Perez final, not the board Flashcards
Do we medicate for personality disorders?
NO, unless they have other diagnoses. If they are depressed, we treat their depression.
Borderline and paranoid, comes in with somatic complaints. Ethics question. ER Dr. calls you at the office. Wants details on patient. What do you do or say?
- You cannot say ANYTHING.
Borderline comes in every 2 weeks for medication management. Patient gets your cellphone number and won’t stop calling. What do you do?
Terminate relationship, give them time and resources to find another NP.
Comes in to emergency room, taking anti-psychotics. Muscle rigidity, fever, severe confusion. What do we see on labs?
Elevated serum creatine phosphokinase
Psych NP says to patient, if you don’t stop yelling we will IM and restrain you. What would the lawyer say you did to the patient?
Not assault or malpractice. Battery to threaten the patient with words.
How do we determine risk for suicide?
ask the patient
Patient acts out in outpatient clinic, threatening staff. What is the most important thing you want to achieve in that situation?
Handle situation with least intensity. Don’t traumatize other patients in the clinic.
Paranoid Personality Disorder. How do they present?
Distant and guarded. They are not necessarily intense or impulsive.
Older adult, last of kids leaves home. Patient is deteriorating, believes no one loves her, not well-groomed. Patient states they are worthless. How would you respond to her?
Spend time together, we can sit quietly. Be present with the patient.
Dementia- What are worried about for an onset of dementia?
Difficulty with word finding
75 y.o. comes with Alzheimer’s. Still verbal. What is more dementia and not depression?
The patient states “I don’t remember”.
Young person diagnosis with dependent personality disorder. What’s the gender
female
Depressed mid-30s. Doesn’t want to talk in front of family members. What do we do?
Ask family members to leave
What bloodwork for an AA female, initial psych eval, issues with memory, cognition, mood lability, depression?
Thyroid and CMP
Acetylcholine- is it a monoamine neurotransmitter?
Yes
Mini mental status exam vs mini cog
the mini cog is just the 3 words and the clock.
The mini mental status is all of those questions.
What would worry you about a 17 y.o., extremely thin, female. What would cause her to be admitted?
Restrictive eating, binging, vomiting, using laxatives, extreme exercise. Could it screw up their electrolytes
Keeping patient against their will in hospital who isn’t voluntary. What can we be arrested for?
Imprisonment
What is the first thing you do when developing a teaching plan for a patient?
Assess knowledge level.
What’s the best therapy for adolescents at home with eating disorders?
Recommend family therapy.
What do you give an older person who wants to sleep?
Zaleplon, because it has the shortest half life
Why do we meet with entire family when a patient is on an MAOI?
Important to know diet restrictions
What part of the brain controls emotional regulation?
Amygdala
Borderline - if they self harm secretly and approach you for help, they are
getting better
MMSE moderate score range is
11 to 20
In bulimia and laxative use, how should you approach the patient?
Be upfront and direct, make it a teaching moment. Start a dialogue by showing curiosity.
Criteria for dx of Anorexia binge and purge type
RECENT COMPENSATORY MEASURES TO AVOID WEIGHT GAIN
Aphasia
loss of words
Apraxia
loss of meaningful movement
Agnosia
loss of recognition of objects
In an eating disorder, refer them to
community resources
Insurance fraud
Qui Tam whistleblower
If an antisocial patient refuses to engage,
use reflective thinking to look back what they were responsive to
ideal for a little old lady with insomnia
Temazepam (restoril)
Hippocampus
memory
Basal ganglia
Motor control
If another person calls for information on a patient, it cannot be determined over the phone who they are but ASK IF IT IS
A LIFE THREATENING EMERGENCY
Example of battery-
If you don’t stop yelling i am going to give you an IM
Thalamus
regulate consciousness
When do you need a Prolactin level
second gen antipsychotic (risperidone, paliperidone)
