PMHNP certification Exam 2022(Actual test Already Passed)

PMHNP certification Exam 2022(Actual test Already Passed) Document Content and Description Below PMHNP certification Exam 2022(Actual test Already Passed) 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 wit h 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) Correct AnswerD. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors When interview teenagers (16 y/o) that arrive with their parents what should you do? Correct Answerinterview 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? Correct Answer-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 Correct Answer-D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? Correct Answer-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? Correct Answer-Lamictal -But remember all mood stabilizers cause some weight gainWhen presented with a question about typical vs atypical antipsychotic the answer is usually to start of a Correct Answer-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 Correct Answer-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? Correct Answer-Bring a support person like a husband Thyroid-Stimulating hormone normal level Correct Answer-0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis Correct Answer-HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance Correct Answer-Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis Correct Answer-(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance Correct Answer-Hypothyroidism Hyperthyroid can mimic Correct Answer-Mania Hypothyroid can mimic Correct Answer-DepressionA patient on depakote complains of RUQ pain and has reddish/brown urine Correct Answer-Hepatoxicity -Check LFTs Signs of Depakote toxicity Correct Answer-Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? Correct Answer-Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? Correct Answer-Kava Kava When taking Kava Kava in combinations with other medications you should caution about Correct AnswerRisk of Hepatoxicity and Sedation TCAs carry a risk of Correct Answer-Hepatotoxicity Signs of Stevens-Johnson Syndrome Correct Answer--fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome Correct Answer-lamictal and tegretol What nationality is most suseptible of getting steven johnson? Correct Answer-Asians When treating asians with tegretal screen for? Correct Answer-HLAB-1502 Allele What two medications cause agranulocytosis? Correct Answer-Clozaril & Tegretal Agranulocytosis when to discontinue medication Correct Answer-Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? Correct Answer-Infection -Fever, sore throat, fatigue, chillsBefore starting any mood stabilizer in a female of childbearing age be sure to check? Correct Answer-HCG Which two medications may decrease the risk of suicide? Correct Answer-clozaril and lithium Medications that increase lithium level Correct Answer-NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? Correct Answer-Heart Failure Certain medications are known to increase lithium level, but HOW? Correct Answer-by reducing renal clearance When educating a patient about lithium teach them about Correct Answer-Hyponatremia Dehydration-hot days, exercise Normal Lithium Level Correct Answer-0.6-1.2 Lithium Toxicity Correct Answer-1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 Correct Answer-Monitor for toxicity Labs before starting lithium Correct Answer-TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium Correct Answer-4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITYLithium side effects Correct Answer-hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity Signs of lithium toxicity Correct Answer-confusion, ataxia, GI upset, palpitation, tremor NMS Correct Answer-muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot Correct Answer-test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome Correct Answer-With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist). Treatment for NMS Correct Answer-Stop Offending Medication -Dantrolene (muscle relaxer) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer Treatment for Serotonin Syndrome Correct Answer-Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine Triptans Correct Answer-Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan Correct Answer--call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCPHow long do you wait when switching between an SSRI to an MAOI? Correct Answer-2 weeks How long do you wait when switching between Prozac and MAOI? Correct Answer-5-6 weeks wash out period What is the first line treatment for depression and why? Correct Answer-SSRI-First line treatment for depression due to less risk of injury from OVERDOSE If a cancer patient has depression what should you consider? Correct Answer-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? Correct Answer-Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose? Correct Answer-Wellbutrin Wellbutrin is contraindicated in patients with Correct Answer-Seizures and anorexia Which medications are best for neuropathic pain? Correct Answer-SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on antidepressants should assess for? Correct Answer-Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome Correct Answer-Those with short half lives such as zoloftSymptoms of serotonin withdrawal syndrome Correct Answer-Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers Ages of onset for schizophrenia in males vs females Correct Answer--MALES 18-25 years -FEMALE 25-35 years Schizophrenia increases the risk for Correct Answer-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 Correct Answer-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 Correct Answer-EVERYTHING DECREASES EXCEPT VENTRICLES -You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter? Correct Answer-Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) Correct Answer-a form of rehabilitation post hospitalization, in home treatmentWhat level of prevention is ACT? Correct Answer-Tertiary What adjunctive treatment is important in schizophrenia Correct Answer--social skills training -Exercise Exercise for mental health patients can promote Correct Answer-Cognition Quality of Life Long-term health ACT is ideal for patients with a history of Correct Answer-Treatment non-compliance -Think about making the treatment convenient for them--bringing it to their home What diagnosis has the highest risk of Homicidality Correct Answer-Antisocial In the MMSE how do you test for abstraction? Correct Answer-proverb interpretation (everyone that lives in glass houses shouldn't throw stones) Are they able to think abstractly Thought Process-Tangential Correct Answer-means that their response has nothing to do with the question Circumstantial Correct Answer-means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes Correct Answer-SI/HI/AH/VH Another name for MMSE Correct Answer-Folstein Scale How to assess concentration on MMSE Correct Answer-Serial 7s or perform an activity backwards i.e list the days of the week backwards Assess ability to learn new material Correct Answer-repeat 3 words after meAssess ability to recall Correct Answer-repeat 3 words after 5 minutes Assess fund of knowledge Correct Answer-Who is the president What is a quick and easy way to assess for neurological issues Correct Answer-Clock drawing test If patient is unable to draw a clock this indicates Correct Answer-Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway Correct Answer-Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway Correct Answer--Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia Nigrostriatal Pathway Correct Answer--This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter Correct Answer--Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to Correct Answer-tardrive dyskinesia Tuberoinfundibular pathway Correct Answer--Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia-DECREASE DOPAMINE INCREASED PROLACTIN Long-term hyperprolactinemia can be associated with what condition Correct Answer-osteoporosis Normal Prolactin Level in Men Correct Answer-level less than 20ng/ml Normal Prolactin Level in Women Correct Answer-less than 25ng/ml Which medication is the highest offender for increasing prolactin Correct Answer-Risperdal Acute Dystonia + Treatment Correct Answer-neck stiffness, muscle spasm of upper body especially neck/face/tongue -Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment Correct Answer-may mimic anxiety, restlessness, can't sit still, rocking, pacing -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos Beta-Blockers such as Inderal are contraindicated with what type of asthma medication Correct Answer-- DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment Correct Answer-A. difficulty initiating movement; slowness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment Correct Answer-caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing-Treatment COGENTIN tardive dyskinesia + Treatment Correct Answer-abnormal facial movements, grinding teeth, lip smacking, protruding tongue -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT Does Cogentin Treat TD Correct Answer-COGENTIN MAKES TD WORSE Typical onset of TD Correct Answer-OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO What non-psych med can cause TD? Correct Answer-REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops InDucers CYP450 Correct Answer-DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylureas Crap GPS Induces me to Madness! InhIbitors of CYP450 Correct Answer-INCREASE CiprofloxacinRitonavir Amiodarone Cimetidine Ketoconazole Acute Etoh Macrolides INH Grapefruit Juice Omeprazole Crack Amigos Erythromycin and Clarithromycin can cause Correct Answer-Increased tegretol levels Patient started on Clozaril or Zyprexa and two months later starts smoking Correct Answer-as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey Correct Answer-as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania Correct Answer-Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patie