PMHNP Board Review (2022) Questions and answers, 100% Accurate, rated A+

PMHNP Board Review (2022) Questions and answers, 100% Accurate, rated A+ Positive Romberg Sign - -(r/t etoh) loss of balance that occurs when closing the eyes ETOH withdrawal delirium may result in? - -Seizures or death DSM Severity for ETOH - -Mild = 2-3 sx Moderate = 4-5 sx Severe = = 6 sx DSM ETOH Remission Criteria - -Early = 3 mos & 12 mos Substantial Remission = 12 mos Screening & Early Intervention scale for SUD - -SBIRT Screening, Brief Intervention & Refereal to Treatment CAGE - -Cut down Annoyed Guilty Eye-Opener =2 is clinically significant Labs for AUD - -ETOH/SUD Blood & urine BAC Ele. AST, ALT, MCV, CDT (Carb deficit transfer) Dec. Hgb, B12, folic acid ETOH W/D Sx - -Most common = tremors (w/i hours of cessation) Ele. b/p. tachy, n/v, poss. hyperthermia Sx of ETOH W/D Emergency - -Hallucinations = 7 - 48 hours DTs - 48 - 72 hours, peaks on 4th day, can last for 2 weeks CIWA - -Clinical Institute Withdrawal Assessment 0-8 Support &Monitoring w/o meds! (NO meds unless =8) 8-14 = Pharm Intervention 15 = IMMEDIATE Pharm Int! Disulfiram (Antabuse) Dosage for ETOH - -Usually 250 mg/day NO perfumes or mouthwash! Meds Used for ETOH W/D Sx including Seizures - -Benzos & Carbamazepine (Tegretol) Vitamin to be given during ETOH detox - -Thiamine 300 mg/day CRAFFT - -SUD screening tool for adolescents (12-21) COWS - -Clinical Opiate Withdrawal Scale 5-12 = mild 13-24 = moderate 25-36 = moderately severe 36 = severe withdrawal Meds used for Opiod Detox & Maintenance - -Buprenorphine (Suboxone) Naloxone (Naltrexone) Methadone Clonidine (use with care! may mask VS changes & inc. seizure risk!) Phenobarbital Cannabis W/D Symptoms Timeline - -Sx begin w/in 24 - 48 hours Peak 4 - 6 hours Duration 1 - 3 weeks Cannabis Treatment - -Motivational Enhancement Therapy (MET) Best Tx is MET + CBT + Contingency Management When to Start & Stop CIWA - -Start: Last ETOH w/i past 12 hours Hx of: w/d sx, large amt of etoh over long time Stop: When score is 10 after 3 consecutive assessments CIWA Measurement Guideline - -N/V Tremors Paroxysmal Sweats Anxiety Agitation Tactile, Auditory, Visual Disturbances H/As or "fullness in head" Orientation/Sensorium Neurological Factors of Addiction - -"Feel good" rewards by Dopamine Pathways Ele. Dopamine Ele. Glutamate Dec. GABA Neurobiological Factor of Addiction Withdrawl - -Significant decrease in dopamine levels Precautions w/Antabuse (disulfiram) - -May use 12 hours after last drink NO mouthwash/perfume Can elevate LFTs Can induce mania in pts w/ BP disorder MSE Findings: Stimulants - -Agitation, anxiety, irritability, mood swings, elevated mood MSE Findings: Opiods - -Mood swings, aggression, disinhibition, impaired cognition, slurred speech, slowed psychomotor MSE Findings: Hallucinogens - -Mood swings, hallucinations, paranoia, flashbacks, panic, impaired judgement MSE Findings: Cannabis - -Confusion, paranoia, panic MSE Findings: Inhalants - -Agitation, irritability, confusion, hallucinations Wernicke-Korsakoff - -Wernicke-Korsakoff syndrome (WKS) is a neurological disorder. Wernicke's encephalopathy and Korsakoff's psychosis are the acute and chronic phases, respectively More veterans die from (?) than combat? - -Suicide Lethal methods of suicide gender based - -Men = guns 60%; Women = overdose 40% Highest rate of suicide (gender, age, & race) - -White males 85 How often should you assess inpatients for suicide? - -Intermittent - q15min Constant visual One-to-one - within arms reach Incidence - -Frequency Prevalence - -Proportion Sensitivity - -True positives Specificity - -True negatives Treatment for Trichotillomania - -Behavioral therapy + SSRIs Reason for biopsy with Trichotillomania - -To R/O medical conditions Gambling Treatment - -12 step ?SSRIs, buspirone, mood stabilizers Cluster A Personalities - -Paranoid, Schizoid, Schizotypal Characteristics: Odd, eccentric, usually a loner, emotionally distant Cluster B Personalities - -Borderline, Narcissistic, Antisocial, Histrionic Characteristics: Dramatic, erratic, egocentric, lacks concern for others, lacks empathy, minimal conscience Cluster C Personalities - -Avoidant, Dependent, Obsessive-Compulsive Characteristics: Avoidant, anxious, fearful, preoccupied with rules or