PMHNP -BC FGD Review Questions

borderline intellectual functioning IQ:

71-84

nightmares are ___ from sleep terrors

DIFFERENT

behavioral therapy in ASD is aimed at targeting what?

E) All of the above

lab analysis associated with eating disorders

serum electrolytes, BUN, creatinine, TSH, (Free T4m T3 if indicated); CBC with diff, AST, ALT, ALP, urinalysis and ESR rate

CBT with medications is considered

the most effective tx of eating disorders

Which of the following are highly protein-bound medications?

D) All of the above

_______ and ____may reduce binge eating episodes in bulimia

Topiramate & Vyvanse

adolescents are able to obtain what without their guardian'/parent's permission?

obtain family planning and sexually transmitted infection assessment and treatment

saying mama/dada specificaly

10-12 months

Conduct disorder: Prevalance

12% M 7% F

Solo walking occurs when

12-18 months

walks solo

12-18 months

suicide rates and anorexia:

18 x greater than the general population

can kick a ball

18-30 months

ODD: prevalence

2-16%

two word sentences

2-3 years

ADHD: who does if affect more? M vs F

2:1 in boys to girls

speech intelligible to people not in frequent contact with the child 75% of the time

3-4 years

Begins to babble

5-7 months

sit alone for 30 seconds

6-8 months

stranger anxiety

8-10 months

intellectual disabilities IQ level is not higher than:

<70

____________ are the gold standard and first choice of agent in tx ADHD in children/adolescents

A) CNS stimulants

Which sleep medication has the longest half-life?

A) Flurazepam

Disorders of childhood neglect and maltreatment: (2)

A) Reactive Attachment Disorder B) Disinhibited Social Engagement Disorder

when to start screening for anxiety in a child/adolescent?

As early as age 8

_____% of children with ADHD will develop a chronic tic disorder

B) 20%

chronic <12 months of severe, persistent irritable or angry mood with frequent severe temper outbursts, either verbal or behavioral x3/week

B) DMDD

The adverse effects of systemic anticholinergic medications most often cause which complication in the older adult?

B) Delirium

Anticholinergics are strongly associated with increased risk of which disorder?

B) Dementia

Conduct disorder: gender specifics

Boys > girls 4:1 M-F ratio

The NP initiated oral therapy for an overactive bladder in the older adult. When can efficacy be established in this patient?

C) 4-6 weeks

cautions with prescribing atomoxetine in adolescents/children with ADHD:

C) A& B

what causes people to die from anorexia?

EKG changes--- worrisome changes with EKG are related to hypokalemia *leads to T wave flattening, ST segment depression, lengthenig QT interval

parents have a right to know what their teenager reports to a NP during psychotherapy:

FALSE

Paroxetine has no anticholinergic properties.

False

SSRI use in bulimia:

can reduce binge eating and purging independently of the presence of a mood disorder

sudden spontaneous expression of single words/phrases along side sudden change in pitch of volume of speech:

complex vocal tics

nightmares in children are able to be:

consoled by their parent and have a vivid recall of the dream

SSRIs are preferred with what comorbid disorders associated with eating disorders:

depression and anxiety delay start unti after weight returns to normal

therapy approaches for ASD:

early intensive behavioral and developmental interventions: - Applied behavior analysis (ABA) therapy for autism

medical complications of bulimia:

electrolyte imbalances, dehydration hypotension and bradycardia

psychotherapy for ASD:

general approach is behavioral therapy

consider a drug holiday if:

height OR weight crosses two percentile lines

nightmares occur when?

in the final third of sleep

Reactive Attachment Disorder

inhibited, emotionally withdrawn behaviors towards adult caregiver, rarely seeks comfort when distressed and/or minimal response to comfort *persistent social and emotional disturbance

management of pts on psychopharmacology for ADHD: Monitor for therapeutic response how often?

initially 1-2 weeks, then. every 1-3 months -assess the effectiveness of meds, the pt's behavior and academic achievement

Atypical antipsychotics target what s/s in ASD:

irritability, aggression, temper tantrums, self-injurious behaviors, quick changing moods

sleep walking/talking has same features as sleep terrors, except:

less autonomic arousal and behavioral agitation

RF for conduct disorder

male gender, chaotic parenting enviornment, chronic exposure to violenec, past dx of ODD, low SES

children with ASD are ____ sensitive to medication's adverse effects

more sensitive--start LOW and go SLOW caution with polypharm*

PMHNPs must obtain what when treating a minor

must get parental/legal guardian's permission outside of individuals who are medically emancipating

in DMDD, the temper outbursts are

not at developmental level and are out of proportion to the situation

tool to assess clinicians with screening for psychosocial factors that infuence the physical and emotional health of adolescents?

