Pocket prep Questions Flashcards
The shingles vaccine should not be given to these 3 groups:
- People with a weakened immune system
- People with HIV, AIDS, or a T-cell count below 200
- Patients being treated with high-dose steroids
oppositional defiant disorder?
A condition characterized by multiple examples of negativistic behavior persistent for at least six months, usually beginning when a child is three or four years old
Mental status exam findings of autism are as follows:
Little or no eye contact
Flat or blunted affect
Lack of emotional reciprocity
Stereotyped or repetitive motor mannerisms
Expressive and receptive language impairment
Extrapyramidal symptoms are drug-induced side effects that affect
motor functioning and muscle movement.
Typical antipsychotics like haloperidol, perphenazine, and chlorpromazine are more likely to cause
EPS
The common types of extrapyramidal symptoms are
Akathisia Akinesia dystonia Pseudo parkinson tardive dyskinesia
Akathisia:
motor restlessness inability to remain still, rocking, pacing, or constant motion of a unilateral limb, subjective sense of restlessness often mistaken for increasing anxiety
Akinesia
absence of movement
difficulty initiating motion
subjective feeling of lack of motivation to move, often mistaken for laziness or lack of interest
Dystonia
muscle spasticity usually in the back or neck, subjectively painful, often mistaken for agitation
Pseudo-Parkinson’s:
shuffling gait motor slowing, mask-like facial expression, pill-rolling, tremors muscle rigidity
Tardive dyskinesia:
involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that may progress to limbs;
can be irreversible
can occur as an acute process at the initiation of medications or as a chronic condition at any point during treatment
Nurse practitioner core competencies include the following:
Scientific foundations Leadership Quality Practice inquiry Technology and information literacy Policy Health delivery systems Ethics Independent practice
Decreased ferritin
levels have been known to potentiate restless leg syndrome.
Decreased folic acid conversion is known to be linked
to clients suffering from depression and anxiety disorders.
Albumin plays a significant role in stabilizing
extracellular fluid
Prolactin is not a blood protein but rather a
a hormone that directs the body to make breast milk.
Belladonna is a psychoactive herbal supplement that
produces psychological effects believed to aid in relieving psychiatric symptoms.
In reflective practice, the provider is
encouraged to tell a story about themselves and/or others in order to gain insight into practice.
Which part of the Medicare program covers allied health services such as physical, occupational, and speech therapy?
PART B
The Medicare program has four parts:
Part A, Part B, Part C, and Part D.
Part A:
Coverage for hospitalizations (up to 90 days)
skilled nursing facility (up to 100 days)
hospice (up to six months for terminally ill)
some home health care
Part B:
Coverage for ambulatory practitioner service
physical, occupational, and speech therapy
medical equipment
diagnostic tests
some preventative care
Part C:
Optional coverage for beneficiaries who can choose to receive all of their health care services through one of the provider organizations covered under the Medicare Advantage plan
Part D:
Optional coverage for outpatient pharmaceuticals
The Health Information Technology for Economic and Clinical Health (HITECH) Act was included under which 2009 law?
American Recovery and Reinvestment Act
American Recovery and Reinvestment Act (ARRA
this law aimed to save and create jobs while financing infrastructure, education, health care, and renewable resources. The ARRA includes the Health Information Technology for Economic and Clinical Health (HITECH) Act, which attempts to update the American infrastructure, including the use of electronic health records.
The corpus callosum is
a large bundle of white matter that connects the right and left hemispheres and provides an area of sensorimotor information exchange.
The American Nurses Association defines nursing as
“the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.
Computed tomography provides
a three-dimensional view of the brain structures and differentiates structures based on density. CT scans provide suggestive evidence of brain-based problems.
X-ray testing provides
minimal insight into brain-based problems and is typically used for structural diagnostics such as broken bones and the presence of fluid in organs such as the lungs.
EMDR (eye movement desensitization and reprocessing)
a form of psychotherapy used to treat patients suffering from trauma disorders.
Transference occurs when
a patient displaces feelings for significant people in their past onto the nurse practitioner
Counter transference
represents the nurse practitioner’s emotional reaction to the patient based on her past experiences. Unresolved positive and negative feelings from the nurse practitioner’s past may cause the projection of these feelings onto patients.
Defending the patient’s inappropriate behavior
reflects an underlying subjective connection with the patient, which is an example of countertransference
goal of family systems therapy?
To increase levels of self-differentiation
Family systems therapy was developed
by Murray Bowen
Murray bowen who developed family systems therapy believed
that an individual’s problematic behavior may serve a function or purpose for the family.
Family Systems therapy focuses on
the chronic anxiety within families
Treatment goals of family systems therapy include
increasing self-differentiation, which helps family members learn that their self-worth is not dependent on external relationships, circumstances, or occurrences.
goal of structural family therapy is
Changing family structure
A goal of experiential therapy is
Developing nurturing communication is
goal of strategic therapy is
Helping family members behave in ways that will not perpetuate the problem behavior
Evidence-based practice simply refers
to combining research, clinical knowledge, and patient preferences to reach a health care decision.
Evidenced Based practice
emphasizes the use of the highest-quality information and de-emphasizes the use of customs, opinions, or rituals to make a clinical judgment.
The goal of evidence-based practice is simple:
provide care that is safe, effective, and compassionate..
The brain itself is divided into two distinct anatomical regions:
the cerebrum and the brainstem.
The cerebrum contains the
cerebral cortex, limbic system, thalamus, hypothalamus, and basal ganglia.
The brainstem includes
the midbrain, pons, cerebellum, medulla, and reticular formation.
Patients suffering from acute delirium, acute stroke, or who have a urinary tract infection often have
symptoms that mimic patients with dementia. The nurse practitioner should rule out acute illnesses when performing their exam prior to diagnosing a patient with dementia.
Females with bipolar disorder are more likely to experience
rapid cycling and mixed states and are more likely to experience depressive episodes. They also have higher rates of comorbid alcohol use disorders and eating disorders.
The peripheral nervous system is composed
of the peripheral nerves that connect the central nervous system to receptors, muscles, and glands. It also includes the cranial nerves just outside the brainstem and includes both the somatic and autonomic nervous systems.
Mediation is a
voluntary and confidential process in which a third party facilitates discussion to reach an agreement.
Common indicators of child abuse:
History of unexplained multiple fractures Burns, hand or bite marks Injuries at various stages of healing Evidence of neglect Bruising on padded parts of the body
According to Erik Erikson, the virtue of wisdom is associated with the successful resolution of the psychosocial stage
Ego Integrity vs. Despair.
Trust vs. Mistrust:
Hope
Autonomy vs. Shame and Doubt:
Will
Initiative vs. Guilt:
Purpose
Industry vs. Inferiority:
Competence
Identity vs. Role
Fidelity
Intimacy vs. Isolation:
Love
Generativity vs. Stagnation:
Care
Ego Integrity vs. Despair:
Wisdom
The cerebral cortex is responsible for
receiving incoming sensory information from the thalamus.
The limbic system’s amygdala
mediates mood, fear, emotion, and aggression.
The limbic system’s hippocampus
converts short-term memory into long-term memory.
The basal ganglia
stabilizes somatic motor activity.
At three years of age, landmarks of normal behavioral development include the following:
Rides tricycle Jumps from bottom of steps Alternates feet going up stairs Builds tower of 9 or 10 cubes Imitates a three-cube bridge Copies a circle and a cross drawing Puts on shoes Unbuttons buttons Feeds self well Understands taking turns with others
Level 1 evidence (strongest):
Level 2:
Level 3:
Level 4:
Level 5:
Level 6:
Systematic review of randomized controlled trials or systematic review of nonrandomized trials
Single randomized controlled trial or single nonrandomized trial
Systematic review of correlational or observational studies
Single correlational or observational study
Systematic review of descriptive, qualitative, or physiologic studies
Single descriptive, qualitative, or physiologic study
Haloperidol is an antipsychotic, and it is usually the drug of choice for managing
an agitated or confused patient with delirium.
Dosing of haldol for delirium
Usually, haloperidol is prescribed as 0.5 mg every 8 hours as needed for agitation or confusion. It comes in intramuscular, IV, and oral forms.
Diphenhydramine and benztropine possess anticholinergic properties that would
worsen the delirium
Lorazepam should be avoided in older adults because
it can cause a paradoxical effect, resulting in worsened agitation.
Medicare is funded by
federal tax dollars. In 2011, it provided health care for 47 million eligible people.
Those eligible for Medicare include the following:
The elderly age 65 and older having worked 40 quarters and paid Medicare taxes
Certain younger individuals with disabilities
Individuals with end-stage renal disease
Individuals in need of a kidney transplant
Individuals receiving Social Security Disability and who have amyotrophic lateral sclerosis
Medicaid is funded by both
federal and state tax dollars. In 2011, Medicaid provided health care for 60 million eligible persons, 85% of whom were children.
Those eligible for Medicaid include the following:
Low-income children
Low-income pregnant women
Elderly and disabled individuals who qualify for the Supplemental Security Income Program
The Centers for Medicare and Medicaid Services (CMS) administer the two major public insurance programs,
Medicaid and Medicare.
Tanner Stages define physical measurement in the
development of primary and secondary sex characteristics in both females and males.
Tanner Stages of a girl’s breast development are as follows:
Stage 1: Prepubertal
Stage 2: Breast bud stage with elevation of breast and papilla
Stage 3: Further enlargement of breast and areola
Stage 4: Areola and papilla form a secondary mound above the level of the breast
Stage 5: Projection of papilla related to recession of areola
Indications for seclusion and restraint:
Prevent clear, imminent harm to the patient or others
Prevent significant disruption to the treatment program or physical surroundings
Assist in treatment as part of ongoing behavior therapy
Decrease sensory overstimulation
Patient’s voluntary reasonable request
Contraindications for seclusion and restraint:
Extremely unstable medical or psychiatric condition
Delirious or demented patients unable to tolerate decreased stimulation
Overtly suicidal patients
Patients with severe drug reactions or overdoses who require close monitoring of their drug dosages
For punishment or convenience of staff
Testamentary capacity
is the level of competence required to make a legally valid will.
The key elements of testamentary capacity include the following:
Comprehension of the act of writing and signing the will
Knowledge of potential heirs
Understanding the extent of one’s assets
Lack of undue influence
The absence of delusions compromising rational thought
A systematic review is
a scientific study that gathers multiple studies and analyzes them to draw a larger conclusion. The term systematic refers to methodical order and planning. When conducting a systematic review, the researcher uses transparent and structured steps in order to avoid bias and increase confidence in the findings. There are two main types of systematic review; each differs by the type of research they analyze and how they analyze it.
Meta-analysis:
a scientific study that statistically analyzes a collection of quantitative studies. These studies use statistics to discover patterns that would be otherwise undetectable.
Metasynthesis:
a scientific study that analyzes a collection of qualitative studies. These studies discover meaning by summarizing the results in a narrative format.
Examples of research dissemination include the following:
Publishing in peer-reviewed journals
Publishing in professional newsletters or blogs
Poster presentations at local, regional, and national conferences
Seasonal workers are those
who travel from their permanent residences seasonally for agricultural employment.
Migrant and seasonal workers
have very high incidences of depression, anxiety, and substance use. Migrant and seasonal workers include men, women, and children of all cultures.
Psychotropic antipsychotics such as Seroquel and Risperdal can cause
blurry vision and cataracts. Patients are advised to have routine eye exams every six months while being treated with antipsychotics.
Variable expression of a gene for a disorder occurs at the
cellular level.
The four forms of health policy are
- process,
- policy reform
- policy environment
- policymakers.
Process is the
formulation, implementation, and evaluation of policy.
Policy reform is t
he act of changing programs and practices.
Policy environment refers to
the process taking place in the government, media, and public forums.
Policymakers are
the key players and stakeholders involved in policymaking.
The psychoanalytic therapy model was originated by
Sigmund Freud
Clearly defined boundaries
maintain a person’s separateness while emphasizing belongingness.
Race
is a concept by which human beings are grouped primarily by physiognomy.
Culturally competent care includes the following concepts:
Culture has learned beliefs and behaviors
Culture includes inherited characteristics such as racial, social, ethnic, and religious beliefs
Cultures have syndromes that are not necessarily linked to psychiatric illnesses
Culture can be influenced by the following:
Family Ethnicity Community Environment, such as: Climate Social contacts Housing and surroundings Altitude Temperature Air pollution Fluoride in the water Water quality Crime Poverty Transportation available
The PMHNP role in policy and process change is to
oversee and guide the psychiatric mental health nurse in designing evidence-based health information and educational programs that are geared to consumer learning needs, ability, and readiness to learn.
The PMHNP is a health care partner. It is important for the PMHNP to partner with clinicians at the bedside in order to formulate potential policy change.
Freud’s stages of psychosexual development:
Oral: birth to 12-18 months Anal: 12-18 months to 3 years Phallic: 3 to 5-6 years Latency: 5-6 years to adolescence Genital: adolescence to adulthood
According to Freud, successful resolution of which psychosexual stage provides the basis for the development of personal autonomy and capacity for self-confidence?
