PMHNP Certification Exam

Dialectical behavior therapy

Marsha Linehan focuses on emotional regulation, tolerance for distress, self management skills, interpersonal effectiveness, mindfulness, with an emphasis on treating therapy-interfering bx

Health Belief Model

Marshall Becker explains that healthy people do not always take advantage of screening or preventative programs because of certain variables: -perception of susceptibility -seriousness of illness -perceived benefits of tx -perceived barriers to change -expectations of efficacy

most outspoken opponents of APRNs

Martha rogers

what medication are MAOIs strictly contraindicated with

Meperidine due to risk of hypertensive crisis and death

family systems therapy

Murray Brown focus on chronic anxiety within families tx goal to increase familys awareness of each members function within the family and to incrase levels of self determination

poor sleep is a sign of possible

OCD

meds that can cause false positives for methadone or PCP

OTC cough meds (Nyquil) dextromethorphan

Primary Prevention care practices are an essential aspect of the PMHNP role. Which is the best example of a primary prevention care strategy for community behavioral health?

Parenting skills classes for pregnant adolescents (Information reduces incidence of disease)

what direct acting dopamine receptor agonist is recommended to be used in the treatment of NMS to help lower the dopamine receptor blockade?

Parlodel

identifying pts with pseudodementia

"Don't know" answers

what does the ego say?

"I evaluate"

the pmhnp is planning to work with a client using an individual therapy model of care. during the first session, the client makes the following statement: "this is the third time my son has run away. I have grounded him, taken away his bike, even tried cutting off his allowance and confining him to his room. what should I do now?" the most therapeutic response for the PMHNP to make is..

"maybe that depends on what you are trying to accomplish"

Panic disorder pharm

- SSRIs -Benzos for short term symptom control or bridge med when starting antidepressant -buspar effective adjunct to antidepressant -other non-benzo anxiolytic meds as adjuncts

wake promoting agents for sleep dx

--Armodafinil (Nuvigil) -indicated for daytime sleepiness associated with OSA

clonidine (Catapres) for EPSE

-0.1mg PO TID -alpha 2 agonist -treats akathisia only

Benztropine (Cogentin) for EPSE

-0.5-2mg PO, TID -Anticholinergic -treats akinesia, akathisia, dystonia, pseudo-parkinson's -NO TD

PTSD diagnostic criteria

-1 month or longer -exposure to traumatic event -traumatic event persistently reexperienced in one or more ways -3 or more avoidance symptoms -2 or more increased arousal symptoms -causing significant distress or impairment in Activities of daily functioning -occur within 3 months of trauma -duration is highly variable (remit within 3 months in 50% cases, common waxing and waning)

Lithium carbonate (Eskalith, Lithobid)

-1,200-2,400mg/day (acute) -900-1200mg/day (maintenance) -SE: common- nausea, fine hand tremors, increased urination and thirst -SE: toxicity- slurred speech, confusion, severe GI effect -establish standard treatment for BP -Prego D -Lact L3 -risk of hypothyroidism -avoid in prego, especially 1st trimester -monitoring of kidney function is essential -concurrent use of NSAIDs and angiotensin-converting enzyme inhibitors (ACEIs) may double lithium level

Cariprazine (Vraylar)

-1.5-6mg QD -SE: EPSE, akathisia, GI upset, restlessness, somnolence --monitor serum lipids/glucose -assess family/personal hx CVD dx -SGA

schizophreniform prognosis

-1/3 recover completely within 6 months -2/3 develop schizophrenia or schizoaffective dx

average duration of ECT treatments

-10 weeks -gradually shift from weekly to monthly treatments over 1-3 months then maintain monthly administration for 6 months

Propranolol (Inderal)

-10-20mg/day PRN -SE: bradycardia, hypotension -performance anxiety -off label use -usually adjunctive with other agent

carbamazepine (Tegretol)

-10-20mg/kg/day -6-12mcg/mL -SE: common- Nausea, dizziness, sedation, headache, dry mouth, constipation, skin rash -SE: rare- agranulocytosis/aplastic anemia, steven johnsons syndrome, particularly in Asians (screen for HLA-B 1502 allele before initiating) -hepatic enzyme inducer -monitor LFTs -alternative to lithium or valproic acid -Prego D -Lact L2

Amantadine (Symmetrel) for EPSE

-100-200mg PO BID -dopamine agonist -treats akinesia and pseudo-parkinson's only

Iloperidone (Fanapt)

-12-24mg/day in divided doses -SE: orthostatic hypotension, sedation, dizziness -titrate slowly d/t alpha 1 agonist properties -may be helpful for PTSD hyperarousal S/S d/t alpha 1 blocking -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA

valproic acid (Depakene), divalproex sodium (Depakote)

-15-40mg/kg/day -SE: common- nausea, diarrhea, abdominal cramps, sedation, tremor -SE: rare- increased liver enzymes, steven Johnson's syndrome (unlike carbamazepine, divalproex does not carry screening directive for HLA-B 1502 antigen at this time) -Depakote minimizes GI effects -more effective than lithium for raid cycling and mixed Bipolar -Loading dose 20mg/kg -prego D -lact L2

combined pharmacotherapeutics and behavioral interventions COMBINE trial

-16 week RCT -1383 alcohol dependent patients -2003 -naltrexone effectively delayed time to relapse compared to placebo -acamprosate faired poorly compared to various combos of naltrexone and combined behavioral intervention (CBI) -found that any combining therapies including CBI, naltrexone, or both; performed better than any combo not including these interventions

Clonazepam (Klonopin) for EPSE

-1mg PO BID -Benzo -treats akathisia and dystonia only

Lorazepam (Ativan) for EPSE

-1mg PO TID -Benzo -treats akathisia and dystonia only

schizophreniform dx hx assess for the following

-2 + of the following frequently present during a 1 month period (delusions, hallucinations, disorganized speech, grossly disorganized bx, presence of negative symptoms) -duration of symptoms for at lest 1 month but not longer than 6 months

Schizophrenia diagnostic criteria

-2+ symptoms frequently present during 1 month period and at least 1 must be delusions, hallucinations, or disorganized speech -significant occupational/social impairment -duration at least 6 months

Brexpiprazole (Rexulti)

-2-4mg/Qday -SE: akathisia, weight gain --monitor serum lipids/glucose -assess family/personal hx CVD dx -SGA

trihexyphenidyl (Artane) for EPSE

-2-5mg PO TID -anticholinergic -treats akinesia, akathisia, dystonia, pseudo-parkinson's -NOT TD

Procyclidine (Kemadrin) for EPSE

-2.5-5mg PO BID-QID -anticholinergic -treats akinesia, akathisia, dystonia, pseudo-parkinson's -NOT TD

Propranolol (Inderal) for EPSE

-20-40mg PO TID -beta blocker -treats akathisia only

Buspirone (Buspar)

-20-60mg/day -SE: dizziness, insomnia, tremors, akathisia, stomach upset, dry mouth -helpful adjunct for anxiety -not PRN

Patient Protection and Affordable Care Act (PPACA)

-2010 -"healthcare reform" -expanded coverage to many previously uninsured Americans -provided specific benefits for those with mental illnesses with inclusion of substance use disorder in an "essential benefits package" -creation of incentives to coordinate primary care and mental health/addiction services -inclusion of mental illness s a chronic illness in creation of "health homes" -prohibits denial of coverage for preexisting conditions -provisions for community health campaigns -increased community based care

lamotrigine (Lamictal)

-25-600mg/day -blood monitoring not necessary -SE: common- dizziness, ataxia, somnolence, diplopia, nausea, headache, hepatotoxicity -SE: Rare- life threatening rashes including steven Johnsons syndrome (unlike carbamazepine, divalproex does not carry screening directive for HLA-B 1502 antigen at this time), leukopenia -indication for maintenance only -helps in depressive phase of Bipolar -titrate slowly -often used in combo with lithium, SGAs, and antidepressants

diphenhydramine (Benadryl) for EPSE

-25mg PO QID -antihistamine -treats akinesia, dystonia, pseudo-parkinson's -NOT TD, akathisia

Gabapentin (Neurontin)

-300-3600mg/day -SE: ataxia, decreased coordination, sedation, disequilibrium -used for anxiety, neuropathic pain, fibromyalgia, and as an anti-craving medication -off label use

Tiagabine (Gabitril)

-4-56mg/day -SE: dizziness, somnolence, stomach upset, tremors, dry mouth -helpful adjunct for anxiety , off label use

Lurasidone (Latuda)

-40/160mg/day -SE: akathisia, sedation, nausea -take with food to increase absorption -use with caution at lower doses in clients with renal and hepatic impairment -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA

Vortioxetine (Brintellix)

-5HT3 and 5HT7 antagonist -5HT 1A agonist -tablet 5, 10, 20mg -20mg QD -SE: nausea, diarrhea, dizziness -Prego C -Lact inadequate info

methylphenidate hydrochloride (Ritalin LA/ Ritalin SR/ Metadate CD/ Metadate ER/ Methylin ER)

-ADHD -Schedule II -10-60mg/day

amphetamine, dextroamphetamine (Adderall)

-ADHD -Schedule II -5-40mg/day

Atomoxetine Hydrochloride (Strattera)

-ADHD -not controlled substance -10-100mg/day

Methylphenidate transdermal patch (Daytrana)

-ADHD -schedule II -10-30mg/day (9hours)

methylphenidate hydrochloride (Concerta)

-ADHD -schedule II -18-72mg/day

Dexmethylphenidate (Focalin/Focalin XR)

-ADHD -schedule II -2.5-20mg/day

lisdexamfetamine dimesylate (Vyvanse)

-ADHD -schedule II -30-70mg/day

methylphenidate hydrochloride (Ritalin)

-ADHD -schedule II -5-40mg/day

amphetamine, dextroamphetamine (Adderall XR)

-ADHD -schedule II -5-60mg/day

methylphenidate hydrochloride (Methylin)

-ADHD -schedule II -5-60mg/day

dextroamphetamine (dexedrine)

-ADHD -scheudle II 2.5-20mg/day

guanfacine (Intuniv)

-ADHD FDA approved 6-17yo -alpha agonist -not controlled substance -1-4mg/day

bupropion (Wellbutrin SR/XL)

-ADHD off label -norepinephrine dopamine reuptake inhibitor -100-450mg/day

clonidine (Catapres)

-ADHD-off label -alpha agonist -not controlled substance -0.1-0.4mg/day

abnormal movement rating scales

-AIMS -Dyskinesia identification system condensed user scale (DISCUS) -simpson-Angus rating scale (SAS)

other substance abuse disorder screening tools

-AUDIT- alcohol use disorders identification test -S-MAST- short Michigan alcoholism screening test (or geriatric version) -CRAFFT- children and adolescent under 21 years of age -COWS- the clinical opiate withdrawal scale

dementia physical exam findings

-Amaurosis fugax (unilateral transient vision loss, described as curtain over eye) -unilateral focal-motor weakness -asymmetrical reflexes

Mahler's Separation/Individuation Theory

-Autistic - Birth to 3 months (total detachment and self absorption, infant spends most time sleeping -Symbiotic - up to 5 months, recognizes mother, but lacks sense of individuality. disruption= narcissistic personality disorder Separation: 3 phases --hatching: increased interest in outside world --Practicing - 9 to 16 months, develops physical ability to separate from mother --Rapproachement - 15 to 24 months, explores outside world but requires mothers presence and emotional support. disruption = borderline personality disorder

MDD cognitive theory

-Beck -represents cognitive diathesis- stress model in which developmental experiences sensitize a person to response to stressful life events in a depressed manner -assumes that people with a tendency to be depressed think about the world differently than nondepressed people and that depressed people are more negative and believe that bad tings are going to happen to them because of their own personal shortcomings and inadequacies

Thiothixene (Navane)

-Capsule, liquid, injection -5-60mg/day -SE: high- EPSE -SE: low- anticholinergic, sedation, hypotension -FGA

Bipolar II

-Clinical hx characterized by occurrences of one or more major depressive episodes accompanied by at least 1 manic or hypomanic episode -recurrent shifts in polarity can occur more frequently-rapid cycling

ADHD standard rating scales

-Conners parent and teacher rating scales -vanderbilt ADHD diagnostic pedant and teacher rating scales

eating disorder pharm management

-Fluoxetine FDA for bulimia nervosa -SSRIs and TCAs effective in reducing frequency of binging and purging

MDD aggression turned inward theory

-Freud -assumes that early psychological developmental issues lay he foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences the loss of the significant mothering person

Bipolar biological theories

-GABA deregulation -increased noradrenergic activity -voltage-gated ion channel abnormalities -abnormalities lead to abnormal balances of intracellular and extracellular levels of neurotransmitters, which then cause subsequent disruption of electric signal transmission in brain regions -kinding

mirror psychotherapy

-Gonzalaz-Jaimes and Turbull-Plaza -psychocorporal, cognitive, neurolinguistic components -holistic focus -effective with adjustment disorder

interpersonal theory

-Harry Stack Sullivan -self-system -when the person's need for satisfaction and security is interfered with by the self system, mental illness occurs -humans experience anxiety and bx is directed toward relieving the anxiety, which then results in interpersonal security

Medicare part A

-Hospital insurance program -funded by a 2.9% tax on earnings paid by employers and workers -covers inpatient hospital services, home health, skilled nursing facilities, and hospice care

eszopiclone (Lunesta)

-Intermediate acting agent

Isocarboxazid (Marplan)

-MAOI -Tablet -20-60mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info

Phenelzine (Nardil)

-MAOI -Tablet -45-90mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info

Selegiline (EMSAM)

-MAOI -Transdermal patch -6-12mg -no dietary restrictions with 6mg dosage -may need higher dose to see antidepressant effect -Prego C -Lact L4 AVOID

Tranylcypromine (Parnate)

-MAOI -tablet -30-60mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info

Hierarchy of needs

-Maslow -survival -safety and security needs -love and belonging -self-esteem -self-actualizaiton

dementia pharm management for cognitive symptoms

-N-methyl D-aspartate glutamate receptor agonists -Cholinesterase inhibitors

Memantine (Namenda)

-N-methyl D-aspartate glutamate receptor antagonist -10-20mg BID -moderate to severe alzheimers dementia -may slow degenerative process -promotes synaptic plasticity -may be used in combo with cholinesterase inhibitors -memantine/donepezil (Namzric) combo medication

Bupropion SR/XL (Wellbutrin SR, XL)

-NDRI -SR 150-400mg/day -XL 150-450mg/day -caution with caffeine and in people with panic dx

Bupropion (Wellbutrin)

-NDRI -Tablet -150-450mg/day -SE: headache, nervousness, tremors, tachycardia, insomnia, decreased appetite -contra if client has sz dx, eating dx -SR offers BID dosing -XL offers QD dosing -can increase energy level -also used for ADHD and smoking cessation -Prego C -Lact L3

Cognitive Theory

-Piaget - four stages of development

Aripiprazole Lauroxil (Aristada)

-Qmonth IM injection -441mg, 662mg, 882mg -SE akathisia -monitor serum lipids/glucose -assess family/personal hx CVD dx -SGA

Trazodone (Desyrel)

-SARI -Tablet -200-600mg/day -NE: sedation, nausea, headache, hypotension -safer in OD than TCAs -priapism possible -not well tolerated at antidepressant dosage d/t sedation -most commonly used as hypnotic at 50-200mg/HS -May prolong QTc interval -Prego B -Lact L2

Nefazodone (Serzone)

-SARI -tablet -300-600mg/day -SE: headache, drowsiness, GI disturbances -must monitor LFTs -can cause liver failure -safer in OD than TCAs -QHS or BID dosing -potent P450 3A4 inhibitor -Prego C -Lact L4 AVOID

mesocortical pathway

-SDAs increase dopamine in this pathway, causing decreased negative syptoms

Quetiapine (Seroquel/XR)

-SGA -tablet -50-800mg/day -SE: common- sedation, hypotension (orthostatic hypotension), weight gain -SE: rare- cataract formation -transient and asymptomatic elevated LFTs -monitor for cataracts -divided BID/TID -no prolactin elevation -monitor wt, BMI, AG, serum lipids/glucose -assess family/personal hx CVD dx

Clozapine (Clozaril)

-SGA -tablet or ODT -25-900mg/day -SE: common- tachycardia, drowsiness, dizziness, hypersalivation (sialorrhea), weight gain, hyperlipidemia -SE: rare- agranulocytosis, myocarditis, neuroleptic malignant syndrome -only drug for tx-resistant schizophrenia -Clozapine REMS program -risk for neutropenia is monitored by the ANC -during 1st 6 months- weekly blood draw -during 2nd 6 months- biweekly blood draw -monthly blood draw thereafter -ANC levels less than 500- suspend drug -can be challenged if benefits outweigh risk -monitor myocarditis -dose-related sz risk -significant weight gain and diabetes risk -rare hyperprolactinemia -monitor wt. BMI, waist circumference -monitor serum lipids and glucose -assess family/personal hx CVD dx

olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv)

-SGA -tablet, IM (acute); 5-20mg/day -IM (long); 150-405mg Q2-4 weeks -SE: acute- sedation, wt gain, hyperlipidemia, elevated glucose/LFTs/mild prolactin -SE: long acting- requires monitoring 3 hours post injection d/trisk of postinjection delirium sedation syndrome -significant wt gain -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx

Risperidone (Risperdal, Risperdal Consta)

-SGA -tablet, liquid, ODT; 2-8mg/day -Injectable; 25-50mg IM Q2 weeks -SE: hypotension, galactorrhea, nausea, insomnia -doses >6mg associated with higher incidence of EPS -less wt gain than Clozaril or Zyprexa -greatest prolactin elevation -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx

Duloxetine (Cymbalta)

-SNRI -Capsule -30-120mg/day -SE: dizziness, headache, GI disturbances -once daily dosing -can elevate BP -can elevate LFTs -has significant discontinuation syndrome if stopped abruptly -Prego C -Lact L3

Venlafaxine (Effexor, Effexor XR)

-SNRI -Capsule (XR), or tablet -75-375mg/day -XR 75-225mg/day -SE: diaphoresis, headache, dizziness, GI disturbances -can raise BP -QD for XR capsules -BID-TID dosing for tablets -full SNRI effect at doses at or above 150mg -safer in OD than TCAs -has significant discontinuation syndrome of stopped abruptly -Prego C -Lact L3

