Georgette's LMR / Georgette's PMHNP Certification Exam Questions With Answers | Latest Update | GRADED A+

What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? cultural assessment What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania Valproic acid produces what teratogenic effect? Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? Liver (hepatoxicity) What are 4 signs of hepatoxicity? Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of Hepatoxicity What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? 150 mcg/ml What are 4 signs of valproic acid toxicity? Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of Delirium How are agitation and psychotic symptoms treated in delirium? Low dose Haldol What 4 drugs can cause mania? Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce Mania What 6 drugs can induce depression? Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? Mania Depression Psychosis What medication to treat acne cause cause birth defects? Isotretinoin (Accutane) What is the therapeutic range for lithium? 0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? Lithium What is the gold standard for treating manic episodes Lithium What mood stabilizer has anti-suicidal effects? Lithium What 5 labs should be drawn with lithium? Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? 0.6-1.2 mg/dL What is the normal range for BUN? 10-20 mg/dL When should you suspect kidney disease with a urinalysis? 4+ protein 4+ protein in the kidney suggests Kidney disease What are 7 side effects of lithium? Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Which 3 drugs can increase lithium levels by decreasing renal clearance? NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? 1.3 mEq/L or higher With suspected lithium toxicity, what do you do first? Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? DC lithium Check lithium level What 2 conditions can increase lithium levels? Dehydration Hyponatremia What birth defect can lithium cause? Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? DNS What 3 parts of the brain are affected with ADHD? Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? 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 is GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? 20 x daily dose What does thought process assess? thoughts and ideas The way a patient organizes his thoughts and ideas is called Thought process A normal thought process is described as Logical Linear Coherent Goal-oriented Moving from thought to thought and never getting to the point is called Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called Thought content Thought content includes 3 items Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes Concentration Attention Calculation Asking the year, season, date, month, and location measures Orientation Asking a patient to repeat "bed, bad, ball" measures Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures Recall (memory) Asking the patient who is the president of the US or governor of state is measuring Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway modulates positive psychotic symptoms Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? Negative symptoms Depressive symptoms The nigrostriatal pathway modulates motor movements Dopamine has what type of relationship with acetycholine Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to Increased prolactin What are 5 symptoms of hyperprolactinemia? Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? Risperidone What is the black box warning for carbamazepine? Agranulocytosis What are 8 symptoms of aplastic anemia? Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? Asians Having the HLA-B*1502 allele increases the risk for SJS Which ethic group is at most likely to have the HLA-B*1502 allele? Asians Asians are most likely to have what allele? HLA-B*1502 In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of Agranulocytosis What are 4 symptoms of agranulocytosis A sudden fever Chills Sore throat Weakness At what ANC should clozapine be stopped (even if asymptomatic)? 1000 What is neutropenia? 2000 PMNs What is agranulocytosis? 500 ANC What does DIGFAST stand for? Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms in Conversion Disorder? Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? After a stressful experience (suddenly) What are 5 stressful events in a child's life that can cause adjustment disorder? 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? Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? Conduct Disorder What are 3 characteristics of Conduct Disorder? Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? Therapy What type of therapy is used in the treatment of Conduct Disorder? Behavioral therapy What is Multisystemic family therapy? Home-based model for youth with serious antisocial and criminal offenses by empowering parents with resources and skills and reducing barriers to resources needed for effective management of youth What is the goal of multisystemic family therapy (MFT)? Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? Multisystemic family therapy What is the moderate range for MMSE 10-20 What is the moderate range for SLUM? 10-20 What is the moderate range for HAM-D? 14-18 What is the moderate range for PHQ-9 10-14 What is the moderate range for BDI? 19-29 What is the moderate range for HAM-A? 18-24 What is the moderate range for GAD-7 10-14 What is the moderate range for COWS? 13-24 If a patient's COWS score is between 5 - 12, what do you do? Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? mild symptoms (7) When do you administer buprenorphine (Suboxone) on the COWS? moderate symptoms (13-24) What is a moderate range on the CIWA? 16-20 When do you administer prn benzodiazepine on the CIWA? Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? 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? 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? 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? Therapy or nothing If a patient has mild anxiety (18 on HAM-A) (10 on GAD-7), how do you treat? Therapy or nothing If a patient has severe anxiety (24 on HAM-A) (14 on GAD-7) how do you treat? 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? Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis Elevated LFTs Extreme muscular rigidity, Mutism, Elevated CPK (creatine phosphokinase), Myoglobinuria, Leukocytosis, and Elevated LFTs are symptoms of NMS What are 2 symptoms of Serotonin Syndrome? Hyperreflexia Myoclonic jerks Hyperreflexia and myoclonic jerks are symptoms of Serotonin Syndrome How do you treat NMS? DC antipsychotic Bromocriptine or Dantrolene What does Dantrolene treat in NMS? Muscle rigidity How do you treat Serotonin Syndrome? DC Antidepressant Cyproheptadine What combination medications increases the risk of Serotonin Syndrome multiple antidepressants (SSRI/SNRI/TCA/MOAI) When switching from an MAOI to SSRI/SNRI, how long should you wait? 2 weeks When switching from Prozac to an MAOI, how long should you wait? 5-6 weeks When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? 5-6 weeks When switching from an SSRI/SNRI to a MAOI, how long should you wait? 2 weeks PMHNP certification Exam May 2022 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 with 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) D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors COWS scale components