Latency
Successful resolution of the anal stage of psychosexual development .
provides the basis for the development of personal autonomy and capacity for self-confidence
Failure to resolve the anal stage results in
pathological traits of excessive orderliness, stubbornness, willfulness, frugality, and parsimony.
Anal characteristics and defenses are typically seen in
obsessive-compulsive disorders.
An intrapreneur is an employee within an established system who champions, manages, and embeds new products or services within an organization. They have characteristics similar to entrepreneurs, including commitment, motivation, and skills to take on risk and develop something new. Nurse practitioners possess a unique vantage in the health care system and are positioned to be successful intrapreneurs. is
an employee within an established system who champions, manages, and embeds new products or services within an organization. They have characteristics similar to entrepreneurs, including commitment, motivation, and skills to take on risk and develop something new. Nurse practitioners possess a unique vantage in the health care system and are positioned to be successful intrapreneurs.
Intrapreneurs characteristics include
They have characteristics similar to entrepreneurs, including
a) . commitment
b) . motivation
c) skills to take on risk and develop something new.
The claim is
a request to the insurance company to pay benefits for a loss.
Pre-approval is the requirement
set forth by an insurance company to approve certain care before it is provided.
The term appropriately describes a nurse practitioner?
Independently licensed practitioner
Symptoms of discontinuation syndrome include
flu-like symptoms fatigue and lethargy myalgia decreased concentration nausea and vomiting impaired memory, paresthesias irritability anxiety insomnia, crying without provocation dizziness and vertigo.
What mental illness affects males and females equally, worsens with each decade of life, is three times more prevalent in older adults, and is associated with indecisiveness, procrastination, avoidance, and difficulty organizing tasks?
Hoarding disorder–Once symptoms begin, hoarding behaviors usually become chronic.
About 80 to 90 percent of individuals with hoarding disorder display
excessive acquisition, most commonly in the form of excessive buying or excessive collection of free items. A less common type of this disorder is called animal hoarding. In animal hoarding, individuals accumulate a large number of pets and fail to provide them with minimal standards of nutrition, sanitation, or veterinary care.
According to Irvin Yalom, what is a responsibility of a group leader during the pre-group phase?
Consider the direction and framework of the group
Irvin Yalom was the first person to put a theoretical perspective on group work. He believed that all groups go through 6 specific phases:
- Pre-group
- Forming
- Storming
- Norming
- Performing
- Adjourning
During the pre-group phase, the group leader’s responsibilities include
- Considering the direction and framework of the group
- Defining the purpose and goals
- Determining the membership criteria and membership size
- Conducting a pre-group interview
- Obtaining informed consent
During the storming phase, the group leader’s responsibilities include
- Allowing expression of both positive and negative feelings
- Assisting the group in understanding the underlying conflict
- Examining unproductive behaviors
Factors facilitating the growth of the nurse practitioner role
- Patient demand for services
- Patient acceptance of and satisfaction with nurse practitioners
- Decreasing stigmatization of psychiatric illnesses
- Emphasis on the need for integrated health care services
Factors constraining the growth of the nurse practitioner role:
- Growing competition in the job market
- Reduction in salary due to nurse practitioner oversupply
- Reimbursement struggles with Medicare and private insurance companies
- Legislative battles for independent practice
- Mandatory physician supervision
- Resistance from powerful medical organizations
Polyuria is a sign of
hypokalemia,
Effects of hyperkalemia:
Muscle weakness Paralysis Tingling of lips and fingers Restlessness Intestinal cramping Diarrhea Electrocardiogram changes
Effects of hypokalemia:
Impaired carbohydrate metabolism Impaired renal function Polyuria Polydipsia Skeletal muscle weakness Smooth muscle atony Cardiac dysrhythmias Paralysis and respiratory arrest
Graduates from the first nurse practitioner program were educated in what medical specialty?
Pediatrics
In 1965, Dr. Loretta Ford (a public health nurse) and Dr. Henry Silver (a pediatrician) established
the first nurse practitioner program at the University of Colorado. This program educated pediatric nurse practitioners with a focus on disease prevention and health promotion. Over the next decade, nurse practitioner schools proliferated across the country. Today, there are over 205,000 nurse practitioners.
At four weeks, landmarks of normal behavioral development include
Hands fisted Head sags but can hold head erect for a few seconds Follows moving objects to midline Responds to speech Smiles preferentially at mother
What cranial nerve assessment tests for tactile perception of the facial skin?
The trigeminal nerve (cranial nerve V, sensory division) assessment tests for tactile perception of the facial skin. This test is performed by touching the face and corneal reflex of the eye with a wisp of cotton and pin-pricking the skin and mucosa to test touch.
The facial nerve (cranial nerve VII motor division) test for
assessment tests for flaccid paralysis.
The hypoglossal nerve (cranial nerve XII) assessment checks
for tremors and other involuntary movements when the client protrudes their tongue.
The olfactory nerve (cranial nerve I) assessment tests
smell and ensures patency of the nasal passages
Cognitive therapy, originating
with Aaron Beck,
Cognitive therapy
purports that external events do not cause anxiety or maladaptive behaviors.
The goal of cognitive therapy is to
change the client’s faulty conceptions, irrational beliefs, and negative cognitive distortions.
The p-value, also known
as the level of significance,
The p-value
describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone.
Children with Rett syndrome present with the following:
- Flat or blunted affect.
- Impairment of expressive and receptive language
- Stereotypic hand movements
Examples of nursing-sensitive adverse events(NSAEs) include:
Examples of NSAEs include:
Failure to rescue Nosocomial infections Pressure ulcers Falls Medication errors Transfusion errors
In how many states do nurse practitioners have the legal authority to administer controlled substances?
39
Nurse practitioners do not have the legal authority to administer controlled substances in which states.
The 11 excluded states are Florida, Kansas, Kentucky, Louisiana, Michigan, Nebraska, New Jersey, New Mexico, North Carolina, Pennsylvania, and South Carolina.
The most common reasons patients seek individual psychotherapy are as follows:
- Loss
- Interpersonal conflict
- Symptomatic presentations such as panic, anxiety, phobias, and negativity
- Unfulfilled expectations and life transitions
- Characterological issues such as narcissism or aggressiveness
Mind-body interventions under the umbrella of complementary and alternative therapies (CATS) include the following:
Guided imagery
Meditation
Yoga
Biofeedback
Aromatherapy is
a biological-based therapy.
Acupuncture and reflexology are
manipulative body-based therapies.
A 63-year-old female with a long history of generalized anxiety disorder tells you she was out shopping two days ago when she suddenly felt dizzy, experienced heart palpitations and pressure on her chest, and felt a sense of impending doom. Shortly after, she “passed out” and woke up minutes later with a crowd of people surrounding her. She states that she then felt better and decided to keep shopping.
What is the most likely diagnosis?
Cardiovascular disease
Anxiety disorders such as panic disorder and social anxiety very .
rarely cause unconsciousness
Nonpharmacological management of ADHD includes all of the following:
Behavior therapy Treatment for learning disorders Family therapy and education Psychoeducation Patient and parent cognitive behavioral training
The Orphan Drug Act
incentivizes pharmaceutical companies to develop drugs to treat rare diseases. These drugs are otherwise unprofitable to develop because the demand is low.
New chemical entities
refers to any new substance submitted to the FDA for approval.
The Nyman model is
an economic theory positing that private health insurance acts as an income transfer between the sick and the healthy.
The Physician Payment Review Commission is
an independent legislative advisory committee that advises the U.S. Congress on methods used to pay physicians for services to Medicare beneficiaries.
Serotonin antagonist/reuptake inhibitors block
5HT2A receptors. This action inhibits glutamate release in the prefrontal cortex of the brain.
blockage of 5HT2A receptors inhibits
This action inhibits glutamate release in the prefrontal cortex of the brain.
Mean, median, mode, and range are examples
of descriptive statistics.
Systemic effects of hypernatremia include
restlessness, thirst, and fever.
Systemic effects of hyponatremia include which of
Confusion
Up to 30 percent of individuals with obsessive-compulsive disorder (OCD) disorder will
develop a tic disorder. This is most commonly seen in males who develop OCD as a child
factors that hinder and constrict growth are as follows:
Reimbursement struggles with Medicare and private insurance companies
Overlapping scope of practice with other NPs
Increased concerns over reimbursement fraud and abuse
Scope of practice and the need for formal supervision by or collaboration with a physician
Factors that foster or facilitate growth are as follows:
Consumer demand for services
Acceptance of the advanced practice nursing role
Emergence of the PMHNP role
Decreasing stigmatization
Emphasis on integrated health care services
The Office of the National Coordinator for Health Information Technology (ONC) is
the federal entity responsible for accomplishing the goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Health Information Technology for Economic and Clinical Health (HITECH) strategic plan includes five goals:
- Achieve adoption and information exchange through the meaningful use of health information technology (HIT)
- Improve care, improve population health, and reduce health care costs through the use of HIT
- Inspire confidence and trust in HIT
- Empower individuals with HIT to improve their health and the health care system
- Achieve rapid learning and technological advancement
converts the action potential in the presynaptic neuron into a chemical signal that is then transferred to the postsynaptic neuron.
The synapse
Neurotransmitters are chemicals synthesized
from dietary substrates that communicate information from one cell to another. They can be divided into four categories: monoamines, amino acids, cholinergics, and peptides.
Neurotransmitters can be divided into four categories:
monoamines, amino acids, cholinergics, and peptides.
Patients with paranoid personality disorder are
suspicious, have few friends, and read hidden meaning into innocent remarks.
Patients with narcissistic personality disorder act s
elf-important. They are preoccupied with envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.
Patients with dependent personality disorder
fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They desperately desire the approval of others, and they often volunteer for unpleasant tasks to gain the favor of others.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
In almost all cultures,———- is the most commonly used intoxicating substance. About 3.8% of all global deaths and 4.6% of global disability-adjusted life-years are due to———-. About 80% of adults in the United States consume——- at some point in their lives, and 65% of adults are current drinkers.
alcohol
About 3.6% of the world’s population
has an alcohol use disorder, although this varies in different parts of the globe:
of those in the African region have an alcohol use disorder
1.1%
alcohol use in the American region
5.2%
alcohol use in the European region
10.9%
By the age of 18, at least —% of individuals smoke tobacco regularly.
20 %
More than % of these people attempt to quit, but only 5% will be successful
80%; 5%
The female-to-male ratio of anorexia nervosa in clinical populations is
10:1.
The 12-month prevalence of anorexia nervosa among females is
0.4%.
Anorexia is most prevalent in high-income
countries such as the United States, Australia, New Zealand, Japan, and some European countries.
Risk factors for developing this AN disorder include the following:
Obsessional personality traits in childhood
Comorbid anxiety disorders
Living in a culture or society that highly values thinness
Having an occupation that values thinness, such as modeling or elite athletics
Having a first-degree biological relative with an eating disorder
put a patient at risk for possible electrocardiogram changes.
Tricyclic antidepressants and antipsychotics
systems thinking looks at
the whole, considering larger numbers and patterns of interaction to gain understanding. Systems thinking is fundamentally different from that of traditional analysis methods. Instead of isolating small parts of a system (providers, patients, illnesses),
Persistent symptoms suggestive of bipolar disorder include
- decreased need for sleep
- marked difference from normal baseline sleep patterns
- inflated self-esteem
- grandiosity
- increased goal-directed activities
- excessive involvement in pleasurable activities with a high potential for painful consequences
- unrestrained buying sprees, sexual indiscretions, unsound business ventures
- excessive substance use or abuse, and highly recurrent depressive episodes.
The systemic effects of hyperthyroidism can mimic the symptoms of bipolar I disorder. Overlapping symptoms include the following:
Motor restlessness Emotional lability Short attention span Compulsive movement Tremor Insomnia
Thyroiditis is more likely to mimic
symptoms of major depressive disorder.
Eating disorders are characterized by
disordered patterns of eating accompanied by distress, disparagement, preoccupation, and a distorted perception of one’s body shape.
Autism spectrum disorder is described as the patient having persistent deficits in social communication and social interaction across multiple settings; it is associated with deficits in the following:
Social reciprocity
Nonverbal communication
Developing, maintaining, and understanding relationships
Restricted or repetitive behavior such as
Stereotyped or repetitive motor movements
Insistence on sameness
Highly restricted, fixed interests
Hyper- or hyposensitivity
The etiology of insomnia is found in the following:
- Dysfunction in sleep-wake circuits of the brainstem
- Neurochemical imbalances impinging on these circuits
- May be stress-related in brief episodic insomnia
Brief psychotic disorder is characterized by
at least one psychotic symptom present for less than one month.
Delusional disorder is a psychotic disorder characterized by the
presence of delusions but no other symptoms of schizophrenia
Schizophreniform disorder is characterized by patients experiencing symptoms of schizophrenia but who
have been ill for only one to six months.
Schizoaffective disorder is characterized by patients
experiencing symptoms of schizophrenia along with either depression or mania.
During the storming phase:
Members appear resistant and begin to use testing behaviors
Issues related to inclusion, control, and affection begin to surface
Leaders allow expression of both positive and negative feelings
Leaders assist the group in understanding the underlying conflict
Leaders examine unproductive behaviors
Hepatic cytochrome P450 enzyme interactions can
induce or inhibit the metabolism of certain drugs, thus changing their desired concentration levels.
