Missed Questions (Pocket Prep and Practice IQ)
What term describes a scientific study that analyzes a collection of qualitative studies. The researchers reveal meaning by summarizing the results in a narrative format.
metasynthesis
houses the ventral segmental area and the substantial migration (areas of dopamine synthesis)
midbrain
a score of 14-17 on the HAM-a would indicate what level of anxiety
mild
-Guided imagery -meditation -yoga -biofeedback are types what type of CAM?
mind-body interventions
A score of 18-24 on the HAM-A would indicate what level of anxiety?
moderate
ECG changes with hypercalcemia
shortened QT interval, depressed T waves, bradycardia, heart block
External validity occurs when:
the sample is representative of the population and the results can be generalized.
Risk reduction for a 22 year old patient with schizophrenia taking olanzapine includes patient education on daily exercise, balanced nutrition, and baseline and periodic monitoring of BP, weight, BMI, and: -waist circumference, fasting glucose, fasting lipid panel -waist circumference, fasting lipid panel, EKG, prolactin level -fasting glucose, fasting lipid panel, electrolytes -fasting lipid panel, EKG, liver enzymes
waist circumference, fasting glucose, fasting lipid panel
This type of therapy's concepts include self-directed growth and self-actualization; people are born with the capacity to direct themselves toward self-actualization.
Humanistic Therapy (Person-centered therapy)
Which therapy did Carl Rogers develop
Humanistic Therapy (person-centered therapy)
Calcium levels > 13.5 are associated with:
Hypercalcemic coma and metastatic cancer
In __________ T4 is increased and TSH is decreased, which produces excitatory and labile/anxious-like symptomatology.
Hyperthyroidism
In __________ T4 is decreased and TSH is increased, which produces slowed processes and depressive-like symptomatology.
Hypothyroidism
acetylcholine is decreased in patients with:
alzheimer's disease impaired memory
Herbal products, vitamins, supplements, and aromatherapy are what type of CAM?
biologically based therapies
Systemic effects of hyperthyroidism may mimic symptoms of:
bipolar affective disorders
Supplement used for menopausal symptoms, premenstrual syndrome, and dysmenorrhea
black cohosh
Tanner stage 2 of breast development
breast bud stage with elevation of breast and papilla; enlargement of areola
Enzyme inhibitors can __________ the serum levels of other drugs that are substrates of that enzyme, this possibly causing __________ levels.
increase; toxic
When T4 and T3 are low, TSH secretion:
increases
Tobacco is a CYP450 __________
inducer
grapefruit, bupropion, and SSRIs are CYP450 __________
inhibitors
__________ therapy allows clients to view reality more clearly through an examination of their central distorted cognitions.
interpersonal
This type of therapy has been applied to treat interpersonal distress related to other disorders, including bipolar, substance use, and eating disorders
interpersonal therapy
This type of therapy is evidence-based with a focus on interpersonal issues that are creating distress. It is time-limited and active
interpersonal therapy
this type of therapy was developed to treat aspects of depression and is effective for both adults and adolescents.
interpersonal therapy
The goal of interpersonal therapy is to change clients':
irrational beliefs, faulty conceptions, and negative cognitive distortions.
in schizophrenia dopamine is increased in the __________ pathway and decreased in the __________ pathway
mesolimbic; mesocortical
What term describes a scientific study that statistically analyzes a collection of quantitative studies. These studies use statistics to discover patterns that would be otherwise undetectable.
meta-analysis
Virtue associated with Trust vs Mistrust
Hope
The average onset of schizophrenia in men is ______ years and in women is ______ years
18-25 years; 25-35 years
Normal ALT levels
7-56 units/L
Normal calcium level
8.8-10.5
Signs & Symptoms of discontinuation syndrome
-Flu-like symptoms -fatigue and lethargy -myalgia -decreased concentration -nausea and vomiting -impaired memory -irritability -anxiety -insomnia -crying without provocation -dizziness and vertigo
Baseline labs before initiation of lithium:
-Thyroid panel -Serum Creatinine -BUN -Pregnancy test -ECG for clients older than 50
symptoms of serotonin syndrome:
-agitation, restlessness -rapid heart rate and elevated BP -headache -sweating, shivering, and goose bumps -myoclonic herding and loss of coordination -confusion, fever, seizures, unconsciousness
In distinguishing between and pseudo dementia which of the following findings would be expected in a patient with psuedodementia?
"Don't know" answers typical
glutamate is increased in patients with:
-bipolar
The PMHNP knows that the ego is a part of the personality and is the logical/rational mind including defense mechanisms. What might this personality part say?
"I evaluate"
What are the four domains of evidence-based decision making and practice?
-current research evidence -clinician's expertise -patient's clinical status, circumstances, and preferences -availability of healthcare resources
serotonin is decreased in patients with:
-depression -OCD -anxiety disorders -schizophrenia
In schizophrenia, which neurotransmitters are thought to be decreased?
-dopamine in mesocortical pathway -GABA -serotonin
is schizophrenia which neurotransmitters are thought to be increased?
-dopamine in mesolimbic pathway -glutamate
Several abnormal brain structures have been identified in people with schizophrenia. These are:
-enlarged ventricles -smaller frontal and temporal lobes -cortical atrophy -decreased cerebral flow -hippocampal and amygdala reduction
_________ attacks are a common manifestation among Cambodian and other Asian cultures, and commonly manifest in neck soreness and tinnitus
"Khyal" (wind)
Risk factors for MDD
-genetic loading -prior MDD episode -Female gender -postpartum period -medical comorbidity -single marital status -significant environmental stressors, especially multiple losses
Core symptoms of MDD are the same for children, however some symptoms are more pronounced such as:
-irritability -somatic complaints -social withdrawal
Labs drawn 1 week after start of carbamazepine, valproic acid/divalproex sodium:
-12-hour trough serum drug level -CBC -LFTs
What are the most common issues that people seek individual therapy for?