Levomilnacipran (Fetzima)

-SNRI -tablet 20, 40, 80, 120mg -40-120mg QD -SE: N/V, constipation, sweating, palpitations, urinary hesitancy, hypertension, hypotension, decreased appetite -Prego C -Lact inadequate info

fluoxetine (Prozac)

-SSRI -capsule, tablet, or liquid -20-80mg/day -SE: insomnia, headache, GI disturbances, sexual dysfunction -Long half-life -Prego C -Lact L2 -discontinuation syndrome unlikely

escitalopram (Lexapro)

-SSRI -tablet -10-20mg/day -SE: somnolence, headache, sexual dysfunction, GI disturbances -prego C -Lact L2

fluvoxamine (Luvox)

-SSRI -tablet -100-300mg/day -SE: sedation, sexual dysfunction, agitation, GI disturbances -Doses above 150mg should generally be given BID -Prego C -Lact L2

citalopram (celexa)

-SSRI -tablet -20-40mg/day -SE: sedation, sexual dysfunction, agitation, yawning, GI disturbances, wt gain -preg C -lact L2 -proglonged QTc interval in doses above 40mg (20mg in older adults) and in those susceptible to prolonged QTc

Sertraline (Zoloft)

-SSRI -tablet -50-200mg/day -SE: sexual dysfunction, GI disturbances, somnolence, headache -Prego C -Lact L2

Paroxetine (Paxil CR, Pexeva)

-SSRI -tablet or liquid -20-60mg/day -SE: headache, GI disturbances, somnolence, sexual dysfunction -Prego D -Lact L2 -Discontinuation syndrome very common

PTSD pharm

-SSRIs -TCAs -Benzos not recommended -antipsychotics useful during flashbacks -alpha agonists (prazosin) for nightmares off label

agoraphobia pharm

-SSRIs -benzos for short term use -beta blockers off label for discrete episodes of social anxiety

OCD pharm

-SSRIs (often need higher dosing ranges for adequate symptom control) -TCA (clomipramine) -SGAs (risperidone off label but have supportive data adjunctive with SSRI)

Vilazodone (Viibryd)

-Serotonin partial agonist reuptake inhibitor SPARI -tablet -20-40mg -SE: diarrhea, nausea, dry mouth, lower risk of sexual side effects -Prego C -Lact unknown, is excreted in breast milk

Psychodynamic (Psychoanalytic) Theory

-Sigmund Freud -all bx is purposeful and meaningful -principle of psychic determinism -most mental activity is unconscious -conscious behaviors and choices are affected by unconscious mental content -childhood experiences shape adult personality -instincts, urges, or fantasies function as drives that motivate thoughts, feelings, and bx -Id, Ego, Superego -conflict is experienced consciously as anxiety

9 dimensions of temperament

-Stella chess and Alexander Thomas -approach or withdrawal -adaptability -attention span and persistence (not quality of sleep)

clomipramine (Anafranil)

-TCA -Capsule -100-250mg/day -approved for OCD -250mg/day maximum d/t increased seizure risk -Prego C -Lact L2

Trimipramine (Surmontil)

-TCA -Capsule -100-300mg/day -Prego C -Lact inadequate data

Doxepin (Sinequan)

-TCA -Capsule or liquid -100-300mg/day -also used for insomnia -Prego C -Lact L5 AVOID

imipramine (Tofranil)

-TCA -Tablet, capsule, or IM -100-300mg/day -also used for enuresis and separation anxiety -Prego D -Lact L2

Nortriptyline (Pamelor)

-TCA -capsule or liquid -50-150mg/day -also used for enuresis and ADHD -Prego D -Lact L2

Protriptyline (Vivactil)

-TCA -tablet -15-60mg/day -Prego C -Lact inadequate data

Amitriptyline (Elavil)

-TCA -tablet or IM -50-300mg/day -also used for chronic pain (particularly neuropathic pain), insomnia -Prego C -Lact L2

Desipramine (Norpramine)

-TCA -tablet or capsule -100-300mg/day -also used for ADHD (off label for pediatric clients and for ADHD) -Prego C -Lact L2

paliperidone (Invega, Invega Sustenna [monthly], Invega Trinza [3 month])

-Tablet; 3-12mg/Day -Monthly injection; 39-234mg -3 month injection; 273mg, 410mg, 546mg, or 819mg -SE: orthostatic hypotension, hyperprolactinemia, GI upset, dizziness, headache -ER risperidone -SGA

baseline labs prior to lithium initiatin

-Thyroid -Serum creatinine -BUN -Prego -ECG for pts over 50yo

standardized rating scales for anxiety disorders

-Zungs self rating anxiety scale -Hamilton rating scale for anxiety -yale-brown obsessive compulsive scale

what is a confounder

-a factor that distorts the true relationship of the study variable of interest by virtue of also being related to the outcome of interest -often unequally distributed among the groups being compared -not associated with increased validity in a clinical research trial

polytherapy in acute withdrawal

-a newer approach that matches drugs required for safe and effective withdrawal with neurotransmitter deficits created by substance use -SSRIs -opioid antagonists nalmefene hydrochloride (Revex), naltrexone (revia), or naltrexone for ER injectable suspension [vivitrol] -N-methyl-D-aspartate (NMDA) agonists

ADHD

-a persistent pattern of inattention or hyperactivity, impulsivity, or both that interferes with functioning and development -inattention, 6+ of the following (fails to give attention to details, difficulty sustaining attention, does not listen when spoken to, does not follow through on instructions, disorganized, avoids or dislikes tasks requiring sustained mental effort, loses things, distracted, forgetful) -hyperactive and impulsive 6+ of the following (fidgets, leaves seat, runs or climbs, unable to engage in quiet activities, on the go, talks excessively, blurts out information, difficulty waiting turn, interrupts others) -several symptoms present before 12yo

conduct disorder

-a repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated - the presence of at least 3 of the following criteria must be present in the past 12 months , with 1 in the past 6 months (aggression toward people or animals, destruction of property, deceit or theft, serious violation of rules) -child onset before age 10 or adolescent onset after age 10

factor analysis

-a statistical technique that is leveraged to explain the variance of a large number of variables by utilizing a smaller number of unobserved factors - example is a general intelligence factor

ADHD polygenic neurobiological deficits

-abnormalities of pronto-subcortical pathways in frontal cortex and basal ganglia -abnormalities of reticular activating system -dopamine dysfunciton -norepinephrine dysfunction

alcohol abuse dx screening

-administered by asking 4 questions -each positive answer = 1 point -negative answers = 0 points -the more points the greater the likelihood of alcohol abuse dx -clients scoring 2+ are at mild-mod risk for alcohol dependency and the score is considered clinically significant -clients scoring 3 or 4 are considered high risk for alcohol dependency

Creutzfeldt-Jakob disease

-adult pt -myoclonic jerks -rapid progress towards dementia -akinetic mutism with specific EEG findings -cerebral atrophy on head CT is suggestive of late disease

Pick's disease

-aka frontotemporal dementia -neuronal loss, gloss, Pick's bodies present -more common in men -personality and bx changes in early stage -cognitive changes in later stages -Kluver-Bucy syndrome: hyper sexuality, hypoerorality, and placidity

The federal emergency medical treatment and Labor Act (EMTALA)

-aka patient anti-dumping law -requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to the emergency room for attention to an emergency medical condition

self-efficacy and social learning theory

-albert bandura -behavior is the result of cognitive and environmental factors

disulfiram (antabuse) for treating caving and maintaining sobriety

-aldehyde dehydrogenase inhibitor averson therapy

Medicare Part C

-allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan -can include health maintenance organizations, preferred provider organizations, or private fee-for-service plans

anxiety meds in children

-alpha agonists often used -clonidine (catapres) 0.003-0.01mg/kg/day off label -guanfacine (tenex) 0.015-0.05mg/kg/day off label

Mirtazapine (Remeron)

-alpha2/5HT2 antagonist -tablet -15-45/day -sedation, weight gain, increased cholesterol -inverse relationship between dosage and sedation -Prego C -Lactation L3

NMS symptoms known to occur first

-altered sensorium -hyperthermia -hyperreflexia

ODD

-an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least 6 months with at least 4 of the associated symptoms (loses temper, touchy or easily annoyed, angry or resentful, argues with authority, actively defies or refuses to comply with request or rules from authority figures, blames others, deliberately annoys others, spiteful or vindictive)

DSM MDD diagnostic criteria

-anhedonia or depressed mood or both -depressed mood most of the day, nearly every day, as indicated by subjective reports or observations of others (irritability in kids) -marked anhedonia in all or almost all ADLs -at least 3 or more significant symptoms present during the same 2 week period that represent a change in previous functioning -weight loss/gain of more than 5% of body weight -hypersomnia or insomnia nearly every day -psychomotor agitation or retardation -fatigue or loss of energy -self-deprecating comments or thoughts -feelings of worthlessness or excessive or inappropriate guilt nearly every day -decreased concentration and memory -symptoms that begin within 2 months of significant loss and do not persist beyond 2 months is bereavement not MDD

glycine

-another inhibitory neurotransmitter -works with GABA

TCA side effects

-anticholinergic -antiadrenergic -antihistaminergic -EKG changes and cardiac dyshrythmias possible -unsafe in many co-occurring disorder such as cardiac disease -significant discontinuation syndrome

clinical management of craving

-anticraving meds such as naltrexone (revia), acamprosate (campral), ondansetron (zofran), or buprenorphine (buprenex)

norepinephrine symptoms of excess

-anxiety, hyper alertness, increase startle, paranoia, decreased appetite -anxiety

cluster C personalities

-anxious -avoidant personality disorder -dependent personality disorder -obsessive-compulsive personality disorder

schizophrenia presence of neurological nonlocalizing soft signs

-astereogonosis -twitches, tics, rapid eye blinking -dysdiadochokinesia - impaired fine motor movement -left-right confusion -mirroring

negative rewards in substance abuse disorder

-aversive, such as increased anxiety and dysphoria -mediated by GABA pathways

sleep hygiene

-avoid computer and other electronic devices for 1 hour before bedtime -never lie in bed for more than 15 minutes if not able to sleep -avoid late-in--the-day exercise intensive

avoidant personality disorder

-avoidance of activities involving significant interpersonal contact -fear of criticism, disapproval, or rejection -unwillingness to be involved with people unless sure of being liked -restraint in intimate relationships for fear of being shamed -preoccupation with being criticized or rejected in social settings -view of self as socially inept, personally unappealing, or inferior -unusual reluctance to take personal risks or engage in new activities

conduct disorder nonpharm management

-behavior therapy is mainstay -individual therpay -family therapy

Tardive Dyskinesia tx

-best tx strategy is prevention through careful monitoring -if present, tx by reducing current dose or change client to atypical agent

clonidine role in opioid withdrawal

-binds alpha 2 autoreceptors -decreases locus coeruleus cell firing -reduces noradrenergic release

binge eating disorder

-binging occurs at least 2 days weekly for 6 months

monoamines

-biogenic amines -dopamine -norepinephrine -epinephrine -serotonin

carbamazepine in BP

-black box warning agranulocytosis and aplastic anemia

valproic acid/divalproex sodium in BP

-black box warning for hepatotoxicity and pancreatitis

Lamotrigine in BP

-black box warning for serious rash

alcohol dependence and abuse produce characteristic lab findings

-blood alcohol level >100mg/dL outpatient; >150mg/dL anytime with symptoms; >300mg/dL any time -aspartate transaminase (AST)/ alanine transaminase (ALT) ration >2.0 -elevated glutamyltransferase, mean corpuscular volume, prothrombin time, uric acid, total cholesterol, and triglycerides -decreased magnesium, calcium, potassium, BUN, hemoglobin, hematocrit, platelet count, and albumin

bulimia nervosa

-both binge eating and inappropriate compensatory behaviors occur at least twice weekly for 3 months

anorexia nervosa physical exam findings

-bradycardia -hypotension -ECG changes (inversion of t-waves, ST segment depression, prolonged QT interval) -peripheral edema -hypertrophy of salivary glands -russells sign

modafinil (provigil)

-can effectively treat hypersolomnence and fatigue in depression (off label) -can rarely cause Steven Johnson's syndrome -can cause rashes -FDA for excessive sleepiness associated with narcolepsy, OSA, and shift work sleep disorder

Loxapine (Loxitane)

-capsule, liquid -20-250mg/day -SE: high- EPSE -SE: moderate- sedation, hypotension -SE: low- anticholinergic -FGA

epinephrine

-catecholamine -produced by the adrenal glands -referred to as the adrenergic system

norepinephrine

-catecholamine -produced in the locus ceruleus of the pons -precursor is tyrosine -major neurotransmitter implicated in mood, anxiety, and concentration disorders -Alpha 1 and 2 receptors

dopamine

-catecholamine -produced in the substantia nigra and ventral tegmental area -precursor is tyrosine -removed from synaptic cleft by monoamine oxidase (MAO) enzyme action -D1-like and D2-like receptors

Lewy body disease

-caused by Lewy inclusion bodies in the cortex -presents with recurrent visual hallucinations -parkinson features (bradykinesia, cogwheel rigidity, tremor) -adversely react to antipsychotics

diagnostic criteria for substance withdrawal

-cessation or reduction in substance use that has been heavy or prolonged -2+ of the following symptoms within several hours or days of reduction or cessation of the substance (hand tremor, insomnia, autonomic hyperactivity [sweating, increased HR, increased BP], N/V, hallucinations or illusions, psychomotor agitation, anxiety, seizures)

abstraction in children

-children ages 12 and younger are not expected to have abstractive thought abilities -young children have concrete thinking

Rivastigmine tartrate (Exelon) in dementia

-cholinesterase inhibitor -1.5-6mg BID -increase gradually to avoid nausea -indicated for mild-mod alzheimers disease and Parkinson's disease dementia -transdermal: 4.5, 9.5, 13.3mg/24 hour patch -retitrate if lapse in tx occurs

Donepezil (Aricept) in dementia

-cholinesterase inhibitor -5-10mg/day -approved for mild, mod, and severe Alzheimers dx -SE: common- N/V, diarrhea, appetite and weight loss, abnormal dreams, insomnia, dizziness

sjorgren's syndrome

-chronic autoimmune disorder -decreased function of salivary and lacrimal glands -dry eyes, dry mouth, enlargement of parotid gland -test for a positive anti-nuclear antibody test (ANA test) 70% -can also test ESR, CBC, rheumatoid factor, and anti-alpha fodrin antibody -diagnosis by salivary gland biopsy

cyclothymic disorder

-chronic, fluctuating mood dx with symptoms similar but less severe than BP -numerous periods of hypomanic and dysthymic symptoms -often regarded by others as temperamental, moody, unpredictable, inconsistent, and unreliable -no psychotic episodes

Persistent Depressive Disorder (Dysthymia)

-chronically depressed mood that occurs for most of the day, more days than not, for at least 2 years -prominent presence of low self esteem, self criticism, and a perception of general incompetence compared to others -less common symptoms: alteration in appetite and sleep-rest patterns

dementia due to HIV disease

-classified as subcortical dementia -parenchymal abnormalities visualized on MRI scan -HIV associated neurocognitive dx or HIV encephalopathy less severe forms -HIV can cause many psych symptoms -manifests by progressive cog decline, motor abnormalities, and bx abnormalities -co-occurs with OCD, PTSD, GAD, depression, and mania -poor prognosis- death w/in 6 months -psych symptoms usually occur in late-stage infection

schizophreniform dx

-closely resembles schizophrenia -2 differences -Total duration of illness at least 1 month but less than 6 months including prodrome, active illness period, and residual symptom phase -does not require impaired social or occupational functioning for diagnosis, although may be present

hepatic encephalopathy

-confusion, alerted LOC, and coma as result of liver failure -severity grades with West Haven criteria -focal neurological signs are less common in males

Freud's Id

-contains primary drives or instincts -drives are largely unconscious -operates on the pleasure principle -"I want"

TBI diagnostic and lab findings

-conventional structural neuroimaging studies are typically normal in mild TBI

Serotonin syndrome tx

-d/c offending agents -supportive tx of symptoms mild symptoms such as restlessness may d/c with removal of agent, close monitoring and judicious use of benzos -severe symptoms constitute a medical emergency necessitating hospitalization and tx such as cyproheptadine, anticonvulsants, and autonomic support

neurobiological factors of eating disorders

-decreased hypothalamic norepinephrine activation -dysfunction of lateral hypothalamus -decreased serotonin

neurotransmitter dysfunction in personality disorders

-decreased levels of serotonin -elevated levels of norepinephrine -dysregulaiton of dopamine receptors

HIPPA provides federal legislation protects employed Americans by

-decreasing the chance of losing existing health insurance coverage -facilitating change from one health plan to another -facilitating purchase of individual or family insurance coverage if coverage is lost from an employers plan or no other health insurance coverage is available

anxiety neurobiological theory

-deficits in limbic system, midline brainstem area, sections of cortex -predispose to abnormal stress response, with hyperactivity of autonomic nervous system -problems with HPA axis -low levels of GABA

Freud's defense mechanisms

-denial -projection -regression -repression -reaction formation -rationalization -undoing -intellectualization -suppression -sublimation -altruism

2 schizoaffective dx subtypes

-depressive -bipolar

dementia lifespan considerations in children

-diagnosis not applicable until ages 4-6yo when cognition can be fully assessed -dementia in children usually presents as deterioration in functioning

dependent personality disorder

-difficulty making everyday decisions without excessive advise -needing others to assume responsibility for most areas of life -difficulty expressing disagreement -difficulty initiating projects by himself or herself -going to excessive lengths to obtain nurturing and support from others -urgent seeking of another relationship if a close relationship ends -unrealistic preoccupation with fears of being left alone

panic disorder diagnostic criteria

-discrete episode in which client experiences 4 or more symptoms having a sudden onset and peaking within 10 minutes of onset -after 1st attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant bx change related to attack -with high somatic sensations, clients are often sensitive to new somatic experiences or perceptions -often intolerant of or concerned with common side effects of medication tx

aversion treatment pharm

-disulfiram (Antabuse) -do not administer until person has been alcohol free for at least 12 hours -can elevate liver function tests, so monitor -may potentially induce mania in people with BP disorder

Benzos for sleep disorder

-do not use in OSA -flurazepam (Dalmane) -temazepam (restoril) -triazolam (halcyon)

nonbenzo hypnotics in sleep disorder

-do not use with OSA -zaleplon (sonata) -zolpidem (Ambien, Ambien CR) -Eszopiclone (Lunesta) -Rozerem -Suvorexant (Belsomra)

nigrostraiatal pathway

-dopamine has a reciprocal relationship with acetylcholine -when serotonin is blocked by the SDA, dopamine increases, therefore ACh decreased, which causes decrased EPSE (caused by increased ACh)

Tuberonfundibular pathway

-dopamine inhibits prolactin -the blockade of dopamine by SDAs cause prolactin to increase, causing galactorrhea and gynecomastia -hyperprolactinemia is associated with antipsychotics may cause sexual problems, galactorrhea, amenorrhea, gynecomastia, and bone demineralization in postmenopausal women not on estrogen

cluster B personalities

-dramatic, affective instability -antisocial personality disorder -borderline personality disorder -histrionic personality disorder -narcissistic personality disorder

norepinephrine symptoms of deficit

-dullness, low energy, depressive affect -depression

insomnia etiology

-dysfunction in sleep-wake circuits of the brainstem

MDD object loss theory

-early psychological developmental issues lay the foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences traumatic separation from significant objects of attachment (usually a maternal object)

psychodynamic theory of personality disorders

-early separations problems -object relations theory -during development, child must accomplish 2 tasks: separation and individuation -failure results in disorders

assess for abnormal labs for NMS

-elevated CPK (creatinine phosphokinase) -elevated WBCs -elevated LFTs

what are postulated physiological disturbances that may explain some symptoms of panic

-elevated catecholamines in the CNS -abnormality of the locus coeruleus -carbon dioxide hypersensitivity -impairment of lactate metabolism

Schizophrenia structural neurobiology

-enlarged ventricles -smaller frontal and temporal lobes -reduced symmetry in temporal, frontal, and occipital lobes -cortical atrophy -decreased cerebral blood flow -hippocampal and amygdala, thalamus reduction -widened cortical sulci -diffuse decrease in volume of white and gray matter

The IOM Report: The Future of Nursing: Leading Change, Advancing Health was released in 2010. The ANA listed the following as goals of nurse advocacy consistent with this report.

