Action: - CORRECT ANSWER=> engaging in specific action to change Action: support and be an advocate. Help accomplish steps for change" "Maintenance: - CORRECT ANSWER=> engaging in behaviors to help relapse Action: help identify the possibility of relapse and identify and use strategies to prevent relapse" "Relapse: - CORRECT ANSWER=> revert back to old ways. Action: help the person holistically look at the situation" "Cognitive therapy - CORRECT ANSWER=> • Aaron Beck
- External events don't cause anxiety. Person's expectation, perceptions, and interpretation of events is what causes the anxiety
- Goal is to change the client's irrational beliefs (negative thoughts) to positive, faulty conceptions, and cognitive distortions" "Behavioral therapy - CORRECT ANSWER=> • Focus on changing maladaptive behavior by participating in active behavioral techniques such as exposure, relaxation, skills training, problem solving, role playing and modeling."