-losses -interpersonal conflicts -symptomatic presentations such as panic, phobias, and negativity -unfulfilled life expectation at life transitions -characterological issues such as narcissism or aggression
forming phase
-members are concerned about self-disclosure and being rejected. -goals and expectations are identified, and boundaries are established -the development of trust and rapport is very important
Storming phase
-members are resistant and may begin to use testing behaviors -issues related to inclusion, control, and affection begin to surface -leaders' tasks are to allow expression of both positive and negative feelings, assist the group in understanding the underlying conflict, and examine nonproductive behaviors
glutamate is decreased in patients with:
-memory and learning difficulty -negative symptoms of schizophrenia
What are the 4 dopaminergic pathways?
-mesocortical -mesolimbic -nigrostriatal -tuberoinfundibular
adjourning phase
-preparation is made to end the group -both members and leaders express their feelings about each other and termination -a discussion and overview of what has been learned, as well as what issues still need to be worked on takes place
Suicide risk is especially high for people who have certain symptoms or history:
-presence of psychotic symptoms -history of past attempts -history of first-degree relative who committed suicide -concurrent substance abuse or dependency -current serious health problem
norming phase
-resistance to the group is overcome by members -a strong attraction to the group and others emerge -open and spontaneous communication occurs and the group norms are established
dopamine is increased in patients with:
-schizophrenia -psychosis
The peripheral nervous system is composed of:
-spinal nerves and cranial nerves -somatic nervous system -autonomic nervous system
dopamine is decreased in patients with:
-substance abuse -anhedonia -parkinson's disease
performing phase
-the groups' work becomes more focused -creative problem-solving and solutions begin to emerge -experiential learning takes place -group energy is directed toward completion of goals
What is the name for a system capable of facilitating learning and organizational change?
. Inquiring system
Lithium therapeutic index
0.5-1.2
Therapeutic serum range for lithium
0.5-1.2
Normal Free Thyroxine T4 (FT4) values
0.8-2.8
Response to treatment with lithium or anticonvulsant medications is __ to __ weeks
1 to 2
Normal sodium levels
135-148
Normal magnesium levels
1.3-2.1
what is the daily dose of carbamazepine per day?
10-20 mg/day
Td (tetanus, diphtheria) vaccine should be given every ___ years starting at age ___
10; 11
Median age of onset of anxiety disorders is ____ years
11
Do not administer Antabuse until the person has been alcohol free for ___ hours
12
What is the daily dose of lithium for acute episodes
1200-2400 mg/day
Normal TSH levels
2-10
Depakote therapeutic index
50-125
The PMHNP treating a patient for schizophrenia on ziprasidone orders an electrocardiogram. Which QTc interval places the patient at greatest risk for torsades de pointes?
500-700 milliseconds
Normal BMI
20 to 25
Delirium tremens usually occur within ___ to ___ hours
24 to 72
Overweight BMI
26 to 29
What is the daily dose of lamictal?
26-600 mg/day
Onset of autistic symptoms is before age:
3
This type of therapy states that each person has the potential to actualize and find meaning
Humanistic (Person-Centered) therapy
normal potassium levels
3.5-5.1 mEq/l
Obese BMI
30 to 35
What percent of United States citizens carry federal (either Medicare or Medicaid) insurance?
31%
___% of Americans have trouble sleeping, ___% meet the criteria for insomnia disorder
33; 10
For adolescents aged 13 to 17, the therapeutic dose of risperidone (Risperdal) is ___ mg/day. The recommended starting dose of risperidone for adolescents is ___ mg/day.
3; 0.5
Persons with schizophrenia are ____ times more likely to have a substance use comorbidity than the general population.
4
Once started, continue antidepressants for ____ to ____ months. If client has more than ____ prior episodes of MDD, consider antidepressants indefinitely.
6 to 12; 2
Who should get the shingles vaccine
60 or older who have had the chickenpox
What percent of United States citizens carry private insurance?
64%
Rapid cycling is the occurrence of ____ or more mood episodes during the previous ____ months.
4; 12
it takes approximately ___ half-lives to achieve a steady state and ___ half-lives to completely eliminate a drug
5
persons with Bipolar disorder are ____ times more likely to have a substance use disorder than the general population
5
Normal ALT levels:
5-35
Normal AST levels
5-40
Normal AST levels
5-40 units/L
Nurse practitioners are reimbursed by Medicare and Medicaid in every state for providing the exact same services as physicians. In nearly every state, nurse practitioners are reimbursed at a rate of ___% of the allowable physician rate. Iowa is the only state where nurse practitioners bill at ___% of the allowable physician rate.
85;100
At what ages should the HPV4 vaccine be given to boys?
9 through 26 years
What is the daily dose of lithium for maintenance?
900-1200 mg/day
Normal chloride levels
98-106 mEq/L
Normal Serum Creatinine level:
<1.5
Gold standard for treating manic episodes
Lithium
This type of therapy promotes change by the development of greater insight and awareness of maladaptive defenses
Psychoanalytic therapy
Which medication for ADHD is approved by the FDA to be started in a child at age 3?
Amphetamines
A family nurse practitioner asks the PMHNP what antidepressant to start for a patient who has a score of 15 on the PHQ9. What is the appropriate response?
A score of 15 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment.
Who developed Cognitive therapy
Aaron T. Beck
Test the strength of the sternocleidomastoid and trapezius muscles against resistance of your hands
Accessory Spinal
Alcohol use rates are highest in which ethnicities and lowest in which?
African Americans, hispanic Americans, and native Americans; asian Americans
What is the black box warning for carbamazepine/valproic acid?
hepatotoxicity and pancreatitis
Triangles
dyads that form triads to decrease stress; the lower the level of family adaption, the more likely a triangle will develop
Cluster B Personality Disorders:
Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder
Cluster C personality disorder characteristics are described as:
Anxious
Who developed behavioral therapy
Arnold Lazarus
For Stevens-Johnson syndrome with Carbamazepine, particularly in people of ______ descent, you should screen for _______ allele before initiating.