-ensure that NPs are equal partners with physicians and other health care professionals in redesigning healthcare -collect and use data to inform workforce planning decisions and policy making decisions that affect creation of an affective healthcare workforce -reduce regulatory barriers, to enable RNs to practice to the full extent of their training and education -support higher education for nurses, including proposed requirements for RNs to attain a baccalaureate degree within 10 years of licensure

fetal alcohol syndrome characteristics

-epicanthal skin folds -low nasal bridge -short nose -indistinct philtrum -small head circumference -small eye openings -wide set eyes -thin upper lip

antipsychotic sexual side effect

-erectile dysfunction and impaired vaginal lubrication secondary to anticholinergic as well as alpha 2 receptor effects -impaired arousal and orgasm through dopamine blocking

TCA/MAOI sexual side effects

-erectile dysfunction and impaired vaginal lubrication secondary to anticholinergic effects

delusional dx subtypes

-erotomanic (leads to obsessive bx such as surveillance or stalking) -grandiose -jealous (usually seen in men) -persecutory -somatic -mixed

authorization bils

-establish laws or programs -can recommend dollar amounts in some cases -do not allocate funds or guarantee funding for programs

schizophrenia neurochemical alterations

-excess dopamine in mesolimbic pathway -decreased dopamine in mesocortical pathway -excess glutamate -decreased gama-aminobytyric acid (GABA) -decreased serotonin

GAD

-excessive worry, apprehension, anxiety about events or activities occurring more days than not for at least 6 months -symptoms worsen as life events stress the person

antisocial personality disorder

-failure to conform to social norms -repeated acts that are grounds for arrest -deceitfulness, lying, and use of aliases for profit or pleasure -impulsivity and failure of future planning -reckless disregard for the welfare of others -consistent irresponsibility -lack of remorse, indifference to the feelings of others

Creutzfeldt-Jakob disease

-fatal and rapidly progressive dx -occurs mainly in middle age or older -initially manifests with fatigue, flulike symptoms, and cog impairment -later manifests with aphasia, apraxia, emotional lability, depression, mania, psychosis, marked personality changes and dementia -death within 6 months

insomnia risk factors

-female gender -advancing age

for panic disorder, consider general medical disorder if

-first episode panic attack symptoms occur after 45yo -panic symptoms are atypical such as: vertigo, loss of consciousness, incontinence, headache, slurred speech, amnesic pattern after attacks

TBI nonpharm management

-follow up for 1 year after anyone with TBI makes suicide attempt -treat vestibular dysfunction with PT to reduce dizziness -treat traumatic vision syndrome with OT, scanning and accommodation difficulties lead to headaches, irritability, and fatigue -treat memory impairment with OT to teach memory improvement skills

borderline personality disorde

-frantic efforts to avoid real or imagined abandonment -pattern of unstable, intense interpersonal relationships -identity disturbances -impulsivity, often with self-damaging behavior -recurrent suicidal behavior -chronic feelings of emptiness -inappropriate, intensified affective anger responses -transient psychotic symptoms of paranoia and dissociation

anxiety psychodynamic theory

-freud -anxiety initially occurs in response to stimulation of birth and need of infant to adapt to changed environment -subsequent anxiety is from intrapsychic conflict -process of unconscious repression of sexual drive is at the core -conflict exists between instinctual needs of the id and the superego

lithium in BP

-gold standard for manic episodes -antisucidial effects -action unknown -rapid cycling rarely responds to monotherapy

narcissistic personality disorder

-grandiose sense of self-importance -preoccupation with fantasies of power, success, brilliance, and beauty -belief of self-importance and being special and unique -excessive admiration required -unreasonable expectations or sense of entitlement -interpersonally exploitative -empathy lacking -envy of others and belief that others envy them -arrogant and haughty behaviors

hight potentcy FGAs

-greater risk of EPSE -less risk of sedation and anticholinergic symptoms

low potency FGAs

-greater risk of sedation and anticholinergic side effects -less risk of EPSE

obstructive sleep apnea

-headache upon awakening is common -abnormally small nasopharynx, tonsillar tissue in children, obesity

anxiety interpersonal theory

-henry stack Sullivan -humans are goal directed toward attainment of satisfaction and security needs that are normally met in interpersonal interactions -anxiety is when needs are unmet -interpersonal conflict

schizophrenia brain abnormalities noted in functional studies

-hypofrontality -decreased cerebral blood flow and metabolism -diffuse hypometabolic action in cortical-subcortical circuitry

bulimia nervosa lab changes

-hypotension -bradycardia -hypokalemia -hyponatremia -hypochloremia -hypomagnesemia -metabolic acidosis or alkalosis -elevated serum amylase

schizotypal personality disorder

-ideas of reference -odd beliefs -magical thinking -unusual perceptual experiences -paranoid ideation -inappropriate or constricted affect -bx overtly odd, eccentric, or peculiar -few or no close friends -excessive social anxiety

what is true regarding standards of practice for nurse practitioners

-identification of expected outcomes is a standard of care for PMHNPs -the standard of practice for PMHNPs includes identification of consumer resources to assist consumers in appropriate use of mental health services

ASD prevalence

-imbalances of glutamate, serotonin, and GABA are thought to be implicated in causation -brain imaging studies of children revealed microscopic and macroscopic abnormalities of the amygdala, hippocampus, and cerabellum -decreased numbers of Purkinje cells in the cerebellum are thought to play a role in the development

atypical antipsychotic MOA

-in addition to dopamine blockade found in 1st gens, 2nd gen capitalize on the interplay between dopamine and serotonin -serotonin binds to 5HT2a heteroreceptors on dopamine neurons, thus further shutting off release of dopamine -dopamine release in the nigrostriatal, tuberoinfundibular, and mesocortical pathways is enhanced

ADHD subtypes

-inattentive type -hyperactive type -combined type

SGA black box warning

-increase in mortality in older adults with dementia-related psychosis

patient centered medical homes

-initiated by the centers of medicare and medicaid services in response to a mandate for provision of targeted, accessible, continuous, and family-centered care to medicare beneficiaries with chronic diseases that require regular monitoring and care

temazepam (Resotril) for sleep dx

-intermediate action agent

serotonin

-known as an indole -produced in the raphe nuclei of the brainstem -precursor is tryptophan -major neurotransmitter implicated in mood and anxiety disorders -5HT1a, 5HT1d, 5HT2, 5HT2a, 5HT3, 5HT4 receptors

children and adolescent sleep patterns

-large amounts of slow-wave sleep

ataques de nervios

-latino cultural syndrome -provoked by disruptions in family bonds -trembling, crying, screaming -in presence of others -relief after

negative schizophrenia symptoms

-less responsive to antipsychotics -better response to atypicals -caused by decrease dopamine in mesocortical pathway

flurazepam (Dalmane) for sleep disorders

-long lasting -may cause excessive drowsiness -avoid in older adults

EPSE risk factors

-long term neuroleptic tx -older age -female presence of mood or cognitive dx

differences in alcohol metabolism between men and women

-lower levels of alcohol dehydrogenase are present in the gastric mucosae of women compared to men -there is a lower total adjusted body water content in women's bodies compared to men

theory of cultural care

-madeline Leininger -regardless of the culture, care is the unifying focus and the essence of nursing

specific criteria needed to identify substance use as abuse

-maladaptive pattern of use occurring for at least a 12 month period of sustained use -must be accompanied by repeated failure to fulfill major role obligations -must be accompanied by use in situation that presents as physically hazardous, such as drinking and driving -abuse continues despite multiple problems related to substance use patterns, such as legal, interpersonal, or social problems

TBI prevention in military personnel

-mandatory post-deployment screening for all vets returning from combat

cholinesterase inhibitors in dementia

-may be initiated for mild to mod Alzheimers dx -can lead to modest clinical improvement in some clients, with studies showing 2-3 point improvement in MSE testing -tx only symptoms, slow loss of function, and may improve agitated bx -do not prevent pathological progression of dx -not effective in severe, end-stage dx -should stop if SE, usually NV, develop -commonly used (Donepezil [Ariciept] and Rivastigmine tartrate [Exelon])

delusional disorder prevalence and demographics

-mean onset 40yo -men more likely to have paranoid delusions -women more likely to have delusions of erotomania

Rozerem

-melatonin receptor agonist

four dopaminergic pathways

-mesocortical -mesolimbic -nigrostriatal -tuberoinfundibular

antiretrovirals and protease inhibitors can interact with psych meds

-metabolized by P450 system or are CYP3A4 inhibitors

TBI cognitive disorders pharm recommendations

-methylphenidate (increase attention, processing speech, general cognitive function, learning, and memory) -dextroamphetamine (increase attention, processing speed) -bromocriptine (off label, possibly helpful in increasing executive function) -amantadine (off label, possibly helpful in increasing general cognitive function, attention, concentration)

benzo intoxication symptoms

-mild: agitation, confusion, drowsiness, blurred vision, dizziness -severe: resp depression, unresponsiveness, coma

Dopamine symptoms of excess

-mild: improved creativity, improved ability for abstract thinking, improved executive functioning, improved spatiality -severe: disorganized thinking, loose association, tics, stereotypic bx -schizophrenia, psychosis

ADHD physical exam findings

-minor physical anomalies at higher rates in people with ADHD than in the general population (hypertelorism, highly arched palate, low-set ears)

lithium-induced hypothyroidism

-more common in women -occurs in 5-35% pts treated with lithium -not a contra to lithium treatment -associated with higher rates of depression and rapid cycling

schizophrenia older adult considerations

-more women than men with rare late onset -although prodromal isolation, more often married -prognosis usually better, more responsive to meds d/t dominance of positive symptom cluster

mild TBI lifespan consideration

-most achieve full recovery within 3 months -if residual symptoms continue, 80-85% will learn within 6 months

delirium children considerations

-most common in febrile states -especially common with anticholinergic meds

dementia of Alzheimer's type (DAT)

-most common type -gradual onset and progressive decline without focal neurological deficits -hallmark amyloid deposits and neurofibrillary tangles

insomnia in children

-most commonly related to stress -often have been poor sleepers since birth -pharm tx not recommended for most children

CAGE screening test

-most commonly used screening tool for alcohol abuse -C- have you ever felt the need to Cut down on 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 the first think in the morning to steady your nerves or get rid of a hangover- Eye-opener

dementia memory impairment- immediate and intermediate

-most prominent feature of dx -usually earliest symptom -produces multiple deficits in daily functioning (unable to learn new info, forgets past info, loses valuables, forgets daily activities such as eating and dressing, becomes easily lost, has other cog deficits such as impaired executive functioning)

what are symptoms of macrocytic anemia due to b12 deficiency

-multi-segmented neutrophils -tingling and numbness in the feet -glossitis

benzo pharm tx of acute withdrawal

-mutliple daily doses of Benzos used according to a fixed schedule and gradually tapered down over several days (lorazepam [ativan], chlordiazepoxide [Librium], diazepam [valium], oxazepam [serax])

10 common alcohol withdrawal symptoms

-n/v -tremors -proxysmal sweats -anxiety -agitaiton -tactile disturbances -auditory disturbances -visual disturbances -headaches -altered sensorium

schizoid personality disorder

-neither desires no enjoys relationships -choses solitary activities -shows little to no interest in sexual activity with another person -derives no pleasure in social activities -lacks close friends or social supports -is indifferent of opinions of others -appears cold and detached -exhibits affective flattening

TBI pharm management

-no specific meds -tx-related symptoms -increased sensitivity to meds -low seizure threshold -start low and go slow

neuropeptides

-nonopioid type (substance P, somatostatin) -opioid type (endorphins, enkephalines, dynorphins) -modulate pain -Decreased amount of neuropeptides is thought to cause substance abuse - opioid type receptors: mu, kappa, epsilon, delta, sigma

rett syndorme hx assessment

-normal psychomotor development through the 1st 5 months after birth

anorexia nervosa lab changes

-normochromic, normocytic anemia -leukopenia -neutropenia -anemia -thrombocytopenia -hypokalemia -hypomagnesemia -hypoglycemia -decreased LH and FSH

dementia instruments for assessing level of impairment

-not in public domain (mini-mental state examination MMSE) -in public domain (Montreal cognitive assessment [MoCA], mini-cog, St Louis University Mental Status Examination [SLUMS])

intellectual disability physical exam findings

-oblique eye folds -small, flattened skull -large tongue -broad hands with stumpy fingers -single transverse palm crease -high check bones -brushfield spots on iris -cryptorchidism -abnormal finger and toe prints -congenital cardiac defects -early dementia -hypothyroidism

rapid cycling

-occurrence of 4 or more mood episodes during the previous 12 months -mood episodes are either major depressive or manic -other than occurring more frequently, mood episodes are same as nonrapid-cycling episodes -20% of people -most are women -identification is important -antidepressants may accelerate cycling -poorer prognosis

insomnia

-occurs at least 3 nights per week -present for at least 1 month (episodic insomnia disorder) and may persist for greater than 3 months (persistent insomnia disorder)

hyper somnolence disorder

-occurs at least 3 times per week and lasts for several months

Cluster A personalities

-odd, unusual, eccentric, asocial -paranoid personality disorder -schizoid personality disorder -schizotypal personality disorder

schizophrenia demographics men

-onset 18-25 yo -tend to have more negative side effects -tend to have poorer prognosis, more hospitalizations, and less responsiveness to meds

schizophrenia demographics in women

-onset 25-35 years -usually less premorbid dysfunction than men -usually experience more dysphoria than men -tend to have paranoid delusions and more hallucinations than men

conduct disorder demographics

-onset is earlier for boys 10-12 years than girls 16 years

intellectual disability

-onset must occur before 18yo -based on adaptive functioning NOT IQ scores

ASD incidence and demographics

-onset on symptoms before age 3 -about 10% of people with ASD also have a genetic or chromosomal conduction such as downs or fragile X

Suvorexant (Belsomra)

-orexin antagonist -suppresses wakefulness -must consider long half-life

phases of the nurse-client relationship

-orientation -working phase (identification, exploration) -termination phase (resolution)

Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study

-patients 18-65 -diagnosed with schizophrenia -assigned to olanzapine, perphenazine, quetiapine, risperidone, or (later) ziprasidone -primary outcome measure was all-cause treatment discontinuation -baseline data revealed that the rate of metabolic disturbance was higher than expected in recruited participants

williams syndrome

-patients often have elfin faces and starburst irises -common comorbidities are anxiety and depression -patients typically have supravalvular aortic stenosis, renal artery stenosis, and HTN -a genetic deletion occurs at chromosome 7

Bipolar diagnostic criteria

-period of abnormally or persistent elevated, expansive, or irritable mood lasting for at least 1 week -mood episode has rapid development and escalation of symptoms over a few days -often precipitated by significant environmental stressor -mood disturbance may result in brief psychotic symptoms -manic episodes last days to several months -briefer duration and ending more abruptly tan major depressive episodes -60% of people, a major depressive episode immediately precedes or follows a manic episode -persistent symptoms of mania -recurrent shifts on polarity -expansive or elevated mood symptoms

ASD

-persistent deficits in social communication and social interaction across multiple settings associated with deficits -restrictive repetitive behavior

