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