Asian; HLA-B 1502
divided into the sympathetic nervous system and parasympathetic nervous system
Autonomic nervous system
A WBC of 4000 in a patient taking clozapine would prompt the PMHNP to take what action?
At a WBC of 4000, the recommendation is to closely monitor CBC with differential twice a week while patient may continue clozapine in the absence of any other signs or symptoms.
multigenerational transmission process
dysfunction present over several generations
Cancerous moles can be detected using the acronym ABCDE which stands for:
Asymmetry Border irregularity Color variation Diameter greater than 6mm Elevation
Cluster C Personality Disorders
Avoidant personality disorder Dependent personality disorder Obsessive-compulsive personality disorder
This type of therapy focuses on changing maladaptive behaviors by participating in active behavioral techniques such as exposure, relaxation, problem-solving, and role-playing.
Behavioral therapy
The mean age of ____________ onset is early 20's
Bipolar
__________ affects 2.3 million Americans; 1.2% of the U.S. adult population older than 18
Bipolar
Which type of Bipolar is characterized by 1 or more manic or mixed episodes.
Bipolar 1
Which type of bipolar is characterized by the occurrence of one or more depressive episodes accompanied by at least one manic or hypomanic episode
Bipolar II
__________ is seen in some thought disorders, and it is defined as the fabrication of facts and details to fill gaps in memory.
Confabulation
Lab work in depression
CBC, chemistry profile, thyroid function tests, B12 and folate levels, drug screen
Virtue associated with Generativity vs Stagnation
Care
Which SSRI has a warning about prolonged QTc interval in doses above 40mg (20mg in older adults)
Celexa
Which SSRI is useful in treating cravings
Celexa
A 57-year-old female diagnosed with major depression arrives at the emergency room in possible cardiac arrest. She is admitted to a unit and shortly thereafter experiences a seizure. Her husband states that she may have taken an increased dose of her medication. Which medication could be responsible for her symptoms? -Atomoxetine -Fluoxetine -Venlafaxine -Clomipramine
Clomipramine Clomipramine is a tricyclic antidepressant that blocks voltage-sensitive sodium channels in both the brain and the heart. In overdose, tricyclic antidepressants can lead to coma, seizures, cardiac arrhythmia, and death.
In children, these alpha-agonists are often used for anxiety:
Clonidine (Catapres) Guanfacine (tenex)
Which antipsychotic medication is the only known antipsychotic to reduce the risk of suicide in schizophrenia?
Clozaril (clozapine)
-History of unexplained multiple -fractures -Burns, hand or bite marks -Injuries at various stages of healing -Evidence of neglect -Bruising on padded parts of the body
Common indicators of physical child abuse
Virtue associated with industry vs inferiority:
Competence
A middle-school boy repeatedly lies, steals, bullies peers, instigates fights, and inflicts harm without feeling any regret or remorse. These are characteristics of which disorder?
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 three of the following criteria must be present in the past 12 months, with one 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
Conduct Disorder
Chronic, fluctuating mood disorder with symptoms similar but less severe than Bipolar Disorder. Numerous periods of hypomanic and dysthymic symptoms.
Cyclothymic Disorder
This type of therapy focuses on emotional regulation, tolerance for distress, self-management skills, interpersonal effectiveness, and mindfulness, with an emphasis on treating therapy-interfering behaviors.
DBT
Medications used in the treatment of NMS:
Dantrium (dantrolene) or Parlodel (bromocriptine)
A PMHNP treating a 32-year-old woman after hospitalization for postpartum psychosis after the birth of her first child needs to consider which as the most important risk factor when monitoring her 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.
__________ is more effective than lithium for rapid cycling and mixed bipolar
Depakote
Patients with ____________ personality disorder fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They desperately desire the approval of others, and they often volunteer for unpleasant tasks to gain the favor of others
Dependent
excitatory response
Depolarization Involves OPENING of sodium and calcium channels with these ions going INTO the cell
Which neurotransmitter is responsible for thinking, fine muscle action, and reward-seeking behavior
Dopamine
__________ is removed from the synaptic cleft by monoamine oxidase (MAO) enzymatic action
Dopamine
Risk Factors for developing somatic symptom disorder:
Female gender Lower socioeconomic status Unemployment Older age Fewer years of education Recent stressful life events Negative affectivity Childhood sexual abuse Comorbid psychiatric condition Perceived illness benefits Sensitization to pain Heightened attention to bodily sensations
Cluster B personality disorder characteristics are described as:
Dramatic and affective instability
Antagonist effect
Drug binds to the receptor but does not activate a biological response
Muscle spasm; spasticity of muscle group, especially back or neck muscles; subjectively painful.
Dystonia
Teratogenic risks of lithium
Ebstain anomaly
__________ is the echoing of words or phrases just spoken by another
Echolalia
Which neurotransmitter is responsible for reducing arousal, aggression, and anxiety
GABA
this is the universal inhibitory neurotransmitter
GABA
This type of therapy states that behavior is determined by personal experience and not by external reality
Experiential therapy
True or false: Bipolar is more common than MDD
FALSE
this theory is based on the idea that one could not understand any family member (part) without understanding how all family members operate together (system)
Family systems theory
Virtue associated with identity vs role confusion:
Fidelity
Which is the only medication that is approved by the FDA to treat depression in children?
Fluoxetine (Prozac)
__________ assessments are specifically for those with a violent, dangerous, and/or criminal record and often take place in a judicial arena such as jail, prison, or court.
Forensic Risk
Who developed EMDR
Francine Shapiro
Who developed psychoanalytic therapy
Freud
This neurotransmitter is the site of action of benzos, alcohol, barbiturates, and other CNS depressants
GABA
In anxiety, neurobiological deficits result in low levels of the neurotransmitter __________, the chemical responsible for inhibitory responses of neurons, and in high levels of __________, the chemical associated with the fight-or-flight response.
