study PMHNP ANCC Review Flashcards
1
Q
2 Classes of Medication that should NOT be used together?
A
Ace inhibitors and ARBs together
2
Q
5HT AKA Serotonin
A
Raphe Nucleus
3
Q
14-year-old with no Axillary hair, has not gotten her Period yet.:
A
This is Normal according to Tanner Stage, start by 16.
4
Q
65-year-old Started on SSRI ?
A
May experience an increase in anxiety in elderly, expect increase side effects, DO An EKG
5
Q
Abnormal Trendelenburg Test
A
Hip Disease, refer child out, Assessed during Head to toe.
6
Q
Accutane Treatment for Acne
A
Can cause Depression and Birth defects.
7
Q
ACE INHIBITORS
A
-PRIL, CHF
8
Q
Acetylcholine (Ach)
A
nucleus basalis of meynert
9
Q
Adjustment disorder
A
reaction to a specific life event (identified
stressor), symptoms within 3 months but no more than 6
months. Think about a patient move.
10
Q
Adolescent with substance abuse and working out has
muscle aches
A
urine is red colored- hematuria, concerned for
rhabdomyolysis (muscle breakdown)
11
Q
Age for schizophrenia female
A
25-35
12
Q
Aggression in brain
A
Stimulation of the amygdala results in
augmented aggressive behavior hypothalamus, is believed to serve a regulatory role in aggression..
13
Q
Anorexic teenager with pain when eating
A
refeeding syndrome causes delayed gastric emptying.
14
Q
Apoptosis
A
neuron loss because of suffocation, enzyme
breakdown
15
Q
Appreciate Inquiry
A
strengths and competencies. What is being
done currently and assessment of strengths, no problem
focused, 3 steps are discovery, understanding, amplifying.
16
Q
Assertive inquiry
A
Appreciative Inquiry (AI) is a collaborative, strengths-based approach to change in organizations and other human systems.
17
Q
Autistic child not responding to your verbal commands:
A
This is normal, repetitive patterns of bx, impaired Social
interactions, verbal/nonverbal communication common.
18
Q
Beck inventory score of 10?
A
0-63, over 30 severe, Don’t start medication just start therapy.
19
Q
Beck Scales
A
Eight, separate, self-report inventories designed to
assess different areas. Scores from 0-63 over 30 is severe.
20
Q
Best therapy for negative thinking
A
CBT, all or nothing thinking catastrophic thinking.
Humanistic therapy-self
Existential- reflection/self-control/personal responsibility
21
Q
Bipolar not taking medication:
A
“Tell me how the medication.
works in your body.”
22
Q
Brother sexually abusing sister:
A
make sure that he is not left!
alone with her and call CPS, mandatory reporter, arrange.
crisis therapy
23
Q
Can disclose info to Medicare /CMS without consent: ..
A
NO
24
Q
Clenched teeth
A
CN 5 Trigeminal (masseter or masticatory
muscle).
25
Clozaril
wbc+anc: If less than 950 discontinue the medication
and get a repeat level, 1000 is the cutoff
1.5-2 cbc biweekly
1-1.5 hold, cbc q dayx 3 weeks
less than 1- Stop medication
12.5initial, target 300-900mg/d once or bid
schizophenrenia/pscyhosis
agranulocytosis, seizures, myocarditis (inflammed heart muscle
-chest pain,diff breath)
wg, increase lipids/glucose
REMS pharmacy need clozaril registry to dispense
to start: WBC must be >_3500 and ANC >_2000
WBC + ANC weekly q6months, then every 2w q6months, then
monthly
26
Dark brown urine
Check LFT from Depakote 
27
DEA regulation monitoring:
State and Federal, PMP
28
Dopamine production IS
substantia nigra and ventral tegmental
area
(The dope sub needed to vent)
29
Early signs of aids dementia
memory, inattention,
concentration changes, worry over decreased cognition.
30
Elderly female with decreased sex drive:
: check testosterone Level
31
Elderly patient with dementia how does you know it can give
consent:
Able to repeat back risks and benefits.
elements= nature/purpose of Tx, risks/benefits of Tx,
risks/benefits not doing Tx, alternatives, diagnosis/prognosis.
32
EPS types
Not Any Dopmine
from long-term use of antipsychotics 
Tardive dyskinesia(Tell daddy to smack his lip) happens after years
Treatment: D/c and can help if ask Clozaril
Acute dystonia( stone stuck in eyes up)(hours), anticholinergic

Parkinsonism(shuffling gates, ), anticholinergic 
Akathisia (Katha likes to pass so block her ass)=beta blockers
33
Erythromycin and Tegretol
Erythromycin is an inhibitor (H=high level).
If on Tegretol and Erythromycin together would
want to reduce the dose of Tegretol!
34
Experiencing irritability/depression/edginess?
best assessment is mood questionnaire for bipolar, 7/13 bipolar.
likely
35
First line neuro-protective for bipolar:
Lithium
36
First symptom of metabolic syndrome?
Large waist circumference
37
Flonase interacts with what mood stabilizer?
Tegretol (inhibitor)
38
Frontal lobe dementia:
A form of dementia characterized by
personality changes/social changes.