Acute intermittent porphyria

-phenothiazines are safe to treat psychosis -onset is between 20 and 50 years -classic triad: episodic/acute/colicky abdominal pain, motor polyneuropathy, psychosis

dissociative disorders causes

-physical: seizures, migraines, psychedelic drugs, alcohol -psych: severe anxiety and traumatic stress

schizophrenia clinical outcome mesure standardized rating scales

-positive and negative syndrome scale (PANNS) -brief psychiatric rating scale (BPRS) -scale for assessment of positive symptoms (SAPS) -scale for assessment of negative symptoms (SANS)

older adult schizophrenia risk factors

-postmenopausal states -presence of human leukocyte antigen -positive family hx

Benzos

-potentiate effect of GABA -use is associated with Alzheimers -longer half lives are more useful for continuous, moderate to severe anxiety or as bridge meds while waiting for efficacy of SSRI (klonopin, valium) -shorter half lives require more frequent dosing and have more severe withdrawal and rebound anxiety (xanex, Ativan)

the Maudsley method

-powerful integration of all schools into a single, manualized, empirically supported method. -treats anorexia nervosa

older adult schizophrenia symptoms

-predominance of positive symptoms -high levels of persecutory delusions and hallucinations -lower levels of disorganized bx -preservation of social and occupational interest -fewer negative symptoms

obsessvie-compuslive personality disorder

-preoccupation with details, rules, order, and organization -perfectionism that interferes with task completion -excessive devotion to work and productivity -overly conscientious, scrupulous, and inflexible on issues of morality -inability to discard worn-out or worthless objects -reluctance to delegate tasks or work with others -adoption of a miserly spending style toward self and others -rigidity and stubbornness

Medicare part D

-prescription drug benefits delivered through private plans with medicare

delusional dx

-presence of 1+ nonbizarre delusions lasting for at least 1 month -psychosocial functioning and daily bx not at all impaired except as they surround content of delusion -seldom any other symptoms; in rare cases may have hallucinations or mood disturbances

agoraphobia diagnostic criteria

-presence of anxiety related to fear of developing panic-like symptoms -never met criteria for panic disorder -avoidant bx as a result of anxiety

delusional dx hs assess for the following

-presence of delusion (well organized and potentially believable) -any usual bx is explainable if content of delusion understood

OCD diagnostic crtieria

-presence of either obsessions or compulsions -person recognizing that the obsession or compulsion is excessive or unreasonable -causing marked distress, time consuming, or interferes with normal daily activity

N-methyl D-aspartate glutamate receptor agonists in dementia tx

-prevent overexcitation of glutamate receptors and stabilize the neurodegenerative process -Memantine (Namenda)

rett syndrome indicence and demographics

-primarily in girls -usually associated with intellectual disability

kindling

-process of neuronal membrane threshold sensitivity dysfunction -long-lasting, epileptogenic changes induced by daily subthreshold brain stimulation -brain becomes overly sensitive to electrical stimuli -neuronal misfiring occurs -process becomes automatic; neuronal firing occurs even without stimuli

appropriation bills

-provide spending authority for a single fiscal year (October 1-september 30) -usually originate in house of reps

the consolidated omnibus budget reconciliation act COBRA

-provides for the continuation of preexisting group health insurance (from the employer) for persons who lose coverage, whether between jobs, if they quite a job, or are fired. -coverage continuation is extended for a fixed period of time

freud's ego

-rational mind, logical and abstract thinking -"I think, I evaluate"

The lead principle of plans for transformation of mental health care in paradigms such as SAMSA, NAMI, the IOM, and the President's New Freedom Commission is...

-recovery -emphasizes the reawakening of hope, engagement in life, and empowerment over illness

structural abnormalities of personality disorders

-reduced gray-matter volume in prefrontal cortex -limbic system deregulation

confidence interval

-reflect a range of values within which one can be confident that the true value is situated -wider confidence intervals are usually based on smaller sample sizes and fewer number outcome events and indicate less precision in estimate of effect

positive schizophrenia symptoms

-respond well to antipsychotics -excess or distortions of normal brain functioning -caused by increased dopamine in mesolimbic pathway

bulimia nervosa physical exam findings

-russells sign -hypertrophy of salivary glands -rectal prolapse

ASD screening

-screened for developmental delays at well-child visit -modified checklist for autism in toddlers M-CHAT -autism diagnostic observation schedule-generic ADOS-G -ages and stages questionnaires ASQ

Vascular dementia (VD)

-second most common type -formally called multi-infarct dementia -primarily caused by CVD and characterized by step-type declines -most common in men with preexisting high blood pressure and cardiovascular risk factors -Hallmarks carotid bruits, fundoscoptic abnormalities, and enlarged cardiac chambers

contras to calcium channel blocker use

-second or third degree heart block -bradycardia -congestive heart failure

ADHD prevention

-secondary prevention is important in young clients

NMS tx

-seek immediate medical care -d/c antipsychotic meds -administration of Dantrolene (Dantrium) or bromocriptine (Parlodel) for antipsychotic induced dopamine receptor blockade -Acetaminophen (antipyretic) and cooling blanket for hyperthermia -IV hydration -Benzo for muscular rigidity (catatonic symptoms)

Rett syndrome associated features

-seizures -stereotypic hand movements

Freud's superego

-sense of conscience or right vs wrong -develops around age 6 -"I should or ought"

Triazolam (Halcion) for sleep dx

-short acting agent -little to no excess sedation -common SE: impaired memory, efficacy decreases over time, should not be used long term

Zolpidem (Ambien, Ambien CR)

-short half life drugs -may affect person the next morning -must allow for 8 hours before planned awakening -give on empty stomach

NREM stages 3 and 4

-slow-wave sleep period -deepest level of sleep -20-25% of total sleep cycle

NREM stage 2

-specific EEG waveforms -50% total sleep cycle

sleep stages are organized and sequential during sleep period

-stages 3 and 4 tend to occur in first 1/3 to 1/2 of sleep period -REM occurs cyclically throughout the night, alternating with NREM on average every 80-100 minutes -REM increases in duration toward morning

carbamazepine autoinduction

-stimulates the transcriptional up regulation of genes involved in its own metabolism -autoinduction of CYP34A and 2B6 -usually complete 3-5 weeks after the initiation of a fixed dose when taken consistently

Huntington's Disease

-subcortical type of dementia -characterized by motor abnormalities (choreoathetoid movements) -psychomotor slowing and difficulty with complex tasks -memory, language, and insight usually intact until late stages -high incidence of depression and psychosis

Asenapine (Saphris)

-sublingual; 5-10mg BID -SE: akathisia, somnolence -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA

antiseizure meds in acute withdrawal

-such as carbamazepine (tegretol) and valproic acid (depakene) -sometimes used to decrease seizure potential

Medicare Part B

-supplemental medical insurance program -funded by general revenues and beneficiary premiums -helps to pay output, home health, and preventative services

ADHD into adulthood

-symptoms of inattention usually remain with a decrease in impulsive and hyperactive symptoms

schizoaffective dx hx assess for the following

-symptoms of schizophrenia (2 + of the following frequently present during a 1 month period: delusions, hallucinations, disorganized speech, grossly disorganized bx, presence of negative symptoms but usually less severe than in those with schizophrenia) -symptoms of 1+ mood dx (MDD, manic episode, mixed-mood episode) -presence of delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

Aripiprazole (Abilify)

-tablet 5-30mg/day -injection (Acute); 5.25-15mg IM -injection (monthly); 200-400mg -SE: headache, agitation, anxiety, insomnia, somnolence, akathisia, GI problems -partial agonist of D2 receptors -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA

Clorpromaizne (Thorazine)

-tablet, SR, liquid -50-2000mg/day -SE: high- sedation, hypotension -SE: moderate- EPSE, anticholinergic -allergic dermatitis -photosensitivity -ECG changes- QTc monitoring -FGA

Trifluoperazine (Stelazine)

-tablet, injection -5-80mg/day -SE- High- EPSE -SE- low- anticholinergic, sedation, hypotension -FGA

Molindone (Moban)

-tablet, liquid -50-225mg/day -SE: high- EPSE -SE: low- anticholinergic, hypotension -SE: very low- sedation -little or no weight gain -FGA

Thioridazine (Mellaril)

-tablet, liquid -50-800mg/day -SE: high- anticholinergic, sedation, hypotension, prolonged QT interval -SE: low- EPS -ECG changes, QTc monitoring -irreversible retinal pigmentation at doses >800mg/day -decreased libido -retrograde ejaculation -FGA

Mesoridazine (Serentil)

-tablet, liquid, injection -100-400mg/day -SE: high anticholinergic, sedation, hypotension -SE: low EPSE -ECG changes- QTc monitoring -FGA

Haloperidol (Haldol)

-tablet, liquid, injection -2-40mg/day -50-300mg IM Qmonth (deconate) -SE: very high- EPSE -SE: high- anticholinergic, sedation -SE: low-hypotension -In older adults, monitor for oculogyric crisis and pneumonia -FGA

Fluphenazine (Permitil, Prolixin)

-tablet, liquid, injection -2-40mg/day, 12.5-75mg/IM Q2 weeks (deconate) -SE: very high- EPSE -SE: low- anticholinergic, sedation, hypotension -FGA

Perphenazine (Trilafon)

-tablet, liquid, injection -8/64mg/day -SE: high- EPSE -SE: low- anticholinergic, sedation, hypotension --FGA

ziprasidone (Geodon)

-tablets; 40-200mg/day -Injectable 10-20mg acute tx -SE: common- hypotension, sedation, dizziness -SE: rare- prolongation of QTc interval, skin reaction, drug reaction with eosinophilia and systematic symptoms (DRESS) -Requires QTc monitoring -avoid coadministration with other drugs known to prolong QTc -take with food increases absorption twofold -use with caution when administering with clients at risk for hypokalemia, hypomagnesemia, after MI, or with DHF -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA

Rett syndrome

-the development of specific deficits following a period of normal functioning after birth

two drives for behavior in interpersonal theory

-the drive for satisfaction -the drive for security

a patient with medicare qualifies for hospice care if

-the pt has medicare part a -has a terminal diagnosis -2 physicians certify that the pt has less than 6 months to live if the illness runs its typical course

nonpharm treatment for ODD

-therapy is mainstay -evidence based treatment -child and parent problem-solving skills training -incredible years (group intervention) -parent-child interactional therapy (individual or family intervention) -adolescent transitions program (ATP; individual or family and group intervention)

lamictal dosing considerations

-titrate slowly: 25mg PO QD for 2 weeks, then 50mg PO QD for 2 weeks etc -concomitant use with divalproex may double lamotrigine level and should be factored into dosing -concomitant use with carbamazepine may increase metabolism and should be factored into dosing

Mini Mental Status Exam MMSE scoring

-total score 30 -25-30 questionable significant -20-25 mild impairment -10-20 moderate impairment -10 or lower severe impairment

NREM stage 1

-transitional stage from wakefulness to sleep -5% of normal sleep cycle

general health maintenance for alcohol dependance

-treat vitamin deficiencies such as thiamine, folic acid, and B-complex vitamins

Malan's therapy model

-triangle of conflict and triangle of persons theories -defense work -forming a portrait to resolve dynamic pathologic defenses

dementia related depression tx

-tx for 6-12 months then attempts to taper -depression may reoccur and need to be tx as a chronic condition -may have less depression as dementia progresses and they become less aware

Zalplon (Sonata) for sleep dx

-ultra short half life makes this particularly useful for initial or middle-phase insomnia

histrionic personality disorder

-uncomfortable in situations in which they are not center of attention -interactions with others characterized by inappropriate seductive or sexualized or provocative behavior, rapid shifting, and shallow emotional responses -consistent use of physical appearance to draw attention to self -speech excessively impressionistic and lacking in detail -suggestible and easily influenced -relationships considered more intimate than they are

glutamate

-universal excitatory neurotransmitter -major neurotransmitter involved in process of kindling (implicated in sz dx and bipolar dx) -imbalance implicated in mood dx and schizophrenia -AMPA and MNDA receptors

personality disorder lifespan considerations

-unusual for someone to be given a personality disorder diagnosis before ages 16-18 -an exception is antisocial personality disorder, which is often observable by onset of puberty, however, diagnosis of antisocial personality disorder is not made until age 18

antidepressants for sleep dx

-used for sedation properties -amitriptyline (Elavil), doxepin (Sinequan, Silenor); generally avoid in older adults -mirtazapine (Remeron) -Trazodone

adrenergic meds in acute withdrawal

-used to decrease blood pressure and pulse rate associated with withdrawal

clinical institute withdrawal assessment for alcohol (CIWAA)

-used to determine likelihood for withdrawal and delirium tremens (DTs), which usually occur within 24-72 hours after cessation of alcohol -10 symptoms -each symptom graded on 0-7 point scale with exception of orientation and sensorium which are graded on a 0-4 point scale -the higher the total score (max 67), the more likely the person will experience severe withdrawal and DTs -0-9 absence or very mild withdrawal -10-15 mild withdrawal -16-20 moderate withdrawal -21-67 severe withdrawal and possible DTs

typical antipsychotics MOA

-useful for treating positive symptoms by blocking dopamine in mesolimbic pathway -can make negative symptoms worse by blocking dopamine in mesocortical pathway -therapeutic effect related primarily to D2 receptor blockade

schizophrenia presence of neurological localizing hard signs

-weakness -decreased reflexes

fluconzaole (diflucan) and warfarin interaction

-will cause elevated INR -fluconzaole is a potent CYP29 inhibitor -CYP29 Metabolizes warfarin

Freud's psychosexual stage of development oral stage age

0-18 months

sensorimotor age

0-2

Hamilton Depression Rating Scale Scoring

0-7 no depression 8-13 mild depression 14-18 moderate 19-22 severe 23+ very severe

CIWAA scale interpretation

0-9 absent or very mild 10-15 mild withdrawal 16-20 moderate withdrawal 21-67 severe withdrawal

Beck depression scale scoring

0-9 not depressed 10-18 mild-mod 19-29 mod-severe 30-63 severe

lithium therapeutic plasma level

0.8-1.2mEq/L for Eskalith 0.6-1.2mEq/L for Lithobid

Free thyroxine T4 normal levels

0.8-2.8ng/dL

pancreatitis occurrence with used with valproic acid

1 in 6000 patients

how long must symptoms be present in children and teens to be diagnosed with cyclothymic disorder

1 year

prevalence of antisocial personality disorder in females

1%

dissociative identity disorder prevalence

1% general population 3% psych inpatients

Recommended clozapine cut off points for discontinuation for granulocyte counts are

1,000-1,500

response to tx with lithium or anticonvulsant med is in

1-2 weeks

Erikson's developmental stage early childhood age

1-3 yo

what % of patients with neurologic problems have conversion symptoms

1-3%

PHQ9 scoring

1-4 minimal depression 5-9 mild 10-14 moderate 15-19 moderately severe 20-27 severe

illness anxiety disorder prevalence percentage

1-5%

persons with a first degree relative with MDD have what more likely hood of developing MDD than the general public

1.5-3x more likely

what percentage of children with divorced parents have psychological trauma

1/3

corprolalia is present in what % of tourettes

10%

prevalence of borderline personality disorder in psych outpt

10%

according to the APA practice guidelines on bipolar disorder, what is the completed suicide rates in patients with BP I

10-15%

what % of teens with recurrent MDD will develop bipolar I

10-15%

prevalence of paranoid personality disorder among psych inpatients

10-30%

SLUMS (st louis university mental status)

11 items orientation, short term memory, calculations, naming of animals, clock drawing, recognition of geometric figures 0-30 score 27-30 normal 21-26 mild 0-20 dementia no cost detects earlier cognitive deficit than MMSE more limited study of validity and reliability than MMSE

Piaget developmental stage formal operations age

12 years-adult

Sullivan's stage of interpersonal development early adolescence age

12-14 years

Erikson's developmental stage adolescence ages

12-20yo

Sullivan's stage of interpersonal development late adolescence age

14-21 years

what % of the population meets criteria for 1+ personality disorders

15%

due to agranulocytosis risk, a pts baseline ANC level must be greater than what to treat with clozapine

1500

to diagnose tourettes disorder, symptoms must be present before what age?

18

Sullivan's stage of interpersonal development childhood age

18 months- 6 years

Freud's psychosexual stage of development anal stage age

18 months-3 years

Schizophrenia typical age onset

18-25 for men 25-35 for women

what is the mean age of onset for first manic, hypomanic, or major depressive episode in BPI?

18yo

Tarasoff Principle

1976 - duty to warn victims of potential harm from client

1mg of xanex equals how many mg of Ativan

2

Recommended clozapine cut off points for discontinuation for WBC blood counts are

2,000-3,000

what is the 12 month prevalence of panic disorder among adults and teens in the US

2-3%

Piaget developmental stage preoperational age

2-7 years

rate of malformations among fetuses exposed to SSRIs

2.6%

what percentage of bereaved people meet criteria for MDD

20%

normal BMI

20-25

Erikson's developmental stage early adulthood ages

20-35 years

lifetime prevalence of anxiety disorders in the US

25-35%

what percentage of time do nurse managers spend dealing with conflict

25-40%

overweight BMI

26-29

according to the DSM 5, how many non-overlapping symptoms must be present to include the "mixed features" specifier in the diagnosis of an episode of MDD, mania, or hypomania?>

3

long term inpatient care usually requires a minimum of

3 months

schizotypal personality disorder occurs in what percent of the population

3%

when unipolar patients are treated with an antidepressant, the rate of experiencing a switch to mania is estimated to be what

3-4%/year

Freud's psychosexual stage of development phallic stage age

3-6 years

Erikson's developmental stage late childhood age

3-6yo

obese BMI

30-35

Erikson's developmental stage middle adulthood ages

35-65 yo

Latuda calorie recommendation

360

by what age is the process of absorption and transportation of drugs comparable between children and adults

4 months

the teratogenic effects of valproate occur at what point in gestation

4-5 weeks

what percentage of the population has obsessive compulsive personality disorder

5-10%

AST normal range

5-40 u/L

Valproci acid/ divalproex sodium therapeutic plasma level

50-125mcg/mL

what differentiates SGAs meds form FGAs

5H2a receptor antagonist properties (FGA meds block d2 receptors; SGAs block D2 receptors and have 5H2a antagonist properties)

what substance is often found in lower concentrations in the CSF of violent, impulsive criminals

5HIAA

What is the MOA of sumatriptan?

5HT1D and 5HT1B Agonist

what serotonin receptor antagonism makes an antipsychotic "atypical"?

