Board Flashcards
Why should the dose of a medication be decreased when a patient stops smoking?
Smoking induces CYP1A2, lowering clozapine serum levels; upon cessation, levels rise.
How can liver disease impact drug levels in the body?
Liver disease affects enzyme activity, leading to potentially toxic drug levels.
What effect does kidney disease have on drug concentrations?
Kidney disease or drugs reducing renal clearance can increase serum drug levels.
What makes older adults more sensitive to psychotropics?
Factors include decreased metabolism, protein binding, muscle mass, and increased body fat concentration.
Why are inducers and inhibitors of enzymes important to know in drug therapy?
They impact drug levels which can lead to subtherapeutic or toxic levels.
What are some examples of drugs that can reduce renal clearance of lithium?
Examples include NSAIDs, thiazides, and ACE inhibitors like HCTZ.
Where is norepinephrine produced in the brain?
Norepinephrine is produced in the locus coeruleus and medullary reticular formation.
What is the role of GABA in the brain and how does it relate to anxiety?
GABA is an inhibitory NT; decreased levels can increase anxiety.
What are some risk factors associated with Autism Spectrum Disorder?
Risk factors include being male, genetic loading, and intellectual disability.
Which part of the brain is the largest and divided into lobes?
The cerebrum is the largest part of the brain, divided into lobes.
Define tolerance in relation to drugs.
Tolerance is the process of becoming less responsive to a particular drug over time.
What are the three levels of prevention in mental health?
Primary, secondary, and tertiary prevention.
What is the primary aim of primary prevention?
Decreasing the incidence of mental disorders.
Give an example of secondary prevention in mental health.
Screening programs or telephone hotlines.
What is the focus of tertiary prevention in mental health?
Decreasing disability and severity.
What are the DSM-5 criteria for ADHD in adults?
≥ 5 symptoms per category, noticeable in ≥ 2 settings, impact on functioning.
What are the common neurotransmitter dysfunctions in ADHD?
Dopamine, norepinephrine, and serotonin dysfunction.
What are the signs of stimulant abuse in ADHD?
Insomnia, tremors, elevated blood pressure, mood swings, etc.
Name a non-stimulant medication used for ADHD.
Strattera (atomoxetine).
What are some nonpharmacological management strategies for ADHD?
Behavioral therapy, psychoeducation, family therapy, etc.
Describe the primary symptoms of Borderline Personality Disorder.
Impulsivity, recurrent suicidal behavior, intense relationships, identity disturbances.
What treatment approach is recommended for Borderline Personality Disorder?
Dialectical Behavioral Therapy (DBT).
List some characteristics of Antisocial Personality Disorder.
Reckless, deceitful, lack of remorse, impulsivity, disregard for others.
What are the core symptoms of Rett Syndrome?
Loss of purposeful hand skills, stereotypic hand movements.
What is unique about the physical exam findings in Rett Syndrome?
Loss of purposeful hand skills and stereotypic hand movements.
What are tics in Tourette’s Disorder?
Involuntary, repetitive movements and vocalizations.
What are the primary neurotransmitters involved in Tourette’s Disorder?
Dopamine, Norepinephrine, Serotonin.
What is the pharmacological management for Tourette’s Disorder?
Atypical antipsychotics, Haldol, Pimozide, Aripiprazole.
What nonpharmacological management strategies can be used for Tourette’s Disorder?
Behavioral therapy, CBT, Deep Brain Stimulation.
What are the differential diagnoses for Tourette’s Disorder?
Chronic Motor or Vocal Tic Disorder, Stereotypic Movement Disorder.
What are the positive symptoms of schizophrenia?
Hallucinations, Delusions, Referential thinking, Disorganized behavior, Hostility.
What are the negative symptoms of schizophrenia?
Affective flattening, Alogia, Abolition, Apathy, Abstract thinking problems, Anhedonia, Attention deficits.
What are the associated neurobiological defects in schizophrenia?
Enlarged ventricles, Smaller frontal and temporal lobes, Cortical atrophy, Decreased cerebral blood flow.
