Questions Flashcards
A 16-year-old Nigerian boy somatic symptoms after moving 3 months ago.
What is this considered?
What treatment would you recommend?
a. This is cultural bound syndrome.
b. Treatment is brief supportive therapy
A patient came in for appointment and verbalize to the NP that they feel terrible and believes the group home where they live is trying to poison their food. So they are thinking about the setting the house on fire while everyone’s sleep at night. How would the NP respond?
Call the group home staff and notify law enforcement about his homicidal thoughts
A 3 year is brought in because her parent think she is “over-sexed” she is preoccupied with the woman’s breast and has been masturbating. What do you tell the parents?
This is normal
12 year old that cries, isolates, has no friends, and is not doing well in school. According to Erickson, which stage has he not resolved?
Identity vs role confusion
What CN deal with mastication (Chewing, biting down)?
CN-V trigeminal
What CN is responsible for puffing out cheeks?
CN VII facial
What CN is asking to stick your tongue out and say ahh?
CN XII hypoglossal use for checking TD
Fungus to toenail. What is the first priority?
Scrape area and send to the lab prior to initiating treatment
This means they have a B12 deficiency, check for b12. Vitamin b12 and folate deficiencies must be ruled out
Microcystic anemia
Man working at the gym and his urine is cherry color
Order myoglobinuria
Adolescent with substance abuse and working out has muscle aches. Urine is red colored hematuria
Concerned for rhabdomyolysis – need to check CK-MB
Dark brown urine (patient with Depakote) = liver damage/problem with liver function.
Check LFTs
Erythromycin increases level of carbamazepine (Tegretol) = Agranulocytosis. What should you do?
Decrease Tegretol medication to avoid toxicity
The patient is on oral antipsychotic meds then develop infection and are prescribed with 14 days antibiotics. What should the np do?
Decrease the antipsychotic medication
A patient has been stabilized on Zyprexa or Seroquel and is also a long time smoker. He is now involved in a smoking cessation program. How will you need to adjust his medication after he stop smoking
Decrease his dosage of Zyprexa
A patient takes Flonase daily for asthma. He was dx with bipolar and needs to be started on a mood stabilizer, what mood stabilizer DECREASES the effectiveness of Flonase
TEGRETOL (carbamazepine)
Patient is taking lithium developed severe back pain and reports this complaint to the pcp. Motrin 400 mg tid was prescribed. You know that the patient developed lithium toxicity if the patient displays what?
COARSE hand tremors, slurred speech, confusion, severe GI problem, metallic taste
Patient present with lithium 1.4, what does that mean?
Monitor for lithium toxicity signs and symptoms
A patient having a performance anxiety and taking albuterol. What medication would be prescribed for maintenance therapy
SSRI
Patient on interferon, Wellbutrin, and taking Lexapro and has complaints that symptoms are the same. What should you do?
Increase lexapro
Patient on Accutane and taking Wellbutrin and has complaints of no change in symptoms. What should you do?
Increase Wellbutrin
When a patient is on 21. Disulfiram (Antabuse), what should you educate him on?
a. Safety first.
b. Alcohol use stay away from alcohol due to severe side effects.
c. 12 hours from the time of the last drink.
d. Wait 2 weeks, mouth wash, shaving cream or any content that contains alcohol.
Patient has weight loss drug due to binge eating d/o for 2 days, BMI 27, and asked for medication.
Continue their Vyvanse.
(Not enough info)
Patient is anxious before going on stage. What would you give?
Propranolol (beta blocker end lol)
Found in children who frequently change foster homes or caregiver) unable to feel loved with caregiver, not seeking comfort or showing no response when comfort is given.
a. What dx would you give?
b. What theory is this?
a. Reactive attachment disorder
b. Bowlby theory of attachment
14 year old patient who moved 2 months ago has been sad, crying, skipping school (truancy), what dx?
Adjustment Disorder
Child in foster care with poor eye contact, isolates, and eats without default.
a. What is it?
b. What screening tools to use?
The patient has autism. Screening tool to use:
(MCHAT) modified checklist for autism in toddlers
iii. (ADOS-G)
iv. (ASQ) ages and stages questionnaires
Mom died or patient loses their job. What do you suggest?
Provide brief supportive therapy
How would an NP measure the readiness of a hospital staff to implement change?
Would ask them to fill out a survey
Patient goes to group therapy and does not want to go back
Offer individual or interpersonal therapy
Couples, referred by pediatric urologist, report that their stepchild is disturbing them by intentionally having enuresis. What will you tell them?
Family contract the family will have agreement
If you give ADHD medication Adderall and at 2pm they start exhibiting the symptoms. What does this mean?
Medication has cleared and may required a 2nd dose or longer acting stimulant.