Enzyme inducers decrease the serum level of other drugs that are substrates of that
, possibly resulting in subtherapeutic drug levels.
enzyme Inducers include
carbamazepine, hypericum (St. John’s wort), phenytoin, phenobarbital, and tobacco.
Enzyme inhibitors can
increase the serum level of other drugs that are substrates of that enzyme, possibly resulting in toxic levels.
Enzyme inhibitors include class.
bupropion, clomipramine, duloxetine, fluoroquinolones, nefazodone, and the SSRI
According to Erik Erikson, during which psychosocial stage would you expect a person to develop loving sexual relationships?
Intimacy vs. Isolation
Failure to resolve Intimacy vs. Isolation
is characterized by fear of relationships with others.
Erik Erikson’s stages of psychosocial development include the following:
Trust vs. Mistrust: birth to 12-18 months
Autonomy vs. Shame and Doubt: 12-18 months to 3 years
Initiative vs. Guilt: 3 to 5-6 years
Industry vs. Inferiority: 5-6 years to adolescence
Identity vs. Role Confusion: adolescence to adulthood
Intimacy vs. Isolation: adulthood
Generativity vs. Stagnation: middle adulthood
Ego integrity vs. Despair: late adulthood
presentations of hypernatremia:
Weight gain Convulsions Pulmonary edema Dry mucous membranes Tachycardia Low jugular venous pressure Restlessness
Presentations of hyponatremia:
Lethargy Headache Confusion Apprehension Seizures Coma Hypotension Tachycardia Decreased urine output Weight gain Edema Ascites Jugular vein distension
Clonazepam (Klonopin) does not carry
an increased risk of major fetal malformations
Commonly used mood-stabilizing medications for bipolar disorder carry
an increased risk of major fetal malformations. However, clonazepam, lorazepam, and alprazolam are effective in the management of acute manic episodes as an adjuvant to maintenance therapy in lieu of antipsychotics. As an adjuvant to lithium or lamotrigine, clonazepam may result in increased time between cycles and fewer depressive episodes.
During the first trimester, the use of lithium (Lithane, Lithobid)
increases the risk of fetal cardiac malformations to 7.7%.
Lithium can be used in the second and third trimesters, but it must be stopped
peripartum due to the rapid fluid shifts during birth.
Both carbamazepine (Tegretol, Carbatrol, Equetro) and divalproex sodium (Depakote)
increase the risk of neural tube defects.
SAM-e may cause the following symptoms in patient with bipolar
hypomania, hyperactive muscle movements, and serotonin syndrome.
Risk factors for suicide include being
- a male aged 45 or older or a female aged 55 or older;
- being divorced, single or separated
- being Caucasian
- living alone
- having a psychiatric disorder or a physical illness
- engaging in substance abuse
- having a previous suicide attempt
- having a family history of suicide
having a recent loss.
A patient presenting with an alcohol use disorder
that is chronic will present with increased MCV and abnormal LFTs.
Elevated potassium and chloride levels
are not always indicative of an alcohol use disorder.
Patients with a chronic alcohol use disorder will have
elevated triglycerides and increased MCV.
Elevated potassium and chloride levels are not always i
indicative of an alcohol use disorder.
originally created interpersonal therapy.
Gerald Klerman and Myrna Weissman
Sigmund Freud created
psychoanalytic therapy
Anna Freud, along with Melanie Klein, is most well known for her
contributions to psychoanalytic child psychology and object relations.
Aaron Beck developed
cognitive therapy and his daughter, Judith Beck, continued his work
Carl Rogers originally developed
humanistic therapy, also known as person-centered therapy.
Yoga is a form of therapy and exercise that
originated in India. Yoga promotes a mind/body connection and uses breathing, physical movements, and meditation to aid in relaxation and healing.
Diagnostic criteria for panic disorder include the following:
Paresthesia Chills or hot flushes Fear of losing control or of going crazy Fear of dying Shortness of breath or a smothering sensation Palpitations, pounding heart, or accelerated heart rate Chest pain, tightness, or discomfort Sweating, trembling, or shaking Nausea or abdominal distress
There are exceptions to patient confidentiality. Exceptions include:
- If a patient reveals an intent to harm self or others
- For attorneys involved in litigation
- When records are released to insurance companies
- When answering court orders, subpoenas, or summons
- When meeting state requirements for mandatory reporting of diseases or conditions
- In cases of child or elder abuse
One of the side effects of being overmedicated with Adderall is
aggression.
stimulants are a schedule II drug,
and this class carries a high risk for potential abuse. Often, primary care providers treat their patients for ADHD and prescribe a stimulant. It is important to assess whether the patient is being prescribed too much medication or if he is secretly taking more than he is prescribed.
Cluster B disorders:
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Cluster A disorders:
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Cluster C disorders:
Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder
There is no cluster D disorder category.
Obsessive-compulsive disorder
patients are bothered by senseless thoughts or behaviors that they cannot stop.
In body dysmorphic disorder,
physically normal patients believe that parts of their bodies are misshapen or ugly.
Trichotillomania patients
compulsively pull hair from various parts of their body.
Excoriation disorder
patients so persistently pick at their skin that they leave scars.
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six goals for quality improvement in health care:
- safe,
- effective,
- patient-centered,
- timely,
- efficient,
- equitable.
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six goals for quality improvement in health care:
- Safe: Avoiding injuries to patients from the care intended to help them
- Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
- Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions
- Timely: Reducing waits and sometimes harmful delays for both those who receive and those who provide care
- Efficient: Avoiding the waste of equipment, supplies, ideas, and energy
- Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
For acute dystonia give
Cogentin 2 mg IM STAT is the best intervention, as Benadryl had previously been given without preventative effects.
In 1971, C. West Churchman, a pragmatic philosopher, laid the groundwork for
systems thinking.
C. West Churchman defined an inquiring system
He defined an inquiring system as a system capable of facilitating learning and organizational change. The
The purpose of inquiring systems is to
Create knowledge and thereby create the capability of choosing the right means for the desired ends.
Churchman’s model for the design of inquiring systems provides
the basis for sustaining evolving organizations.
A person diagnosed with schizotypal personality disorder, schizoid personality disorder, or paranoid personality disorder falls under which category of personality disorders?
Cluster A
The axon
transmits signals away from the neuron’s cell body to connect with other neurons and cells
The dendrite
collects incoming signals from other neurons and sends the signals toward the neuron’s cell body.
High-risk characteristics for committing suicide include the following:
Male gender Alcohol use disorder Previous suicide attempt Caucasian race History of violent behavior
has one of the lowest suicide rates, and females rate lower in suicide risk than males.
New Jersey
is ranked high in suicide rates among men.
Montana
In what phase of group therapy will the leader consider the direction and framework of the group?
Pregroup
In the forming phase,
goals and expectations are identified and boundaries established. In the storming phase, the leader is to allow expression of both positive and negative feelings and assist the group in understanding underlying conflicts and nonproductive behavior
In the norming phase,
the leader allows for open and spontaneous communication, and norms are established.
Patients learn to consciously control their physiological functions when
undergoing biofeedback,
Both acupuncture and acupressure are based
on the idea in Chinese medicine that vital energy called chi flows along specific pathways in the body. Manipulating this energy using needles or pressure can correct imbalances. Acupuncture and acupressure are thought to produce their therapeutic effects by aiding in the activity of endorphins and the immune system. It is also thought that they alter brain chemistry by changing the release of certain neurohormones and neurotransmitters.
Other medications approved for OCD are as follows:
TCAs (tricyclic antidepressants)
Second generation antipsychotics
FDA-approved for the treatment of OCD.
Prozac is an SSRI-
Ativan is a benzodiazepine
FDA-approved for generalized anxiety disorder.
OCD is in the family
of anxiety disorders
Risk factors of bipolar disorder include the following:
Genetic loading
Family history of a first-order relative having major depressive or bipolar disorder
A relative having bipolar type I disorder (24% increase in risk)
A common comorbidity of obsessive compulsive disorder?
Eating disorders. Patients suffering from obsessive compulsive disorder often experience eating disorders such as anorexia and bulimia. They also experience hypervigilance and strict associations with exercise, patterns of behavior, routines, and hobbies.
Agoraphobia patients fear
situations or places where they might have trouble obtaining help if they become scared.
Specific phobia patients fear
specific objects or situations such as animals, storms, heights, blood, airplanes, or any situation that may lead to vomiting, choking, or developing an illness.
Social anxiety disorder
patients fear embarrassment when they speak, write, or eat in public.
In generalized anxiety disorder (GAD), the nature of the stressor
shifts frequently.
Clients suffering from moderate/severe forms of anxiety often require adjunct therapy while being stabilized on
antidepressant therapy.
Benzodiazepines such as clonazepam and diazepam are more useful
for continuous, moderate-to-severe anxiety or as bridge medications while waiting for the efficacy of antidepressants.
Calcium values can be increased
during treatment with lithium, thiazide diuretics, alkaline antacids, or vitamin D.
In family systems therapy, what is the term for parents transmitting their own level of differentiation onto the most susceptible child?
Family projection process
The projection process follows three steps:
The parent focuses on a child out of fear that something is wrong with the child;
The parent interprets the child’s behavior as confirming the fear; and
The parent treats the child as if something is really wrong with them.
In a nuclear family emotional system, the level of differentiation of the parents is
usually equal to the level of differentiation for the entire family.
Multitransmission process refers to
family dysfunction that is present in several generations.
Triangles in family
are groups of three family members that form in order to decrease stress. The presence of triangles indicates a lower level of family adaptation.
Countertransference can present in the provider as r
recurrent episodes of anxiety and uneasiness when dealing with a particular client. Countertransference is the nurse’s emotional reaction to the client based on his or her own experiences.
Which federal plan replaced Medicare + Choice and gave enrollees the option of choosing private insurance plans?
Medicare Advantage
Research and studies show that the Recovery Model of Care is t
he single most important goal in the transformation of mental health care over the past two decades.
Which term best describes the use of aggregate variance data to change a system of health care practice?
Outcomes management
Variance is any
event that alters patient progress toward expected outcomes. Sources of variance include practitioner behavior (competency), the severity of illness, and practice patterns that either expedite care or inhibit delivery of care.
Which of the following is a common non-psychoactive supplement used to help cure symptoms of illnesses such as depression, osteoarthritis, and liver disease?
SAM-e
is a dietary supplement used to treat depression, osteoarthritis, and liver disease.
SAM-e
common non-psychoactive dietary supplements with physiological (not psychological) effects used to cure illnesses and maintain health are as follows:
Omega-3 fatty acids Tryptophan Vitamin E Melatonin Fish oil
Omega-3 fatty acids
are important in the treatment and prevention of heart disease.
Tryptophan is a
dietary supplement aiding in nitrogen balance in adults and growth in infants. Tryptophan also aids in the creation of niacin, which is essential in creating the neurotransmitter serotonin.
Tryptophan also aids in the creation
of niacin, which is essential in creating the neurotransmitter serotonin.
Fish oil is a
dietary supplement known to reduce inflammation in the body and improve hypertriglyceridemia.
In a hospital psychiatric consultation setting, what is one of the most common mental illness diagnoses?
Adjustment disorders are very common. They are one of the most common diagnoses given in a hospital psychiatric consultation setting, frequently reaching up to 50 percent.
About 5 to 20 percent of patients in an outpatient mental health clinic meet the criteria for this diagnosis as well.
Adjustment disorders
describes an individual with antisocial personality disorder?
They show no remorse for their behavior
Patients with antisocial personality disorder exhibit
criminal behavior beginning in childhood, such as truancy, fighting, destructiveness, and theft. They often default on debts, behave irresponsibly, and act recklessly. They show no remorse for their behavior.
Patients with schizoid personality disorder
care little for social relationships, have restricted emotional range, and appear indifferent to criticism or praise.
Patients with borderline personality disorder exhibit i
impulsivity, self-harm, inappropriate anger, and affective instability. They feel empty and bored, and they frantically try to avoid abandonment.
Patients with avoidant personality disorder are
timid and easily wounded by criticism from others. They fear embarrassment and hesitate to form interpersonal relationships.
schizoaffective disorder
A disorder characterized by patients experiencing symptoms of schizophrenia along with either depression or mania
Delusional disorder is a
psychotic disorder characterized by the presence of delusions but no other symptoms of schizophrenia
Brief psychotic disorder is characterized
by at least one psychotic symptom present for less than one month. Schizophreniform disorder is characterized by patients experiencing symptoms of schizophrenia but who have been ill for only one to six months.
You are a new nurse practitioner opening your own solo practice. You understand that you are expected to be competent in your role of treating and diagnosing patients. As a nurse practitioner, you are expected to be competent in all of the following core competency areas except:
Practice inquiry
Technology and information literacy
Policy
Nurse practitioner core competencies include the following:
Scientific foundations Leadership Quality Practice inquiry Technology and information literacy Policy Health delivery systems Ethics Independent practice
Barriers to the implementation of meaningful use include
- staff training,
- usability,
- workflow changes
- . altered patient-provider interaction,
- clinician resistance to change.
