ANCC PMHNP Review PB
Thyroid Stimulating Hormone levels
0.4-4.0
Sodium levels
135-145
What medication do you use to treat neuroleptic malignant syndrome?
1st discontinue the antipsychotic. Than Dantrolene. Then Bromocriptine (dopamine agonist) to activate the dopamine receptors in the brain and trick the brain into thinking it is getting more dopamine.
WBC level
4500 to 11000
What differentiates atypical antipsychotic medications from first-generation or typical anti-psychotic medications?
5HT2a receptor antagonist properties
Lewy body dementia
A form of dementia characterized by an increase in Lewy body cells in the brain. Symptoms include gradual decline in cognitive function. visual hallucinations, momentary loss of attention, falling, visual hallucinations and fainting.
Agranulocytosis
A life-threatening drop in white blood cells. This condition is sometimes produced by the atypical antipsychotic drug clozapine. WBC less than 3.0 to 3.5 and neutrophil les than 1.3-2.
What brain abnormalities are often seen in ADHD?
Abnormalities in the Reticular Activating System (RAS) and in the prefrontal cortex. Involved in regulating wakefulness, attention and arousal.
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 assum-ing 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 which of the following?
Accountable Care Organization (ACO)
A patient with schizophrenia has developed parkinsonian symptoms while on an antipsychotic. What should you do and what pathway is involved?
Add an anticholinergic medication to counteract the extrapyramidal side effects. the nigrostriatal pathway.
When working with a 26-year-old, Mike, who presents for treatment of cannabis use and gambling, you use motivational interviewing techniques. As a PMHNP, you are familiar with the core counseling skills used in motivational interviewing. Mike made the following state-ment: "I don't know why I came here in the first place but I thought maybe some medica-tion would help me." You respond by saying, "You're feeling confused about the process" and Mike replies, "I never thought I'd need to come to a place like this." You respond, "You kept your appointment today and I appreciate the courage it took for you to come here." What two motivational interviewing techniques are used in this interaction?
Affirming and Reflecting
For a client who has paranoid personality disorder, what are the best treatment strategies?
Alcohol use disorders
What part of the brain plays a central role in processing emotions like fear and anxiety?
Amygdala (part of the limbic system)
First-generation antipsychotics mechanism of action
Blocks dopamine D2 receptors in the mesolimbic pathway while increasing dopamine in the nigrostriatal pathway. This helps alleviate positive symptoms of schizophrenia such as hallucinations and delusions.
What tests should you order before starting Lithium for kidney function?
Blood Urea Nitrogen (BUN) and Creatinine. BUN 7-20. Creatinine 0.7 to 1.2. Ratio is 10:1 or 20:1.
What liver enzyme is primarily responsible for the metabolism of Clozapine (Clozaril)
CYP1A2 induction may lead to increased clozapine metabolism, reducing its effectiveness and potentially causing treatment failure.
What effects pharmacokinetics (PK)
CYP450 enzymes
Strong Inducers (shredders)
Carbamazepine (Tegretol) antiepileptic, Phenobarbital (Luminal) barbiturate, Phenytoin (Dilantin) antiepileptic, Rifampin (rifadin) antimicrobial.
What mood stabilizer requires genetic testing in the Asian population?
Carbamazepine (Tegretol). Can cause severe skin reactions especially in the presence of HLA-B1502 Allele
What part of the brain controls balance, coordination and fine motor skills?
Cerebellum (located at the base of the skull)
What part of the brain is responsible for higher-order functions such as processing sensory information, conscious thought, and voluntary motor activity?
Cerebrum (specifically frontal lobe)
What neurotransmitters are associated with Alzheimer's Disease?
Deficit in acetylcholine and excessive glutamate in the cerebral cortex. Also causes enlarged ventricles and hippocampal atrophy.
Persons with obsessive-compulsive personality disorder often use isolation as a de-fense mechanism. Which of the following examples best describes isolation as a defense mechanism?
Describing information with very little affect variation.
How to test for Huntington's Disease
Direct genetic testing is a highly accurate DNA test that directly detects the presence of the HD gene mutation.
Long term stable lithium user for bipolar disorder complains of recent increased thirst, urination, muscle weakness, severe diarrhea and vomiting. Lithium level is 1.6. What is the initial action?
Discontinue Lithium and start patient on an alternative mood stabilizer. Normal lithium levels are 0.6-1.2. 1.6 suggests severe lithium toxicity.
Neurotransmitter that is involved in reward and motivation?
Dopamine
What neurotransmitter is related to the motor symptoms in Parkinson's Disease?
Dopamine
In ADHD what neurotransmitters are directly involved in the regulation of executive function in the prefrontal cortex?
Dopamine and norepinephrine.
Which is true about pharmacologic treatment of anxiety in older adults?
Drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated.
What neurotransmitters are effected in ADHD?
Dysregulation of dopamine and norepinephrine.Hypothalamic-pituitary-ad
Patient on Olanzapine (Zyprexa) with minimal physical activity, diet high in processed foods, sedentary lifestyle has developed metabolic syndrome. What is the initial action?