the reactions of others Apraxia - -inability to carry out motor activities (deficits may exist in motor, sensory, comprehension, or cooperation) Akathisia - -Excessive motor activity (ex: pacing, wringing hands, inability to sit still) Circumferential Thought - -The client goes through multiple related thoughts before arriving at the answer to the question Tangential Thought - -The client discusses related thought, but NEVER arrives at the answer to the question Egosyntonic - -Behaviors/Feelings that are in AGREEMENT WITH a client's ego Egodystonic - -Behaviors/Feelings that are AGAINST a client's ego Ataxia - -Impaired balance or coordination Diadochokinesia - -Ability to perform rapid alternating movements Dysdiadochokinesia - -Inability to perform rapid alternating movements Astereognosis - -Inability to discriminate between objects based on touch (result of parietal lesion) (SOFT SIGN) Choriform Movements - -Jerking or writhing movements (SOFT SIGN) Agraphesthesia - -Inability to recognize symbols, letters or numbers traced on the skin (SOFT SIGN) Stereognosis - -Ability to recognize an object by feel Alogia - -Poverty of speech (Negative Sx of Schizophrenia) Avolition - -Lack of motivation to begin or complete a task (Negative Sx of Schizophrenia) Hypnopompic - -Hallucinations upon WAKING Hypnagogic - -Hallucinations when GOING to SLEEP Adrenaline - -"Fight or Flight" Where is adrenaline produced? - -Adrenal Glands Catecholamine NTs - -Adrenaline Norepinephrine Dopamine Monoamine - Indole NT - -Serotonin Amino Acid NT - -GABA (universal inhibitory NT) Glutamate (universal excitatory NT) Cholinergic NT - -Acetylcholine Noradrenaline role - -Concentration - affects attention Dopamine role - -Pleasure Serotonin role - -Mood, affects well being and happiness GABA role - -Calming Glutamate role - -Memory and learning Most common NT - -Glutamate Acetylcholine role - -Learning, thought, & memory, involved in physical muscle action Where is acetylcholine synthesized? - -Basal nucleus of Meynert Acetylcholine receptors - -Nicotinic & Muscarinic Effects of Acetylcholine - -Increased heart rate, secretions, sweating, salivation, memory & muscle contractions Where is Dopamine produced - -Substantia Nigra & Ventral Tegmental Dopamine is removed from (?) by (?) - -Synaptic Cleft & MAO (monoamine oxidase) Dopamine Pathways - -Mesocortical Mesolimbic Nigrostriatal Tuberoinfundibular Effects of Dopamine - -Increased sense of well being & satiety Decreased hunger & cravings Effects of GABA - -Increased sleepiness Decreased anxiety, alertness, memory & muscle tension Effects of Glutamate - -Heightens perceptions (usually taste) Where is Norepinephrine produced? - -Locus Ceruleus of Pons Effects of Norepinephrine - -Increased heart rate, alertness & well-being Decreased pain sensitivity & circulation Where is Serotonin produced - -Raphe Nuclei of the Brain Stem Effects of Serotonin - -Increases well-being & satiety Decreases pain perception High Risk Factors of Suicide - -SI Plan w/details & means Hopelessness/Desperation Previous attempt Suicide of significant person in their life Mental Status Exam (MSE) - -"All Bad Subjects Are Tough Troubled Characters" Appearance Behavior Speech Affect Thought Content Thought Process Cognitive Exam Mini-Mental Status Exam (MMSE) - -ORAL 23 RWD Orientation to place & time Recognition (repeat 3 objects)/Recall (repeat 5 minutes later) Attention (Serial 7's backwards from 100) Language Identify 2 objects Follow 3-step command Reading (Read & Do "close your eyes) Writing (Write a sentence) Drawing (copy a design) MMSE Scoring - -0 - 7 = Severe Delirium/Dementia 18 - 23 = Mild Delirium/Dementia 24 - 30 = NO Cognitive Impairment Hallucinations - -Hear, feel, see, taste, smell Delusions - -Fixed belief that isn't real Illusions - -Something that is real that is believed to be something that it isn't St. Louis University Mental Status Exam (SLUMS) Scale - -0 - 20 = Dementia 21 - 26 = Mild Neurocognitive Dx 27 - 30 = WNL Patient Health Questionnaire (PHQ-9) (Depression) - -1 - 4 = Minimal Depression 5 - 9 = Mild Depression 10 - 14 = Moderate Depression 15 - 19 = Moderately Severe Depression 20 - 27 = Severe Depression Generalized Anxiety Disorder Screening Tool (GAD-7) - -5 - 9 = Mild Anxiety 10 - 14 = Moderate Anxiety