The federal government did provide incentives in the form
of financial rewards and potential reduction in Medicare reimbursement.
Some states use the umbrella term advanced practice nurse to refer to all of the following providers
Mid-level provider
Some states use the umbrella term advanced practice nurse to refer to nurse practitioners, clinical nurse specialists, nurse-midwives, and nurse anesthetists. Nurse practitioners differ from advanced practice nurses in that
they offer a wider range of services to a wider portion of the population.
Patients suffering from impaired memory or Alzheimer’s disease present with a decrease in
acetylcholine.
Patients suffering from Parkinsonian symptoms present with an increase in
acetylcholine.
Patients suffering from schizophrenia present with an increase in .
dopamine
Patients suffering from psychosis due to ischemic neurotoxicity or excessive pruning present with an increase in.
glutamate
stabilizes somatic motor activity, initiates complex motor function, and maintains muscle tone, posture, and common reflexes.
The basal ganglia
not the basal ganglia, is responsible for connecting sensory smell information with emotions.
limbic system’s amygdala
Which of the following takes place during the installation phase of eye movement desensitization and reprocessing (EMDR)?
The patient inserts and strengthens the positive thought that replaced the original negative thought in their mind
Eye movement desensitization and reprocessing (EMDR) is a form of behavioral therapy that was developed by . It is most commonly used in posttraumatic stress disorder, and its goal is adaptive resolution.
Francine Shapiro
EMDR
It is most commonly used in posttraumatic stress disorder, and its goal is adaptive resolution.
There are three phases in EMDR:
desensitization, installation, and body scan.
The patient visualizes the trauma, verbalizes negative or maladaptive beliefs, and remains attentive to physical sensations. The patient also blocks out negative thoughts, breathes deeply, and verbalizes what he or she is imagining.
Desensitization
The patient installs and strengthens the positive thought that he or she has declared as a replacement of the original negative thought.
installation
The patient visualizes the trauma along with the positive thought and then scans his or her body mentally to identify any tension within
Body scan
Who was the first person to put a theoretical perspective on group work?
Irvin Yalom
Sigmund Freud founded
psychoanalysis.
Carl Rogers originally developed
humanistic therapy.
Viktor Frankl developed
existential therapy.
Irvin Yalom was the first person to put a theoretical perspective on group work. He identified 10 curative factors that differentiate group work from individual therapy:
instillation of hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing
Patients with bipolar I disorder will present with psychomotor agitation (not retardation) and insomnia (not hypersomnia).
Other criteria include the following:
Inflated self-esteem
Increased goal-directed activity or energy for at least one week
Flight of ideas and distractibility
Which medication can potentially cause all of the following symptoms: anxiety, mood changes, psychosis, and delirium?
Corticosteroids
Corticosteroids are known to cause
a wide range of psychiatric symptoms including anxiety, mood changes, psychosis, and delirium.
medications that can potentially cause all of the following symptoms: anxiety, mood changes, psychosis, and delirium
Other medications that can cause all these symptoms include the following:
Analgesics Anesthetics Anticonvulsants Antidepressants Antihypertensives
Benzodiazepines and antiulcer agents
can cause mood changes.
NSAIDs can cause
psychosis.
Biofeedback is a process providing a person with
visual or auditory information about the autonomic physiological functions of their body, such as blood pressure, muscle tension, and brain wave activity
Biofeedback is used in the following situations:
Stress-related symptoms such as anxiety Pain Insomnia Neuromuscular problems such as migraines or muscular tension Neurobehavioral disorders Enhancement of healing Athletic and work performance
Dissemination includes
publication in peer-reviewed journals and professional newsletters.
Histrionic, antisocial, borderline, and narcissistic personality disorders all fall under
Cluster B.
Patients with histrionic personality disorder
are most likely to act overly emotional and seductive. They often demand constant reassurance about their appearance.
Patients with antisocial personality disorder exhibit
criminal behavior beginning in childhood, such as truancy, fighting, destructiveness, and theft. They often default on debts, behave irresponsibly, and act recklessly. They show no remorse for their behavior.
Patients with borderline personality disorder exhibit
impulsivity, self-harm, inappropriate anger, and affective instability. They feel empty and bored, and they frantically try to avoid abandonment.
Patients with narcissistic personality disorder act
self-important. They are preoccupied with envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.
Nurse practitioner:
Evaluate, diagnose, and treat a wide range of medical conditions
Clinical nurse specialist:
Consult, research, educate, and coordinate care
Nurse anesthetist:
Preoperative assessment, administration of anesthesia, and postanesthesia recovery
Certified nurse-midwife:
Well-woman gynecological care, management of pregnancy and childbirth, antepartum and postpartum care
OCD is the
presence of anxiety-provoked obsessions or compulsions that function to reduce the person’s subjective anxiety level.
Acute panic disorder with anxious traits and generalized anxiety disorder, acute, single episode, are symptoms of
OCD.
The following are specific attributes often found in those suffering from major depressive disorders:
Unkept appearance Tired appearance Wearing dark-colored clothing Wearing loose-fitting clothing Significant weight gain or loss
Lorazepam is an
antianxiety medication in the class of benzodiazepines. This medication can help alleviate her anxiousness prior to the surger
Lorazepam can
can help alleviate her anxiousness prior to the surgery
Specifiers are
special descriptions added to a patient’s diagnosis to provide more information. Specifiers help characterize the condition and describe its overall course. Specifiers used to describe mood disorders include the following:
Mood disorder with atypical features:
These patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection.
Mood disorder with melancholic features:
These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions.
Mood disorder with anxious distress:
These patients have high levels of tension, restlessness, worry, and fear.
Mood disorder with catatonic features
These patients exhibit either motor hyperactivity or inactivity.
Mood with mixed features:
These patients are experiencing a mixture of both manic and depressive symptoms.
Mood disorder with peripartum onset:
These patients develop a mood episode during pregnancy or within a month of having their baby.
Mood disorder with psychotic features:
These patients develop delusions or hallucinations along with their mood symptoms.
Mood disorder with rapid cycling:
These patients have experienced at least four mood episodes in the past year.
Mood disorder with seasonal pattern:
These patients regularly become ill at a certain time of the year.
To establish a medical malpractice suit, the plaintiff must establish that
a dereliction of duty directly caused damage (also known as the four Ds of medical malpractice). The plaintiff must establish that:
four Ds of medical malpractice
dereliction of duty directly caused damage
The plaintiff must establish that:
The nurse practitioner owed the plaintiff a duty
The nurse practitioner’s conduct fell below the standard of care
The nurse practitioner’s conduct caused the plaintiff injury
The burden of proof in medical malpractice suits is
by a preponderance of evidence (greater than 50%). Medical malpractice suits are civil cases. Proof beyond reasonable doubt applies to criminal cases.
Medical malpractice suits are
civil cases
Patients requiring inpatient hospitalization are
at an illness state that requires acute stabilization. The outpatient setting is an inappropriate level of care when the disease state is at this point.
Cyclothymic disorder can be described as
a chronic, fluctuating mood disorder with symptoms similar to but less severe than those of bipolar disorder. Onset later in life usually suggests the patient may have a general medical condition called multiple sclerosis.
Cyclothymic disorder is a mental disorder that
involves numerous periods of depressive symptoms and hypomanic symptoms. However, they are not sufficient to be diagnosed as a major depressive episode or a hypomanic episode.
In obsessive-compulsive disorder (OCD),
males have an earlier age of onset. Up to 25 percent of males with OCD are diagnosed before they turn 10 years old. Onset in childhood often indicates that it will be a lifelong illness.
For OCD, the mean age of onset
is 19.5 years, and onset after the age of 35 is very rare.
Females are affected with OCD at a
slightly higher rate than males. The 12-month prevalence of OCD in the United States is 1.2
Social anxiety disorder
patients fear embarrassment when they speak, write, or eat in public.
Panic disorder patients experience .
brief episodes of intense dread accompanied by physical symptoms like chest pain, chills, shortness of breath, and an irregular heartbeat
Generalized anxiety disorder patients feel
tense or anxious a majority of the time and worry about many different issues.
Agoraphobia patients
fear situations or places where they might have trouble obtaining help if they become scared.
Agranulocytosis is a potential serious risk when prescribing patients
mood stabilizers such as carbamazepine and antipsychotics such as clozapine.
Health care informatics is
the integration of computer science, information science, and health care. Examples of tools in health care informatics include clinical guidelines, electronic health records, patient care technology devices, and databases of health care outcomes.
Examples of tools in health care informatics include
clinical guidelines, electronic health records, patient care technology devices, and databases of health care outcomes.
childhood-onset fluency disorder,
Stuttering occurs when the normal fluency of speech is frequently interrupted.
Tourette’s disorder is characterized
by two or more motor tics and at least one vocal tic that occur frequently throughout the day.
Attention-deficit/hyperactivity disorder is characterized by
hyperactivity, impulsivity, and inattentiveness.
Oppositional defiant disorder is characterized
by multiple examples of negativistic behavior persisting for at least six months, usually beginning when a child is three or four years old.
Alprazolam is a
benzodiazepine used to treat panic disorder.
benzodiazepine
used to treat panic disorder.
Nurse practitioner standards of practice:
Give authoritative statements regarding the quality and type of practice that should be provided
Offer a way to judge the nature of care provided
Reflect the expectation for the care that should be provided to patients
Reflect professional agreement focused on the minimum levels of acceptable performance
Can be used to legally describe the standard of care
May be either precise or general guidelines
Nurse practitioner scope of practice:
Defines the nurse practitioner’s roles and actions
Identifies competencies assumed to be held by all nurse practitioners who function in a particular role
Has broad variations from state to state due to outdated legislation
The S-MAST, also known
as the Michigan Alcoholism Screening Test for Geriatrics,
the Michigan Alcoholism Screening Test for Geriatrics,
is a clinical assessment tool used to assess and screen for alcoholism in geriatric populations.
The COWS means
(Clinical Opiate Withdrawal Scale)
The COWS
assessment is used to assess the withdrawal severity of opiates.
The CIWA assessment is used
to assess the withdrawal severity of alcohol and/or benzodiazepines.
The AUDIT assessment
is an alcohol use assessment tool, less commonly used than CIWA.
The benefits of group therapy include the following:
It increases insight about oneself
It increases social skills
It is cost-effective
It promotes a sense of community
Individual counseling provides
a set time for patients to attend exclusively to their own needs.
The definition of primary care is:
The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community
The following common medications can induce depression:
Beta blockers such as propranolol Steroids Interferon Isotretinoin Some retroviral drugs Neoplastic drugs Benzodiazepines Progesterone
The following medications can induce mania:
Steroids
Disulfiram
Isoniazid
Antidepressants
According to Piaget, the cognitive-spatial concept of reversibility develops
during middle childhood, not adolescence.
Piaget’s stages of cognitive development:
Infancy (birth to 2 years): Sensorimotor Early Childhood (2 to 5 years): Preoperational Middle Childhood (6 to 11 years): Concrete operational Adolescence (11 to 19 years): Formal operational
During the formal operational stage, adolescents develop the following cognitive-spatial concepts:
Hypothetical-deductive reasoning: quick to think of excuses
Imaginary audience: feel as though everyone is looking at them
Personal fable: inflated opinion of themselves
Propositional thinking: can think of many possibilities
A body mass index higher than the ————percentile places children at an increased risk of becoming overweight.
85th
Intrauterine insults may include
- prenatal exposure to toxins,
- including viral agents
- oxygen deprivation
- maternal malnutrition
- substance use
- other illnesses.
Countertransference represents a nurse practitioner’s
emotional reaction to a patient based on his or her past experiences
Signs that indicate the presence of countertransference include
- Intense emotional reactions during the first encounter with a patient
- Recurrent anxiety or uneasiness while dealing with a patient
- Uncharacteristic carelessness when following up with a patient
- Difficulty empathizing
- Resistance to others treating the patient
- Preoccupation with or dreaming about the patient
- Frequently running overtime or cutting time short with a patient
- Depression during or after an interaction with a patient
Magnesium is responsible for neuromuscular activity and excitability. An increased level of magnesium in the body is linked to all of the following
Hyperthyroidism Hypothyroidism Renal failure Addison's disease Diabetic ketoacidosis Dehydration
Alcoholism is
linked to decreased levels of magnesium in the body.
According to Piaget, children between the ages of six and eleven years develop which cognitive-spatial concept
Conservation
Piaget’s stages of cognitive development:
Infancy (birth to 2 years): Sensorimotor Early Childhood (2 to 5 years): Preoperational Middle Childhood (6 to 11 years): Concrete operational Adolescence (11 to 19 years): Formal operational
Children between the ages of six and eleven years develop the following cognitive-spatial concepts:
Hierarchical classification Reversibility Conservation Decentration Spatial operations Horizontal decalage Transitive inference
Egocentrism and transductive reasoning are
developed during early childhood (2 to 5 years),
Imaginary audience is
developed during adolescence.
Poor community integration is an example
of a social risk factor for developing a psychiatric condition.
Psychiatric risk factors fall into three categories:
biological, psychological, and social.