GABA; norepinephrine
Diseases that have increased thyroid levels:
Graves disease Thyrotoxicosis due to T4 Hashimoto's Thyroiditis acute thyroiditis
Your patient with bipolar disorder recently suffered a myocardial infarction (MI). He was stabilized at the hospital and discharged on propranolol (Inderal, Hemangeol, InnoPran), losartan (Cozaar), and hydrochlorothiazide (Microzide). Prior to his MI, his lithium level was consistently around 0.8 mmol/L on 900 mg of lithium carbonate per day. He arrives at your office today, and his lithium level is now 1.3 mmol/L on the same dose. What caused this change?
HCTZ
ECT is a treatment for depression. What adverse effects are common for a patient to experience after receiving ECT treatments?
Headaches, memory disturbances, and muscle soreness are common immediately after ECT treatment.
What term is related to the value, effectiveness, and efficiency of care received.
Health economics
What term is a mathematical expression that shows the relationship between an individual's health and a number of other variables, including the amount of health care consumed.
Health production function
Your patient wants to communicate with your through email. You have a secure email account that is encrypted and will protect health information as required by HIPAA. Your patient does to have an encrypted email account. Your reply is:
In order to communicate back and forth, you will have to find a way to encrypt your protected health information (PHI).
In distinguishing between HIV-related depression from HIV dementia, which of the following findings would be indicative of HIV dementia? -Incoordination -Decreased motivation -Diminished attention and concentration -apathy and intertia
Incoordination
an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least six months with at least 4 of the associated symptoms: -loses temper -touchy or easily annoyed (Haley) -angry or resentful -argues with authority -actively defies or refuses to comply with requests of rules from authority figures -blames others -deliberately annoys others -spiteful or vindictive
ODD
Gerald L. Klerman and Myrna M. Weissman developed which therapy
Interpersonal Therapy
Who was the first person to put a theoretical perspective on group work
Irvin Yalom
Who developed strategic therapy
Jay Haley
Lithium is excreted through the:
Kidneys
When evaluating a 5 year old child with language deficits, which of the following is a key indicator in differentiating autistic disorder from a mixed receptive-expressive language disorder?
Language abnormalities such as echolalia are common in autistic disorders
In the neurobiological theory of anxiety, deficits are genetically mediated by and involve predominantly the ___________, __________, and sections of the __________.
Limbic system; midline brainstem area, cortex
Mr. Ready is a 58-year-old new patient at a community mental health center. He's seen by the PMHNP for depression, anxiety, and co-morbid substance use disorder, which the patient describes as effective in treatment of his symptoms. He does not have a PCP and does not know when he last had laboratory values drawn. Ready takes Tylenol PRN for knee pain and Prilosec OTC b.i.d., and has been on his current psychotropic medications for over 2 years. Buspirone 20mg b.i.d., Sertraline 200mg po daily, and Aripiprazone 2mg daily. Which lab are appropriate for this patient?
Lipid profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D. Following APA, ADA, and SGA guidelines, he should have a CMP and Lipid profile; based on a history of depression, need to rule out an organic cause and should check thyroid and vitamin D; and due to long-term treatment on PPI, his B12 level should be checked. As he is on an atypical antipsychotic, his CBC should be monitored.
Virtue associated with Intimacy vs isolation
Love
Marijuana is used by 3% of all pregnant women. Chronic marijuana use is associated with the following symptoms in neonates:
Low infant birth weight Prematurity Withdrawal-like symptoms Excessive crying Tremors Hyperemesis (severe vomiting)
Those eligible for Medicaid include the following:
Low-income children Low-income pregnant women Elderly and disabled individuals who qualify for the Supplemental Security Income Program
What class of medication are Phenelzine (Nardil), Tranylcypromine sulfate (partite), and Selegiline is
MAOI
Women are 1.5 to 3 times more likely than men to develop which of the following psychiatric conditions beginning in adolescence? -OCD -MDD -Schizophrenia -Alcohol Use Disorder
MDD
In bipolar 1 disorder, men are more prone than women to have:
Manic Episodes
Which intervention has evidence-based findings to reduce co-morbid substance use in patients with schizophrenia?
Manualized group intervention with motivational enhancement
Who developed DBT
Marsha Linehan
Who developed family systems therapy
Murray brown
You are seeing a female patient who is morbidly obese. She also suffers from major depression, anxiety, and antidepressant-induced decreased libido. She has been stabilized on Desvenlafaxine (Pristiq) 50mg 1 po Q AM and Buproprion (Wellbutrin) 50mg. She also taken Mononessa (Ortho-Cyclen) 1 po Q AM. She has had trouble maintaining weight loss. She asks you about using Phentermine for weight loss. You discuss options with her and decide to:
Naloxone should be added to the Bupropion to extend the decreased cravings for good.
white matter is:
the myelinated axons of neurons
__________ are word inventions or unusual application of current words
Neologisms
Which neurotransmitter is responsible for alertness, focused attention, learning, and memory
Norepinephrine
__________ is associated with Group A beta-hemolytic streptococcal infections (scarlet fever, strep throat)
OCD
Cluster A personality Disorder characteristics are described as:
Odd, unusual, eccentric and asocial
On Old Olympus Towering Top A Finn And German Viewed Some Hops
Olfactory Optic Oculomotor Trochlear Trigiminal Abducens Facial Acoustic Glossopharyngeal Vagus Accessory Spinal Hypoglossal
Supplement that is used for ADHD, dyslexia, cognitive impairment, dementia, cardiovascular disease, asthma, lupus, and rheumatoid arthritis
Omega-3 fatty acids
CBT is often one of the first-line treatments for anorexia nervosa. One of the primary goals of CBT is to assist the patient in which of the following ways:
Overcome distorted thinking
patients with __________ personality disorder are suspicious, have few friends, and read hidden meaning into innocent remarks
Paranoid
Cluster A personality disorders:
Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder
most likely SSRI to have discontinuation syndrome
Paxil
Which inferential statistic tests the relationship between two variables
Pearson's r corrleation
Treat hypertensive crisis with:
Phentolamine
What is the treatment of a hypertensive crisis involving MAOIs?