5HT2A

carbamazepine therapeutic plasma level

6-12 mcg/mL

Erikson's developmental stage school-age ages

6-12yo

Sullivan's stage of interpersonal development juvenile age

6-9 years

what percent of people with specific learning disorder with impairment are male

60-80%

what is the maximum dose of divalproex

60mg/kg/day

Standard deviations from the mean

68-95-99.7 for 1 2 and 3

Freud's psychosexual stage of development latency stage age

6years-puberty

Piaget developmental stage concrete operations age

7-12 years

ALT normal range

7-56 u/L

Sullivan's stage of interpersonal development preadolescence age

9-12 years

according to the CDC, what % of school aged kids are diagnosed with ADHD

9-12%

normal serum creatinine

<1.5mg/dL

Erikson's developmental stage late adulthood age

>65yo

pneumacococal vaccine for older adults

>65yo or with chronic lung conditions, chronic CVD, DMII, chronic renal disease, chronic liver disease, chronic alcohol use disorder, and immunocompromising conditions= PPSV23 <65yo = PPSV13

MOA of memantine

AKA Namenda NMDA receptor antagonist

you are treating a client with schizophrenia who takes clozapine. what lab values will indicate the client needs to d/c treatment?

ANC count of less than 1,000 uL

Cognitive therapy

Aaron Beck goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions

Erikson's developmental stage infancy indications of developmental mastery

Ability to form meaningful relationships, hope about the future trust in others

one of the health care changes that has occurred as a result of the affordable care act (ACA) is that doctors/hospitals/clinic groups or health systems are coming together and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The health care clinics/systems doctors or hospitals that join together are called what?

Accountable Care Organization (ACO)

Isotretinoin

Accutane never to be used by someone pregnant or who may become pregnant can be stopped abruptly

what test is recommended by the WHO for ADHD screening in the general adult population

Adult ADHD self report screener

behavioral therapy

Arnold Lazarus focus on changing maladaptive bx by participating in active bx techniques such as exposure, relaxation, problem solving, and role playing

5 As for health behavior change

Assess Advise Agree Assist Arrange

what increases likelihood that psych symptoms be determined by HIV infection

CD4 count <600

which CYP enzyme is implicated as a tobacco inducer when an individual is treated with clozapine

CYP 1A2

Cytochrome P450 System

CYP1A2, 2C9, 2C19, 2D6, 3A4, and 3A5 enzymes are responsible for metabolizing over 90% of drugs processed in the liver

AST>ALT MEANING

Chronic liver disease or recent MI

available resources that synthesize currently available research information

Cochrane review clinical practice guideline

delirium screening instrument

Confusion assessment method (CAM) instrument

pregnancy category A

Controlled studies show no risk

difference for criteria for delusional disorder in DSM 5

Criterion A for delusional disorder no longer requires delusions to be non-bizarre

DIGFAST bipolar

D distractability I indiscretion G grandiosity or inflated self esteem F flight of ideas or racing thoughts A activities increase S sleep deficit T talkativeness

Delirium cause mneumonic

D-rugs E-lectrolyte abnormality L-ow oxygen saturation I-nfection R-educed sensory input I-ntracranial U-rinary or renal retention M-yocardial

EPSE cause

D2 receptor antagonism -when dopamine receptors are blocked, ACh increases, which causes EPSE -a reciprocal relationship exists between Each and dopamine

The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope and Standards of Practice is...

Define the Role and actions for the NP

theory of self-care

Dorothy orem -self care

agonist effect

Drug binds to receptors and activates a biological response

antagonist effect

Drug binds to the receptor but does not activate a biological response

inverse agonist effect

Drug causes the opposite effect of agonist; binds to same receptor

REM sleep

EEG activation, muscle atonia, rapid eye movements, muscle twitches, breathing irregularities

teratogenic risks of lithium (Eskalith)

Epstein anomaly

Deontological Theory

Ethical theory that states an action is judged as good or bad based on the act itself regardless of the consequences

Teleological Theory

Ethical theory that states an action is judged as good or bad based on the consequence or outcome

who coined the term schizophrenia

Eugen Bleuler

Principle of psychic determinism

Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content

what is used to treat OD of Benzos

Flumazenil short half life needs careful monitoring to prevent recurrence of overdose symptoms

eye movement desensitization and reprocessing EMDR

Francine shapiro behavioral and exposure therapy PTSD goal to achieve adaptive resolution

psychoanalytic therapy

Freud promotes change by development of greater insight and awareness of maladaptive defenses

most common side effect of galantamine

GI disturbance (diarrhea/nausea)

GI SE of lithium

GI upset diarrhea vomiting cramps anorexia

interpersonal therapy

Gerald klerman and myrna Weissman evidence based therapy focus on interpersonal issues creating distress time limited, active, focus on the present and on interpersonal distress

MDD endocrine dysfunction theory

HPA axis result of abnormal stress response related to HPA dysregulation

in order to obtain reimbursement from medicare, the NP must learn how to use the...

Healthcare common procedure coding system HCPCS

therapeutic nurse-client relationship theory or interpersonal theory

Hildegard Peplau -first significant psych nursing theory -sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship

what schedule drug are stimulants

II

what type of psychotherapy is the most studied and used for cluster C personality disorders

Individual psychotherapy

Jason misses several appointments. the PMHNP notes she feels resentful toward Jason and is struggling with how to respond when he finally comes in for his appointment. which statement demonstrates a therapeutic response?

Jason, help me understand what is going on so we can figure out how to proceed

who coined the term schizoaffective disorder

Kasanin

who started the first nurse practitioner program

Loretta ford

females with PTSD commonly have what comorbid diagnosis

MDD

process of quality improvement PDSA cycle

Plan Do Study Act

pregnancy category D

Positive evidence of isk

dimension reduction

Process of reducing the number of variables studied to focus on a smaller number

The Stark Law

Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment.

Mr. Smithers, an involuntary hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year". Your actions should be based on your knowledge of what?

Psychiatric clients can refuse treatment

AIMs screening schedule for clients on FGAs

Q6months

REM and NREM

Rapid eye movement REM alternates with 4 distinct non rapid eye movement NREM stages

SIGECAPS

S sleep disorder I interest deficit G guild E energy deficit C concentration deficit A appetite disorder P psychomotor retardation S suicidality

mesolimbic pathway

SDAs block dopamine in this pathway, causing decreased positive symptoms

APA recommends admission when there is a presence of

SI and a co-morbid medical condition possibly contributing to the suicidal risk level

SSRIs can cause what side effect in the elderly

SIADH

common inhibitors

SICK/FACES.COM/G -sodium valoproate (valproic acid) -Isoniazid (INH) -Cimetidine -Ketoconazole -Fluconazole -Alcohol (binge amounts) -Cloramphenicol -Erythromycin -Sulfonamides -Ciprofloxacin -Omeprazole -Metronidazole -Grapefruit juice

citalopram (celexa) for treating caving and maintaining sobriety

SSRI Decreases desire

first line tx for first episode major depression with mild to mod symptoms

SSRIs

social anxiety disorder pharm

SSRIs Benzos for short term beta blockers for discrete episode relief

specific phobia pharm

SSRIs TCAs short term Benzos

First line agents for chronic anxiety disorders

SSRIs acts on serotonin system and indirectly on GABA system

personality disorder pharm management for affective instability

SSRIs anticonvulsant mood stabilizers

personality disorder pharm management for impulsivity

SSRIs anticonvulsant mood stabilizers

GAD pharm

SSRIs Buspar Benzos PRN

structural family therapy

Salvador minuchin main tx goal to produce structural change in the family organization to more effectively manage problems changing transactional patterns and family structure

MDD learned helplessness-hoplessness theory

Seligman -modified aspect of cognitive theory -a person becomes depressed due to perceptions of lack of control over life events and experiences -these perceptions are learned over time, especially as the person perceives others seeing him or her as inadequate

neurotransmitters involved in suppressing the HPA axis

Serotonin GABA

FDA treatment for PTSD

Sertraline Paroxetine (Venlafaxine-2nd line)

cardia SE of lithium

T-wave inversions dysrhythmias

second line drugs for treating MDD

TCAs

for dealing with symptoms of post-menopause such as nocturnal hot flashes, anxiety, depressed mood, low energy, little motivation, diminished sex drive, and work related stress; what complimentary therapies are evidence-based

Tai chi dietary soy flaxseed

ms. Thomas has been diagnosed with MDD an dis placed on fluoxetine 20mg for her depression. for the PMHNP to effectively monitor her use of the medication, which action should be part of ongoing care.

The use of a standardized rating scale of depression

what medication combo can extend the decreased craving for food

Wellbutrin and naltrexone

Bipolar rating scales

Young mania rating scale a daily mood chart

the role of neurotransmitters in the CNS is to function as

a communication medium

classical conditioning

a conditioned stimulus elicits a conditioned response due to its proximity to an unconditioned stimulus

according to the DSM5, which is true

a culturally expected response to a stressor is not a mental disorder

partialism

a fetishistic attraction to a specific part of the body

up coding

a fraudulent practice in which provider service is billed at higher procedure costs than were actually performed resulting in a higher payment by medicare or other third party payers

Current Procedural Terminology (CPT)

a list of identifying codes owned by the American Medical Association used to describe procedures

the PMHNP is tasked with continually improving the quality of care on an inpatient unit. the NP implements...

a plan-do-study-act process

with the publication of the 2003 report, Achieving the Promise: Transforming Mental Health Care in America, mental health professionals were first sensitized to the need for what

a recovery-oriented mental health system

continuous reinforcement

a reward is given every time the target responses occurs

Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services and is displaying an increase in regressive defense mechanisms. The best explanation of Mrs. French's behaviors is

a sign of normal resistance to termination seen in the termination phase of therapy

Erikson's developmental stage middle adulthood indications of developmental mastery

ability to give time and talents to others, ability to care for others

Piaget developmental stage formal operations

ability to think abstractly thinking operates in a formal, logical manner

Erikson's developmental stage school-age indications of developmental mastery

ability to work; sense of competency and achievement

akinesia

absence of movement difficulty initiating motion subjective feeling of lack of motivation to move often mistaken for laziness or lack of interest

Pregnancy category X

absolutely contraindicated

cholinergics

acetylcholine

when working with an avoidant patient with a history of trauma, what type of communication techniques are helpful

activation is needed to allow memories stored in the amygdala to be processed

substance use disorder is synonymous with what

addiction

what neurotransmitter is involved in the promotion of sleep

adenosine

separation anxiety disorder occurs at what age

after age 4

Serotonin agonist and reuptake inhibitors SARIs act on

agonist of serotonin 5HT2 receptors and elevate serotonin levels

adverse reaction with mirtazipine use

agranulocytosis

tertiary prevention

aimed at decreasing the disability and severity of mental disorder rehabilitative services avoidance or postponement of complications

primary preventions

aimed at decreasing the incidence (number of new cases) of mental disorders helping people avoid stressors or cope with them more adaptively

secondary prevention

aimed at decreasing the prevalence (number of existing cases) of mental disorders early case finding screening prompt and effective tx

Clerambault syndrome

aka erotomania

P value

aka level of significance describes the probability of a particular result occurring by change alone if P=0.1, there is a 1% probability of obtaining a result by chance alone

tumors of the upper brain stem can cause what

akinetic mutism

what is propranolol contraindicated with

albuterol due to risk of CNS stimulation

the most frequently studied gene implicated in the development of substance use disorders encodes what substance

alcohol and aldehyde dehydrogenase

norepinephrine general function

alertness focused attention orientation primes fight or flight learning memory

AACAP practice parameter for forensic evaluations

all states require a response to a subpoena request

balanced budget act of 1997

allows direct reimbursement to nurse practitioners by medicare

what receptor does mirtazapine have effect

alpha-2 adrenergic antagonist

brief psychotic dx prognosis

always returns to premorbid level of functioning

meds that can cause false positives for cocaine

amoxicillin most antibiotics NSAIDS

stimulants

amphetamine/destroamphetamine (Adderall) dexmethylphenidate (focalin) dextroamphetamine (Dexedrine) methylphenidate (Ritalin) lisdexamfetamine dimesylate (Vyvanse)

the PMHNP evaluates at 3yo male and makes the diagnosis of ADHD. following the FDA labeling of approved medication for children, what medication can be started at a child age 3?

amphetamines (methylphenidate and guanfacine are approved for 6+yo) (fluoxetine and bupropion are 8+)

most individuals with intellectual disability profound have which condition

an identified neurological condition accounting for the intellectual disability

schizoaffective dx

an uninterrupted period of illness in which the person experiences psychotic symptoms similar to those seen in schizophrenia as well as mood symptoms similar to MDD or BP

2 sample t test

analyze continuous data from two separate samples with normal distributions

aspartate

another excitatory neurotransmitter -works with glutamate

blurry vision side effect in psychotropics

anticholinergic side effect Seroquel may cause cataracts

what lab test is frequently positive with systemic lupus erythematosus

antinuclear antibody

belladonna herbal use

anxiety

what is the demographics of transient tics

as many as 15% of boys ages 8-12 may have transient tics

Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose one month ago. she was started on imipramine (TCA) after that event but stopped taking the med one week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. What is the most appropriate initial action?

asking mrs. shea how to help her

Mr. Jonas 65yo, has been stable on Celexa 20mg QDAY. he comes in for an appointment complaining that over the last 2-3 weeks he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. what action is most appropriate?

assess for hyponatremia (Can occur on SSRIs and is common in elderly patients. he is reporting symptoms of moderate hyponatremia)

t test

assesses whether the means of two groups are statistically different from each other

definition of remission during acute phase of major depression

at least 3 weeks of absence of both sad mood and reduced interest and no more than 3 remaining symptoms of a major depressive episode

PTSD delayed onset

at least 6 months between traumatic event and onset of symptoms

Attachment relationships between an infant and mother are considered critical by neurobehavioral researchers because

attachment to significant relationships facilitates self-regulation of emotions

acetylcholine general function

attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone

what is revealed by studies of hallucinations in schizophrenia

auditory hallucinations are due to an over activation of the temporal-parietal cortex

in forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. which is an essential part of building a therapeutic relationship?

authenticity

a client with bipolar I disorder presents to your PMHNP office for a follow up visit. during the visit the client informed you that he no longer wants to be treated with medication., and he does not have bipolar disorder, that was a misdiagnosis. he further informs you he stopped all his medication 2 months ago and is here to thank you for your care and tell you that he no longer needs follow up appointments. understanding the ethical conflict, you use which of the following ethical principles in working with this client?

autonomy

Erikson's developmental stage early childhood developmental task

autonomy vs. shame and doubt

dementia genetic loading

autosomal dominant trait

what best describes homeostasis in a family system

balance or stability that the family returns to despite its dysfunction

Sean is a 47 yo gulf war vet who was in combat during operation desert storm. Sean has been treated by the PMHNP for MDD and associated anxiety symptoms. during the most recent visit, the PMHNP learns that sean sustained a TBI during his service, which was recently diagnosed at the TBI clinic at the VA. what is the rational for the PMHNP to taper him off clonazepam?

benzos cause memory problems and confusion in clients with a hx of TBI

med that can induce depression

beta blockers steroids interferon isotretinoin (Accutane) some retroviral drugs antineoplastic drugs benzos progesterone

Erikson's developmental stage infancy age range

birth-1 year

Sullivan's stage of interpersonal development infancy age

birth-18 months

Piaget developmental stage sensorimotor age

birth-2 years

Erikson's developmental stage late adulthood indications of developmental failure

bitterness, sense of dissatisfaction with life, despair over impending death

MOA of amphetamine and methylphenidate

both increase intrasynaptic levels in norepinephrine and dopamine

cluster analysis

breaks a large group into smaller groups so that each individual cluster is more homologous by some measure

CP450 inhibitors

bupropion clomipramine cimetidine clarithromycin fluoroquinolones grapefruit ketoconazole nefazodone SSRIs

anxiolytics

buspirone (buspar)

though process and content age of understanding

by age 4, children have some understanding of what is real or made up

von Recklinghausen disease physical characteristics

cafe au lait spots neurofibromas

CYP1A2 substrates

caffeine clozapine duloxetine imipramine olanzapine ramelteon amitriptyline

Tim is a board-certified PMHNP working in a busy community mental health center (CMHC). he is currently seeing a client diagnosed with BPI disorder who has comorbid hypertension and diabetes. during the visit, Tim takes the client's BP and her reading is 160/94mmHg. the client denies any headaches, nausea, chest pain, or shortness of breath. the client states I can't afford all these medications so I haven't seen my doctor in 7 months and I am out of all my blood pressure and sugar medications, can you give me some? what is times most appropriate action?

call the client's PCP, explain the situation, and coordinate the client getting an appointment and medication refills

a pmhnp who is working on the consult liaison service is referred to a patient in the medical intensive care unit by the attending hospitalist. the consult note read evaluate the patient for competency to make independent medical decisions and consent for a surgical procedure. based on the scope of practice of a PMHNP, which response would be most appropriate.

call the hospitalist and provide education that competency is a legal concept and explain that you can assess the patient for the capacity to make medical decisions

what substance or technique was first used to induce convulsions to treat psychiatric illness

camphor

caffeine and nicotine with antipsychotics

can diminish effect dose may need to be higher

concurrent administration of what medication is likely to decrease levels of valproic acid

carbamazepine

CP450 inducers

carbamazepine hypericum/ st johns wort phenytoin phenobarbital tobacco

meds that are safe while breastfeeding

carbamazepine valproic acid phenytoin phenobarbital primidone (klonopin=resp depression, lithium=ekg changes and toxicity, lamtictal=fatal rash)

steven Johnson syndrome med risk

carbamazepine or lamotrigine

humanistic therpay

carl rogers person-centered therapy self directed growth and self actualization people are born with capacity to direct themselves toward self actualization

how to treat antipsychotic induced parkinsonisms

cessation of the drug

shared psychotic disorder (Folie A Deux)

characterized by development of a delusion in a client who has a close relationship with another person who already has a psychotic disorder with a prominent delusion

CYP1A2 inducers

charcoal broiled beef tobacco marijuana omeprazole cruciferous vegetables modafinil

Piaget developmental stage concrete operations

child begins to use logic develops concepts of reversibility and conservation

Bowlby attachment theory

children who come from parents with high expressed emotion and unresolved losses tend to develop disorganized attachment characterized by not feeling safe with their caregiver and an inability to feel soothing comfort

Serotonin selective reuptake inhibitors SSRIs

citalopram (celexa) fluvoxamine (Luvox) paroxetine (paxil) paroxetine mesylate (pexeva) fluoxetine Prozac) sertraline (Zoloft) escitalopram (Lexapro)