Biological risk factors:
History of mental illness in the family
Poor nutritional status
Poor general health
Psychological risk factors:
Poor self-concept
External locus of control
Poor ego defenses
Social risk factors:
Stressful occupation
Low socioeconomic status
Poor level of social integration
Which class of psychiatric medications is most likely to cause extrapyramidal side effects?
Typical antipsychotics
Extrapyramidal symptoms are drug-induced side effects that affect
motor functioning and muscle movement.
The common types of extrapyramidal symptoms are
akathisia, akinesia, dystonia, pseudo-Parkinson’s, and tardive dyskinesia.
Typical antipsychotics
(also known as first-generation antipsychotics) are more likely to cause these side effects than
atypical antipsychotics
(also known as second-generation antipsychotics).
The etiology of insomnia is found in the following:
Dysfunction in sleep-wake circuits of the brainstem
Neurochemical imbalances impinging on these circuits
May be stress-related in brief episodic insomnia
n 2010, the Institute of Medicine published a groundbreaking report titled The Future of Nursing: Leading Change, Advancing Health. This report considered the obstacles that all nurses encounter as they provide quality health care in the United States. The report was actively challenged
by the American Medical Association. They iterated that physicians are the true leaders of health care.
The psychoanalytic theory attends to
past, developmental, environmental, and psychodynamic factors that shape present behaviors.
In systems thinking,
the belief is that a system is perfectly designed to produce what it produces. The belief is that whatever comes from a system is what the system was designed to produce, regardless of whether the design of the system was planned or unplanned and whether the results were intended or unintended.
Testamentary capacity
is the level of competence required to make a legally valid will.
The key elements of testamentary capacity include the following:
- Comprehension of the act of writing and signing the will
- Knowledge of potential heirs
- Understanding of the extent of one’s assets
- Lack of undue influence
- The absence of delusions compromising rational thought
What psychiatric condition accounts for 25 percent of all completed suicides?
Bipolar disorder
Bipolar disorder accounts for percent of all completed suicides.
25%
The lifetime risk of suicide in those diagnosed with bipolar disorder is
15 times greater than that of the general population. These individuals are more likely to complete suicide if they have a history of suicide attempts and have spent the majority of the past year in a depressed episode.
What was the original name of the Centers for Medicaid and Medicare Services (CMS)?
Health Care Financing Administration
The Health Care Financing Administration (HCFA) was an agency of the United States Department of Health and Human Services that was created to
oversee the financing and quality-control programs for Medicare and the federal portion of Medicaid. The agency has since been renamed Centers for Medicaid and Medicare Services (CMS).
Forensic risk assessment is intended to protect
the public from persons with known mental disorders having dangerous, violent, and criminal histories.
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six goals for quality improvement in health care:
Safe: Avoiding injuries to patients from the care intended to help them
Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions
Timely: Reducing waits and sometimes harmful delays for both those who receive and those who provide care
Efficient: Avoiding the waste of equipment, supplies, ideas, and energy
Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Safe
Avoiding injuries to patients from the care intended to help them
Effective:
Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
Patient-centered:
Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions
Timely:
Reducing waits and sometimes harmful delays for both those who receive and those who provide care
Efficient:
Avoiding the waste of equipment, supplies, ideas, and energy
Equitable:
Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Which federal entity is responsible for accomplishing the goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act?
Office of the National Coordinator for Health Information Technology (ONC)
The Office of the National Coordinator for Health Information Technology (ONC) is
the federal entity responsible for accomplishing the goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Their strategic plan includes five goals
Office of the National Coordinator for Health Information Technology (ONC). Their strategic plan includes five goals:
- Achieve adoption and information exchange through the meaningful use of health information technology (HIT)
- Improve care, improve population health, and reduce health care costs through the use of HIT
- Inspire confidence and trust in HIT
- Empower individuals with HIT to improve their health and the health care system
- Achieve rapid learning and technological advancement
Disorganized thinking, loose associations, tics, and stereotypic behavior suggest that a patient is experiencing an excess of which neurotransmitter?
Dopamine
A_____ ____ results in symptoms of disorganized thinking, loose associations, tics, and stereotypic behavior.
dopamine excess
A _______ results in symptoms of Parkinson’s disease,endocrine alterations, poor spatiality, and lack of abstract thought.
dopamine deficit
A___________ results in restlessness, agitation, myoclonus, and vital sign abnormalities.
serotonin excess
A ______________ results in restlessness, agitation, myoclonus, and vital sign abnormalities.
serotonin excess
An _________results in over-inhibition, anxiety, somatic complaints, self-consciousness, and drooling
acetylcholine excess
A _________ results in hyperalertness, paranoia, and decreased appetite.
norepinephrine excess
What method do adolescents most commonly use to successfully commit suicide?
Firearms
Firearms are the most common method
by which adolescents commit suicide.
Drug overdose is the most common
method of suicide attempts, but it accounts for far fewer completed suicides.
Factors constraining growth of the NP:
- Growing competition in the job market in general for NPs
- Reimbursement struggles with Medicare and private insurance companies
- Overlapping scope of practice with other NPs
- Increased concerns over reimbursement fraud and abuse
- Scope of practice and need for formal supervisory or collaborative relationships with physicians
foster and facilitate growth of NP are as follows:
- Consumer demand for services
- Acceptance of the advanced practice nursing role
- Emergence of the PMHNP role
- Decreasing stigmatization
- Emphasis on integrated health care services
Social anxiety disorder
patients fear embarrassment when they speak, write, or eat in public.
Generalized anxiety disorder patients feel
tense or anxious a majority of the time and worry about many different issues.
Panic disorder patients experience
brief episodes of intense dread accompanied by physical symptoms like chest pain, chills, shortness of breath, and an irregular heartbeat.
Extrapyramidal symptoms are
drug-induced side effects that affect motor functioning and muscle movement. Typical antipsychotics like haloperidol, perphenazine, and chlorpromazine are more likely to cause these side effects than atypical antipsychotics like olanzapine, lurasidone, and risperidone.
Akathisia:
motor restlessness, inability to remain still, rocking, pacing, or constant motion of a unilateral limb, subjective sense of restlessness, often mistaken for increasing anxiety
Akinesia:
absence of movement, difficulty initiating motion, subjective feeling of lack of motivation to move, often mistaken for laziness or lack of interes
Dystonia:
muscle spasticity usually in the back or neck, subjectively painful, often mistaken for agitation
Pseudo-Parkinson’s:
shuffling gait, motor slowing, mask-like facial expression, pill-rolling, tremors, muscle rigidity
Tardive dyskinesia:
involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that may progress to limbs; can be irreversible, can occur as an acute process at the initiation of medications or as a chronic condition at any point during treatment
Medicare Part B provides coverage for ambulatory practitioner services and physical, occupational, and speech therapy. It also covers medical equipment, diagnostic tests, and some preventative care. Covered preventative services include the following:
Pap smears Mammography Screening for colorectal cancer Screening for prostate cancer Screening for cardiovascular disease Screening for diabetes Glaucoma screening Influenza vaccinations Pneumonia vaccinations
Cognitive-behavioral therapy combines
techniques from cognitive and behavioral therapy, both of which can help alleviate symptoms of panic disorder. Cognitive techniques will help this patient identify maladaptive thought processes or cognitive distortions. Behavioral techniques might include exposing the patient to feared situations in a safe environment in order to extinguish anxiety.
non-benzodiazepine anxiolytic used for treating anxiety in adults.
Tiagabine is a non-benzodiazepine anxiolytic used for treating anxiety in adults.
Alprazolam is a
.
benzodiazepine.
Levomilnacipran is
an antidepressant.
Brexpiprazole is
an antipsychotic
most common reasons that patients seek individual psychotherapy
Characterological issues such as narcissism or aggressiveness
The most common reasons patients seek individual psychotherapy are as follows:
- Loss
- Interpersonal conflict
- Symptomatic presentations such as panic, anxiety, phobias, and negativity
- Unfulfilled expectations and life transitions
- Characterological issues such as narcissism or aggressiveness
What type of study is considered the cornerstone of evidence-based practice?
Systematic reviews
the cornerstone of evidence-based practice.
Systematic reviews
Systematic reviews integrate the results from
multiple studies using methodical and/or statistical procedures. When possible, nurse practitioners make their clinical judgments based on the findings of systematic reviews.
What virtue is associated with the successful resolution of the psychosocial stage Trust vs. Mistrust?
Hope
What virtue is associated with the successful resolution of the psychosocial stage Autonomy vs. Shame and Doubt:
Will
What virtue is associated with the successful resolution of the psychosocial Initiative vs. Guilt:
Purpose
What virtue is associated with the successful resolution of the psychosocial Industry vs. Inferiority:
Competence
What virtue is associated with the successful resolution of the psychosocial Identity vs. Role Confusion:
Fidelity
What virtue is associated with the successful resolution of the psychosocial Intimacy vs. Isolation:
Love
What virtue is associated with the successful resolution of the psychosocial Generativity vs. Stagnation:
Care
What virtue is associated with the successful resolution of the psychosocial Ego Integrity vs. Despair:
Wisdom
Decision #3 of the Team Leadership Model states that
Decision #3 states that the leader should “decide whether it is necessary to intervene internally or externally.”
Decreased levels of calcium can cause which of the following?
Renal failure
example of management of a patient’s health status.
Conducting a physical exam and ordering diagnostic tests is an
Nurse practitioner core competencies:
Providing culturally sensitive care
Management of the patient’s health status
Maintenance of the nurse practitioner-patient relationship
Teaching and coaching
Professional role
Negotiating health care delivery systems
Monitoring quality of care
Nurse practitioner core competencies in teaching and coaching:
Offering health promotion and disease prevention techniques
Using motivational interviewing to direct behavioral change
Providing psychoeducation
Risk reduction
Providing psychopharmacological education
According to Irvin Yalom, which curative factor occurs when participants reexperience family conflicts within group therapy?
Corrective refocusing
the first person to put a theoretical perspective on group work.
Irvin Yalom
Irvin Yalom identified 10 curative factors that differentiate group therapy from individual therapy:
Instillation of hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing
Corrective refocusing occurs when
participants reexperience family conflicts in the group. These experiences allow them to recognize and change their problematic behaviors.
Interpersonal learning allows participants.
to increase their adaptive interpersonal relationships through group therapy sessions
Altruism results from
sharing oneself with another.
Universality occurs as participants
discover that others have similar problems, thoughts, or feelings.
Social anxiety (phobia) disorder is described
as a marked and persistent fear of social or performance situations in which embarrassment may occur.
Patients with social anxiety (phobia) disorder lack
assertiveness.
Other descriptive features include the following:
Sensitivity to criticism
Inferiority feelings
Medicare Part B provides coverage for ambulatory practitioner services and physical, occupational, and speech therapy. It also covers medical equipment, diagnostic tests, and some preventative care. Covered preventative services include the following:
Pap smears Mammography Screening for colorectal cancer Screening for prostate cancer Screening for cardiovascular disease Screening for diabetes Glaucoma screening Influenza vaccinations Pneumonia vaccinations
Galantamine dual actions of (s.
1) inhibiting acetylcholinesterase and (2) positive allosteric modulation of nicotinic cholinergic receptor
Concrete forms of communication are
specific, definite, and vivid rather than vague and general.
Proverbial forms of communication are more
general and commonly use adages such as “practice makes perfect.”
prohibit nurse practitioners in a managed care setting from discussing alternative treatment options not covered by the insurance plan. They are also prohibited from providing information on the limitations of the plan or commenting negatively about the plan to patients.
Gag rules
The general function of norepinephrine involves
alertness, orientation, fight-or-flight, learning, memory, and focus and attention.
The general function of serotonin involves
regulation of sleep, pain perception, mood states, temperature, aggression, and libido.
The general function of glutamate involves
memory and sustained autonomic functions.
he general function of dopamine involves
normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition.
Decreased levels of potassium are seen in laxative abuse. They are also seen in the following:
Alkalosis Excessive insulin Burns Trauma Surgery Cushing's syndrome Hyperaldosteronism Thyrotoxicosis Anorexia nervosa Diet deficient in meat and vegetables
Increased levels of potassium are seen in the following:
Acidosis Insulin deficiency Addison's disease Acute renal failure Hypoaldosteronism Infection Dehydration
Hepatic encephalopathy is the loss
of brain function when a damaged liver does not remove toxins from the blood. It is difficult to diagnose and can present in a variety of ways.
Asterixis is characteristic of
hepatic encephalopathy, but not diagnostic.
Other signs may of hepatic encephalopathy include
ecchymosis, peripheral edema, ascites formation, palmar erythema, and spider angiomas. Family members and friends may state that the patient’s personality has changed and that their cognitive abilities have deteriorated.
Preventative factors that protect a person from developing a psychiatric condition..
are those that protect a person from developing a psychiatric condition. They fall into three categories: biological, psychological, and social
Biological preventative factors that protect a person from developing a psychiatric condition.:
Without a history of mental illness in the family
Healthy nutritional status
Good general health
Psychological preventative factors that protect a person from developing a psychiatric condition.:
Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses
Social preventative factors that protect a person from developing a psychiatric condition:
Low-stress occupation
Higher socioeconomic status
Higher level of education
What psychiatric condition is characterized by the consumption of material that is not food, such as soap, chalk, plaster, or paper?