Phentolamine
In distinguishing between cortical and subcortical dementias, which of the following findings would be indicative of subcortical dementia?
early gait disturbance
houses the locus cerulean (area of norepinephrine synthesis)
Pons
Fanning of toes and dorsiflexion of the great toe
Positive Babinski
__________ prevention is aimed at decreasing the number of new cases of mental disorders. An example of primary prevention is Drug Abuse Resistance Education (D.A.R.E.) programs in elementary and middle schools.
Primary
Virtue associated with Initiative vs Guilt
Purpose
A client says that because he wished his sister was dead, and your client's sister subsequently was killed in a motor vehicle accident, the death was caused by the client's wishes. The client also revealed that he can read other's minds. The client is most likely suffering from which personality disorder?
Schizotypal Personality Disorder (Characterized by ideas of reference and magical thinking)
__________ prevention is aimed at decreasing the number of existing cases of mental disorder. Examples of secondary prevention include telephone hotlines, crisis intervention, and disaster response.
Secondary
family system
the process by which all family members operate together
A score of 25-30 on the HAM-A would indicate what level of anxiety?
Severe
What term describes a scientific study that gathers multiple studies and analyzes them to draw a larger conclusion?
Systematic Review
Act primarily to increase serotonin levels in CNS by inhibiting their presynaptic reuptake
SSRIs
Who developed structural family therapy
Salvador Minuchin
Supplement that is used for depression, osteoarthritis, and liver disease
Sam-e
inhibitory response
Repolarization; involves the opening of chloride channels with chloride going into the cell, potassium leaves, or both
__________ is the development of specific deficits following a period of normal functioning after birth
Rett Syndrome
Risk factor for Rent Syndrome
Seizures
This psychotropic may cause cataracts
Seroquel
a 31 year old male diagnosed with depression undergoes an fMRI. His test reveals increased activity in the ventromedial prefrontal cortex. Which class of medication aids in pyramidal cell functioning in the prefrontal cortex by preventing the excessive release of glutamate:
Serotonin antagonist/reuptake inhibitors (SARIs) block 5HT2A receptors which inhibits glutamate release in the prefrontal cortex of the brain
Which of the following lab findings would raise the greatest concern when prescribing Lithium? -Serum Creatinine 3.0 mg/dL -GFR Rate 115 mL/min -BUN 20 mg/dL -Na+ 120 mEq/L
Serum Creatinine -Normal serum creatinine is <1.5 mg/dL. Elevated creatinine indicates decreased renal function. Lithium is excreted through the kidneys and decreased renal function can result in lithium toxicity.
__________ thinking is the understanding of structures that undergird complex systems and the use of this understanding to effect significant and enduring change. __________ thinking is an important skill for nurse practitioners who wish to enact effective quality improvement initiatives.
Systems
All of the following endocrine findings are suggestive of alcohol dependency except: Splenomegaly Gynecomastia Testicular atrophy Sexual dysfunction
Splenomegaly Splenomegaly is a gastrointestinal finding suggestive of alcohol dependency. Other gastrointestinal findings include hepatomegaly and intestinal tenderness. Testicular atrophy, gynecomastia, and sexual dysfunction are all endocrine findings suggestive of alcohol dependency.
What class of medication is Clomipramine (Anafranil) in?
TCA
Considered second-line drug in treating MDD
TCAs
If the pituitary gland fails, what happens to TSH
TSH is not secreted and blood levels of TSH fall.
You are treating a patient with MDD, insomnia and chronic low back pain. During his fourth medication session with you, the patient states that money is tight and an appointment is required with his GP to refill the Hydrocodone. The patient asks you to refill the Hydrocodone to save the cost of another appointment. What is your reply?
State that your certification is for psychiatric care only and refer him back to his GP.
who developed solution-focused therapy
Steve deShazer, Bill O'Hanlon, and Insoo Berg
a rare, potentially life-threatening immune reaction to a foreign antigen that can occur with exposure to any anticonvulsant drug.
Stevens-Johnson syndrome
established that a mental health professional has a "duty to warn" potential victims of impending danger from a patient. State laws on "duty to warn" vary by state. It is professional responsibility to know what is required in the state where one practices.
Tarasoff v Regents of the University of California
What legal precedent guides the nurse practitioner's duty to warn?
Tarasoff v. Regents of University of California
The etiology of ODD includes the following:
Temperament Parents who model extreme ways of expressing emotions Trauma Unresolved conflicts
__________ prevention is aimed at decreasing the disability and severity of a mental health disorder. Providing social skills education for a group of intellectually disabled teenagers is an example of tertiary prevention.
Tertiary
Ca levels < 7.0 are associated with:
Tetany
Per HIPAA, a Nurse Practitioner who is in an independent, single practitioner practice is considered a "Covered Entity" because:
The NP transmits protected health information in electronic forms.
a PMHNP has a collaborative agreement with a psychiatrist. The PMHNP reviews all new and complex cases with the psychiatrist on a monthly basis. A young adult patient with recurrent depression has been under the care of the PMHNP for 3 months when she commits suicide. The family sues for wrongful death. Who is responsible for this patient's care in a court of law?
The PMHNP
Your 37-year-old female patient suffers from schizophrenia. She has been maintained in stable condition for four years on Quetiapine (Seroquel). She tells you that her gynecologist has recommended that she have a total hysterectomy. You asked her if her gynecologist plans to prescribe hormone replacement after the total hysterectomy. She responds "no". You initiate a call to the gynecologist to discuss hormone replacement therapy as follows:
The abrupt loss of estrogen from the ovaries can precipitate deterioration of mental state, hallucinations, delusions, and depression as well as the stress from surgical menopause.
Those eligible for Medicare include the following:
Those age 65 and older having worked 40 quarters and paid Medicare taxes Certain younger individuals with disabilities Individuals with end-stage renal disease Individuals in need of a kidney transplant Individuals receiving Social Security Disability and who have amyotrophic lateral sclerosis
__________ is the sudden stoppage of speech attributed to losing thought
Thought blocking
a 33 year old female patient has been diagnosed with bipolar disorder. Before starting this patient on lithium, which of the following laboratory tests are appropriate to obtain for this patient?