What alterations in chemical neuronal signal transmission occur in schizophrenia?
Excess dopamine, Excess glutamate, Decreased GABA, Decreased serotonin.
What preventative care measures should be taken for individuals with schizophrenia?
Monitor routine labs, Serum glucose and lipid panels, Weight/BMI, Eye exams, Liver and kidney function.
What are Erikson’s stages of development and their characteristics?
Trust vs. Mistrust, Autonomy vs. Shame and Doubt, Initiative vs. Guilt.
What nonpharmacological management strategies can be used for schizophrenia?
Individual/group therapy, Assertive Community Treatment.
What is the virtue associated with the stage of industry vs. inferiority?
Competency
What is the virtue associated with the stage of identity vs. role confusion?
Fidelity
What is the virtue associated with the stage of intimacy vs. isolation?
Love
What is the virtue associated with the stage of generativity vs. stagnation?
Care
What is the virtue associated with the stage of integrity vs. despair?
Wisdom
What is the unfavorable outcome of the industry vs. inferiority stage?
Inferiority in understanding and organizing
During which stage does a personal sense of identity develop according to Erikson’s theory?
Identity vs. role confusion
What is the age range for the stage of intimacy vs. isolation?
20-35 years
What stage focuses on giving time and talents to others in middle adulthood?
Generativity vs. Stagnation
What stage involves fulfillment and comfort with life in late adulthood?
Integrity vs. Despair
At what age range does the formal operational stage begin according to Piaget’s stages of cognitive development?
12 years to adulthood
What concept describes a child’s ability to know that objects continue to exist even when not seen or heard?
Object permanence
At what age range does the concrete operational stage occur according to Piaget?
7-11 years
Which of Freud’s stages involves focusing on the genitals?
Phallic stage
What is the age range for the oral stage in Freud’s psychosexual stages?
0-18 months
What muscle relaxant is recommended for treating neuroleptic malignant syndrome (NMS)?
Dantrolene
What are the symptoms of serotonin syndrome?
Hyperreflexia, myoclonic jerks, agitation, rapid heart rate, elevated blood pressure, headache, sweating, shivering, confusion, fever, seizures.
What is the onset time for serotonin syndrome?
Within hours
How should serotonin syndrome be treated?
Discontinue offending agent, use Cyproheptadine
What are the symptoms of serotonin discontinuation syndrome?
Flu-like symptoms, insomnia, nausea, imbalance, sensory problems, hyperarousal, fatigue, lethargy, myalgia, decreased concentration, vomiting, ataxia, impaired memory, agitation.
What are the effects of an agonist on receptors?
Activates a biological response by opening the ion channel
What is the difference between an inverse agonist and a partial agonist?
Inverse agonist causes opposite effect, partial agonist has limited actions.
What type of drug binds to receptors but does not activate a biological response?
Antagonist
Define delusion and paranoia.
Delusion: False belief despite evidence. Paranoia: Belief that others are against you.
What is assessed in a mental status exam?
Appearance, behavior, speech, mood, affect, thought process, thought content.
What components are included in the Mini Mental Status Exam (MMSE)?
Concentration, orientation, speech, registration, recall, fund of knowledge.
Name some instruments for assessing cognitive impairment.
Montreal Cognitive Assessment (MoCA), Mini Cog, St Louis University Mental Status Exam (SLUM)
What age groups have a higher suicide risk based on gender?
Age 45 or older for males, age 55 or older for females.
List some risk factors for suicide.
Previous suicide attempts, older age, divorced/single/separated, white, living alone.
What are the key features of delirium?
Acute onset, altered level of consciousness, inattention, changes in cognition and concentration.
What is the preferred treatment for agitated delirious patients?
Haloperidol (Haldol) per APA guidelines.
What are the pharmacological management options for delirium?
Antipsychotic agents, atypical agents, anxiolytics for insomnia.
What is the one-year mortality rate for clients with delirium?
Up to 40%.
What are the types of dementia based on cortical and subcortical characteristics?
Cortical (affects cerebral cortex) and Subcortical (dysfunction below cortex).
