PMHNP certification Exam KM Deck Flashcards
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<div><b>Which patient is at highest risk for SI</b></div>
<div><b>A. 30y/o married AA female with previous SI attempt *1 risk factor</b></div>
<div><b>B. 35 y/o single Asian male with previous SI attempt *3 risk factors</b></div>
<div><b>C. 38 y/o single AA male who is a manager of a bank *2 risk factors</b></div>
<div><b>D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)</b></div>
<div><b>D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)</b></div>
<div></div>
<div>Count the risk factors</div>
When interview teenagers (16 y/o) that arrive with their parents what should you do?
interview them separately from parents. <br></br>-This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child.
Which Ethnic group has the highest rate of suicide?
Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine?<br></br>A. Increased waist circumference<br></br>B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism<br></br>C. Increased Lipids<br></br>D. Metabolic Syndrome
<div><b>D. Metabolic Syndrome</b> (UMBRELLA ANSWER)</div>
Which antipsychotics have the least weight gain?
<div><b>Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY</b></div>
Which mood stabilizer have the least weight gain?
Lamictal <br></br>-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a
atypical
<div><b>A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?</b></div>
<div><b>A. </b>Thalamus</div>
<div><b>B.</b> Hypothalamus</div>
<div><b>C. </b>Limbic System</div>
<div><b>D. </b>Hippocampus</div>
Hypothalamus<br></br>A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage?
Bring a support person like a husband
Thyroid-Stimulating hormone normal level
0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis
HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE
Key symptoms of Heat Intolerance
Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis
(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
Key symptoms of Cold Intolerance
Hypothyroidism
Hyperthyroid can mimic
Mania
Hypothyroid can mimic
Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine
Hepatoxicity<br></br>-Check LFTs
Signs of Depakote toxicity
Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do?
Check <br></br>-LFT<br></br>-Ammonia<br></br>-Depakote Level
What herbal supplement can cause hepatoxicity?
Kava Kava
When taking Kava Kava in combinations with other medications you should caution about
Risk of Hepatoxicity and Sedation
TCAs carry a risk of
Hepatotoxicity
Signs of Stevens-Johnson Syndrome
NAME?
-Fever, sore throat, fatigue, chills
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
Dehydration-hot days, exercise
Discontinue and re-order lithium level
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Gabapentin
TCA
such as zoloft
Quality of Life
Long-term health
-Think about making the treatment convenient for them-->bringing it to their home
-Treatment Cogentin
Ciprofloxacin
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Acute Etoh
Macrolides
INH
Grapefruit Juice
Omeprazole
Crack Amigos
Increase mood stabilizer to maintain stability, steroids can also trigger depression
2. impaired judgment
3. euphoria
4. elevated BP
5. tachycardia
6. dilated pupils
7. hallucinations
8. TREMORS
9. IMSOMNIA
-MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI
Panic disorder = SSRI
Panic Attack is ACUTE
Panic Disorder is CHRONIC
Feels like impending doom
basal ganglia
reticular activating system
Executive Function
Cognition
Processing
Working Memory
Problem Solving
7/13 Bipolar Diagnosis Likely
So what should you assess if a parent reports that a child is having nightmares
HIV Dementia is a type of subcortical dementia
ASQ (ages and stages questionnaire)
M-CHAT (modified-checklist for autism-toddler)
-Hippocampus
-Amygdala
-Hypothalamus
-Thalamus
smoking
caffeine
lack of exercise
diet lacking calcium and vit D
*Provide Education*
-Emphasizes accepting freedom and making responsible choices
-Focus on the present
Why am I here, What is my purpose
Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement
Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within
I: Intervention
C: Comparison
O: Outcome
T: Time
At least (2)
-little bias because the subjects are identified prior to outcome - randomization is lost
If older baby still has this reflex->refer to specialist
If present past normal range->refer to specialist
If not present within the normal age->Xray may be a sign of a broken bone, nerve injury, or spinal injury