Thyroid function tests, creatinine, pregnancy test
A 34 year old African American female presents for an initial psychiatric evaluation. On examination, she reports that she thinks she has attention deficit disorder because she has a short attention span, poor recent memory, nervousness, and mood lability, and she is sweating more. Which laboratory test should you order to rule out an organic etiology of her symptoms?
Thyroid panel
Outcomes measurement is the collecting and reporting of data about the effect of an intervention. Purposes of outcome measurement include all of the following except: to analyze the effectiveness of an intervention; to suggest changes in treatment; to profile practice patterns of providers; to observe errors in data reporting of an intervention
To observe errors in data reporting of an intervention.
_______ elevate serotonin and norepinephrine levels primarily by inhibiting their presynaptic reuptake
Tricyclic antidepressants
Who developed existential therapy
Viktor Frankl
Who originated experiential therapy
Virginia Satir
Which laboratory test should be ordered to run out a medical cause of dementia symptoms? -Albumin -Vitamin B12 -Vitamin D3 -Thiamine
Vitamin B12
Omega-3 fatty acids can interact with:
Warfarin (Coumadin), increasing anticoagulant effects
Which antidepressants can cause a false positive for amphetamines
Wellbutrin and prozac
Virtue associated with autonomy vs shame and doubt:
Will
Virtue associated with Ego Integrity vs Despair
Wisdom
When counseling a woman with children who is living in a violent domestic relationship, the PMHNP needs to advise that:
Written material about shelters found by the perpetrator may trigger further violence.
Which antidepressant can cause a false positive for benzos
Zoloft
Biofeedback
a process providing a person with visual or auditory information about the autonomic physiology functions of his or her body, such as blood pressure, muscle tension, and brain wave activity. The person learns to consciously control these processes, which were previously regarded as involuntary.
There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and which disorders?
alcoholism, anxiety, depression, diabetes, and heart disease
When should the HPV vaccine be given to girls?
age 11 or 12 with earth-up doses at ages 13 through 26
If a client is presenting with elevated temperature and is also taking psychotropic meds such as carbamazepine (Tegretol) or clozapine (Clozaril), be alert for:
agranulocytosis
What does Carbamazepine have a black box warning for?
agranulocytosis and aplastic anemia
tertiary prevention
aimed at decreasing the disability and severity of a mental disorder
primary prevention
aimed at decreasing the incidence (number of new cases) of mental disorders
secondary prevention
aimed at decreasing the prevalence (number of existing cases) of mental disorders
Motor restlessness; inability to remain still; rocking, pacing, or constant motion of unilateral limb; also can manifest as a subjective sense of restlessness without objective finding. Often mistaken for increasing anxiety
akathisia
absence of movement, difficulty initiating motion, subjective feeling of lack of motivation to move. Often mistaken for laziness or lack of interest
akinesia
Trazodone and ranitidine can cause a false positive for:
amphetamines
responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions
amygdala
which inferential statistic tests the difference among three or more groups
analysis of variance (ANOVA)
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which of the following?
annual of lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan.
Cluster B personality disorders
antisocial, borderline, histrionic, narcissistic
GABA is decreased in patients with:
anxiety
norepinephrine is increased in patients with:
anxiety
what is belladonna used for
anxiety
Tanner stage 4 of breast development
areola and papilla from a secondary mound above level of breast
Mr. Jones' depression has been successfully treatment with citalopram 20mg PO daily. During a visit, Mr. Jones complains that in the last 2 to 3 weeks, he has had nausea, fatigue, feeling, weak, with a headache and decreased appetite. Which action would be the most appropriate for Mr. Jones?
assess for other symptoms of hyponatremia and check a serum sodium level
This is a latino cultural syndrome usually provoked by disruptions in family bonds and may be manifested by trembling, crying, and screaming. The attacks are usually experienced in the presence of others and the person often feels relief afterward
ataques de nervios
Which of the following best depicts the PMHNP in a grassroots mental health advocacy role?
attending a town hall meeting to seek timely police response to rising domestic violence crisis calls.
regulates internal body functions to maintain homeostasis; conveys information from the CNS to smooth muscle, cardiac muscle, and glands; responsible for involuntary movement
autonomic nervous system
Cluster C personality disorders
avoidant, dependent, obsessive-compulsive
serves as a complex feedback system to modulated and stabilize somatic motor activity (information conveyed from he CNS to skeletal muscles)
basal ganglia
Be alert for Stevens-Johnson syndrome, especially if the client is taking:
carbamazepine or lamotrigine (Lamictal)
Your work as a NP makes you aware that there are many people who cannot afford services for their mental health needs. As part of your concern for social justice you:
care for a number of patients pro bono each year.
also known as soma; made up of the nucleus and cytoplasm within cell membrane
cell body
responsible for maintaining equilibrium; acts as a gross movement control center
cerebellum
largest part of the brain, which is divided into two halves
cerebrum
When AST > ALT one suspects:
chronic liver disease or recent post MI
NSAIDS can cause a false positive for which drug
cocaine
Systemic effects of hypernatremia:
convulsions, pulmonary edema, thirst, fever, dry mucous membranes, hypotension, tachycardia, low jugular venous pressure, restlessness
a large bundle of white matter that connects the two cerebral hemispheres and is an area of sensory exchange between the two
corpus callosum
examples of tertiary prevention
day treatment programs, case management for physical, housing or vocational needs, social skills training
Enzyme inducers can __________ the serum level of other drugs that are substrates of that enzyme, this possible causing __________ drug levels.