Trazodone adverse effects
Priapism and QT Prolongation
Patient is taking an antipsychotic but medication is not effective.
Check to see if patient taking antacid or PPI because it can decrease absorption of antipsychotics. You can avoid this by taking them at least two hours before or one hour after taking your medication
Neuropathic pain and do not want to take medications
Refer for acupuncture
What do you perform with a patient that has disseminated encephalomyelitis?
A neurological exam
You do a neurological exam with a patient that has disseminated encephalomyelitis. What are some findings and what do you assess for?
a. Assess for asymmetry of extremities
b. Patient usually have blurring or double vision, weakness, numbness, loss of balance – unsteady and falling
How long does palmar and grasp reflex last?
They last 5-6 months
There is a question on the boards that talk about a neglected 2 year old who still has grasp reflex. What is the answer?
This is abnormal so order an x-ray
7 year old child complains of pain when its time for gym class. His parents think its performance anxiety. He has a positive Trendelenburg sign, what does the NP tell parents?
He has an issue with his hips. We need to consult with a specialist or refer him to specialists.
Kids received too many calories due to staff letting him eat more food, what do you do?
Meet with dietician, discuss with manager
a. Assess means of two groups are statistically different from each other
b. Analysis of variance (ANOVA) – Test the differences among three or more groups
c. Person R correlations – tests the relationship between two variables
T-Test
Patient couldn’t sleep and has anxiety, presented with this during the working phase (not enough info. Just memorize)
Identify goals
Patient is on Risperdal and started on Reglan, what is the priority teaching for the NP?
Metoclopramide (Reglan) can cause TD
Patient with 20 year IV drug use starts showing signs of cognitive decline, what test should be ordered
Order HIV test
Patient presents with for evaluation of suspected dementia, cognitively intact with s/s of depression and answers “ I don’t know” to all screening questions
Pseudo dementia or depression
Antacids altered absorption of antipsychotic medications-what do you educate?
Do not take with 2 hours of medication.
75-year-old patient wandering, disoriented, with hallucination. What does he have and what do you do?
He has delirium
but to rule out UTI, so GET LABS
On the boards, they will have a question referring to Depakote and Lamictal. (Just read)
a. Lamictal will double causing Stephen Johnson syndrome
b. So reduce Lamictal to 50%
14 year old boy with anxiety because his 11 year old sister has smaller breast than him
Normal response and will resolve spontaneously
A mom comes in with a child with ODD. What do you suggest to the parents?
Reinforce firm parenting skill with parents
Patient diagnosed with herpes zoster 3 weeks prior to assessment but lost job
Adjustment disorder with depressed mood
13 year old patient with s/s anxiety for 6 months prior, now with s/s of agoraphobia after a shooting in his neighborhood
GAD
What kind of question do you ask a child that is reluctant to participate in answering your questions?
Use Open-ended questions
Patient from Zimbabwe stating he needed tx for think to much, what assessment would NP use?
Culturally competent care
Native American patient dx with schizo, does not want medical treatment, wants to use spiritual counseling, after confidentiality clearance what does the NP do?
Involve parents and spiritual healer in treatment planning
Patient states, its not right they wont let me get treatment because they think I cant afford it which principle was violated?
Justice
Performing med rec and see ACE inhibitor prescribed, what condition is being treated?
Cardiac Failure
Family in crisis, what do you suggest to family to help cope?
Choose to review past and present coping mechanism that were successful.
Pseudo Parkinson, what pathway has been affected
Nigrostriatal pathway
Hesitant to prescribe to amphetamines to patient dx with schizo?
Potentiate dopamine release
Something about the condition related to dopamine depletion, want to say it was EPS effect of antipsychotics
Nigrostriatal pathway
Child waking up screaming at night
Assess for other family members with sleep disorders
4 year old reporting dreams of monster fighting in the sky or something then curling up and dying
Normal as this is when they develop magical thinking
Indirect vs direct press of starting a business
Cost vs Revenue
Patient in a residential facility, on 2000 calorie diet, but staff giving more food
Consult with nurse manager of educate staff
Native American upset and agitated as staff has removed his healing stick from the room. What does NP do?
Educate staff on cultural competency
Patient presents for follow up, appears restless, anxious, states she was raped while walking into NP office.
Reassure her safety first
Patient presents irritable, depressed, with labile mood. What do you assess with?
Administer mood questionnaire
NP notices teen with hi SI and DM, presents multiple time with DKA and leaves without psych screen
Collab with ER MD to provide psych screen if the present again
NP makes decisions for patient no capable of doing so and has no family present
Veracity of the decision
Client grieving over loss of husband
Uses idealization to cope with loss
Child in foster care since birth, eats without interest, show little emotions
Reactive Attachment Disorder (RAD)
Elderly patient presenting with 2 days history of s/s of delirium - \
Check UA
Child dx with autism not responding to parents anymore. What is this due to?