What functional deficits are associated with cortical dementia?
Apraxia, Agnosia, Aphasia.
What is the hallmark of Lewy body disease?
Recurrent visual hallucinations.
What are the early signs of dementia due to HIV disease?
Cognitive decline, motor abnormalities, behavioral abnormalities.
What is the second most common type of dementia?
Vascular dementia.
What is the cardinal feature of Huntington’s disease?
Motor abnormalities (choreoathetoid movements).
What are the key characteristics of Disruptive Mood Dysregulation Disorder (DMDD)?
Chronic dysregulated mood, frequent temper outbursts, severe irritability, anger, no identifiable stressor.
What is a characteristic of Intermittent Explosive Disorder (IED)?
Involves repeated sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts.
What neurotransmitters are dysregulated in Major Depressive Disorder (MDD)?
Dopamine, norepinephrine, serotonin (DNS).
What cognitive and memory symptoms of MDD in older adults are often confused with dementia?
Pseudodementia.
What does SIGECAPS stand for in the context of MDD?
Sleep disturbance, interested reduced, guilt/self-blame, energy loss/fatigue, concentration problems, appetite changes, psychomotor changes, suicidality.
What are the differences between Dementia and Pseudodementia?
Onset, progression, insight, behavior, memory, disability emphasis, affect, psychiatric history, suicide risk.
What is the recommended duration for continuing antidepressants in MDD treatment?
Minimum of 6-12 months; 2+ prior episodes consider continuing indefinitely.
What are the first-line and second-line pharmacological treatments for MDD?
First-line: SSRIs; Second-line: TCAs.
What are the non-pharmacological management options for MDD?
ECT, TMS, CBT.
What are the contraindications for Electroconvulsive Therapy (ECT)?
Cardiac disease, compromised pulmonary status, history of brain injury or tumor, anesthesia medical complications.
What are the potential adverse effects of Electroconvulsive Therapy (ECT)?
Possible cardiovascular effects; systemic effects like headaches, muscle aches, drowsiness; cognitive effects like memory disturbances, confusion.
How should suicidal ideation be managed clinically?
Always assume seriousness; assess and intervene promptly.
What teratogenic risks are associated with benzodiazepines?
Floppy baby syndrome, cleft palate
Name the teratogenic risk associated with carbamazepine.
Neural tube defect
What is the teratogenic risk of lithium (Eskalith) during pregnancy?
Ebstein anomaly
Which teratogenic risk is specific to Divalproex Sodium (Depakote)?
Neural tube defects, specifically spina bifida
What severe skin condition can Lamictal (Lamotrigine) cause?
Stevens-Johnson Syndrome (SJS)
What signs and symptoms may be seen in patients with Stevens-Johnson Syndrome (SJS)?
Fever, sore throat, facial swelling, rash, skin sloughing
Mention the black box warning associated with carbamazepine.
Agranulocytosis and aplastic anemia
Why is screening for HLAB-1502 allele important before initiating carbamazepine?
Highly associated with outcome of carbamazepine-induced SJS
What condition is monitored by absolute neutrophil count in patients taking Clozapine?
Risk for neutropenia
When should Clozaril be discontinued if Absolute Neutrophil Count (ANC) is less than 1000?
Discontinue if ANC is less than 1000
What is the recommended daily intake of folic acid for women planning pregnancy?
0.4 - 0.8mg daily
What does the BMI range of 18.5-24.0 indicate?
Normal weight
Which medication is FDA-approved for bulimia nervosa?
Fluoxetine (Prozac)
List the features commonly seen in patients with Anorexia Nervosa.
Low BMI, amenorrhea, emaciation, bradycardia, hypotension
What is the mechanism of action of Wellbutrin (Bupropion)?
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
Why is Wellbutrin contraindicated in bulimia and eating disorders?
Increased risk of seizures and electrolyte imbalance
Which enzyme is responsible for the metabolism of Clozapine (Clozaril)?
Cytochrome P-450 enzyme CYP1A2
What is the goal of exposure therapy for PTSD?
To achieve adaptive resolution.