C) A& B

ADHD: Tx is focused at

C) A&B

Disinhibited Social Engagement Disorder

C) A&B

_____ is one of only two medications FDA approved for use with adolescents with MDD:

C) A&B

management of pts on psychopharmacology for ADHD: assess for

C) A&B

periodically assess for medication need:

C) A&B

consider using atomoxetine or alpha-2 adrenergic agents in patients with what concerns?

C) substance use disorder or concerns with diversion

Most effective tx of Eating disorders:

CBT= most effective DBT- also helpfu

The NP is educating an older adult about the etiology of postural hypotension. What topics should be included?

D) All of the above

management of pts on psychopharmacology for ADHD: School and home assessment (e.g Conner's or Vanderbilt)

D) All of the above

etiology of ADHD:

D) Multifactorial: All of the above

Applied behavior analysis (ABA) is what?

D) all of the above

An older adult presents to the clinic with reports of vomiting. Which age-related change is most concerning to the NP?

D) increased risk for dehydration

Pediatric assessment tools: which of the following is a pediatric assessment scale?

G) ALL of the above

differential dx for ADHD in children?

G) all of the above

physical examination for an eating disorder (anorexia /bulimia/binge eating)

H) All of the above

choice of agent concerns to balance prior to prescribing:

H) Multifactorial: all of the above

children often require ____ doses of antidepressants:

HIGHER due to their increased metabolism

Severe intellectual disability

IQ 20-35 4% OF PEOPLE -may develop communication skills, learn to count and recognize words -may do well in supervised living situations and work-related tasks with supervision

Moderate intellectual disability

IQ 35-50 affects 10% achieves 2-3rd grade academics -needs social and vocational support, may work under supervision

Mild intellectual disability

IQ 50-70; 85% of people *achieves 6th grade academics -may live independently with support and families

Profound ID:

IQ <20 AFFECTS 1-2% -may learn self care skills and to communicate with training

Conduct disorder: age of onset

M 10-12 F 14-16 Childhood onset=before age 10 Adolescent onset= no criteria before age 10

sudden, rapid, recurrent, nonrhythmic motor movement of vocalization

TIC

Lower albumin causes increased free drug availability with highly protein-bound drugs.

True

____ is indicated for weight loss and reduction in binge eating episodes with binge-eating diosrder

Vyvvanse

contraindications to stimulants may include:

all of the above

one of the most lethal psych dx:

anorexia mortaity rates: 5-18% due to medical complications

when to start screening for depression in a chld/adolescent

as early as age 12

management of pts on psychopharmacology for ADHD: monitor for adverse effects with ADHD meds:

assess severity and burden--consider watch and wait if clinically significant adjust dose, change meds, and add adjunct meds if necessary

risk of ADHD meds

balance risks vs benefits -risks are a small reduction in height gain -no clear relationship to reductions in adult height

in DMDD, the onset of symptoms occurs when?

before age 10--present in at least 2 settings

ODD gender specifics:

boys > girls equal ratio after puberty

With teens, practice honesty in all interactions, includes what?

breaking confidentiality when needed for the adolescent's safety

CRAFFT questionnaire:

brief screening for adolescent substance use disorder C- Car (have you ridden in a car driven by you/someone under the infuence) R- Relax (do you use alcohol /drug to relax) A- Alone (do you use drug/drink when alone) F-Forget (do you forget things when you use drug/etoh) F- Friends (do your family/friends tell you you should cut down) T- Trouble (have you gotten into troublle while you were drinking/drugs)

what occurs more often? anorexia or bulimia?

bulimia occurs more than anorexia

ODD: age of onset

can be as early as age 3 , typically occurs before age 8 -first s/s seldom in adolescence

Russell's sign:

scarring of the dorsum of hand, associated with bulimia

frequent or persistent nightmares require evaluation for what psych disorders:

trauma and/or anxiety disorders

FDA approved SGA: (2)

two approved by FDA: 1) Risperidone 2) Abilify

gestures, jumping, touching ,pressing, stomping, twiring when wal,ing

type of tic= complex motor tic

sudden, tic like vulgar, sexual or obscene gesture:

type of tic= copropaxia

eye blinking, nose wrinkling, neck jerking and facial grimacing:

type of tic= simple motor tic

throat clearing grunting, sniffing, snorting, chirping:

type of tic= simple vocal tic

Atypical antipsychotics common adverse effects in ASD:

weight gain, metabolic syndrome, tremor, EPS, increased salivation and sedation

Avoid what med in those with eating disorders:

wellbutrin--increases seizure risk

ABA is most effective when:

when used twenty hours a week before age 4 ABA= applied behavioral analysis therapy for ASD