PICA
Pica is a psychiatric condition
occurring when a patient eats material that is not food, such as soap, chalk, plaster, or paper.
Primary prevention is aimed at
decreasing the number of new cases of mental health or substance abuse disorders. Nurse practitioners can engage in primary prevention strategies by helping people avoid stressors or cope with them more adaptively.
Examples of primary prevention strategies:
Stress management classes for graduate students
Smoking prevention classes
Drug Abuse Resistance Education (DARE)
Participating on a disaster response team and volunteering for a suicide hotline are examples of ————-prevention.
secondary
Providing case management for intellectually disabled teenagers is an example of
tertiary prevention.
External validity:
When the sample is representative of the population and the results can be generalized
Internal validity:
When the independent variable causes a change in the dependent variable
Probability:
The likelihood of an event occurring
Standard deviation:
Indication of the possible deviations from the mean
Intimate partner violence (IPV) is defined as:
The physical, emotional, economic, or sexual pain and injury that is intentionally inflicted by a person’s intimate partner
Functional imaging is a technique that measures
functioning of areas of the brain and bases the resulting assessment on blood flow. In functional imaging, pharmaceuticals are used to cross the blood-brain barrier.
published a groundbreaking reporting titled The Future of Nursing: Leading Change, Advancing Health. This report considered the obstacles that all nurses encounter as they provide quality health care in the United States.
In 2010, the Institute of Medicine
The report developed four key messages from the inistitute of medicine in 2010 :
Nurses should practice to the full extent of their education.
Nurses should seek higher levels of education through seamless academic progression.
Nurses should be full and equal partners with physicians.
To improve the quality of health care, nurses need an improved information infrastructure.
Functional imaging is a technique t
hat measures functioning of areas of the brain and bases the resulting assessment on blood flow. In functional imaging, radioactive pharmaceuticals are used to cross the blood-brain barrier.
Common functional imaging testing includes
EEG and evoked potentials testing, magnetoencephalography (MEG), single photon emission computed tomography (SPECT), and positron emission tomography (PET).
An atypical presentation is characterized by the following:
Mood reactivity Weight gain Increased appetite Hypersomnia Leaden paralysis Long-standing pattern of interpersonal rejection sensitivity
Anhedonia is
the inability to feel pleasure
Anhedonia occurs
occurs in both typical and atypical presentations of major depressive disorder.
Macrobiotics refers to specific foods classified
as yin (cold and wet) and yang (hot and dry).
yin food
cold and wet)
yang food
(hot and dry).
Privilege refers to gs.
the patient’s right to prevent disclosure of confidential information in judicial hearin
Nonmaleficence refers to
the principle of bioethics that asserts an obligation not to inflict harm intentionally
Beneficence refers to
an action done for the benefit of others.
Confidentiality refers to the nurse practitioner’s
responsibility to not release patient information learned in the course of treatment to third parties.
Conflict occurs when a person believes
his or her needs, interests, or values are incompatible with those of others. When conflict occurs, it is often the result of two people opposing or competing with each other due to their differing viewpoints.
Eye movement desensitization and reprocessing (EMDR) is
a form of behavioral therapy that was developed by Francine Shapiro. It is most commonly used in posttraumatic stress disorder, and its goal is adaptive resolution.
EMDR most use in
posttraumatic stress disorder,
Developed EMDR
Francine Shapiro.
There are three phases in EMDR:
- desensitization,
2 installation, and - body scan.
What happen in EMDR Desensitization phase
: The patient visualizes the trauma, verbalizes negative or maladaptive beliefs, and remains attentive to physical sensations. The patient also blocks out negative thoughts, breathes deeply, and verbalizes what he or she is imagining.
What happen in EMDR installation phase
The patient installs and strengthens the positive thought that he or she has declared as a replacement of the original negative thought.
Body scan
The patient visualizes the trauma along with the positive thought and then scans his or her body mentally to identify any tension within.
Which of the following assesses the patient’s attention during the mini-mental status exam (MMSE)?
Spell the word “world” backward
The mini-mental status exam (MMSE) is a brief instrument designed to assess the patient’s overall cognitive functioning.
Asking the patient to spell the word “world” backward assesses their attention.
Asking the patient to say this “no ifs, ands, or buts” assesses their ability to repeat what they hear.
Asking the patient remember the three objects apple, table, and penny assesses their short-term memory.
Asking the patient tell the year, season, month, date, and day assesses their orientation.
Asking the patient to spell the word “world” backward assesses their
attention.
Asking the patient to say this “no ifs, ands, or buts” assesses their ability to
repeat what they hear.
Asking the patient remember the three objects apple, table, and penny assesses
their short-term memory.
Asking the patient tell the year, season, month, date, and day assesses
their orientation.
Primary prevention is aimed at
decreasing the number of new cases of mental disorders. An example of primary prevention is stress management classes for graduate students
Secondary prevention is aimed at decreasing
the number of existing cases of mental disorder. Examples of secondary prevention include telephone hotlines, crisis intervention, and disaster response.
Examples of secondary prevention include
telephone hotlines, crisis intervention, and disaster response.
Tertiary prevention is aimed at
decreasing the disability and severity of a mental health disorder. Providing social skills education for a group of intellectually disabled teenagers is an example of tertiary prevention.
Clinically significant side effects of monoamine oxidase inhibitors include
insomnia, weight gain, sexual dysfunction, dizziness, hypertensive crisis, lightheadedness, and anticholinergic side effects.
a major cation for the structure of bones and teeth, it
calcium
an enzymatic cofactor for blood clotting. It is required for hormone secretion, for the function of cell receptors, for plasma membrane stability and permeability, and for the transmission of nerve impulses and the contraction of muscles.
calcium
Ethical principles that provide the foundation and direction for true leadership include the following:
Doing what is fairVeracity Telling the truthRespect_ Treating everyone with equal dignityFidelity_ Being true and loyal
Characteristic diagnoses of abusers are as follows:
Antisocial personality disorder
Narcissistic personality disorder
Borderline personality disorder
Complex partial seizures. T
These symptoms are not indicative of hypoglycemia, and neither obsessive-compulsive or major depressive disorder would present with impaired consciousness.
his type of seizure usually includes sensory auras and automatic behaviors. Prior to the seizure, this patient might complain of a bad smell or a weird taste in her mouth. During the seizure, she may smack her lips, blink her eyes, or fiddle with her clothing. Complex partial seizures also usually result in impaired consciousness.
Around ___________%of those diagnosed with a mood disorder experience manic or hypomanic episodes
25%
Almost all patients who experience a manic or hypomanic episode also experience periods of ____________
depression The severity and duration of the highs and lows differentiate the types of bipolar disorder.
Bipolar I disorder:
These patients experience at least one manic episode and may or may not experience a major depressive episode.
Bipolar II disorder:
These patients experience at least one hypomanic episode and at least one major depressive episode.
Cyclothymic disorder:
These patients experience mood swings, but they are not severe enough to be called major depressive episodes or manic episodes.
Schizoaffective disorder is a
psychotic disorder characterized by patients experiencing symptoms of schizophrenia along with either depression or mania.
There are four levels of systems in health care:
microsystems, macrosystems, megasystems, and metasystems.
Microsystem ex :
direct patient care
Macrosystem:
hospitals, skilled nursing facilities, clinics
Megasystem:
American health care system
Metasystem
: economic, political, and social level of society
0 Who should not receive the MMR vaccine.
- Those who have received a blood transfusion in the past two weeks,
- pregnant women,
- people with cancer,
- those with weakened immune systems, and
- those who have HIV or AIDS with T-cell counts below 20
What is the primary goal of the American Medical Association’s Scope of Practice Partnership (SOPP) initiative?
To limit patients’ choice of which health care provider they can see for treatment
The American Medical Association’s Scope of Practice Partnership (SOPP) initiative lobbies the federal government to limit patients’ choice of which health care provider they can see for treatment.
Patients’ Access to Responsible Care Alliance (PARCA).
In response to American Medical Association’s Scope of Practice Partnership (SOPP) a group of 35 non-physician organizations created PARCA. This alliance aims to provide federal policymakers with more accurate information from all health care disciplines. PARCA is committed to ensuring patients have a choice of providers. PARCA includes nurses, nurse practitioners, audiologists, optometrists, chiropractors, social workers, and others.
Forensically trained PMHNPs have a good knowledge base of the following:
The functions of the court system
Litigation procedures
Workings of the criminal justice system
Relevant case law and health litigation
Mental health and distorted thinking patterns and impaired cognition
Safety, security, management, and risk assessment of individuals
Internal validity occurs
when the independent variable causes a change in the dependent variable.
External validity occurs
when the sample is representative of the population and the results can be generalized.
Variance
describes how the values are dispersed around the mean.
Probability is
the likelihood of an event occurring.
What type of phobia is experienced equally by both genders?
Needles
here are five categories of phobias:
- Animal (spiders, insects, dogs, etc.)
- Natural environment (heights, storms, water, etc.)
- Blood-injection-injury (needles, invasive medical procedures, blood transfusions, etc.)
- Situational (elevator, airplane, enclosed places, etc.)
- Other (situations that may lead to vomiting, loud sounds, costumed characters, etc.)
Women are more likely than men to experience —————–phobias
animal, natural environment, and situational phobias.
Nonmaleficence refers to the principle of bioethics that asserts an obligation
not to inflict harm intentionally.
Beneficence
refers to an action done for the benefit of others.
Confidentiality
refers to the nurse practitioner’s responsibility to not release patient information learned in the course of treatment to third parties.
Privilege refers to the patient’s right to
prevent disclosure of treatment information in judicial hearings.
Genes are a sequence of
DNA that cause human characteristics to be passed to the next generation.
meets the criteria for involuntary admission to a psychiatric hospital?
Inability to care for self
Patients suffering with bipolar disorder can present as either
expansive in mood or depressed, depending on the episode.
Involuntary admission to a psychiatric hospital is justified when the patient is:
- An imminent danger to self
- An imminent danger to others
- Unable to care for themselves adequately
The criteria for involuntary admission comes from
the legal doctrine of police power (state as protector) and parens patriae (state as parent).
Parens patriae allows the state to intervene and act as a surrogate parent for those who are
unable to care for themselves or who may harm themselves. Police power allows the state to intervene if the patient is a danger to others.
Wellbutrin (bupropion) is an NDRI (norepinephrine and dopamine reuptake inhibitor) antidepressant and can produce a false positive
for methamphetamine.
Wellbutrin (bupropion) class is an
NDRI (norepinephrine and dopamine reuptake inhibitor)
Zoloft (sertraline) can produce a false positive for
benzodiazepines
Nyquil can produce a false positive for
methadone
Valium can produce a false positive for
alcohol
What is a rare but dangerous side effect of the antidepressant medication trazodone (Oleptro)?
Priapism
The incidence of priapism is about___________________men who are taking trazodone (Oleptro).
1 in 6,000
Priapism usually occurs in the
the first month of treatment and should prompt immediate discontinuation.
a communication technique used by the PMHNP when responding to a client about their intentions and treatment goals in the context of the client’s noncommittal approach to treatment.
Recognizing
first nurse practitioner program
In 1965, Dr. Loretta Ford (a public health nurse) and Dr. Henry Silver (a pediatrician) established the1st NP program at the University of Colorado.
1st Np program educated
This program educated pediatric nurse practitioners with a focus on disease prevention and health promotion. Over the next decade, nurse practitioner schools proliferated across the country. Today, there are over 205,000 nurse practitioners.
The Therapeutic Relationship involves the following characteristics:
Genuineness Acceptance Nonjudgment Authenticity Empathy Respect Maintaining professional boundaries
Who authored the report Crossing the Quality Chasm, which emphasized the need for interprofessional collaboration in order to improve the quality of health care?
Institute of Medicine
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified four key issues contributing to poor quality of care and undesirable patient outcomes:
The complexity of knowledge, skills, interventions, and treatment required to deliver care
The increase in chronic conditions
The inefficient, disorganized delivery system
Challenges to greater implementation of information technology
In the report Crossing the Quality Chasm the Institute of Medicine emphasized
In this report, the Institute of Medicine emphasized the need for health care providers to actively collaborate, exchange information, and make provisions for care coordination, because the needs of any person or population are beyond the expertise of any single health profession.
a primary category of assessment in the mental status exam?
Concentration
Mental status exam findings are based on primary categories, which include
- general appearance,
- speech,
- affect,
- mood,
- thought process,
- thought content,
- orientation,
- memory,
- concentration,
- abstraction,
- judgment.
The brainstem is made up of the cells that produce
neurotransmitters like serotonin and dopamine.
The basal ganglia, also called the corpus striatum, functions in
learning and automatic actions like walking and driving a car
The basal ganglia, also called
the corpus striatum,
The hypothalamus regulates
appetite, water balance, circadian rhythm, body temperature, and libido.
Melatonin is known to interact with
aspirin, NSAIDs, beta blockers, corticosteroids, valerian, kava kava, and alcohol.
Substance use screening tool interpretation is an important part of advanced assessment and of the role of the psychiatric-mental health nurse practitioner. The most common tool used to assess for alcohol abuse is:
The CAGE screening tool asks the following questions:
C = Have you ever felt the need to cut down on your drinking?