decrease; subtherapeutic
When T4 and T3 are high, TSH secretion:
decreases
collect incoming signals from other neurons and send the signal toward the neuron's cell body
dendrite
signs of compassion fatigue
denial about problems, excessive blaming, holding in emotions, isolating from others, an unusual amount of complaints, complaining about administrative functions, substance abuse used to mask feelings, compulsive spending, over eating, gambling or sexual addiction, poor self care and poor self hygiene
Norepinephrine is decreased in patients with:
depression
High BMI is a risk factor for:
diabetes, heart disease, stroke, hypertension, osteoarthritis, and some forms of cancer
Childhood depressive disorder that is diagnosed in children older than age 6 but younger than age 18
disruptive mood dysregulation disorder
__________ is produced in the substantial migration and the ventral segmental area
dopamine
Agonist effect
drug binds to receptors and activates a biological response
inverse agonist effect
drug causes the opposite effect of agonist; binds to the same receptor
Partial agonist effect
drug does not fully activate the receptors
In distinguishing borderline personality disorder from chronic post-traumatic stress disorder related to childhood sexual abuse and victimization, which of the following would be more indicative of borderline personality disorder/ -affect lability often associated with intense fear -irritability or intense outbursts of anger -efforts to avoid real or imagined abandonment -feeling of detachment or estrangement from others
efforts to avoid real or imagined abandonment
At what age can fluoxetine and bupropion be started according to the FDA?
eight
which neurotransmitter is produced by the adrenal glands
epinephrine
What does the Romberg test assess?
equilibrium
patients with this disorder so persistently pick at their skin that they leave scars
excoriation disorder
This type of therapy states that a basic dimension of humans includes finding meaning and purpose in life— "Why am I here?" "What is my purpose?"
existential therapy
This type of therapy focuses on being authentic, on freedom of choice, on human validation, and on experiencing the moment
experiential therapy
Dementia with Lewy bodies is usually accompanied by:
extrapyramidal symptoms
this type of therapy focuses on chronic anxiety within families
family systems therapy
Existential therapy emphasizes accepting __________ and making __________.
freedom; responsible choices
problems in the __________ lobe can lead to personality changes, emotional and intellectual changes
frontal
Tanner stage 3 of breast development
further enlargement of breasts and areola; no separation of their contour
This is the universal excitatory neurotransmitter
glutamate
this is the major neurotransmitter involved in the process of kindling, which is implicated in seizure disorders and possible bipolar disorders
glutamate
________ matter is the working area of the brain and contains the synapses, the area of neuronal connection
gray
Regulates memory and converts short-term memory into long-term memory:
hippocampus
Calcium levels > 11.0 are associated with:
hyperparathyroidism
plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormonal regulation
hypothalamus
Neuroimaging has shown consistent abnormalities in which structures of the brain in people with chronic and severe depression
hypovolemic hippocampus hypovolemic prefrontal cortex-limbic stratal regions
You have a 16-year-old patient who suffers from binge eating disorder. She is 5 foot 10 inches (70 inches) and has a BMI of 30. You consult the National Guideline Clearing House for the best information on treating the patient. Part of your treatment plan includes:
implementing non-diet health at every size therapy in addition to psychotherapy to help with weight stabilization and binge eating.
Systemic effects of hyponatremia:
lethargy, headache, confusion, apprehension, seizures, coma, hypotension, tachycardia, decreased urine output, weight gain, edema, ascites, jugular vein distention
What hematological changes are associated with lithium?
leukocytosis
When suspecting a patient has NMS, which laboratory values would help confirm the diagnosis?
leukocytosis (elevated WBC) and elevated creatine phosphokinase (CPK)
the __________ is the essential system for the regulation and modulation of emotions and memory
limbic system
how to test the hypoglossal nerve
look for tremors and other involuntary movement when the client protrudes his or her tongue.
acupressure and acupuncture, massage, and reflexology are what type of CAM
manipulative and body-based therapies
Tanner stage 5 of breast development
mature stage: projection of papilla only, related to recession of areola
Together with the Pons, contains autonomic control centers that regulate internal body functions
medulla
_______ elevate serotonin and norepinephrine levels primarily by inhibiting MAO, the enzyme that breaks down monoamine neurotransmitters.
monoamine oxidase inhibitors
NMS can be differentiated from serotonin syndrome by the presence of:
mutism, leukocytosis, dysphagia, and laboratory evidence of muscle injury, i.e. elevated CPK, myoglobinuria, or rhabdomyolysis
ECG changes with hyperkalemia
narrow and taller T waves Mild: shortened QT interval Severe: depressed ST segment, prolonged PR interval, widened QRS complex leading to cardiac arrest
gray matter is composed of:
nerve cell bodies and dendrites
Teratogenic risks of Carbamazepine
neural tube defects
teratogenic risks of depakote
neural tube defects specifically spina bifida, atrial septal defect, cleft palate, and possible long-term developmental deficits.
the __________ is the basic cellular unit of the nervous system
neuron
__________ is produced in the locus ceruleus of the pons
norepinephrine
__________ is the major neurotransmitter implicated in mood, anxiety, and concentration disorders
norepinephrine
Patients with ___________ personality disorder are perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
obsessive-compulsive
problems in the __________ lobe can lead to visual field defects, blindness, and visual hallucinations
occipital
Which of the following antipsychotic medication has dosage formulations which include oral tablets, orally disintegrating tablets, short-acting injections, and long-acting injections?
olanzapine (Zyprexa)
Thorazine (chlorpromazine) can cause what side effect secondary to the alpha 1-adrenergic blockade
orthostatic hypotension
which inferential statistic describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone.
p-value (level of significance)
Cluster A personality disorders
paranoid, schizoid, schizotypal
maintains or stores energy; inhibits or decreases activity of organs
parasympathetic nervous system
family projection process
parents transmitting their own level of differentiation on the most susceptible child
acetylcholine is increased in
parkinsonian symptoms
Be aware that lithium and anorexia nervosa can cause:
peripheral edema
_______________ are chronically maladaptive patterns of behavior that cause functional impairment in work, school, or relationships.
personality disorders
When a clinical trial fails to reject the null hypothesis (i.e., when p-value > 0.05), the investigator may have missed a true intervention effect. One should consider what to avoid a type II error?
power Type II errors occur when there is insufficient power to detect the difference between variables, and is linked to the adequacy of the sample size.