Explain the desensitization phase in exposure therapy.
Clients visualize trauma, verbalize negative thoughts, focus on physical sensations.
What occurs during the installation phase of exposure therapy?
Clients strengthen positive thoughts to replace negative ones.
Describe the body scan process in exposure therapy.
Scan body to identify any tension.
What is the focus of family systems therapy?
Chronic anxiety within families.
What are the treatment goals of family systems therapy?
Increase family’s awareness, enhance self-differentiation.
Explain the concept of triangles in family systems therapy.
Dyads forming triads to decrease stress levels.
What is the primary goal of structural family therapy?
Produce structural change in family organization.
What is one of the primary methods used in structural family therapy?
Direct interactions between family members.
What are paradoxical directives in strategic therapy?
Negative tasks assigned to resistant family members.
What is the focus of solution-focused therapy?
Reworking present solutions based on past success.
What is one of the key techniques used in solution-focused therapy?
Miracle question - envisioning a problem-free scenario.
Describe projection as a defense mechanism.
Attributing unacceptable thoughts to another person.
Explain displacement as a defense mechanism.
Redirecting impulses onto a powerless target.
What is sublimation as a defense mechanism?
Redirecting unacceptable emotions into constructive behaviors.
Define intellectualization as a defense mechanism.
Focusing on intellectual aspects to avoid emotional ones.
What does rationalization involve as a defense mechanism?
Logically justifying generally unacceptable behavior.
What are the clinical manifestations of hyperprolactinemia?
Amenorrhea, galactorrhea, sexual dysfunction, gynecomastia.
List the symptoms of pseudoparkinsonism.
Stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest.
How is acute dystonia characterized?
Facial grimacing, involuntary upward eye movements, muscle spasms.
What are the symptoms of akathisia?
Restlessness, trouble standing still, constant foot movement.
Define akinesia.
It is the absence of movement, difficulty initiating movement.
Describe the symptoms of tardive dyskinesia.
Protrusion and rolling of the tongue, sucking/smacking movements, facial dyskinesia.
What are the physical characteristics of Fetal Alcohol Syndrome?
Low birth weight, microcephaly, midface hypoplasia, underdeveloped jaw.
Which medication is associated with most cardiac adverse effects among antidepressants?
Citalopram.
Differentiate between pharmacodynamics and pharmacokinetics.
Pharmacodynamics studies drug effects on the body. Pharmacokinetics studies body’s actions on the drug.
List medications that can cause mania and depression.
Steroids, disulfiram, isoniazid, antidepressants (mania); steroids, isotretinoin, beta blockers (depression).
What are the physical characteristics of Fragile X Syndrome?
Larger head/ears, short stature, hyper-extensive joints, broad forehead.
What are the signs and symptoms of Neuroleptic Malignant Syndrome (NMS)?
Extreme muscular rigidity, mutism, hyperthermia, tachycardia, diaphoresis.
What percentage of the exam covers ‘Scientific Foundation’ and ‘Advanced Practice Skills’?
45% (30% for Scientific Foundation and 25% for Advanced Practice Skills)
How many questions are there in total on the test?
175 questions
What type of answers should you avoid choosing on the test?
Partially correct answers
What is the recommended strategy when faced with adjective-based questions like ‘priority’ or ‘initial action’?
Prioritize in order: i. Airway, breathing, and circulation ii. Maslow’s Hierarchy of Needs iii. The nursing process: Assessment before intervention
What are some baseline labs to monitor for Lithium therapy?
Thyroid panel, Serum Creatinine, BUN, Pregnancy Test if 12-51 years old, ECG if over 50 years old
What are some side effects of Lithium on the endocrine system?
Hypothyroidism, weight gain
What are some CNS side effects of Lithium?
Hand tremors, fatigue, nystagmus, mental cloudiness, headaches
What are some dermatological side effects of Lithium?
Maculopapular rash, pruritis, acne
What gastrointestinal side effects may occur with Lithium therapy?
Diarrhea, vomiting, cramps, anorexia
How can a hypertensive crisis occur when taking MAOIs?