Educated the patient on lifestyle modification including diet and exercise.
How do you test CN 5?
Facial nerve. Have the patient smile, frown and puff out their cheeks.
Strong Inhibitors (Fluffers)
Fluvoxamine (Luvox) SSRI, Fluoxetine (Prozac) SSRI, Fluconazole (Diflucan) antifungal, Ketoconazole (Nizoral) antifungal. They can cause the VICTIM substrate to linger longer in the system and increase the concentration in the blood.
What part of the brain dysfunction is responsible for impulsivity and emotional lability?
Frontal lobe
Pick's disease
Frontotemporal lobar degeneration. S/S behavioral changes, personality disturbances, language difficulties and atrophy in the frontal and temporal lobes.
What neurotransmitter is the most abundant inhibitory neurotransmitter in the brain and plays a crucial role in reducing neuron excitability and reducing anxiety?
GABA
It is the most abundant excitatory neurotransmitter in the brain, and it enhances neuron excitability and synaptic transmission.
Glutamate
The primary excitatory neurotransmitter is
Glutamate
What standardized tool is appropriate for a history of GAD, with complaints of persistent worry, restlessness and muscle tension?
Hamilton Anxiety Rating Scale (HAM-A). Includes psychological and somatic symptoms.
A patient with history of alcohol use disorder, presents with cognitive impairments, memory deficits, confusion and difficulty with every day tasks. What area of the brain is most likely affected?
Hippocampus due to its role in memory consolidation and spactial navigation.
When conducting a neurological examination 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
What can contribute to treatment resistant depression?
Hypothalamic-pituitary-adrenal (HPA) axis hyperactivity. Chronic stress and MDD can lead to this by persistent activation of the stress response system and altered neuroendocrine function.
What part of the brain is responsible for regulating physiologic functions like appetite, thirst, body temperature and hormone balance?
Hypothalamus
Target symptoms identification is best explained as
Identification of specific, precise, and individualized symptoms reasonably expected to improve with medication
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This is most likely an example of
Immature regressive defense mechanism
What does pharmacogenomics test for?
It assesses the genetic variations that impact medication response and side effects.
Why is group therapy beneficial
It is always time limited
Bipolar patient with alcohol use disorder is stabilized on Lithium. What do you need to be cautious of?
Lithium levels may be higher due to decreased renal clearance (caused by alcohol use). Lithium is excreted by the kidneys so if they are compromised the body can't clear it and it will build up in the blood.
Why choose lithium for bipolar patients with a history of suicide attempts?
Lithium modulates glutamate receptors which reduced impulsivity.
What neurotransmitters are involved in GAD?
Low Serotonin and norepinephrine. Treat with SSRIs.
What happens when you take a strong inducer and adda CYP450 inhibitor?
Lower the dose of the inducer to avoid possible toxicity bc the inhibitor can increase serum levels of the Inducer.
Symptoms include disorganized thought processes, auditory hallucinations, and impaired reality testing. Family history of schizophrenia. What dopamine pathway is contributing to his symptoms, and what structure?
Mesolimbic pathway in the Ventral tegmental area (VTA)
In ADHD what medication primarily affects the neurotransmitters for dopamine and norepinephrine?
Methylphenidate (Ritalin)
A 74-year-old married white woman was referred to you by her primary care provider for a psychiatric evaluation. She had a normal medical and neurological examination 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, it's just a normal part of getting older, and the kids think everything is fine." During the assess-ment you compete the mini mental status examination (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
What part of the brain is responsible for visual processing and perceptions?
Occipital lobe
A new patient arrives at the office for treatment for depression. The patient reports taking simvastatin (Zocor) and lisinopril (Zestril). When selecting an antidepressant, the psychiatric-mental health nurse practitioner eliminates fluoxetine hydrochloride (Prozac), based on the knowledge that the combination can lead to increased plasma levels of the statin, resulting in an increased risk of muscle damage and rhabdomyolysis. What is the nurse practitioner's rationale?
One medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inhibitor.
What part of the brain is responsible for sensory perception, spatial awareness, and integration of sensory information?
Parietal lobe
In ADHD what part of the brain is involved that is crucial for impulse control, attention and decision making?
Prefrontal Cortex
You are asked by a church organization to work with members within your health system to develop a flu vaccination program. According to public health principles, this is an example of what level of prevention?
Primary
Cytochrome 450 enzymes (CYP450)
Produced mainly in the liver. Makes chemicals less lipid soluble so they can be excreted in urine or bile. Most important 1A2, 2D6, 3A4 and 2C19.
What has been the trend in legal rulings on cases involving mental illness over the past 25 years?
Protect the person's freedoms or rights when he or she is committed to a mental hospital.
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 psychodynam-ic principle assumes that all behavior and actions are purposeful?
Psychic determinism principle
Dialectical behavioral therapy (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
Neuroleptic Malignant Syndrome (NMS)
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Treatment: dantrolene, D2 agonists (e.g., bromocriptine).