39
GAD-7 scale:
More than 15 severe!!
GENERAL Anxiety (Anxiety 25/15 severe)
40
HAM-A:
Hamilton Anxiety Scale most commonly used.
14 domains, 14=mild, 18-24= moderate, 25-30=severe
(Anxiety 25/15 severe)
41
Fungus on toenail:
Scrape toenail and sent for testing.
42
Grade 2/5 hoarse systolic heart murmur:
Aortic stenosis Hyperthyroidism
43
Hamilton Depression Scale HAM-D
Severe 19- 23 (monitor for SI)
ii. Moderate 14 - 18
iii. Mild 8 -13
0-7 normal
44
The health care policy is access, cost and
Quality
45
How does Tegretol interact with cipro:
Cipro and erythromycins are inhibitors. Cause increased level of Tegretol.
Black box warning
46
How do you get paid for Medicare:
CPT current procedural code
47
Ibuprofen + lithium:
Idican
Increases the serum level of Lithium up to
double
48
Just Culture:
refers to an organization's commitment to
accountability and a focus supporting universal safety in
health care. Find out the error ad where went wrong!
49
Keeping chronically mentally ill in the community?
ACT mode
50
Kleinfelter's Syndrome:
male with more than one X
chromosome (XXY), little to no sperm, fertility treatment
51
Labs for Macrocytic anemia:
Folic acid, vitamin B12, ESR/CRP,
HGB, MCV (liver
52
Labs for rheumatoid arthritis:
ESR erythrocyte sedimentation
rate elevation. Synovial fluid analysis. X ray of joints.
Rheumatoid factor titer, CRP, Hgb
53
Lab values concerning for patients on lithium:
4+ protein in urine,
Leukocytosis, creatinine, BUN, Na,
54
Locus coeruleus
a small nucleus in the reticular formation that
is involved in directing Attention
55
Masturbating 3-year-old:
Phallic stage is normal 3-6 years old.
56
Parity Laws
Law that makes sure people with mental health issues get
the same financial treatment?
When we are having a party, everyone gets the same treatment
57
Levels of Prevention
Primary: prevent/promotion, classes,
safety initiatives, education, classes, modifying environment
Secondary: screen-early detection, crisis hotlines, disaster
Tertiary: treat- to prevent further deterioration, rehab,
restoration, day treatment, social skills
58
Lithium level is 1.4
monitor for toxicity, toxicity=1.5, nausea,
vomiting
59
Lithium toxicity:
1.5, 3 is an emergency, severe
diarrhea/nausea/vomiting, metallic taste, tremor, slurred
speech, number one intervention, give fluids, sweating give.
Electrolytes too
60
Medication for NMS?
Dantrolene and Bromocriptine (My BRO DAN)
61
Medicine that can cause mania.
Steroids/prednisone
Antabuse, isoniazid
62
MMSE part for thought disorder:
proverb interpretation,
abstract vs concrete interpretations
0-17 bad (MMSE &SLUM Are the only two That 0 is Bad)
63
MMSE scores:
24-30 no cognitive impairment
18-23 mild cognitive impairment
0-17 severe cognitive impairment
64
NMS is like S&M
NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool
65
NMS: neuroleptic malignant syndrome
Severe fever
Changing LOC
Autonomic instability
Rigidity
Sweating and drooling
FEVERS- fever, encephalopathy, vitals instability, elevated
white blood cell count/cpk, rigidity
66
Neurotransmitters involved in alcoholism:
dopamine and Gaba
67
Norepinephrine (NE): Were in the Brain
Synthesized in locus coeruleus arousal.
and other functions like mood, hunger, and sleep
68
Nuchal rigidity:
stiffness in cervical neck area, meningitis
69
NMS labs
NMS labs: increased CPK, WBC
70
Np notices teen with DKA leaving without Eval:
Collaborate with ER to provide a psych assessment
71
NSAIDs & ACE inhibitors effect:
can double lithium levels.
72
Nucleus basalis of Meynert:
Alzheimer disease cognitive and memory function
73
Nurse attacked 3 weeks ago and now scared to go to work:
Acute Stress Disorder, as it happened less than 1 month ago.
74
. patient continues to say "I don't know":
Depression, not dementia
75
OB/PMHNP in same clinic:
IT increased access to mental health
access
76
ODD child:
help the parents with positive reinforcement and
parenting skills, limit setting, logical consequences,
consistency, power struggle/control issues problematic,
parenting/family dysfunction exacerbates.
77
PANDAS:
Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal infections. OCD- recent strep
throat
78
Patient abusing stimulants, what does NP assess for:
Insomnia and tremor, irritability, weight loss, nervous,
hypertension, tachycardia
79. Patient cold what labs to get?
79
On Interferon and Lexapro:
Interferon can cause depression, increase Lexapro.
80
Patient cold what labs to get?
Check TSH 0.5-5
81
Patient has neuropathic pain, what medication will help, gabapentin not helping:
Alpha 2 delta, pregabalin- lyrica
82
Patient is borderline and suicidal what therapy?
DBT, Goal IS to
decrease emotional reactivity/crisis bxs and self-validation.