Bipolar I

clinical history characterized by occurrence of 1 or more manic or mixed episodes

Tricyclics

clomipramine (anafranil) amoxapine (asendin) amitriptyline (Elavil) desipramine (norpramin) nortripyline (pamelor) doxepin (sinequan) trimipramine (surmontil) imipramine e(tofranil) protriptyline (vivactil)

a WBC count of 4,000 on clozapine would prompt the PMHNP to do what

closely monitor CBC with diff twice a week while continuing clozapine in absence of any other signs or symptoms.

second generation antipsychotics

clozapine (Clozaril) ziprasidone (Geodon) risperidone (Risperdal) quetiapine (Seroquel) olanzapine (Zyprexa) aripiprazole (abilify) paliperidone (Invega) iloperidone (fanapt) asenapine (saphris) lurasidone (luatuda)

ambiphilia

combination of both androphilia and gynephilia

ego-syntonic personality

comfortable

Erikson's developmental stage early adulthood indications of developmental mastery

committed relationships, capacity to love

MOA of amphetamines

competitive blockage of dopamine reuptake in the synaptic cleft dopamine and norepinephrine release from presynaptic nerve terminals

what sex hormone-related condition results in increased rates of homosexuality

congenital renal hyperplasia

Combo of MAOI and serotonergic agent

contra d/t serotonin syndrome risk

clomipramine toxicity symtpoms

convulsions and coma

central points to the international society of psychiatric mental health nurses vision of mental health care in the 21st century

creation of a consumer-based system -reduction of fragmentation of services -creation of a mental health workforce to carry out the transformation of mental healthcare delivery -emphasis to providing services to underserved populations (Children, teens, older adults)

nominal or categorial data example

cultural background variables

what is the most widely used tool for assessing the healthcare safety culture within an organziation

culture of patient safety assessment developed by AHRQ

high reliability organizations

culture of safety foster a learning environment and evidence-based care promote positive working environments for nurses are committed to improving safety and quality care

hypertensive crisis tx

d/c MAOI give phentolamine (binds with norepinephrine receptor sites, blocks norepinephrine) -stabilize fever

the PMHNP sees a 12yo pt who takes Vyvanse 50mg QD for ADHD. the NP observes a tic, which the patents report began after the pt began taking the stimulant, and it has been increasing in severity. both the parents and the school report that the med is helpful. the NP...

d/cs the stimulant and prescribes Intuniv and monitors the pt

important risk factor in postpartum psychosis when monitoring response to treatment

data suggest that an episode of postpartum psychosis is essentially an episode of a mood disorder, and is usually an indicator of bipolar disorder

spironolactone, estrogen, and steroid sexual side effects

decrease sexual desire secondary to decreased testosterone

goals of DBT

decrease suicidal bx decreased therapy interfering bx decrease emotional reactivity decrease self invalidation decrease crisis-generating bx decrease passivity increase realistic decision making increase accurate communication of emotions and competencies

enzyme inducers can

decrease the serum level of other drugs that are substrates of that enzyme possibly causing subtherapeutic drug levels

systemic effects of hypothyroidism

decreased T4 and increased TSH mimics symptoms of unipolar mood dx

neurotransmitters and symptoms with schizophrenia

decreased acetylcholine = cognitive decline increased norepinephrine in reward circuits = anhedonia increased serotonin = increase severity of both positive and negative symptoms increased dopamine = increase severity of positive symptoms

when treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which reason?

decreased protein binding

Sullivan's stage of interpersonal development childhood developmental task

delayed gratification

primary clozapine overdose symptoms

delirium lethargy tachycardia hypotension respiratory failure

ginkgo herbal use

delirium, dementia, sexual dysfunction caused by SSRIs

compassion fatigue symptoms

denial about problems excessive blaming holding in emotions isolating from others an unusual amount of complaints complaining about administration functions substance abuse used to mask feelings compulsive spending overeating gambling sexual addiction poor self care and hygiene

positive predictive value (PPV)

dependent on the prevalence of a disease in a population.

early-morning wakefulness is a possible sign of

depression

oral contraceptives, reserpine, alcohol, hydralazine, amantadine, Benzos, guanethidine, and clonidine can all cause what

depression

Ginseng herbal use

depression fatigue

Freud's psychosexual stage of development anal stage psych disorder linked to failure of stage

depressive disorder

3 phases of EMDR

desensitization phase installation phase body scan

MDD chronobiological theory

desynchronization of circadian rhythms produces the symptoms constellation collectively called MDD

characteristic of preoperational stage

development of imagination and symbolic thinking, including language

inductive reasoning

devleoping generalizations from specific observations

what amphetamine isomer is most rapidly eliminated from the body

dextro-isomer in acidified urine

social anxiety disorder

diagnosed only if symptoms persist longer than 6 months do NOT feel better or experience decreased anxiety when accompanied by a trusted companion

what benzo is most rapidly absorbed when taken orally

diazepam

brief psychotic disorder

disorder with sudden onset of psychotic symptoms lasting gat least 1 day but less than a month

delusional dx risk factors

disorders of the limbic system and basal ganglia

which known teratogenic effects can be causes by the common psychotropic medications divalproex and lithium?

divalproex-spina bifida lithium- Epstein anomoly

what neurotransmitter is thought to play a major role in social phobia

dopamine

what neurotransmitter promotes wakefullness

dopamine

what TCA has the highest concentration in breast mild

doxepin

carbamazepine/ valproic acid/divalproex sodium lab monitoring

drawn 1 week after start 12 hour trough serum drug level CBC LFTs

partial agonist effect

drug does not fully activate the receptors

what is true about pharmacologic treatment of anxiety in older adults

drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated (liver enzyme functioning among other things diminishes as we age)

drug steady state

drugs usually are administered once every half-life to achieve this it takes approx. 5 half lives to achieve a steady state and 5 half lives to completely eliminate a drug

anticholinergic side effects

dry mouth blurred vision constipation memory problems from muscarinic receptor blockade

sexual side effects with typical antipsychotics

due to effects on the alpha-2 receptors

what does medicare part B cover

durable medical equipment medically necessary services and supplies and preventative services

what four elements need to be present for a malpractice lawsuit to be filed?

duty of care, breach of standard of care, injury, and injury must be related to breach of standard of care

mixed state

dysphoric hypomania

MDD abnormalities of neurotransmitter function theory

dysregulation of dopamine, serotonin, and norepinephrine

what finding would be indicative of cortical dementia

early aphasia early difficulties in calculations normal speed of cognitive processing until late in the disease euthymic mood articulate speech until late in the disease normal motor speech and control absence of adventitious movements such as tremors/tics/dystonias

a client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependancy. these behaviors indicate developmental failure of which stage of development?

early childhood

ADHD typical age onset

early childhood (per DSM by age 12)

what finding would be indicative of a subcortical dementia

early gate disturbance (impaired coordination) slow cognitive processing depressed mood dysarthria bowed or extended posture slowed motor and speech control chorea tremor tics dystonia

TCAs in anxiety

effective but affect multiple receptors and have problematic side effect profiles

what lab values confirm an NMS diagnosis

elevated creatine phosphokinase (CPK) due to skeletal muscle breakdown elevated WBCs (leukocytosis)

what to watch for if on psychtropics such as carbamazepine (Tegretol) or clozapine

elevated temp agranulocytosis

MAOIs act on

elevating serotonin and norepinephrine levels

TCAs act on

elevating serotonin and norepinephrine levels

Erikson's developmental stage early adulthood indications of developmental failure

emotional isolation, egocentrism

Fay Abdella nursing theory

emphasizes the delivery of nursing care for the whole person to meet the physical, social, emotional, intellectual, and spiritual needs of the client and family

family life cycle

empty nesting finding new meaning or redefining meaning for life normal tasks include renegotiation of marital system as a dyad, development of adult-adult relationships between grown children and their parents, realignment of relationships to include in-laws and grandchildren, and dealing with disabilities and death of parents or grandparents

enzyme inhibition vs induction

enzyme inhibition is a faster process than enzyme induction

health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. what are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation?

equity and efficiency

Virtue ethics

ethical theory that states actions are chosen based on the moral virtues (eg. honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person making the decision

Wisconsin card sorting test

evaluates executive function

Assertive Community tx (ACT)

evidence based case management program for schizophrenia

Illness management recovery (IMR)

evidence based recovery program for schizophrenia

combined structural and functional testing

examine structure in conjunction with function mainly for research functional MRI fMRI 3D, event realted functional MRI 3fEMRI Fluorine magnetic spectroscopy Dopamine D2 receptor binding

what are overlapping symptoms of both ADHD and pediatric bipolar

excessive talking increased activity distractibility

magnesium is a cause of neuromuscular what

excitability

Freud's psychosexual stage of development phallic stage primary means of discharging drives and achieving gratification

exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love

Therapy approach to increase awareness of choices and responsibility for consequences of choices

existentialism theoretical framework

Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours she states she wishes to leave because "this place can't help me." The best action that reflects the legal right of this client is

explain that the client cannot leave until you can complete further assessment. (almost every state allows for a brief period of detainment to assess a client for dangerousness to self or others before allowing a client to leave a hospital setting, even if the admission was voluntary)

restless leg lab findings to check

ferritin level

the most preventable cause of intellectual disability is what

fetal alcohol syndrome

CNS SE of lithium

fine hand tremors fatigue mental cloudiness headaches coarse hand tremors with toxicity nystagmus

what is a prominent risk factor for antisocial personality disorder

first degree relative with this

teratogenic risks of benzos

floppy baby syndrome cleft palate

SSRI discontinuation syndrome

flu-like symptoms agitation nausea

what medication can reduce the need for perfectionism and the development of unnecessary rituals?

fluoxetine

what drugs can be used to treat aggression

fluoxetine clonidine buspirone (antipsychotics, SSRIs, lithium, anticonvulsants, beta. blockers) (NOT bupropion)

what SSRI would cause the most issues with a pt on Clozaril

fluvoxamine it inhibits 1A2 which clozaril is a substrate of

CYP1A2 Inhibitors

fluvoxamine cimetidine ciprofloxacin grapefruit juice ketoconazole

prospective cohort study

follows similar individuals overtime with respect to certain variables to determine how those variables will impact the rate of a certain outcome

when is the use of transdermal selegiline not beneficial

for pts with pheochromocytoma due to excess norepinephrine leading to hypertensive crisis

Sullivan's stage of interpersonal development juvenile developmental task

forming peer relationships

a client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. in planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the...

frontal lobe

Erikson's developmental stage late adulthood indications of developmental mastery

fulfilment and comfort with life, willingness to face death, insight and balanced perspective on life's events

Erikson's developmental stage middle adulthood developmental task

generativity vs. self-absorption or stagnation

The NP Roundtable, and advocacy organization composed of APN organizations, was successful in what

getting language included into the Congressional Reconciliation Act that allowed the Secretary of Health and Human Services to include NPs as leaders in medical home demonstration projects

how to avoid the emergence of Wernickes encephalopathy

give thiamine IM or IV 100mg prior to any fluids or food with caloric value

carbon monoxide poisoning causes lesions in what area of the brain

globus pallidus and deep cerebral white matter

Trimethoprim/Sulfamethoxazole (Bactrim) contras

glucose-6-phosphotase deficiency folate deficiency anemia

the primary excitatory neurotransmitter is

glutamate

amino acids

glutamate, aspartate, gamma-aminobutyric acid (GABA), glycine

GAD non pharm

good candidates for therapy as single tx modality

OCD associated in children with what

group A beta-hemolytic streptococcal infections (scarlet fever, strep)

which of the following client statements best describes imitative behavior as a therapeutic factor in group therapy?

group members begin to model aspects of other members of the group and group leaders

for pts with histrionic personality disorder, which therapy is useful for addressing provocative and attention seeking behavior?

group therapy

other ADHD and ADD agents

guanfacine (intuniv) clonidine (kapvay) atomoxetine (Strattera) antidepressants such as desipramine (norpramin), venlafaxine (Effexor), and bupropion (Wellbutrin) are also used

which type of hallucination is rare in persons with psychotic illnesses and is often associated with an organic etiology

gustatory

typical antipsychotics

haloperidol (Haldol), haloperidol deconate (Haldol deconate) loxapine (loxitane) thioridazine (mallaril) thiothixene (navane) fluphenazine (prolixin), fluphenazine deconate (prolixin doconate) mesoridazine (serentil) trifluoperazine (stelazine) chlorpromazine (thorazine) perphenazine (trilafon)

a pt who has borderline personality disorder experiences intense anxiety when the PMHNP goes on vacation. the most appropriate explanation for this reaction is that the pt...

has not developed object constancy

chinese ethnicity and drug metabolism

have a lower average level of CYP2D6 and may require lower doses of antipsychotics and antidepressants metabolized through that enzyme

MDD genetic predisposition theory

having a depressed parent is the single strongest predictor of depression

Madeline Leininger's theory

health as a state of wellbeing that is culturally defined and valued by a designated culture

what is the primary function of free association in psychoanalysis

helps with working through transference neurosis

experiential family therapy

here-and-now focus encourages change through growth experiences

what is the immunization vaccine recommend for those 50+

herpes zoster

teen suicide protective factors

high grade point average connectedness with family connectedness with school

Lawrence Kohlberg's Stage Theory of Moral Development criticism

his schema is Western, predominantly male, and hierarchical

acamprosate (campral) for treating caving and maintaining sobriety

homotaurine decreases craving

as a pmhnp working in an output addiction clinic, you often refer your clients to community AA and NA meetings. using yalom's therapeutic factors, you are aware that peer-led groups can inspire and encourage other group participants. which therapeutic factor is instilled in AA and NA group members.

hope

PMDD treatment

hormonal contraceptives SSRIs both

nurse practitioner process

hx assessment labs diagnosis first line tx

dopamine hypothesis

hyperdopaminergic state in striatal D2 system prompts positive symptoms

arcus senilis when seen before 40yo is associated with what disorder

hyperlipidemia

peptides opioid type symptoms of deficit

hypersensitivity to pain and stress decreased pleasure sensation dysphoria substance abuse

MAOIS and tyramine

hypertensive crisis

when conducting a neurological exam on a client, the pmhnp asks the client to hold out her arms and stick out her tongue while assessing for tremors. which cranial nerve is being assessed?

hypoglossal

a client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. what is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?

hypothalamus

what disease causes risk of carpal tunnel syndrome

hypothyroidism

MDD structural brain changes

hypovolemic hippocampus hypovolemic prefrontal cortex-limbic striatal regions

a 20 year old asian man who was recently diagnosed with schizophrenia comes to your office for a follow up appointment. during the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10pm evening news. what symptom is the client describing

ideas of reference

the concept of target symptom identification is best explained as

identification of specific, precise, and individualized symptoms reasonably expected to improve with medication

which of the following is a function of the psychiatric interview

identify the mental health needs of the client

strategies to manage flashbacks

identifying the phenomenon as a flashback or dissociative period of grounding techniques (noticing things in the present)

Erikson's developmental stage adolescence indications of developmental failure

identity confusion, poor self-identification in group settings

the goal fo the psychiatric assessment process performed by the PMHNP is to

identity the mental health needs of the client

Erikson's developmental stage adolescence developmental task

identity vs role confusion

Greif and bereavement pharmacological management

if needed short term use of anti-anxiety agents such as Benzos if needed short term use of sleep-induction agents such as Benzos, nonbenzo hypnotic such as Zolpidem, TCA or other sedating antidepressants, antihistamines

positron emission tomography PET

images of brain when positron-emitting radionuclei interact with an electron expensive

Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. while discussing his current concerns of martial stress, he lies the floor and assumes the fetal position. this is most likely an example of

immature regressive defense mechanism

antihypertensive sexual side effects

impaired vaginal lubrication due to antiadrenergic effects

Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital. the PMHNP on call as the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "people make me nervous". his room is a the end of the hallway and is the farthest away from the nursing station. the PMHNP's action should be based on awareness that the best location to do the assessment is...

in a quiet place, but public enough to get assistance with client care should it be required during the assessment

The MMSE is a brief, standardized screening tool for use...

in adults to quantify cognitive status

which statement best reflects the different between nurse-client relationship and a social relationship?

in the nurse-client relationship, the primary focus on on the client and the client's needs

Freud's psychosexual stage of development latency stage psych disorder linked to failure of stage

inability to form social relationships

areas assessed by ADHD rating scales completed by parents and teachers

inattention impulsivity hyperactivity mood memory problems self-esteem sleep pattern temperament

for the ER form of divalproex, what is the correct dose adjustment compared to the regular formulation

increase ER dose by 15%

therapeutic goals of behavioral couples therapy

increase reinforcing behaviors decrease punishing behaviors replace arguing with problem solving (does not emphasize cognition)

enzyme inhibitors can

increase the serum level of other drugs that are substrates of that enzyme possibly causing toxic levels

lab findings for pt with alcohol use disorder indicate

increased LFTs increased MCV elevated triglyceride levels

systemic effects of hyperthyroidism

increased T4 and decreased TSH may mimic symptoms of bipolar affective disorders

oxcarbazepine (trileptal) metabolic side effects

increased blood sugar but normal A1c, increased peeing

signs and symptoms of cannabis intoxication are

increased sensitivity to external stimuli

SSRIs act on

increasing serotonin levels

Erikson's developmental stage school-age developmental task

industry vs. inferiority

Intellectual disability typical age onset

infancy- usually evident at birth

how does necrosis differ from apoptosis

inflammatory response

single photon emission computed tomography (SPECT)

information of cerebral blood flow limited available expensive

SNRIs act on

inhibiting dual reuptake of norepinephrine and serotonin

SSRI sexual side effects

inhibition of arousal and orgasm by increased serotonergic activity

Bipolar follow up

initially seen weekly

Erikson's developmental stage late childhood developmental task

initiative vs guilt

peptides opioid type symptoms of excess

insensitivity to pain catatonic-like movement disturbance auditory hallucinations decreased memory

clinically significant side effects of MAOIs include

insomnia hypertensive crisis weight gain anticholinergic side effects lightheadedness and dizziness sexual dysfunction

lithium is associated with what metabolic complication

insulin-like effect lowers blood glucose and increases appetite and weight gain

Freud's psychosexual stage of development genital stage primary means of discharging drives and achieving gratification

integration and synthesis of behaviors from early stages, primary genital-based sexuality