If present past normal range->refer to specialist
Bulemia-Normal BMI
> 10 moderate
> 15 moderately severe
> 20 severe
Max score 27
>14 Moderate
>17 Severe
>15 Moderate
>24 Severe
>14 Mild
>20 Moderate
>29 Severe
>40 EXTREME
Max score 63
>5 Mild Anxiety
>10 Moderate Anxiety
>15 Severe Anxiety
Max score 21
This is often seen in grieving before acceptance of the loss
-Varies broadly state to state
IM ordered
IM antipsychotic for agit/psychosis
A. Create interdisciplinary teaching team
B. Develop Outcome measures
C. Market the educational plan
D. Utilize a survey to assess the educational needs of the staff
A. Asking the clinical manager to explore options for access
B. Organizing a political protest
C. Working with the local chapter of the nurses professional association
D. Writing letters to the editor of the local newspaper
A. Autonomy
B. Nonmaleficence
C. Justice
D. Beneficence
A. Identifies what steps the mother has already tried in caring for the child
B. Explain that the symptoms are viral infection
C. Educates about importance of fluid electrolyte imbalance
D. Respects the mother's understanding of the child's illness
* Use to screen substance use disorders
2. autonomy vs. shame and doubt
3. initiative vs. guilt
4. industry vs. inferiority
5. identity vs. role confusion
6. intimacy vs. isolation
7. generativity vs. stagnation
8. integrity vs. despair
2. preoperational
3. concrete operational
4. formal operational
Object permanance
i.e finding similarities in objects, grouping things
Age (Teenager or Elderly),
Depression,
Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness),
3 or more prescription medications,
Organized plan,
No spouse (divorced, widowed, or single especially if childless). Social support lacking.
WHITE
Women try more often. Men succeed more often.
>60 Moderate
>70 Severe
25-49 is NORMAL RANGE
100 is max score
1. Lithium
2. Carbamazepine
3. Depakote
4. Benzo
2. Neural Tube
3. Neural Tube (specifically spina bifida, atrial septal defect, cleft palate)
4. Floppy Baby
-Education
-Safety Initiatives
-Modifying environment
-Early findings
-Screening
-Prompt and effective treatment
Example: Crisis hotline, disaster response
Omega-3
Decongestants
TCAs
Atypical Antipsychotics
St.Johns wart
L-Tryptophan
Stimulants
Asthma meds
Labs: Folic Acid, B12, ESR/CRP, HGB, MCV
Together can cause renal dysfunction
too much acetylcholine
Parkinson's and EPS
Clenched Teeth
Less than 1000 Stop
-Decreased sperm, fertility issues
Tox Screen
Why? it is an H1 blocker but is also has serotonin receptor blocking activity. Specifically, it acts to block 5-HT1A and 5-HT2A receptors which are the ones responsible for serotonin syndrome
-Low reticulocytes may be seen is iron def. anemia, pernicious anemia, folic acid deficiency, and aplastic anemia
severe hypothermia temp less than 96.8
HR less than 40
BP less than 70
Hypokalemia less than 3mEq/L
BMI<16
An inferential statistical test for comparing the means of three or more groups
Bupropion, Fluoxetine, Paxil
may I Ask what happened
at any time
* also Risperdal
Nurse as therapeutic tool
-Care for the person as well as the illness
-Patients are PEOPLE not DIAGNOSES
R-L confusion
Difficulty writing (agraphia)
Aphasia(difficulty of language)
If fine then check creatinine
i.e dice in hand
Increases benzo
Increases coumadin
Priapism
Glaucoma
-Delayed puberty
-Amenorrhea
-Web neck, osteoporosis, lymphedema
-poor social skills
-Respect
-Beneficence
-Justice
Lipids
Campral
Lithium
-Decrease dose of drug
Expect to give instructions and help make decisions
Amulet for adults
guanfacine
Normal Range 0.5-1.5
Viral Load is high
<20% get it with antiretroviral treatment
Emotions are controlled by amygdala
Prefrontal Cortex is still not fully developed (may be why young boys are risk takers)
-publication-highest level
-Presenting at national conference
-Journal club
specificity - how well a test identifies truly well people (True negative)
*In medical diagnosis, testing sensitivity is the ability of a test to correctly identify those with the disease (true positive) whereas test specificity is the ability of the test to correctly identify those without the disease (true negative)
-National ID for providers, health plans and employers.
-Not SIMPLY Confidentiality.
KCL
Zonegran
0-7 subclinical
8-15 Mild
16-23 Moderate
24-31 Severe
32-40 Extreme
Until court orders it
"due process"
-It is unconstitutional to commit a person involuntarily who is not imminently dangerous to self or others
Donalson was a patient hospitalized for 15 years