PMHNP Certification Exam with complete solution 2023

PMHNP Certification Exam with complete solution 2023. FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty things • This is NORMAL for children this age. 4. What do you do when a patient has an increased prolactin level?: • Stop prolactin (stop the agent that cause increase prolactin) 5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP to ONE MONTH - Less than 1 month. • If LONGER than 1 month = PTSD - Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder 6. What would you do if a 5-year-old tells you his brother sodomized him?: • Tell mom don't leave him alone with patient and call CPS implement crisis 7. If a child is playing with doll in a sexual way, what do you do first?: • You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you have to have something (assessment data) to report - Assess = FIRST 8. If a 13-year-old tells you he want to smoke, what would be an appropriate response?: • Ask him of his plan to stop smoking 9. If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect?: • Cranial nerve V-Trigeminal nerve (FIVE) 10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis 11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7 12. What cranial nerves do you assess for papillary reaction to light and accommodation?: Nerves 3,4,& 6 13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular movements?: Nerves 3, 4, & 6 2 / 57 14. What cranial nerves do you assess for corneal light reflex?: 3, 4, & 6 15. Cranial Nerve 1: Olfactory (smell) 16. Cranial Nerve 2: Optic - vision 17. Cranial Nerve 3: Oculomotor (eye movement): The occulomotor nerve is responsible for motor enervation of upper eyelid muscle, extraocular muscle and pupillary muscle. 18. Cranial Nerve 4: Trochlear (eye movement): The trochlear nerve controls an extraocular muscle. 19. Cranial Nerve 5: Trigeminal: The trigeminal nerve is responsible for sensory enervation of the face and motor enervation to muscles of mastication (chewing). 20. Cranial Nerve 6: Abducens (motor): The abducent nerve enervates a muscle, which moves the eyeball. 21. Cranial Nerve 7: Facial nerve: The facial nerve enervates the muscles of the face (facial expression). 22. Cranial Nerve 8: Vestibulocochlear (hearing and balance): The vestibulocochlear nerve is responsible for the sense of hearing and balance (body position sense). 23. Cranial Nerve 9: Glossopharyngeal: The glossopharyngeal nerve enervates muscles involved in swallowing and taste. Lesions of the ninth nerve result in difficulty swallowing and disturbance of taste. 24. Cranial Nerve 10: vagus nerve: The vagus nerve enervates the gut (gastrointestinal tract), heart and larynx. 25. Cranial Nerve 11: accessory: The accessory nerve enervates the sternocleidomastoid muscles and the trapezius muscles. 26. Cranial Nerve 12: Hypoglossal (tongue movement): The hypoglossal nerve enervates the muscles of the tongue. 27. What is the best action for a 16 y/o with conduct disorder that refuses tx?: • Send to psych specialist for acting out kids - Referrals - Have to see if you aregoing to refer the same patient to the same provider - Cannot refer the patient to another provider that is the same as you (ie psych) - you must refer to a neurologist or another specialist or PCP 28. What is a priority consideration for a 16-year-old that shows up with mother for first therapy?: • Confidentiality (ex. mom sits in lobby) 3 / 57 29. What is important to know about ACE inhibitors (Meds for Heart failure/HTN): • This medication can cause increased lithium levels to toxic levels - must collaborate with PCP to determine whether to change ACE or change Lithium - Can't use both 30. What medication INCREASES Lithium serum level up to double: Ibuprofen 31. Why is Lithium used?: • First-line neuro-protective for bipolar 32. • Lab Values concerning for patient on Lithium:: • Leukocytosis • Creatinine • BUN • NA+ • 4 + PORTEIN in Urine • + Pregnancy Test 33. • Lithium (Eskalith/Lithobid) Toxicity: • Normal Range of LITHIUM LEVEL - 0.5 - 1.2 mEq/L • MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l • Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic taste and SEVERE tremor. 