A = Have people annoyed you by mentioning your drinking?
G = Have you ever felt bad or guilty about your drinking?
E = Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
The AUDIT assessment is
also an alcohol use assessment tool but is not the most commonly used.
The CIWA assessment is used to assess .
withdrawal severity of alcohol and/or benzodiazepines
The COWS assessment is used to
assess withdrawal severity of opiates.
A database is an
organized collection of information that is easy to maintain, sort, and search.
Hardware is physical technological objects such as s.
disks, disk drives, display screens, keyboards, printers, boards, and chip
A web browser is a software application for
retrieving, presenting, and traversing information resources on the World Wide Web. A website is a location connected to the internet that maintains one or more pages on the World Wide Web.
Sixty-seven percent of individuals with obsessive-compulsive disorder also have what mental illness?
Major depression
Li-censure
Which term is defined as a process by which an agency of state government grants permission to individuals to engage in the practice of that profession?
Licensure is a process
by which an agency of state government grants permission to individuals to engage in the practice of that profession. Licensure prohibits all unlicensed persons from engaging in a legally protected practice.
Credentialing is a process
used to protect the public by ensuring a minimum level of professional competence.
Certification is a process
by which a professional organization certifies that an individual has met certain predetermined standards specified by that specialty practice. The nurse practitioner’s certification determines his or her scope of practice, and it assures the public that he or she has mastered a body of knowledge in a particular medical specialty.
Oppositional defiant disorder (ODD) is an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior which lasts at least six months. It is believed that the etiology of ODD has its roots in all of the following
Under-stimulating environments and living situations
The 4 etiology of ODD includes the following:
Temperament
Parents who model extreme ways of expressing emotions
Trauma
Unresolved conflicts
Nurse practitioner standards of practice:
Give authoritative statements regarding the quality and type of practice that should be provided
Offer a way to judge the nature of care provided
Reflect the expectation for the care that should be provided to patients
Reflect professional agreement focused on the minimum levels of acceptable performance
Can be used to legally describe the standard of care
May be either precise or general guidelines
Reflect one guideline applicable to all psychiatric nurse practitioners regardless of their practice location
Nurse practitioner scope of practice:
Defines the nurse practitioner’s roles and actions
Identifies competencies assumed to be held by all nurse practitioners who function in a particular role
Has broad variations from state to state due to outdated legislation
Delusion vs illusion
A delusion is a false belief despite contrary evidence, and an illusion is a false perception of a real stimulus
Hallucinations:
False sensory perceptions without stimuli present; they can be tactile, olfactory, gustatory, auditory, or visual
Delusions:
False beliefs that are firmly maintained despite contrary evidence
Illusions:
False perceptions of real stimuli
Hopelessness:
A belief that things will not improve
Helplessness:
A belief that one will not be able to change the course of events
Depersonalization:
Feeling far away or disconnected from oneself
Derealization:
A sense that one’s environment has changed
The accessory spinal (cranial nerve XI) assessment tests
the strength of the sternocleidomastoid and trapezius muscles against the resistance of the provider’s hands.
The trigeminal nerve (cranial nerve V, sensory division)
assessment tests for tactile perception of the facial skin. The trigeminal nerve (cranial nerve V, motor division) assessment tests for masseter muscle strength.
The facial nerve
(cranial nerve VII, motor division) assessment checks for flaccid paralysis.
The vagus nerve (cranial nerve X) assessment tests for
elevation of the uvula by having the client open their mouth and say “ah.” This test also checks for a present gag reflex by touching the back of the client’s throat with a tongue blade.
The hypoglossal nerve (cranial nerve XII) assessment checks for
tremors and other involuntary movements when the client protrudes their tongue.
The glossopharyngeal nerve (cranial nerve IX) is tested in conjunction with
the vagus nerve and tests for taste.
The abducens nerve (cranial nerve VI) assessment uses the same process as that for cranial nerve
III (oculomotor) and IV (trochlear) to test for eye movement.
Adolescents with mania often present with
Adolescent manic episodes present differently from adult manic episodes. Adolescents present with more psychotic features, antisocial behavior, substance abuse, school truancy, and failing grades.
The general function of dopamine involves
normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition. Dopamine irregularities are closely linked to disease processes such as schizophrenia.
In common psychiatric disorders, which neurotransmitter is implicated in the complex pathophysiology of certain disease processes involving normal functions such as decision-making and integrated cognition?
Dopamine
The general function of norepinephrine involves
alertness, orientation, fight-or-flight, learning, memory, and focus and attention. Norepinephrine irregularities are closely linked to disease processes such as panic disorders and anxiety.
The general function of serotonin involves
regulation of sleep, pain perception, mood states, temperature, aggression, and libido. Serotonin irregularities are closely linked to depressive disorders.
The general function of glutamate involves
memory and sustained autonomic functions.
Glutamate irregularities are closely linked to
bipolar type disorders.
Serotonin irregularities are closely linked to
depressive disorders.
Does need to get Flu shot
Healthy individuals between the ages of 19 and 49 are not required to receive the annual influenza vaccine unless they meet any of the criteria below.
The following people should always receive the influenza vaccine:
Children from six months to 18 years of age
Anyone aged 50 years and older
Anyone who lives in a nursing home or in a long-term care or assisted living facility
Anyone with a chronic health condition including asthma, diabetes, renal or hepatic dysfunction, HIV, and neuromuscular disorders
Pregnant women
Health care personnel
Caregivers of children younger than five years
Screening tools used, but not the most common or age-appropriate, include the following:
AUDIT - Alcohol Use Disorders Identification Test
S-MAST - Short Michigan Alcoholism Screening Test (or Geriatric Version)
CRAFFT - Children and Adolescents under 21 years of age
COWS - The Clinical Opiate Withdrawal Scale
The Food and Drug Administration (FDA) is
- the federal agency that regulates the introduction of new drugs in the United States.
- The FDA protects consumers from the risks associated with drug purchases.
- They approve new drugs before they can be sold
- they determine which drugs should be assigned over-the-counter or prescription status.
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six goals for quality improvement in health care:
Effective–Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
Which goal can be described as providing services based on avoiding injuries to patients from the care intended to help them
Safe
Which goal can be described as providing services based on care that is respectful & responsive to patient preference
Patient centered
Which goal can be described as providing services based on reducing delays.
Timely
Which goal can be described as providing services based on avoiding waste
Efficient
Which goal can be described as providing services based on personal characteristics
Equitable
gambling disorder is most prevalent among which of the following ethnic/racial groups?
African Americans.. Indigenous populations also experience high rates of gambling disorder. Males are more likely to develop this disorder than females.
Males with gambling disorder:
- Are more likely to wager on cards, sports, and horse races
- Tend to begin gambling earlier in life
- Tend to develop the disorder over a quicker period of time
- Are less likely to seek treatment
Females with gambling disorder:
- Are more likely to gamble with slot machines and bingo games
- Are more likely to have a comorbid psychiatric condition such as depressive, bipolar, or anxiety disorder
- Tend to develop the disorder progressively over time
- Are more likely to seek treatment
Stevens-Johnson syndrome is a risk closely associated with what medication?
Lamotrigine
Stevens-Johnson syndrome is
a serious, life-threatening side effect of lamotrigine in which a painful burning rash appears. The medication should be discontinued immediately and the patient should report to the emergency room for stabilization.
The majority of homeless families are headed by
A single parent who is usually female
_______is hould be considered in the differential diagnosis of panic disorder.
Pheochromocytoma
Pheochromocytomas produce symptoms often seen in panic disorder such as
flushing, trembling, and tachycardia
Other medical conditions that mimic panic disorder include the following:
Hyperthyroidism
Hyperparathyroidism
Cardiac arrhythmias
Schizoaffective disorder is characterized by
patients experiencing symptoms of schizophrenia along with either depression or mania.
Delusional disorder is a
psychotic disorder characterized by the presence of delusions but no other symptoms of schizophrenia.
Brief psychotic disorder is characterized by at least
one psychotic symptom present for less than one month.
The Health Insurance Portability and Accountability Act (HIPAA) was the first national comprehensive privacy protection act. HIPAA guarantees patients four fundamental rights:
To be educated about HIPAA privacy protection
To have access to their own medical records
To request an amendment of their health information to which they object
To require their permission for disclosure of their personal information
The top four dimensions of the Recovery Model of Care:
Health
Home
Purpose
Community
The Recovery Model of Care is an important
concept when it comes to the transformation of mental health care. This model is patient-specific and goal-directed
mnemonics for assessing delirium
D = Drugs E = Electrolyte abnormality L = Low oxygen saturation I = Infection R = Reduced sensory input I = Intracranial U = Urinary or renal retention M = Myocardial The other options are not correct mnemonics for assessing delirium.
A 44-year-old Latina woman presents to your office with suspected conversion disorder. According to Erik Erikson, failure to resolve which psychosocial stage is associated with later development of this psychopathology
Initiative vs. Guilt
Failure to successfully resolve the psychosocial stage Initiative vs. Guilt is associated with the later development of
conversion disorder.
Failure to resolve Trust vs. Mistrust is associated with
psychosis, addictions, and depression.
Failure to resolve Autonomy vs. Shame and Doubt is associated with
paranoia, obsession, compulsions, and impulsivity.
Failure to resolve Industry vs. Inferiority is associated with
creative inhibition.
Massage therapy is believed to affect anxiety and tension by increasing lymph flow through r
eduction of blood pressure and increase of blood flow, thus improving muscle tone and relaxation of the mind.
Who created the family systems therapy model?
Murray Bowen
Murray Bowen believed that
a person’s problematic behaviors may serve a function or purpose for the family or be a symptom of dysfunctional patterns. The family systems therapy model focuses on chronic anxiety within families.
The family systems therapy model focuses
on chronic anxiety within families.
Salvador Minuchin created
the structural family therapy model.
Virginia Satir created
the experiential therapy model.
Jay Haley created
the strategic therapy model.
Decreased, not increased, levels of sodium (Na) can cause
Addison’s disease, renal disorders, and gastrointestinal fluid loss from vomiting and diarrhea.
The Hamilton Anxiety Scale (HAM-A) is the
most commonly used clinician-administered anxiety rating scale. It is best used in the evaluation of anxiety severity and tracking the efficacy of anxiety treatments over time.
The HAM-A is based on various domains
of anxiety including anxious mood, fears, sleep disturbance, somatic complaints, tension, and observed behavior. The severity of each domain is ranked from 0 (not present) to 4 (severe)
Scoring is as follows on HAM-A:
Score of 14-17: Mild anxiety
Score of 18-24: Moderate anxiety
Score of 25-30: Severe anxiety
Autism spectrum disorder (ASD) affects
about 1% of the population in the United States.
ASD is more common in children with a
family history of pervasive developmental disorders
The concordant rate for an ASD identical twin with autism is
60%
The incidence rate of ASD
is 2 to 5 cases per 10,000 in the US
male to female ratio on ASD is
The male to female ratio is 4:1
Onset of ASD symptoms is before
age 3
About _________of people with autism also have a genetic or chromosomal condition such as Down syndrome or fragile X syndrome
10%
t-test: assesses
whether the means of two groups are statistically different from each other
Analysis of variance (ANOVA):
tests the difference among three or more groups
Pearson’s r correlation:
tests the relationship between two variables
Probability:
the likelihood of an event occurring
p-value (level of significance):
describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone.
Failure to resolve the Generativity vs. Stagnation stage
is associated with the development of a mid-life crisis
Failure to resolve the Industry vs. Inferiority stage is
associated with creative inhibition.
Failure to resolve the Initiative vs. Guilt stage is associated
with conversion disorder, phobias, and psychosomatic disorders.
Which term best describes the use of a software application for placing medical orders in both inpatient and outpatient settings?
Computerized provider order entry (CPOE)
The onset of symptoms in Alzheimer’s disease usually follows this progression:
(1) mood changes, (2) cognitive impairment, (3) decline in functional independence, (4) behavioral and motor symptoms. Mood changes are usually manifested as apathy; however, some patients do experience depression.
Depression in the early stages of Alzheimer’s disease is usually
resistant to antidepressant medications (such as SSRIs) but responsive to cholinesterase inhibitors.
Which initiative developed a 10-year plan for nursing’s path toward computer and information literacy?
The Technology Informatics Guiding Education Reform (TIGER) initiative developed a 10-year plan for nursing’s path toward computer and information literacy. It involved more than 1,100 nursing content experts, and it took three years to complete. This initiative successfully defined the basic technology competencies and required curriculum for nurse practitioner education. The TIGER initiative declared that it is a nurse practitioner’s responsibility to understand and shape the landscape of health care technology in order to improve access, quality, and the patient experience.
Arbitration is a process
in which a third party reviews evidence from both sides and makes a decision to settle the case
You diagnose a new patient with schizophrenia and prescribe him ziprasidone. True statements regarding ziprasidone
- Taking it with food increases absorption twofold
- It requires QTc monitoring
- It should be used with caution in patients with congestive heart failure
Ziprasidone side effects include
its side effects include:
- hypotension,
- sedation,
- dizziness, and
- prolongation of the QTc interval.