Erikson's developmental stage late adulthood developmental task

integrity vs despair

self system

interpersonal theory total components of personality traits

what therapy is most useful in depressed HIV positive patients

interpersonal therapy

Erikson's developmental stage early adulthood developmental task

intimacy vs isolation

serotonin symptoms of deficit

irritability, hostility, depression, sleep dysregulation, loss of appetite, loss of libido OCD, anxiety disorders, schizophrenia

GABA symptoms of deficit

irritability, hostility, tension and worry, anxiety, seizure activity anxiety disorders

why is group therapy beneficial?

it is always time limited (it increases social skills, is cost-effective, and enables participants to acquire the curative factors)

the Iowa model of EBP is characterized by what

it is important to determine if an identified issue is a priority for an organization

strategic therapy

jay haley tx goal to help family embers behave in ways that will not perpetuate the problem bx interventions are problem focused

caring theory

jean Watson caring is an essential component of nursing

relational theory

jean baker miller focuses on the real relationship between patient and therapist to understand and relieve conflict and social inhibition and to achieve social intimacy

Mary is a PMHNP who is working in a hospitalist role. Mary has encountered over five incidences in which attending physicians and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and wants to improve quality, reduce error to promote safety. what concepts is Mary employing?

just culture

what herbal supplement is effective for pts with adjustment disorder with anxiety, according to an RCT

kava kava

period of symptoms required for dysthymia in kids vs adults

kids 1 year adults 2 years

glutamate symptoms of excess

kindling, seizures, anxiety or panic bipolar affective disorder, psychosis from ischemic neurotoxicity or excessive pruning

GGT is used to evaluate and monitor clients with what

known or suspected alcohol abuse levels rise even after ingestion of small amounts of alcohol

acetylcholine symptoms of deficit

lack of inhibition, decreased memory, euphoria, antisocial action, speech decrease, dry mouth, blurred vision, constipation alzheimers dx

Erikson's developmental stage late childhood indications of developmental failure

lack of self-initiated behavior, lack of goal orientation

Fragile X physical characteristics

large, long head and ears short stature hyperextendable joints postpubertal macroorchidism

Major Depression typical age onset

late adolescence to young adulthood

what ethnicity of veterans experience the highest levels of PTSD

latino

transactional leadership model

leader only intervenes when something goes wrong

EEG and evoked potentials testing

least expensive test convey info on electrical functioning of CNS

PTSD acute

less than 3 months

combo of TCAs and MAOIs

lethal serotonin syndrome, hypertensive crisis, or both adhere to two week washout period (5 weeks for fluoxetine) before switching between the two classes of medications

hem SE of lithium

leukocytosis

what hematological change is associated with lithium

leukocytosis

hypertensive crisis

life threatening and cannot be reversed unless more MAO is produced by the body sudden, explosive like headache, usually in occipital region elevated BP facial flushing palpitations pupillary dilation diaphoresis fever

probability

likelihood of an event occurring lies between 0 and 1 an impossible event has probability of 0 a certain event has a probability of 1

TSH values can be increased during therapy with what

lithium

what pharm treatment is clinically supported for treating kleptomania

lithium

in completing the pmhnp assessment for the mrs. shea, the most appropriate lab test for the PMHNP to order at this time is

liver function tests

risk factors for teen suicide

living alone substance abuse affective disorder (not low IQ)

what are of the brain has the largest concentration of norepinephrine

locus coeruleus and medullary reticular formation

PTSD chronic

longer than 3 months

Benzodiazepines BNZs

lorazepam (Ativan) clonazepam (klonopin) chlordiazepoxide (Librium) oxazepam (serax) clorazepate (tranxene) alprazolam (xanex)

schedule V drugs

lowest abuse potential handled similar to noncontrolled drugs buprenorphine (buprenex), cheratussin (robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil)

derm SE of lithium

maculopapular rash pruritus acne

ebsteins anomaly

malformation of tricuspid valve

sudden, dramatic decrease in sleep is a sign of possible

mania or schizophrenia

in bipolar I, men are more prone than women to have...

manic episodes

intervention that has evidence based findings to reduce co-morbid substance use in pts with schizophrenia

manualized group intervention with motivational enhancement

what does the term "goodness of fit" mean by Chess and Thomas

match or mismatch between a persons temperament and features of their environment

MMSE score interpretation

max 30 no cognitive impairment 24-30 (average 27) delirium/dementia (18-23 = mild, 0-7 severe)

conduct disorder lifespan consideratiosn

may be diagnosed in clients ages 18+ if criteria for antisocial personality disorder are not met

ECT when treating major depression in pts with parkinsons

may cause delirium

cross-sectional study design

measures both the risk factor and the outcome simultaneously. used to reveal associations and to identify possible risk factors "snapshot" data is obtained does not determine causation through a single study best method to determine prevalence

Functional imaging

measures function of areas of the brain and bases the resulting assessment on blood flow -may use radioactive pharmaceuticals to cross blood-brain barrier -mainly used for research -EEG and evoked potentials testing -magnetoencephalography MEG -single photon emission computed tomography SPECT -positron emission tomography PET

prospective payment system (PPS)

medicare-approved program that pays a set amount for patient care based on the Diagnosis Related Group (DRG)

schedule II drugs

medicinal drugs in current use high potential for abuse and dependency written script only no telephone orders no refills on script morphine sulfate, codeine, fentanyl, methadone, hydromorphone (dilaudid), oxycodone (oxycontin, Percocet), hydrocodone (Vicodin etc), amphetamine salts, methylphenidate

schedule III drugs

medicinal drugs with less abuse than II telephone orders if followed by written script prescription must renew Q6months refills limited to 5 appetite suppressants, butalbital, testosterone, buprenorphine/naloxone

schedule IV drugs

medicinal drugs with less abuse than III dextropropoxyphene (Darvon), pentazocine (talwin), benzos, modafinil (Provigil), phenobarbital, zolpidem (ambien), eszopiclone (Lunesta), temazepam (Restoril), armodafinil (nuvigil)

what part of the brain controls the respiratory function for the body

medulla

an initial psych eval of a pt reveals a normal mental status and appropriate bx, despite parents report of disobedience, poor grades, and laziness. to further assess the pt's functioning, the PMHNP...

meets with the parent and pt together to explore the discrepant report

glutamate general function

memory, sustained automatic functions

delirium older adult considerations

men more prone than older women for unknown reasons

black cohosh herbal uses

menopausal symptoms PMS dysmenorrhea

Hypertensive crisis and death occurring when MAOIs taken in conjunction with certain meds

meperidine decongestants TCAs atypical antipsychotics st johns wort l-tryptophan stimulants and other sympathomimetics asthma meds

how does trazodone cause activation of the CNS

metabolite activity as well as inhibition of serotonin reuptake in presynaptic receptors

GAD 7 scoring

mild 5-9 mod 10-14 severe 15-21

Hamilton anxiety rating scale scorign

mild <17 mild-mod 18-24 mod-severe 25-30

dopamine symptoms of deficit

mild: pour impulse control, poor spatiality, lack of abstractive thought -severe: Parkinson's disease, endocrine alterations, movement disorders -substance abuse, anhedonia

motivational interviewing

miller and rollnick -focused, goal-directive therapy -motivation is elicited from the client -nonconfrontational, nonadversarial

a 74 year old married women was referred to you by her pcp for a psych eval. she had a normal medical and neurological exam in the last 2 months. the client presents with her husband of 45 years who states "my wife is just not the same anymore, she is irritable and asks the same question several times, even though I've answered it many times. the client responds, oh Henry, you do the same thing, its just a normal part of getting older, and the kids think everything is fine. during the assessment you complete the MMSE and the client scores 18. as the pmhnp treating the client, you know the results of her MMSE indicate which level of cognitive impairment.

moderate cognitive impairment

peptides opioid type general function

modulate emotions, reward center function, consolidation of memory, modulate reactions to stress

Piaget developmental stage preoperational

more extensive use of language and symbolism magical thinking

adolescent manic episodes present differently than in adults

more psychotic features often associated with antisocial bx often associated with substance abuse prodromal period of significant bx problems (School truancy, failing grades)

dementia typical age onset

most common after age 85

delirium course

most symptoms resolve within 3-6 months

NMS can be differentiated from serotonin syndrome by

mutism leukocytosis dysphagia lab evidence of muscle injury (elevated CPK, myoglobinuria, rabdomyolysis)

buprenorphine and naloxone (Suboxone) for treating caving and maintaining sobriety

narcotic analgesic opioid agonist/antagonist

methadone (dolophine) for treating caving and maintaining sobriety

narcotic analgesic suppresses withdrawal

what drug can cause fatal liver failure in rare cases

nefazodone CYP3A4 inhibitor

what schizophrenia symptoms are most debilitating

negative symptoms

you have been working within 54 yo man who has been treated for schizophrenia since age 19. he has limited social interactions, likes to be alone, and has never dated nor had a desire to date. his symptoms are best explained by what?

negative symptoms

teratogenic risks of carbamazepine (tegretol)

neural tube defects

teratogenic risks of divalproex sodium (Depakote)

neural tube defects specifically spina bifida atrial septal defect cleft palate possible long term developmental deficits

does ambien need to be tapered to discontinue?

no

pregnancy category B

no evidence of risk to humans

methylphenidate metabolism

no significant CYP2D6 metabolism majority of metabolism occurs at first pass effect outside of the liver

the PMHNP working at a student mental health clinic has now been working with a freshman student for several weeks. the PMHNP leans that the student considers himself shy. he tells the NP that he has always felt uncomfortable in social situations or when he has to do oral presentations in class. he had few friends up until senior year of high school when he discovered he could enjoy himself if he had a couple of drinks before going out. he has continued this pattern in college and now occasionally drinks 2 to 3 beers on weekends as well. according to the DSM 5, does this student have a mental disorder?

no, at this point, the student does not meet criteria for a mental disorder

personality disorder pharm management for anxiety

non-benzo anxiolytics SSRIs Benzos used with extreme caution

schedule 1 drugs

nonmedicinal substances high abuse potential used for research only not available by prescription heroin and marijuana

findings during adolescent growth spurt

nonspecific pain in legs markedly elevated alkaline phosphatase level

MAOIs

not first or second line d/t dangerous food/drug interactions

Prader-Willi Syndrome physical characteristics

obesity small stature small hands and feet hypotonia hypogonadism

mr d is a 35 year old, married, high tech industry executive who is referred to the PMHNP for insomnia. mr d reports that he falls asleep quickly bu that difficulty staying asleep. he wakes up several times during the night, and believes he tosses and turns even when he is sleeping. he wakes up feeling exhausted and drinks a pot of coffee to stay awake and concentrate during his long work day. he drinks 1 glass of wine most evenings. he denies any illicit substance use. he denies any symptoms of a mood or anxiety disorder, but is feeling increasingly frustrated and concerned about his sleep. which of the following is the most likely contributing factor to mr. Ds ongoing middle insomnia.

obstructive sleep apnea

Type II research error

occur when investigators falsey reject a null hypothesis and conclude that no relationship exists between variables when, in fact, a relationship does exist. this occurs when there is insufficient power to detect the differences between variables, and is linked to adequacy of the sample size. if a sample size is too small, the study will have insufficient power to detect differences between groups, if differences exist. -consider power to avoid this error

reinforcement in substance abuse disorder

occurs int he ventral segmental area and the nucleus accumbens of the brain collectively caused the reward center -Dopamine release is enhanced further by the release of natural morphine-like neurotransmitters called neuropeptides (enkephalins, beta-endorphins)

brief psychotic disorder incidence and demographics

occurs more in younger clients (20-30yo)

which intervention by the PMHNP for a person experiencing statue de nervosa demonstrates culturally informed care?

offering brief supportive psychotherapy

selegiline in treatment of Parkinson's

offers early neuroprotective effect but lacks long term benefit

IM (revia; vivitrol) for treating caving and maintaining sobriety

opioid antagonist increases abstinence

nalmefene (Revex) for treating caving and maintaining sobriety

opioid antagonist increases abstinence

naloxone (narcan) for treating caving and maintaining sobriety

opioid antagonist, antidote blocks effects of opioids

buprenorphine (buprenex) for treating caving and maintaining sobriety

opioid partial agonist opioid antagonist agonist and antagonist, decreases cravings

Sullivan's stage of interpersonal development early adolescence developmental task

opposite- sex relationships

Sullivan's stage of interpersonal development infancy developmental task

oral gratification, anxiety occurs for the first time

a client comes into the clinic with a longstanding history of depression and chronic renal failure. he is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. the best initial PMHNP action at this time is

order a comprehensive metabolic panel

antiadrenergic side effects

orthostatic hypothension from alpha 1 receptor blockade

acetylcholine symptoms of excess

overinhibition, anxiety, depression, somatic complaints, self-consciousness, drooling, EPS parkinsonian symptoms

in considering whether to order an MRI of the head for a client, what would be a contra for this diagnostic test?

pacemaker

panic and anxiety episodes during sleep is a sign of possible

panic disorder

in pts preseting with dementia, what is the concern regarding brain tumors

paraneoplastic limbic encephalitis should be suspected

what part of the brain is responsible for sensory integration

parietal lobe

in what neuropsych condition are levels of coenzyme q10 lower than normal

parkinsons

FDA approved meds for GAD

paroxetine citalopram escitalopram duloxetine venlafaxine buspirone

melatonin for sleep disorders

particularly useful to correct sleep onset issues and may be helpful for the person with ADHD

substance use disorder

pattern of related use that leads to clinically significant impairment or distress with 3+ of the following symptoms within a 12 month period (tolerance, withdrawal, persistent craving or unsuccessful attempts to cut down, using larger amounts than intended, large amount of time spent obtaining substance, using substance, or recovering from substance, activities decreased or given up because of use, using despite consequences)

Freud's psychosexual stage of development latency stage primary means of discharging drives and achieving gratification

peer relationships, learning, motor-skills development, socialization

what can both lithium and anorexia nervosa cause

peripheral edema

Erikson's developmental stage adolescence indications of developmental mastery

personal sense of identity

dysthymic disorder is associated with what

personality disorders

The risk of bleeding on SSRIs, NSAIDS, or aspirin is an example of what principle

pharmacodynamics interaction is due to the risk of platelet aggregation

the study of what the body does to the drug is called

pharmacokinetics

what medication is most affective for treating social phobia/ social anxiety disorder

phenelzine (MAOI)

Monoamine oxidase inhibitors MAOIs

phenelzine (nardil) tranylcyprmie sulfate (parnate) selegiline transdermal (EMSAM)

in dbt, dialectics refers to

philosophy and approach to communicating with patients

specific phobias

phobic diagnosis should occur only when accompanied by significant functional impairment

the process of allocating scare resources is a definition of

politics

what is true regarding psychosis-induced polydipsia

polydipsia and water intoxication are associated with heavy cigarette use

sleep can be measured by

polysomnography

renal SE of lithium

polyuria with related polydipsia diabetes insipidus edema microscopic tubular changes

glutamate symptoms of deficit

poor memory, low energy, distractible learning difficulty, negative symptoms of schizophrenia

Erikson's developmental stage infancy indication of developmental failure

poor relationships, lack of future hope, suspicious of others

Erikson's developmental stage early childhood indications of developmental failure

poor self-control, low self esteem, self-doubt, lack of independence

highest level of evidence for treating PSTD-related nightmares in adults

prazosin and image rehearsal therapy

what area of the brain has been implicated to modulate pain and can help explain how TMS can decrease pain?

prefrontal cortex

what reflects current understanding of neurodevelopment and best explains risk taking behaviors in adolescent males?

prefrontal cortex is not fully mature until mid-20s or early 30s

group phases

pregroup phase forming phase storming phase norming phase performing phase adjourning phase

genetic testing FDA required in people of Asian descent

presence of HLA-B*1502 allel inherited variant of HLA-B gene prior to prescribing carbamazepine d/t risk of steven Johnson syndrome and toxic epidermal necrolysis TEN

you are asked by a church organization to work with members within your health systems to develop a flu vaccination program. according to public health principles, this is an example of what level of prevention.

primary

a community has an unusually high incidence of depression and drug use among the teenage population. the public health nurses decide to address the problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. what is this an example of?

primary prevention

what is true of measures to evaluate quality improvement in healthcare

process measures can be based on scientific evidence

other agents to tx anxiety dx

propranolol (Inderal) atenolol (Tenormin)

Sarah presents for her initial intake appointment with complaints of depression. She is being treated for HTN and asthma by her PCP. Knowing that certain medications may cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression?

propranolol d

The trend in legal rulings on cases involving mental illness over the past 25 years has been too..

protect the persons's freedoms or rights when they are committed to a mental hospital

food related sleep hygiene

proteins keep you awake carbs make you sleepy

semiformal community support systems

provide physical and emotional assistance provide goods and services

magnetic resonance imaging (MRI)

provides a series of 2D images that represent the brain -advantages: can view brain structures close to the skull and can separate white matter from gray matter; readily available; resolution of brain tissue superior to CT scanning -disadvantages: expensive, many contras to use, claustrophobia

computed tomography CT

provides a three-dimensional view of the brain structures -differentiates structures based on density provides suggestive evidence of brain-based problems but not specific testing for psychiatric disorders -advantage: widely available, relatively inexpensive -disadvantage: lack of sensitivity, cannot differentiate white matter from gray mater; cannot view structures close to the bone tissue; underestimation of brain atrophy, inability to image sagittal and coronal views

structural imaging

provides evidence of size and shape of anatomical structure -computed tomography CT -Magnetic resonance imaging MRI

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)

provides federal legislation that requires any annual or lifetime limits on medical and surgical benefits be the same for mental health and substance use disorder benefits.

older Americans act (OAA)

provides improved access to transportation to older Americans and native Americans

Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful?