Occurs when taken with foods containing tyramine or certain medications
What is the treatment for hypertensive crisis?
Discontinue the MAOIs
What are the stages of change in the Transtheoretical Model?
Precontemplation, Contemplation, Preparation, Action, Maintenance, Relapse
What action step is recommended in the Contemplation stage of change?
Help them see benefits of changing and consequences of not changing
What is the goal of Cognitive Therapy according to Aaron Beck?
To change clients’ irrational beliefs, faulty conceptions, and negative cognitive distortions
What tools are used in Cognitive Behavioral Therapy (CBT) for clients’ problems?
Journaling, nightmare exposure and rescripting, relaxed breathing, cognitive restructuring
Who originated Dialectical Behavioral Therapy (DBT)?
Marsha Linehan
What are the goals of Dialectical Behavioral Therapy (DBT)?
Decrease suicidal behaviors, increase realistic decision making and emotion communication
What does Existential Therapy emphasize?
Accepting freedom, responsible choices, and focusing on personal responsibility
Who originated Humanistic Therapy?
Carl Rogers
What is the focus of Interpersonal Therapy?
Interpersonal issues creating distress, modifying relationship problems
What is the goal of Eye-Movement Desensitization and Reprocessing (EMDR)?
To provide a form of behavioral therapy
What are at least 3 symptoms required for conduct disorder diagnosis?
Aggression, destruction of property, deceit or theft
Which type of therapy is recommended for managing conduct disorder?
Behavioral therapy (family & individual therapy)
What are the main symptoms of conversion disorder?
Blindness, mutism, paralysis, paresthesia, other unexplained neurological symptoms
How soon do symptoms of adjustment disorder typically occur after a stressful event?
Within 3 months of the event/change
What are the subtypes of adjustment disorder with specific mood disturbances mentioned?
Adjustment disorder with depressed mood, anxiety, conduct issues, mixed emotions and conduct
Describe the characteristics of grief and loss as compared to major depression.
In grief, self-esteem is usually preserved unlike in major depression
What are some nonpharmacological management strategies for grief and loss?
Encourage expression, support groups, community resources, psychoeducation, psychotherapy
What are the core symptoms of post-traumatic stress disorder (PTSD)?
Reexperiencing traumatic event, increased arousal, avoidance of trauma stimuli
List pharmacological treatments recommended for PTSD.
SSRIs, TCAs, Prazosin for nightmares
What are some nonpharmacological treatments for OCD?
CBT, EMDR, Exposure therapy, Supportive group therapy, Relaxation techniques
What are the main obsessions and compulsions in obsessive-compulsive disorder (OCD)?
Obsessions: Recurrent thoughts causing anxiety; Compulsions: Repetitive behaviors
What are some risk factors associated with OCD?
First-degree relatives, PANDAS (associated with streptococcal infections)
Which cerebral hemisphere controls most right-sided body functions?
The left hemisphere controls most right-sided body functions.
What connects the two cerebral hemispheres?
The corpus callosum, a large bundle of white matter.
What functions are controlled by the frontal lobe?
Thinking, planning, problem solving, emotions, behavioral control, decision making.
What is the primary auditory area located in?
The temporal lobe.
What does the parietal lobe involve primarily?
Perception, object classification, spelling, visuospatial processing.
What is the primary function of the occipital lobe?
Vision, visual processing, color identification.
What part of the brain is crucial for balance and hand-eye coordination?
The cerebellum.
Which brain structure regulates body temperature and heart rate?
The brainstem.
What is the main purpose of the Clock-Drawing Test (CDT)?
To screen for signs of neurological problems like dementia.
What system is essential for the regulation of emotions and memory?
The limbic system.
What does the hippocampus regulate primarily?
Memory, converts short-term memory to long-term memory.
Which brain structure is responsible for mediating mood and emotions?
The amygdala.
What does hyperactivity of dopamine in the mesolimbic pathway mediate?
Positive psychotic symptoms.
What is postulated to be the cause of negative symptoms in schizophrenia?
Decreased dopamine in the mesocortical projection.