34. Common side effects of Lithium (Eskalith/Lithobid): Nausea, fine-hand tremors (start monitoring for toxicity), increased urination and thirst 35. What pregnancy category is Lithium (Eskalith/Lithobid): CATEGORY D: AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect 36. What increases risk of lithium (Eskalith/Lithobid) toxicity?: NSAID, dehydration and Thiazides 37. What co-morbid risk in increased with Lithium (Eskalith/Lithobid)?: • Risk of Hypothyroidism 38. What do symptoms of hypothyroidism (decreased T4 & increased TSH) mimic?: Unipolar mood disorders: - confusion - decreased libido - impotence - decreased apetite - memory loss - lethargy - constipation - headaches 4 / 57 - slow or clumsy movements - syncope - weight gain - fluid retention - muscle aches and stiffness - slowed reflexes - somatic discomfort including aching and joint stiffness - slowed speech and thinking - sensory disturbances including hearing - cerebellar ataxia (may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements) - loss of amplitude in ECG 39. What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic?: Bipolar affective disorders - motor restlessness - emotional lability - short attention span - compulsive movements - fatigue - tremor - insomnia - impotence - weight loss - increased appetite - abdominal pain - excessive sweating - flushing - elevated upper eyelid leading to decreased blinking, starring, and fine tremor - tachycardia - dysrhythmias 40. What does ADPIE stand for?: • Assessment • Diagnosis • Planning • Implementation • Evaluation 41. Recommend CBT for: Depression & Anxiety (keep a daily log) 42. pg 209 and every PB pages for each dx: all thing for each disorder 43. What medication is best for an aggressive patient?: IM Geodon 5 / 57 44. Medications to improve anxiety...: act directly or indirectly on GABA system - SSRIs - Benzodiazepines - Tricyclics (TCA) - Buspirone - Tiagabine (Gabitril) - gabapentin - propranolol in children: - alpha agonists : clonidine (catapres) & guanfacine (tenex) 45. advantages of Benzodiazepines with short have lives: - less daytime sedation - less drug accumulation - quick onset - useful for tx of insomnia 46. disadvantages of Benzodiazepines with short have lives: increase risk of addiction 47. non-pharmacological Management for anxiety: - behavioral therapy - CBT - interpersonal therapies - community self help groups - alternate therapies as adjunct tx 48. SSRI's: - first line tx for anxiety - act on serotonin and indirectly on GABA - takes 3-4 weeks to reach symptom control - black box warning for kids is SI 49. Agoraphobia treatment: • BZs: Short term symptom relief • SSRIs: long term maintenance • Fluoxetine (Prozac) • Paroxetine (Paxil) • Sertraline (Zoloft) • SNRIs: long term maintenance • Venlafaxine (Effexor) TCAs: long term maintenance PMHNP Certification Exam with complete solution 6 / 57 • Beta blockers (off-label use) used for discrete episodes of social anxiety - contraindicated for clients with asthma 50. Alprostadil (PGE1): • Ductal-dependent Congenital Heart disease (all forms) • Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction. • 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO 51. Amygdala: • A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression 52. Anorexia nervosa: • Anorexia (SAFETY = KEY) • BMI less than 18.5 • BMI < 16 = AUTOMATIC ADMISSION • An eating disorder in which an irrational fear of weight gain leads people to starve themselves • Anorexia admission criteria for hospitalization - Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L). • Set up family therapy (especially adolescent pts since they have no control over food choices) 53. • ANOVA (analysis of variance): • 3 or more • An inferential statistical test for comparing the means of three or more groups 54. PROZAC Causes What?: • Increase Anxiety in Elderly 55. • Apoptosis: • Cell death in aging/elderly 56. • Appreciative inquiry: • An organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work • An organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements PMHNP Certification Exam with complete solution 7 / 57 • Discovery (best of what is) • Dream (wishes or dreams of organization) • Design (decide what you want to change) • Destiny (make it happen, implanting change) • Identify the problem • Analyze the problem • Generate solutions • Implement best solution 57. • Assertive Community Treatment (ACT): • Community-based programs that provide many of the services that are necessary for successful community living; include case management, problem solving, social skills training, support teaching on a 24/7 basis 58. • Assertive questions: • Use "I want", "I need", or "I feel" to convey basic assertions and get your point across firmly. For example "I feel strongly that we need to bring in a third party to medicate this disagreement" another example "Dave, your request has caught me off guard. I'll get back to you within the half hour". 59. Transtheoretical Model of Change: • States that change such as in health behaviors occurs in six predictable stages • Precontemplation: The person has no intention to change. • Contemplation: The person is thinking about changing; is aware that there is a problem but not committed to changing. • Preparation: The person has made the decision to change; is ready for action. • Action: The person is engaging in specific, overt actions to change. • Maintenance: The person is engaging in behaviors to prevent relapse. 