You must monitor for QTc prolongation; taking it with food increases absorption twofold.
You should use caution when administering ziprasidone to patients at risk of hypokalemia or hypomagnesemia, after myocardial infarction, or with congestive heart failure.
Risperidone,
another atypical antipsychotic, possesses the greatest risk for prolactin elevation.
According to the family systems theory, a system is
any unit structured on feedback.
The family systems theory is based on the idea that
one could not understand any family member (part) without understanding how all family members operate together (system). In the family systems theory, a system is any unit structured on feedback.
What percent of the incarcerated population in the United States has a severe mental illness?
15% to 24%
What are the most common potentially law-breaking sexual behaviors?
Voyeuristic acts
Voyeuristic acts are the
most common potentially law-breaking sexual behaviors. Up to 65% of adult men in the general population have engaged in these acts. Voyeuristic disorder is defined as recurrent and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity. The lifetime prevalence of voyeuristic disorder is 12% in males and 4% in females.
The lifetime prevalence of voyeuristic disorder is
12% in males and 4% in females.
Exhibitionistic disorder is defined as
recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person. The lifetime prevalence of this disorder is about 2% to 4% in males and unknown in females.
The lifetime prevalence of this disorder is
about 2% to 4% in males and unknown in females.
Frotteuristic acts occur in
30% of adult males in the general population.
Frotteuristic disorder is defined as
recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person. The prevalence of this disorder is unknown.
Fetishistic disorder is defined as recurrent and intense sexual arousal
from either nonliving objects or a highly specific focus on nongenital body parts. The prevalence of this disorder is unknown.
Certification is a process by which a
professional organization certifies that an individual has met certain predetermined standards specified by that specialty practice. The nurse practitioner’s certification determines his or her scope of practice, and it assures the public that he or she has mastered a body of knowledge in a particular medical specialty.
Credentialing is
a process used to protect the public by ensuring a minimum level of professional competence.
Licensure is a process
by which an agency of state government grants permission to individuals to engage in the practice of that profession.
Licensure prohibits
all unlicensed persons from engaging in a legally protected practice.
First line treatment of GAD.
SSRIs are the standard of care and the first line treatment of GAD
Pharmacological treatment includes
SSRI’s, anxiolytics such as buspirone and clonazepam.
Insomnia may be related to the following underlying psychiatric disorders:
Mood disorders
Anxiety disorders
Attention-deficit hyperactivity disorder
Alzheimer’s disease
Interprofessional collaboration describes
the interactions among individual professionals who bring their unique educational backgrounds, experiences, values, roles, and identities to a process.
The forensic PMHNP should possess theoretical and practical knowledge of the criminal justice and mental health systems. Forensically trained PMHNPs have a good knowledge base of the following:
The functions of the court system
Litigation procedures
Workings of the criminal justice system
Relevant case law and health litigation
Mental health and distorted thinking patterns and impaired cognition
Safety, security, management, and risk assessment of individuals
A pharmacy benefit management company serves as
an intermediary to secure favorable prices from drug manufacturers. Usually, an insurance company hires them to negotiate lower prices for medications to be included on the insurance company’s formulary.
In corrections, the nurse-client relationship is based on
the offender’s current mental health and medical conditions.
Which medication is least likely to worsen metabolic profile?
Ziprasidone
Ziprasidone, olanzapine, quetiapine, and risperidone are all
atypical antipsychotics.
is the least likely to cause weight gain and has been shown to lower triglyceride levels.
Ziprasidone
For patients at an increased risk for developing metabolic syndrome __________is the antipsychotic of choice.
ziprasidone
A client presents himself to the ER, status post suicide attempt by cutting his wrists. You show that you understand the importance of client safety by first:
Obtaining accurate vital signs
Strategic therapy was originally developed by
Jay Haley.
Strategic therapy views symptoms as _______
Goal of Strategic therapy is _____
It views symptoms as metaphors that reflect problems in the hierarchal structure of the family. The treatment goal is to help family members behave in ways that will not perpetuate the problem behaviors. Interventions are problem-focused.
Strategic therapy counselors use the 3 following techniques:
- Straightforward directives: Tasks that are designed in expectation of the family members’ compliance
- Paradoxical directives: A negative task that is assigned when family members are resistant to change
- Reframing belief systems: Problematic behaviors are relabeled to have a more positive meaning
Miracle questions are a technique used in
solution-focused therapy.
Sexual identity refers to
one’s perception of self in relation to who they are romantically or sexually attracted to
Sexual orientation also
refers to the direction of sexual attraction; however, most people prefer the term sexual identity because it allows people to determine their own identities. Sexual orientation or identity does not always relate to gender identity.
Gender identity refers
to a person’s identity along a continuum between normative constructs of masculinity and femininity
Gender identity disorder is a
formal diagnosis to describe persons who experience significant gender dysphoria.
Transgender is an umbrella term
describing people whose gender identity does not conform to gender norms associated with the sex they were assigned at birth.
Potassium is involved in
ntracellular activity,
Autism spectrum disorder forms
in early childhood and results in impaired social interaction and communication. These patients usually demonstrate stereotyped behaviors and interests
Global developmental delay describes
a child under the age of five who seems to be falling behind developmentally, but the practitioner cannot reliably assess why.
Unspecified intellectual disability is a term
used when a child is five years old or older and cannot be reliably assessed due to a physical or mental impairment.
Borderline intellectual functioning
describes a person with a nominal IQ ranking of 71 to 84 who does not have the coping problems associated with an intellectual disability.
Aromatherapy is a form of
olfactory stimulation used to elicit feelings or memories during psychotherapy. It uses plants or oils to obtain many therapeutic effects, such as analgesic, psychological, and antimicrobial benefits.
Autism spectrum disorder is described as
being a persistent deficit in social communication and interaction across multiple settings.
Statistics show that autism spectrum disorder has a higher prevalence
in boys.
Other important facts surrounding ASD are as follows:
- ASD is more common in children with a family history of pervasive developmental disorders
- The concordant rate for an identical twin with autism is 60%
- The incidence is 2 to 5 cases per 10,000 in the US
- The male to female ratio is 4:1
- Onset of symptoms is before age 3
- About 10% of people with autism also have a genetic or chromosomal condition such as Down syndrome or fragile X syndrome
The precise mechanism of action of selective serotonin reuptake inhibitors (SSRIs) remains unknown. Considering the delayed therapeutic response, one theory involves:
Down-regulation of postsynaptic 5-HT2 receptor sites
The exact mechanism of action of selective serotonin reuptake i
nhibitors (SSRIs) remains unclear. Acutely, they inhibit serotonin reuptake pumps, thus increasing the amount of available serotonin in the synapse. However, patients typically do not experience symptomatic relief for several weeks. Some research demonstrates that the delayed therapeutic effects are due to a down-regulation of postsynaptic 5-HT2 receptor sites.
Which statement accurately defines an unspecified intellectual disability?
A term used when a child is five years old or older and cannot be reliably assessed due to a physical or mental impairment
Global developmental delay .
describes a child under the age of five who seems to be falling behind developmentally, but the practitioner cannot reliably assess the degree of impairment
Borderline intellectual functioning describes
a person nominally ranked in the IQ rank of 71 to 84 who does not have the coping problems associated with an intellectual disability.
Autism spectrum disorder forms in
early childhood and results in impaired social interactions and communication. These patients usually demonstrate stereotyped behaviors and interests.
Unspecified intellectual disability is a term
used when a child is five years old or older and cannot be reliably assessed due to a physical or mental impairment.
Those who are victims of abuse present with the following mental status exam findings:
Fearfulness Evasiveness Being guarded Depression Passiveness Dependence
Reasons to assess diagnostic and laboratory testing in psychiatry include the following:
To assist in the establishment of a diagnosis; as knowledge of underlying pathophysiology grows, diagnostic and laboratory testing use will grow as well
To rule out other disorders such as medical causes of psychiatric symptoms; helpful in differential diagnostic assessment
To determine whether a client’s symptoms are better explained by a nonpsychiatric disorder or by factors such as drug use or abuse
For routine ongoing monitoring such as general health screening, monitoring drug levels of certain psychiatric meds, and assessment and monitoring for complications of psychiatric disorders due to adverse effects of drugs
Cluster A personality disorder characteristics are described as:
Odd, unusual, eccentric and asocial
Cluster B personality disorder characteristics are described as:
Dramatic
Having affective instability
Cluster C personality disorder characteristics are described as:
Anxious
Research demonstrates that nurse practitioners are as effective as physicians in diagnosing and treating health care problems. Nurse practitioners are also______—–less costly to both consumer and insurance company compared with physicians.
20%
The Health Insurance Portability and Accountability Act (HIPAA) was the first national comprehensive privacy protection act. HIPAA guarantees patients four fundamental rights:
To be educated about HIPAA privacy protection
To have access to their own medical records
To request an amendment of their health information to which they object
To require their permission for disclosure of their personal information
Insomnia may be related to the following underlying psychiatric disorders:
Mood disorders
Anxiety disorders
Attention-deficit hyperactivity disorder
Alzheimer’s disease
Ethical principles that provide the foundation and direction for true leadership include the following:
Doing what is fairVeracity Telling the truthRespect_ Treating everyone with equal dignityFidelity_ Being true and loyal
Drugs with a high therapeutic index such as
Divalproex have a high margin of safety. This means that the therapeutic dose and the toxic dose are far apart.
The purpose of meditation is to
consciously direct one’s attention to alter one’s state of consciousness.
Meditation produces physiological effects such as decreases in heart rate, blood pressure, respiratory rate, and anxiety, and it increases alpha brain waves.
The insurance premium is
the amount charged for insurance coverage, usually paid on a monthly basis by both the employer and the employee.
The loading charge is the amount
charged by the health insurance company on a renewal premium when people make claims on their policy.
Desvenlafaxine is a
serotonin-norepinephrine reuptake inhibitor (SNRI), and it is an active metabolite of venlafaxine. It has demonstrated efficacy in treating depression and vasomotor symptoms in menopausal women.
Duloxetine effectively treats
depression and diabetic peripheral neuropathy
Which neurotransmitter’s general function involves regulation of sleep, pain perception, mood states, temperature, aggression, and libido?
Serotonin
The best evidence comes from ________ of the evidence hierarchy, and the weakest evidence comes from
Level 1
Level 7.
7 Level of evidence
Level 1 (strongest): Systematic review of randomized controlled trials or systematic review of nonrandomized trials
Level 2: Single randomized controlled trial or single nonrandomized trial
Level 3: Systematic review of correlational or observational studies
Level 4: Single correlational or observational study
Level 5: Systematic review of descriptive, qualitative, or physiologic studies
Level 6: Single descriptive, qualitative, or physiologic study
Level 7 (weakest): Opinions of authorities and expert committees
Bipolar disorder is considered a complex brain-based illness with the primary characteristic of disturbance of the
mood.
Which federal insurance program is funded by both federal and state taxes?
Medicaid and the Children’s Health Insurance Program (CHIP) are funded by both state and federal taxes.
Medicare, TriCare, and the Veterans Health Administration are all funded by
federal taxes.
SSRIs work by
They elevate serotonin and norepinephrine levels by inhibiting their presynaptic reuptake.
Which SSRI is FDA-approved for the treatment of depression in adolescents?
Prozac
the only drug FDA-approved for the treatment of depression in adolescents.
fluoxetine (Prozac) is the only selective serotonin reuptake inhibitor
Vilazodone (Viibryd) is
a SPARI (serotonin partial agonist reuptake inhibitor) and a serotonin multimodal (S-MM)
Vortioxetine (Trintellix) is
a serotonin multimodal (S-MM) and is not FDA-approved for adolescents.
Buproprion (Wellbutrin) is
an NDRI (norepinephrine dopamine reuptake inhibitor).
Which inferential statistic tests the relationship between two variables?
Pearson R correlation
Inferential statistics are numerical values that
enable one to reach conclusions that extend beyond the immediate data alone.
t-test: assesses
whether the means of two groups are statistically different from each other
Analysis of variance (ANOVA):
tests the difference among three or more groups
Probability:
the likelihood of an event occurring
p-value (level of significance): describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone.
he probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone.
p-value
(level of significance)
all support interprofessional collaboration.
The Institute of Medicine, the Robert Wood Johnson Foundation, the American Nurses Association, and The Joint Commission
Barriers preventing interprofessional collaboration include the following:
Gender, power, socialization, education, status, cultural differences
Lack of a payment system and structure that rewards collaboration
Misunderstanding of the scope and contribution of each profession
Turf protection
Indications for seclusion and restraint:
Prevent clear, imminent harm to the patient or others
Prevent significant disruption to treatment program or physical surroundings
Assist in treatment as part of ongoing behavior therapy
Decrease sensory overstimulation
Patient’s voluntary reasonable request
Contraindications for seclusion and restraint:
Extremely unstable medical or psychiatric condition
Delirious or demented patients unable to tolerate decreased stimulation
Overtly suicidal patients
Patients with severe drug reactions or overdoses who require close monitoring of their drug dosages
For punishment or convenience of staff
Which inferential statistic tests the relationship between two variables?
Pearson’s r correlation