Following best practice guidelines, which pharmacologic and nonpharmacologic treatments are the best studied and have the highest level of evidence for the treatment of nightmares in adults with PTSD?
prazosin (Minipress) and Image Rehearsal Therapy
Tanner stage 1 of breast development
prepubertal
Diseases that have decreased thyroid levels:
primary hypothyroidism secondary hypothyroidism (pituitary insufficiency) Tertiary hypothyroidism (hypothalamic failure) Thyrotoxicosis due to T3 Renal failure Cushing's syndrome Cirrhosis
which inferential statistic is the likelihood of an event occurring
probability
As an individual advanced practitioner, you cannot afford to have a standalone EHR system to keep all of your patient's health information on a computer-based system. How could you problem solve this dilemma?
process your notes and patient records in a secure electronic system with a template for patient information and interactions, supporting quick access within your network.
ECG changes with hypocalcemia
prolonged QT interval
least likely SSRI to have discontinuation syndrome
prozac
this type of therapy attends to past developmental and psychodynamic factors, which shape present behaviors
psychoanalytic therapy
You are treating a new patient. He indicates that he is a Muslim and follows all of the principles of that religion. He is suffering from depression. What special considerations should you take to help him in his treatment.
refer him to a male practitioner for medications and explain the patient's need to use medications that contain no gelatin products.
Existential therapy uses a philosophical approach in which __________ on life and __________ is encouraged.
reflection; self-confrontation
The core values that underlie advanced practice nursing and culturally competent care are:
respect, advocacy, partnership
-Total duration of the illness is 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 these may be present
schizophreniform disorder
This personality disorder is characterized by ideas of reference and magical thinking
schizotypal
The NP is working with a patient secondary to an injury that he sustained while working on the job. The NP is managing both the medications and psychotherapy portions of the patient's care. The patient is involved in workman's compensation regarding his injury. The patient's employer sends the NP a release of information form requesting the patient's complete medical record. The NP:
sends the complete record but withholds the psychotherapy notes. HIPAA does not allow the provider to make most disclosures about psychotherapy notes about you without your authorization
What is the black box warning for Lamotrigine?
serious rash
Which neurotransmitter regulates sleep, pain, mood states, and temperature
serotonin
which neurotransmitter is produced in the raphe nuclei of the brainstem
serotonin
these two neurotransmitters are removed from the synaptic cleft and returned to storage via an active reuptake process
serotonin and norepinephrine
_______ inhibit dual reuptake of norepinephrine and serotonin. Action very selective on neurotransmitters
serotonin norepinephrine reuptake inhibitors
At what age can methylphenidate and guanfacine be started according to the FDA?
six
Which facial characteristics would lead the PMHNP to believe a child has fetal alcohol syndrome
small head, thin upper lip, and smooth philtrum
The focus of ____________________ therapy is to rework for the present situation solutions that have worked previously
solution-focused
Treatment goal of ___________________________ therapy is effective resolution of problems through cognitive problem-solving and use of personal resources and strength
solution-focused
This type of therapy uses techniques such as -miracle questions -exception finding questions -scaling questions
solution-focused therapy
conveys information from the CNS to skeletal muscles; responsible for voluntary movement
somatic nervous system
The CNS is composed of:
spinal cord and brain
transmits signals away from the neuron's cell body to connect with other neurons and cells
stem or axon
Therapists that use ____________________ are mainly concerned with those techniques that change the sequence of interactions that is maintaining the problem
strategic family therapy
This type of therapy uses techniques such as -straightforward directives -paradoxical directives -reframing belief systems
strategic family therapy
In this type of therapy symptoms are viewed as metaphors and reflect problems in the hierarchal structure. Symptoms are a way to communicate metaphorically within a family
strategic therapy
examples of primary prevention
stress management classes for graduate students, smoking prevention classes, DARE
The main goal of this type of therapy is to produce a structural change in the family organization to more effectively manage problems
structural family therapy
This type of therapy believes that a person's symptoms are rooted in the context of family transaction patterns. The symptom is a function of the health of the whole family and is maintained by structural problems in the system
structural family therapy
emphasis is placed on how, when, and to whom family members relate in order to understand and then change the family's structure
structural family therapy
this type of therapy uses family structure, structural mapping (genograms) and hierarchies
structural family therapy
pharmacodynamics
study of what drugs do to the body
Pharmacokinetics
study of what the body does to drugs
the excitatory division; prepares the body for stress (fight or flight); stimulates or increases activity of the organs
sympathetic nervous system
Which inferential statistic assesses whether the means of two groups are statistically different from each other
t-test
Patients with frontotemporal dementia are usually extremely:
talkative and disinhibited
examples of secondary prevention
telephone hotlines, crisis intervention, disaster responses
problems in the __________ lobe can lead to visual or auditory hallucinations, aphasia, and amnesia
temporal
You are considering using text message technology with your patients as a way to communicate quickly in our fast-paced world. What considerations are necessary when texting?
text messaging using a secure text messaging platform within specific joint commission guidelines could be used for orders only.
sensory relay system except for small; modulates flow of sensory information to prevent overwhelming the cortex; regulates emotions, memory, and related affective behaviors
thalamus
Internal validity occurs when: the independent variable causes a change in the dependent variable.
the independent variable causes a change in the dependent variable.
Pregroup Phase
the leader considers the direction and framework of the group
__________ is the precursor to serotonin
tryptophan
a positive babinski is normal in infants up to age:
two
__________ is the precursor for norepinephrine
tyrosine
__________ is the precursor to dopamine
tyrosine
Systemic effects of hypothyroidism may mimic symptoms of:
unipolar mood disorder
Which of the following atypical antipsychotic medications has FDA approval for treatment of bipolar depression when combined with fluoxetine (Prozac)? -abilify -zyprexa -risperdal -seroquel
zyprexa (Symbyax)