82
Patient lost a friend now experiences paralysis:
Conversion syndrome, repression of unconscious intrapsychic conflicts
83
Patient in hospital with no family and failing cognitive test:
perform an MRI, labs to rule out substances.
84
5. Patient moving states, what do you do with medication?
Send enough medication is standard of practice
85
Patient on Risperdal and elevated prolactin:
stop or decrease the medication, Tubin tract (hyperprolactemia)
86
Patients husband shows up but not the patient:
both people need to be present, reschedule.
87
Patient wakes up screaming at night:
ask family if anyone else has sleep problems.
88
PICOT:
(A project)
P: Population/problem
I: Intervention/issue
C: Comparison
O: Outcome
T: Time
The population income out time 
89
PHQ9:
score 1-27, over 20 is severe
90
Person with EPS will most likely experience what:
Tardive dyskinesia
91
Phases of policy making:
formulation, implementation,
evaluation
92
PTSD: Acute stress disorder-
less than 1 month
PTSD- after 1 month
93
PTSD nightmares:
Prazosin (PTSD- after 1 month)
94
Puff cheeks
CN 7 facial (sensory and motor)
95
Pulling hair out:
OCD/trichotillomania
Trichotillomania, also known as hair-pulling disorder or compulsive hair pulling, is a mental disorder characterized by a long-term urge that results in the pulling out of one's own hair
96
Raphe nuclei:
A string of nuclei in the Midline of the midbrain
and brainstem that contain most of the serotonergic neurons of
the brain
97
Reflexes expected at 1 month:
Moro until 4 months, Palmer
until 4 months, Plantar util 8 months, Babinski (2 years is
disease)
98
Reluctant/silent patient:
open ended questions
99
Rhett Syndrome:
A rare disorder found virtually exclusively in
Girls, is a neurodevelopmental disorder in which the child.
usually develops normally until about 6 to 18 months of age at
which characteristics of the syndrome emerge, characteristics
include:
Hypotonia (loss of muscle tone), reduced eye contact,
decelerated head growth, and disinterest in play activities
100
Risk factors for Serotonin Syndrome:
more than 1 SSRI, st john's wart, tramadol, Demerol, Ultram, meperidine, 5HT
101
Scope of practice:
Comes from the state, board of Nursing/American nurse
association.
102
Serotonin Discontinuation Syndrome:
syndrome caused by
abrupt withdrawal of an antidepressant drug, resulting in
sensory disturbances, sleeping disturbances, disequilibrium,
flu-like symptoms, dizzy, vertigo, paresthesia (brain zaps),
nausea/vomiting, and gastrointestinal effects
103
Shrill CRY
Increased cranial pressure.
104
Signs of fetal alcohol syndrome:
small head, shoey
palpebral fissure, inner epicanthal folds. Do IEP and early!
intervention specialist
small head, shoey
palpebral fissure, inner epicanthal folds. Do IEP and early
intervention specialist
105
Signs of serotonin syndrome:
-shivering
-anxiety
-diaphoresis
-hyperthermia
Shits and Shivers
diarrhea, shivering, hyperreflexia/myoclonus, increased.
temperature, vital sign instability, encephalopathy, restlessness,
sweating
106
Smoking cessation and antipsychotic:
Decrease the level of
Zyprexa, smoking is an inducer causing decreased levels of
the medication. When stop smoking re-increase the medication?
107
Started on a medication then comes back in 2 weeks?
Increase the dose after 1-2 weeks, therapeutic effects 4-6
weeks
108
Teen commits suicide, NP does presentation:
To teens in
order to normalize the grieving process.
108
Substantia nigra IS
Midbrain structure where dopamine is
produced; involved in control of movement.
109
Tegretol side effects:
Aplastic anemia, agranulocytosis, steven
Johnson's, hyponatremia. Watch with cipro and Erythromycin.
110
Telemedicine asking a legal question??
Licensing jurisdiction for the np
111
therapeutic communication:
open ended, 'tell me
112
Tics what advice?
Fairly common in children and will often
remit on its own, ADHD concomitants
113
To reduce stigma among teens seeking mental health..
Educate friends/peers
114
Ventral tegmental area (VTA):
midbrain structure where dopamine is produced: associated with mood, reward, and addiction.
114
Treatment for ADHD:
Stimulant and therapy together
115
Wandering, disoriented person on the streets for 2 days:
Delirium
116
What are you looking at when you are assessing the
function of an elderly individual:
ability to manage a
checkbook, instrumental ADLs go first (meds, phone, drive,
house week, balancing check book), then ADLs
eating/dressing, Exec functions=judgement, planning, taxes
117
. What medication can alter absorption of antipsychotics?:
Antacids, can decrease antispsychotic effects
118
2. What medication to give for serotonin syndrome:
Cyproheptadine
119
. What medication can alter absorption of antipsychotics?
?
120
doxycycline is an abt which is an inhibitor and it takes precedence which Causes
Causes Toxic levels
InDucers= decrease other drugs
INhibitors= increase other drugs
121
Benzodiazepines during pregnancy patient Teaching
Clonazepam klonopin causes floppy baby syndrome, and twice as many miscarriages 