What is the Tarasoff Principle about?
Duty to warn potential victim of imminent danger of homicidal clients.
Explain the elements of informed consent.
Decision capacity, full disclosure, comprehension, voluntariness, documentation.
What does the principle of justice involve?
Doing what is fair in all aspects of care.
Define nonmaleficence in healthcare ethics.
Doing no harm, such as stopping harmful medications or treatments.
What does beneficence promote in healthcare?
Promoting well-being and doing good for patients.
Explain the concept of veracity in healthcare ethics.
Telling the truth about medical conditions and treatment options.
What is autonomy in healthcare context?
Right to self-determination, respecting patient decisions.
Describe the goal of case management.
Promote quality and cost-effective outcomes for clients.
What does Stark Law prohibit in healthcare referrals?
Referring family members for patient treatment.
What do the acronyms PICO and LOE stand for in research?
PICO: Patient, Intervention, Comparison, Outcome. LOE: Level of Evidence.
Define Adverse Childhood Experiences (ACEs)
Potentially traumatic events occurring during childhood (0-17 years)
What did Felitti et al. find in their seminal study on ACEs?
Positive unintended pregnancy, STDs, depression, anxiety, cancer, etc.
What does the Biopsychosocial Framework of Care Recovery Model emphasize?
Resilience, control over problems and life, and not just symptom resolution.
What are the aims of the Recovery Model in mental health care?
Help individuals look beyond survival, recognize abilities, foster dreams.
Name the four dimensions of recovery in the Recovery Model.
Health, home, purpose, community
What is the goal of Assertive Community Treatment (ACT)?
To help people integrate into the community, reduce hospital reliance.
Describe the approach of Assertive Community Treatment (ACT).
Intensive, integrated mental health services in a community setting.
Who determines the Scope of Practice for Nurse Practitioners?
State legislative statutes (State Board of Nursing)
What is the Standard of Practice determined by?
American Nurses Association (ANA)
What does confidentiality refer to in mental health practice?
Client’s right to expect non-disclosure of provided information.
List some exceptions to confidentiality in mental health care.
Intent to harm self or others, litigation, court orders.
What are the four components of health policy?
Process, policy reform, policy environment, policymakers.
What is the aim of a just culture?
To create an environment that encourages individuals to report mistakes.
How does forced field analysis work?
It looks at driving and hindering forces toward a goal.
What is the core competency in nursing?
Ability to meet clients’ needs through logical thinking and nursing skills.
Explain Root Cause Analysis (RCA).
It uncovers causes of problems using various tools and techniques.
What does the Americans with Disabilities Act of 1990 mandate?
Employers must make reasonable accommodations for individuals with mental health disorders.
What is the goal of quality improvement projects?
To improve systems, decrease costs, and enhance productivity.
How does patient advocacy relate to mental health stigma?
It helps reduce the stigma through education and support.
Define problem-based learning (PBL).
A student-centered approach where students learn by working.
What is risk analysis in healthcare?
An ongoing process to understand and address organizational risks.
How does patient-centered care model incorporate sociocultural competence?
By understanding and considering various aspects of a client’s background.
What is reflective practice in nursing?
Linking theory to practice to enhance critical thinking.
Define transference in a therapeutic relationship.
Displacement of feelings for significant people in the client’s past onto the provider.
Explain countertransference in the context of nursing.
The nurse’s emotional reaction to the client based on his or her past experiences.
What are the three medications approved by the FDA for alcohol dependence?
Acamprosate (Campral), disulfiram (Antabuse), naltrexone (Vivitrol).
How does acamprosate (Campral) work in alcohol dependence treatment?
It reduces alcohol consumption.
Explain the concept of clinical opiate withdrawal scale (COWS).
It assesses symptoms of opiate withdrawal such as yawning, anxiety, pupil dilation, etc.
What is the purpose of the Screening, Brief Intervention, Referral, and Treatment (SBIRT) model?
It screens for substance use disorders and provides intervention and referrals for treatment.
What type of problem does a group aim to solve?
An open-ended problem