Due to mirror neurons of the brain
Nurse attacked at work and doesn’t want to return, its been 3 weeks.
Acute Stress Disorder (ASD)
VO/ID double check in book
Nurse attacked at work and doesn’t want to return, its been 3 weeks.
Weight-bearing exercise, decrease caffeine, no smoking
Frontal lobe injury = what kind of behavior
Inappropriate behavior
NP want to start up a business, what should np focus on?
Quality
Patient comes to you incapacitated
Consult ethics committee- Just memorize
Child with bipolar and d/o depression, what do you do first
Psychotherapy because his a child, you to treatment before medications.
Immigrant comes to consult, has difficulty understanding you
Call for interpreter
Teenager misbehaving, rude ODD
Consult for parental skills
Early sign of Alzheimer’s disease
Memory Decline
NP is being sued in court
EHR will be used and scared of purgery
Diabetic patient is having pain, what kind of meds are prescribed to help with pain?
Alpha d delta ligand – Neurontin (GAPAPENTIN), Lyrica (Pregabalin),.
Macrocytic anemia, what do you give?
Vitamin b12 and folic acid
How do you determine the readiness of hospital staff to implement change?
Have surveys to be filled out
Drug affects Flonase
Just know what?
(Just know that Flonase has interactions with zantac and Tegretol)
Flonase has steroids which is an inhibitor it can lead to increased Tegretol levels - causing angrocytosis. So what do you do?
Decrease Tegretol
IF a patient takes Risperdal and develops NMS, which other atypical should you avoid in the future?
Zyprexa
Menopausal women- (what to educate??)
Hormone therapy and replacement
Ensure equal coverage for mental and physical illness equal life time and annual limits
Mental health parity act 1996
NSAID, dehydration and thiazides increase risk of Lithium toxicity- what meds cause this? (Just read)
NSAID - INDOCIN, hydrothiazide, thiazide, Pril, Cozaar (losartan), TCA, flagyl
ODD what will you do to prevent it from becoming Conduct disorder
Therapy to target Mood and aggression
Patient comes with vague symptoms depression irritability. What’s one scale you can use besides PHQ9?
Beck depression scale
Patient think someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis
Delusional disorder
What included in the treatment of fibromyalgia?
Sleeping meds, antidepressants, and pain meds.
Examples: Cymbalta, Effexor, elvil, Pamelor, Lyrica, gabapentin, Ultram, benzos
What is often common to patients with fibromyalgia
Sexual abuse
What is the impact of steroid inhalers on children?
a. Slows bone growth
b.decrease ultimate height
What should you watch for with Tegretol?
Agranulocytosis and Hyponatremia
a. Help the patient with positive reinforcement and parenting skills
b. Limit setting, logical consequence, consistence
Interventions for ODD (Oppositional Defiant disorder)
Patient came in with history of anorexia, has not been eating for days, now started eating again with compliant of stomach ache, what the cause?
Refeeding Syndrome
What medication will you prescribe when someone on lithium for long time?
Synthroid
Patient came to the hospital asking for renew of medication. What kind of prevention is that?
Tertiary Prevention
You performing MMSE exam on an elderly, and she unable to draw clock, what part of the brain affected?
Parietal lobe or right hemisphere cerebrum
Patient taking Effexor will have positive read of PCP, the answer is?
Continue with the medication, no test needed
Patient lost weight, and need medication to improve appetite
Remeron
Patient your prescribing someone Risperdal to treat OCD off label what do you make sure you do?
Pick the answer that says, DOCUMENT that you made aware the patient or parent know, and educate.
Patient on Flonase and also taking Depakote, what will you do?
Increase Depakote
a. Flonase is steroid – causing mania – which cause regular dose of Depakote ineffective, so you increase dose.
There’s an aggressive patient in the ER. What do you give?
IM Geodon
An organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn’t work
Appreciative inquiry
Patient on Accutane and pregnant
Stop medication
Patient taking Viagra, what educations?
Rapid acting
Patient lost a friend now experiencing paralysis
Conversion Disorder
A patient is going from residential to and IOP program, hx of alcoholism and depression and when he is depressed he just drinks and stays alone? What would be a barrier to him going to a lower level of care?
Using alcohol to treat his depression in the past
Client diagnosed with borderline personality disorder is depressed, what medication are you going to administer?
SSRI
Patient has chronic pain, the person afraid of medication and doesn’t want to take meds.
Inform them about acupuncture
What level of prevention is socialization for a schizophrenia
Tertiary prevention
If you have a scenario where a child who is school died, and you are called as an NP to give presentation
Normalize the grieving process
This is a 70 year old person who is anxious, what part of the brain is involved?