What is the mechanism of action for second-generation antipsychotics?
SGA have a strong affinity for serotonin receptors, leading to increased serotonin (5HT2A) transmission. Like FGA it also antagonizes dopamine receptors (D2). Together they reduce positive and negative symptoms with a lower risk of extrapyramidil side effects.
Neurotransmitter involved in mood regulations and digestion.
Serotonin
Bipolar 1 disorder is related to what neurotransmitters?
Serotonin and Dopamine. Low serotonin is linked with depression. Elevated dopamine levels cause mania or hypomania.
What neurotransmitters are associated with mood disorders?
Serotonin and norepinephrine
Patient reports history or recurrent episodes of depression and anxiety. Low mood, fatigue, excessive guild, poor concentration, heightened anxiety, restlessness and racing thoughts. What neurotransmitters are involved?
Serotonin and norepinephrine. Both are indicated in mood disorders. Low serotonin is linked to depression, and imbalanced norepinephrine can cause anxiety.
Following evidence-based (EB) practice, which laboratory screening tests and assessments should be completed prior to placing a person on a second-generation ("atypical") antipsy-chotic medication?
Serum glucose or hemoglobin A1c, lipid profile, weight, body mass index, blood pres-sure, waist circumference, and family history of cardiovascular disease
Cortical dementia s/s
Severe memory deficit, impaired language abilities, difficulty with speech and comprehension.
Samantha is a 26-year-old 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 two children, ages 2 and 6. Samantha 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 don't 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
Serotonin syndrome
Similar to NMS but caused by serotonin medications, and has HYPERreflexive muscle activity
Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral theory in DBT include which of the following?
Skills training and exposure
Subcortical dementia s/s
Slowness in moving, tremors, difficulty with find motor tasks.
How does smoking effect medication dosing?
Smoking can decrease the effectiveness of some medications by increasing the rate it is metabolized requiring a higher dose. It effects the CYP450 enzyme.
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 awoke 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
You have been working with Cody, a 30-year-old single man, in weekly individual psychother-apy for 3 weeks. At the start of session 4 he says, "I noticed when I came in that your usual parking spot has a new car in it with temporary tags, and it's a BMW. Nice car." What is the best response from the PMHNP psychotherapist to Cody?
Sounds like having expensive things is important to you
What non-psych medications can cause new onset of depression symptoms?
Steroids
Dopamine is produced in which of the following locations
Substantia nigra
In Parkinson's disease motor symptoms like bradykinesia, resting tremors and rigidity are due to the degeneration of dopaminergic neurons in what part of the brain?
Substantia nigra (in the midbrain)
What part of the brain is associated with auditory processing, face recognition, memory formation and language comprehension?
Temporal Lobe
What part of the brain is the relay station for sensory information, transmitting sensory signals to various parts of the brain for processing?
Thalamu
Schizophrenic patient with sexual dysfunctions, breast discharge and hyperprolactinemia are side effects from what pathway?
The tuberoinfundibular pathway, due to the blockade of D2 receptors.
S/S of lithium toxicity
Tremors, nausea, confusion, course hand tremors.
What lab test is most crucial before starting psychotropic medications?
Urine pregnancy test
What treatment would you use in a schizophrenic patient with auditory hallucinations and delusions? What pathway is involved?
Use a medication that blocks D2 receptors in the mesolimbic pathway.
Defense mechanisms are best viewed as a function of the ego
Used to resolve a conflict
PharmoDynamics
What the Drug does to the body. Mechanism of action. Does not effect blood levels of either interacting drug.
PharmacoKINetics
What the body (Ken) does to the drug. Movement in and out of the body. DOES effect blood levels of drugs.
Metabolite
When a substrate is metabolized
Substrate
a drug that is bio transformed by an enzyme (VICTIM)
How to treat akathisia (constant need to move) caused by antipsychotics?
beta-blocker
Antagonist (PD)
blocks, diminishes an action or response
Akinesia
complete or partial loss of muscle movement. Can be brought on by antipsychotics.
Inducers
drugs that increase the production of metabolite enzymes. Stimulates liver to make extra enzymes which increase the metabolism and quicker clearance of VICTIM drugs. Decrease serum levels and may not take full effect for 2-4 weeks.
Inhibitors
drugs that interfere with an enzymes ability to metabolize other medications. Binds more tightly than the VICTIM and can either be metabolized itself or block the other substrates metabolism. The VICTIM either has to find another enzyme to metabolize it or hope it can be excreted unchanged. Strong inhibitors can cause the VICTIM to linger longer and increase it's half life which increases the VICTIM level in the blood.
A patient who has borderline personality disorder experiences intense anxiety when the psychiatric-mental health nurse practitioner goes on vacation. The most appropriate explanation for this reaction is that the patient:
has not developed object constancy.
Synergistic/Additive (PD)
increase the effects of medications with similar effects or side effects.
The study of what the body does to drugs is
pharmacokinetics