psychic determinism principle

first line tx for children and teens with anxiety dx

psychotherapy

Freud's psychosexual stage of development genital stage age

puberty forward

ingestion of methyl alcohol would cause hemorrhage in what part of the brain

putamen

the chief nursing officer of a large behavior health system approached the PMHNP to discuss the new healthcare effectiveness data and information set (HEDIS) behavioral health measures and specifications. the pmhnp is asked to do a retrospective chart review of all hospital discharge clients who received a follow up visit within 7 days of discharge and within 30 days of discharge. the PMHNP has been asked to engage in what?

quality improvement initiative

meds that can cause false positives for heroin or morphine

quinolones rifampin codeine poppy seeds

DBT affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. this philosophy is a supportive principle of DBT training. the central dialectical pattern emphasized in DBT involves the tension between

radical acceptance and change (DBT emphasizes acceptance of current reality of what is and the ability to engage in personal change)

serotonins is produced in what location

raphe nuclei

the PMHNP uses CBT approach to help a pt address self-defeating bx. after identifying the stressor that causes the inappropriate bx, the initial strategy is to explore

rational and irrational beliefs about the stressor

what defense mechanisms are commonly used by persons with obsessive compulsive personality disorder

rationalization isolation intellectualization

which is the best rationale for using CBT

recognize and change his or her automatic thoughts

which communication technique is the PMHNP using in the following situation? Client: "Sorry I was late. I didn't realize what time it was". PMHNP: " this is the third time now that you have been late for our sessions. I am wondering how committed you are to our working on your problems"

recognizing

GABA symptoms of excess

reduced cellular excitability sedation impaired memory

GABA general function

reduces arousal, reduces aggression, reduces anxiety, reduces excitation

formal community support systems

regulated by laws or statutes provided by social workers financial support by social security medical support by medicare

serotonin general function

regulation of sleep pain perception mood states temperature regulation of aggression libido precursor for melatonin

negative punishment

removal of a desirable stimulus to decrease a specific behavior

amiloride is used to treat what side effects of lithium

renal side effects

the core values that underlie apn nursing and culturally competent care are

respect partnership advocacy

positive rewards in substance abuse disorder

results in the social rewards commonly associated with drug use such as disinhibition, euphoric mood, and anxiety reduction -mediated by dopamine pathways

norepinephrine dopamine reuptake inhibitors NDRIs act on

reuptake of norepinephrine and dopamine

MOA of donepezil (Aricept)

reversible acetylcholinesterase inhibition

pregnancy category C

risk cannot be ruled out

what is the importance of preventing delirium

risk of 1 year mortality rate

what is the best reason for considering the SSRI among the first-line drug choices for treating major depression

safe use in suicidal overdose clients

as a pmhnp working in a crisis evaluation center, you are aware that the initial focus of crisis assessment is on what

safety of the client and others

Sullivan's stage of interpersonal development preadolescence developmental task

same-sex relationships

what is correct regarding the study of samples from a larger population compared to study surveys of the population

samples may allow estimations of error in resulting statistics

3yo milestones

says up to 1000 words uses 3-4 word sentences balances on 1 foot plays make believe

what schedule class are Benzos

schedule 4

Freud's psychosexual stage of development oral stage psych disorder linked to failure of stage

schizophrenia, substance abuse, paranoia

temporal lobe abnormalities and differences in the corpus callosum and thalamic nuclei have been identified on MRI studies of pts with which condition

schizotypal personality disorder

eating disorder prevention

secondary prevention important in young clients

conduct disorder prevention

secondary prevention is important in younger clients

catnip herbal use

sedation

valerian herbal use

sedation

chamomile herbal use

sedation anxiety

gabapentin overdose symptoms

sedation ataxia diplopia

antihistaminergic side effects

sedation and weight gain from histamine receptor blockade

serotonin symptoms of excess

sedation, increased aggression, hallucinations (rare)

what meds should be taken on an empty stomach?

sedatives/hyponotics

Erikson's developmental stage middle adulthood indications of developmental failure

self-absorption, inability to row and change as a person, inability to care for others

Erikson's developmental stage early childhood indications of developmental mastery

self-control, self-esteem, willpower

Erikson's developmental stage late childhood indications of developmental mastery

self-directed behavior, goal formation, sense of purpose

Sullivan's stage of interpersonal development late adolescence developmental taks

self-identity developed

Erikson's developmental stage school-age indications of developmental failure

sense of inferiority, difficulty with working, learning

Tramadol and SSRI reaction

serotonin syndrome

following EBP, which laboratory screening tests and assessments should be completed prior to placing a person on an SGA?

serum glucose or hemoglobin A1c, lipid profile, wt, BMI, blood pressure, waist circumference, and family hx of CVD

what are components of interprofessional education at the Rosalind Franklin University of Medicine and Science

service component didactic clinical experience

androphilia

sexual attraction to men or masculinity

gynephilia

sexual attraction to women or femininity

Freud's psychosexual stage of development phallic stage psychiatric disorder linked to failure of stage

sexual identity disorders

Freud's psychosexual stage of development genital stage psych disorder linked to failure of sage

sexual perversion disorders

a client returns for a follow-up appointment 3 weeks after starting on fluoxetine 20mg. during this appointment you notice that her speech is a little rapid, in marked contrast to the psychomotor retardation and paucity of spontaneous speech she displayed on her first visit. instead of looking at the floor, she now makes normal eye contact. her affect has gone from constricted to expansive. she continues to have difficulty sleeping, but her energy has improved and she states she feels so much better! what should you conclude about the shift in the clients presentation?

she is becoming hypomanic

Samantha is a 26 yo partnered woman who works full time as a teacher. she is in a long-term relationship with Mary and they are getting along well, and doing well financially. they have 2 children, ages 2 and 6. Samatha is seeing the pMHNP to address her concerns that she is feeling down and sad for no reason and states, I know my life is going well but I just dont feel happy. I have always worried a lot and have been sad most of my life. as a PMHNP trained in transactional analysis (TA), you understand that personality is multifaceted and wonder if which of the following is affecting her ability to experience happiness.

she likely had a traumatic event in her childhood and her thoughts and feelings related to the event are locked together in her brain and cannot be accessed. (according to TA, when a person is traumatized the thoughts and feelings get tied tighter and the process of therapy is to unlock the two)

what change in a dose response curve is observed when a patient becomes tolerant of a medication

shift to the right

instrumental activities of daily living (IADLs)

shopping using the telephone using transportation activities that facilitate or enhance the performance of ADLs

brain structure abnormalities for dissociative identity disorder

significantly smaller hippocampus and amygdala

Magnetoencephalography MEG

similar to EEG detects different electrical activities used in complementary fashion with EEG testing

z test

similar to t test but requires either a very large sample or a known population variance

DBT draws on cognitive theory and behavioral theory, along with other theories. elements of behavioral therapy in DBT include what?

skills training and exposure (DBT focuses on cogntiive and behavioral techniques, mindfulness including medication, and emotional regulation)

informal community support

social network-family, friends who provide actual assistance in some way

In an attempt to bring the client toward the goal he or she is working on, you ask the client, "if a miracle were to happen tonight, while you slept, and you woke in the morning and the problem no longer existed, how would you know, and what would be different?" This technique is used in which type of therapy?

solution focused therapy

d-amphetamine vs L-amphetamine

some patients have different responses to each

Freud's psychosexual stage of development anal stage primary means of discharging drives and achieving gratification

sphincter control, activities of expulsion and retention

transtheoretical model of change

states that change such as in health bx occurs in 6 predictable stages -precontemplation -contemplation -preparation -action -maintenance

meds that can induce mania

steroids disulfiram (Antabuse) isoniazid (INH) antidepressants in persons with BP

solution focused therapy

steve deshaer bill ohanlon and insoo berg focus to rework for the present situations that have worked previously tx goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths

meds that can cause false positives for amphetamines

stimulants Wellbutrin Prozac trazodone ranitidine nefazodone (serzone) nasal decongestants pseudoephedrine

steven johnsons syndrome tx

stop offending agent supportive measures often in hospital burn unit

you are working with a family: mother, father, and 2 biological children. sam, the father, is very rigid and controlling, which seems to be out of fear that something might happen to his family. he worries daily and it affects his family relationships. you give sam a paradoxical directive and instruct him to intensely worry about everything he can think of for 1 hour a day. using a paradoxical directive is part of which therapy?

strategic

when working with a dysfunctional family, you find that the father worries excessively and is resistant to change. you give him a paradoxical directive to worry extremely well for 1 hour per day, knowing that he will likely be noncompliant, and thus change will occur. with this technique, you are unison which time of therapy?

strategic therapy

Donabedian model

structure, process, outcome

dopamine is produced in what location

substantia nigra

Freud's psychosexual stage of development oral stage primary means of discharging drives and achieving gratification

sucking, chewing, feeding, crying

an example of a mature, healthy defense mechanisms is...

suppression (the client channels conflicting energies into growth-promoting activities)

acetylcholine

synthesized by the basal nucleus of Meynert -precursors are acetylcoenzyme A and choline -nicotinic and muscarinic receptors

a 23 year old women is brought into the ER after attempting suicide by cutting her wrists. which nursing action by the PMHNP would be of highest priority initially.

take her vital signs

a client says to the pmhnp "some days life is just not worth it. all my wife and I ever do is fight and scream. things at home would be calmer and simpler if I just wasn't there anymore". the most therapeutic response for the PMHNP to make is

tell me what you mean by "it would be simpler if you just weren't there anymore"?

delirium symptom pattern

tends to fluctuate during the day

test recall in children

test recall after 5 minutes in school age children show be able to remember 3 objects

analysis of variance (ANOVA)

tests the difference among three or more groups

pearson's r correlation

tests the relationship between two variables

you are the pmhnp treating Tim, a 10 yo child for ADHD and social anxiety disorder. his mother presents with Tim for his scheduled individual therapy session. at the end of the session his mother says I need to take Tim to see his pediatrician and at the last visit I was told he needed some HPV shot. I don't know, he's a boy, why would he need that? what do you think? what is the pmhnps best response to her question?

the CDC recommends the hpv vaccine for all boys and girls at age 10. hpv can cause cancer in both men and women, and the vaccine is effective in protecting against the virus. can you tell me your concerns about Tim getting this vaccine?

tina is a 54 year old single white women who has been a PMHNP for over 20 years. she is considering making application to a DNP program but states of a DNP is required to practice ill get grandfathered in, no need for me to go back to school. following the 2008 license, accreditation, certification, and education (LACE) consensus model for APRN regulation, what is correct?

the DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfathered into a DNP

sunset legislation

the act must be reviewed by a certain date or be automatically rescinded

meaningful use

the concept instituted by medicare and medicaid to improve quality, safety, and efficiency, in healthcare through the use of certified electronic health record technology

Piaget developmental stage sensorimotor

the critical achievement of this stage is object permanence

who runs the Clozapine rems program

the drug company

pleasure principle

the id seeks immediate satisfaction

test specificity

the likelihood of a negative result when the patient does not have the disease of interest

Test sensitivity

the likelihood of a positive result when the pt does have the disease of interest

the numerator in an item by item measurement of a quality improvement measure is

the number of patients for whom the item was performed

a 74 year old woman presents for an evaluation. the pmhnp has her complete a MMSE and a clock drawing. the pt is unable to correctly draw the face of the clock. what area of the brain is most likely to have compromised functioning?

the right hemisphere (involved with facial expression recognition, music and visual images causing disturbances in drawing)

what is not insured by the Universal Bill of Rights for Mental Health patients

the right to refuse a particular mode of treatment is insured except in an emergent situation where the pt is deemed an imminent danger to self or others

dementia screening for the general population is not recommended for the following reason

the service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental ADLs

factor analysis

the statistical technique that seeks to explain the variance of multiples by utilizing a smaller number of unobserved factors

what meds are contraed in ECT

theophylline (cause prolonged seizures) hypoglycemic beta blockers (can cause asystole) lidocaine (can reduce seizure induction) lithium (caused prolonged seizures and confusion)

what is significant about the metabolism of cyclophosphamide, carbamazepine, theophylline, ifosfamide, and aminoglutethiamide?

they auto induce their own metabolisms

what is true regarding the treatment of older adults who are depressed

they constitute a disproportionate number of suicides

per HIPPA, an NP who is in an independent, single practitioner practice is considered a "covered entity" because

they have the ability to transmit protected health information

what is true regarding nurse-managed health centers (NMHC) in the ACA provision

they were funded in the first year

dopamine general function

thinking decision making reward-seeking behavior fine muscle action integrated cognition

what is the primary responsibility of team members on a healthcare quality improvement team

to contribute information and experience

your client sam is being treated for panic disorder with agoraphobia. he currently is being prescribed paroxetine (Paxil CR, 37.5 mg QD) and clonazepam (Klonopin, 0.5mg QD, PRN). he has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. this is possibly an example of which process?

tolerance

SNRIs and other agents

trazodone (Desyrel) venlafaxine (Effexor) desvenlafaxine (Pristiq) mirtazapine (Remeron) nefazodone (serzone) bupropion (Wellbutrin, Forfivo, Aplenzin) duloxetine (Cymbalta) vilazodone (viibryd) vortioxetine (brintellix) levomilnacipran (Fetzima)

Erikson's developmental stage infancy developmental tasks

trust vs. mistrust

in assessing a client, you ask him the meaning of the proverb "people who live in glass houses shouldn't throw stones". he replies "because it will break the windows". the correct interpretation of this finding is

unable to interpret the finding without knowing the client's age (this is a normal thought process in children younger than 12yo)

ego-dystonic personality

uncomfortable

GABA

universal inhibitory neurotransmitter -site of action of benzos, alcohol, barbiturates, and other CNS depressants -GABAa and GABAb receptors

combo of TCA and SSRI

use caution SSRI can elevate TCA concentrations because of pharmacodynamic or pharmacokinetic interactions monitor TCA levels

omega 3 fatty acid supplements

used for ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, and rheumatoid arthritis interacts with warfarin

fish oil supplement

used for bipolar disorder, hypertension, lowering triglycerides, and decreasing blood clotting interacts with warfarin, aspirin, NSAIDs, garlic, and ginkgo may alter glucose regulation

tryptophan supplement

used for depression, obesity, insomnia, headaches, and fibromyalgia increased risk of serotonin syndrome with use of SSRIs, MAOIs, and st johns wort

Sam-e supplement

used for depression, osteoarthritis, and liver dx may cause hypomania, hyperactive muscle movements, and possible serotonin syndrome

melatonin supplement

used for insomnia, jet lag, shift work, and cancer interacts with aspirin, NSAIDS, beta blockers, corticosteroids, valerian, kava kava, and alcohol can inhibit ovulation in large doses

vitamin E supplement

used in enhancing immune system and protecting cells from effects of free radicals used for neurological dx, diabetes, and PMS interacts with warfarin, antiplatelet drugs, and statins increasing risk of rhabdomyolysis

chi-square test

used to compare samples with non measurable nominal/catagorical variables example is color

student t test

used to compare the means of 2 independent sample populations

paired t test

used to compare the means of 2 related (paired) sample populations

ANOVA

used to compare the means of multiple groups to determine if all are equal, thereby generalizing the 2 sample t test to several groups

cohort studies

used to determine incidence, risk factors, and prognosis

discriminant analysis

used to determine the independent variables (x) that appear to affect a quantity of interest (y)

defense mechanisms are best viewed as a function of the ego ....

used to resolve a conflict

case-control studies

used to study rare diseases and outcomes

meds that can cause false positives for alcohol

valium

valproic acid and lamotrigine interaction

valproate doubles the elimination half life of lamotrigine

mood stabilizers

valproic acid (depakene) divalproex sodium (Depakote) lithium carbonate (eskalith, lithobid, lithonate, lithotabs) lamotrigine (lamictal) carbamazepine (tegretol) carbamazepine ER (equetro) oxcarbazepine (Trileptal; off label)

interfering factors of magnesium levels

values can be increased by drugs such as antacids, laxatives containing mg, salicylates, and lithium

interfering factors of calcium levels

values can be increased by excessive ingestion of milk or during tx with lithium, thiazide diuretics, alkaline antacids, or vitamin D -values can be decreased during tx with anticonvulsants, aspirin, calcitonin, corticosteroids, heparin, laxatives, diuretics, albuterol, and oral contraceptives

interfering factors of Free T4

values can be increased during tx with heparin, aspirin, and propranolol values can be decreased during tx with furosemide (Lasix) or Methadone

interfering factors of ALT levels

values can be increased with Tylenol, allopurinol, aspirin, ampicillin, carbamazepine, cephalosporins, codeine, digitalis, indomethacin, heparin, isoniazid, methotrexate, methyldopa, oral contraceptives, phenothiazines, propranolol, tetracycline, and verapamil

sleep circuits

ventrolateral preoptic nucleus in hypothalamus inhibits brainstem arousal in nuclei, which leads to inhibition of wake center producing restful sleep

existential therpay

viktor frankl goal to live authentically and to focus on the present and on personal responsibility

experiential therapy

virginia satir focus on being authentic, freedom of choice, human validation, and experiencing the moment tx goals to develop authentic, nurturing communication and increased self worth of each family member overall goal is growth rather than symptom reduction alone does not focus on particular techniques

endocrine SE of lithium

weight gain impaired thyroid functioning

TCA serum blood levels

well identified levels guide dosing particularly nortriptyline predicts toxicity

operant conditioning

when a reinforcement or punishment is used to modulate the frequency of a behavior

contracted service system

when the np is paid directly by the patient's payer who agrees to pay the NP for providing care for a specific population

what is true regarding the conversion to ICD-10-CM

will increase by tenfold the amount of data that describes clinical conditions

joint commission provider r/s face-to-face guidelines

within 1 hour of initiation and every 8 hours if they remain in r/s

grief and bereavement develops when

within 3 months of stressor

fact witness

witness who has knowledge about the details of a case

can nurses request an opportunity to testify in a legislative arena committee?

yes

a new client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3 year old son. she goes on to say that the boyfriend has thrown things at her and on one occasion threw a glass of water at her and hit her son in the back. should the pmhnp report this to CPS?

yes, the pmhnp has a duty to report

what drug is effective in improving sexual dysfunction in men, but when given with an antidepressant to counter its adverse sexual effects, its actually anxiolytic

yohimbine

for informed disclosure, the following must be included

you may refuse treatment education treatment alternatives

meds that can cause false positives for benzos

zoloft