60. erectile dysfunction medications: • Avanafil (Stendra) 15 minutes prior to sex • Tadalafil (Cialis) 45 minutes prior to sex • Vardenafil (Levitra) 45 minutes prior to sex • Sildenafil (Viagra) 1 hour prior to sex - brand-name version of the generic drug. It is a phosphodiesterase type 5 (PDE5) inhibitor. 61. • Beck depression inventory: • A questionnaire useful for determining the level of depression • 0-13 minimal depression • 14-19 mild depression PMHNP Certification Exam with complete solution 8 / 57 • 19-29 Moderate depression • 30-63 severe depression Intimate therapy for child with a score 10 62. Big Freaking Problems: • Bupropion Fluoxetine Paxil • Those are strong inhibitors of 2D6 63. • Borderline personality disorder treatment: • Dialectical behavior therapy 64. If a boy patient states that he wishes to be a girl and tells you not to tell his parent, what do you do?: Don't tell 65. If you see a bruise on the padded part of patient's arm, what do you do?: • Say I see you have bruises on your arm • Ask what happened 66. • Can an advanced directive ever be revoked?: • Yes, at any time 67. Can asthma medications cause depression?: • Yes • Examples: INTERFERON 68. • Can you take Buspar during pregnancy?: • Category B: OK if really needed 69. • Can you take Klonopin during pregnancy?: • Category C: Avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms • Floppy baby 70. • Carb and Barb (Carbamazepine and Phenobarbital): • Strong inducers of 3A4 • Decrease INR 71. • Change agent: • The person formally in charge of guiding a change effort • Administrator - Usually the person on top in the facility is responsible for being the change agent. 72. • Charge of DEA: • State and federal 73. A child in foster home 5 years poor eye contact, isolated self, eat without difficulty.. what is dx: autism 74. A child in foster home since birth, eats without interest, shows little emotion.. what is dx?: REACTIVE ATTACHMENT DISORDER = Look for NO Emotion 75. • Child reports Sexual abuse: • Interview the young child and infants with parent PMHNP Certification Exam with complete solution 9 / 57 76. TRICYCLIC ANTIDEPRESSANTS (TCAs): Not commonly used due to side effects and overdose toxicity risk; however, TCAs should be considered for appropriate patients who do not respond to other antidepressants. There are nine TCAs approved by the FDA for depression (amitriptyline, amoxapine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine), and one approved for OCD - clomipramine (Anafranil). Tertiary TCAs (more sedating): Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg. Secondary TCAs (less sedating): Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5 mL oral solution. Side Effects: Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision. Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT prolongation, AV block. 77. Clozaril (Clozapine): • DC Clozapine at - ANC < 1000 - WBC ANC & WBC WEEKLY for 6 months: • When a patient is on Clozapine monitor for signs for agranulocytosis such as: • Sores in the mouth, throat, • Chronic infections of the gums, throat, or skin, • Fever • Chills 78. • Co-morbidities of bipolar: • Anxiety, alcohol and substance abuse 79. • Inducer; Pushes the substrate out of the exit pathways, < the serum level of other drugs, < therapeutic effect.: I'll Come See Pumpkin Pie Tomorrow or Monday And Chow PMHNP Certification Exam with complete solution 10 / 57 • Carbamazepine/Oxcarba (1A2, 2C19 and 3A4) • St. John's Wart (3A4) • Phenytoin • Phenobarbital • Tobacco (1A2) • OCP (1A4) (watch with use of Topamax/Tegretol) • Methadone (1A2) • Antiretroviral • Cyclosporine Or Bull Shit CRAPGPS • Barbiturates • St. Johns Wart • Carbamazepine • Rifampin • Alcohol (chronic use) • Phenytoin • Griseofulvin • Phenobarbital • Sulfonylureas 80. • Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion, Increase the serum level of other drugs, Increase toxic risk: S • Sodium Valproate • Isoniazid • Cimetidine • Ketoconazole • Fluconazole • Alcohol • Chloramphenicol • Erythromycin • Sulfonamides • Ciprofloxacin • Omeprazole • Metronidazole Plus Grapefruit juice 81. • DBT (Dialectical behavior therapy): • Relaxation muscle prior to DBT • Borderline Patients - NO meds - DBT therapy PMHNP Certification Exam with complete solution 11 / 57 82. what therapy uses a diary log: • CBT 83. what medication is used for ENURESIS: • DDAVP (Desmopressin) Works in the SAME manner of ANTIDIEURTIC HORMONE • Makes less urine - Used for ENURESIS 84. what medications increase INR?: Depakote and Disulfiram 85. What medication causes Spina bifida?: Depakote, so check HCG level 86. • DIGFAST for Mania: • Distractibility