Anterior cingulate
In the brain anatomy of a schizophrenia what is there? (Size)
Enlarged ventricles
Thought process / affect of a schizophrenia
Concrete/flattening
A crisis and all the family members are in crisis, panicking, upset what do you do?
Look for the calmest person in the family and work with them first, appears to have the best composure, look for the family leader
Prior to seeing your client and doing any DBT with them , what do you do first?
Breathing exercises
Scenario about a 12 years old and they are giving you an example of ice to water and water to ice (what part of piagets)
Concrete operations
Scenario about a 12 years old have abstract thinking, school project, and journal
Formal operations
A woman comes ins with a 22 month old their hand out and they grab your finger is this normal?
Abnormal refer neurology or do x-ray
7 to 8 years old who is in school and they boy is having trouble in school because he is a rule follower and this causing problem because the other kids are not following rules? What stage of Erikson is this?
Industry vs inferiority
If someone has dementia and they have Lewy bodies, what symptom is going to tell you its LB?
Visual Hallucinations
You have a patient who comes into your office and he says he feels funny and he has been sniffing acetone?
Send him to the ER
A patient has a decrease sex drive it can be a male or female
Check testosterone level
Which herbal remedy will reduce the effectiveness of levodopa
Kava Kava
What will you be education a patient who takes kava kava on its signs and symptoms? What labs should you check?
Hepatotoxicity-check LFT
A patient came in and is on kava, what medications will you educate them to avoid
Benzos
A young lady who needs a mood stabilizer agreed for treatment however is concerned about her weight and would not want to be on medication that will cause her to gain weight, which medication is appropriate to give?
Lamictal- If the asked for mood stabilizer with less weight gain
A depressed lady who has marital conflicts come to you that she is interested in therapy, however she would like to engage for 3 to 4 month or 4 to 6 months. What therapy would you suggest
Interpersonal
a. Short duration therapy
An 80 year old patient who diagnosed with Alzheimer’s disease 3 year ago and scored a 27 on MMSE, he came to you and score a 26 on MMSE. What diagnosis will you give this patient
Reconsider diagnosing him with Alzheimer’s
What is the first line of treatment for a first psychotic episode
Invega- because it a second generation and cause less effect. First generations cause more EPS and NMS
Another question that could be on the boards is about what are they most likely to have twice after EPS
Tardive Dyskinsia
For me they gave me an example of symptom of Parkinson and asked me what pathway will be affected (Dopamine pathways).
Nigrostriatal pathway
The same question above, with symptoms of Parkinson and the asked what neurotransmitter was affected
Acetylcholine
a. The rational – the reason why the patient is having Parkinson symptoms such as shuffle gait, rolling pin fingers or mask like is because dopamine has inversion with acetylcholine. Dopamine was depleted in nigrostriatal pathway causing acetylcholine to accumulate causing Parkinson symptoms.
A patient came to you and you have done all your assessment, diagnosis and discussed a treatment plan that incudes medications, you decided to start the pt. on certain medications and faxed med to pharmacy. What patients right have you violated
Informed consent
a. Because patient did not agreed to the treatment.
The young boy who came in and was worried about having Huntington disease because his dad passed from it. What will you be educating the child about the genetic testing Huntington
The hereditary and it common to have test.
a. The child have 25% of getting it. So, testing is common.
What part of the brain or the frontal cortex will most likely be affected by executive functioning
Dorsolateral
Who is at greatest risk of SI
Asian male 65 above with chronic SI
a. Has more factors, male, age and his or chronic SI
Couples report that their stepchild is disturbing them by intentionally having enuresis. What will you tell them
Do or initiate family contract or family member will have agreement before further assessment.
Child in foster care, isolative, doesn’t socialize well-
Autism
What is Alprostadil (PGE1) (Prostaglandin E1) used to treat?
What do you educate patient?
How is it administered?
a. Alprostadil (PGE1) (Prostaglandin E1) is used to treat erectile dysfunction.
b. By SLOW injection into the penis or placement in the urethra.
c. It has RAPID absorption.
What would you be educating patient about PGE1 injections?
Slowly
a. Remember the medication absorb rapidly when injected into the penis or urethral, but to administer it, you slowly inject the medications.
Another question on a surgeon who wanted to educate certain patient on pre op something.
Its ethical that all patient should be taught about the medication trial
What do you know about native American who is 19 years and committed suicide
Pick suicide is natural cultural something for them
(not enough info. Just memorize)
Autistic patient was brought in and mom is worried that he or she no longer answering his name or active when called his or her name
Lack of mirror neuron ( pick neuro mirror problem)
a. They do not respond because the lack mirror neurons)
