Exam 6 Psychiatric Mental Health NP Flashcards

1
Q

What nursing skill did the Technology Informatics Guiding Education Reform (TIGER) initiative seek to improve?

A

Computer and information literacy

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2
Q

The Technology Informatics Guiding Education Reform (TIGER) initiative developed

A

a 10-year plan for nursing’s path toward computer and information literacy. It involved more than 1,100 nursing content experts, and it took three years to complete. This initiative successfully defined the basic technology competencies and required curriculum for nurse practitioner education.

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3
Q

The TIGER initiative declared that it is a nurse practitioner’s responsibility to

A

understand and shape the landscape of health care technology in order to improve access, quality, and the patient experience.

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4
Q

Core symptoms of major depressive disorders in children are

A

irritability, somatic complaints, and social withdrawal.

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5
Q

Less common symptoms of major depressive disorders in children include

A

psychosis, motor retardation, hypersomnia, and increased appetite

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6
Q

To assess a patient’s potential to harm others in addition to themselves, nurse practitioners should ask the following questions:

A

Are there others who you think may be responsible for what you are experiencing?
Are you having thoughts of harming others? Who?
Are there other people you want to die with you?
Are there others who you think would be unable to go on without you?

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7
Q

For patients who present with thoughts about wanting to harm themselves, nurse practitioners could consider asking:

A

How close have you come to acting on those thoughts?
How likely do you think it is that you will act on them in the future?
What do you envision happening if you actually killed yourself?
Have you made a specific plan to harm yourself?
Are guns or other weapons available to you?
Have you made particular preparations for your death?

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8
Q

When clients are involuntarily admitted to an inpatient psychiatric facility,

A

they are admitted against their will, they are unable to come and go as they please, and the amount of time they can be kept against their wishes varies by state. These are examples of civil liberties that are withdrawn during the involuntary admission process.

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9
Q

If a client is voluntarily admitted to an inpatient psychiatric facility, they desire and agree to treatment and confinement within the structure of a hospital setting. The client maintains

A

all civil liberties, and they are able to leave as they please as long as they are not a danger to themselves or others or gravely disabled.

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10
Q

Clients are able to make phone calls, have visitors, and refuse medication. These civil liberties are maintained

A

even when admitted to an inpatient psychiatric unit involuntarily.

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11
Q

Prozac (fluoxetine) is an SSRI antidepressant and can produce a false positive for

A

methamphetamine.

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12
Q

Zoloft (sertraline) can produce a false positive for

A

benzodiazepines

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13
Q

Motrin can produce a false positive for

A

cocaine

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14
Q

Poppy seeds can produce a false positive

A

for heroin or morphine

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15
Q

Pharmacokinetics refers to

A

what the body does to a drug when it’s ingested.

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16
Q

Pharmacodynamics is the term that describes

A

what a drug does to the body when ingested and paired with the individual’s pharmacodynamic gene profile.

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17
Q

Norepinephrine:

A

alertness, focused attention, learning, and memory

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18
Q

Dopamine

A

_thinking, fine muscle action, and reward-seeking behavior

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19
Q

GABA_

A

reduces arousal, aggression, and anxiety

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20
Q

Serotonin

A

regulates sleep, pain, mood states, and temperature

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21
Q

Nurse practitioner core competencies include the following:

A
Scientific foundations
Leadership
Quality
Practice inquiry
Technology and information literacy
Policy
Health delivery systems
Ethics
Independent practice
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22
Q

What court case determined that the presence of a mental illness alone cannot justify involuntary hospitalization?

A

O’Connor vs. Donaldson

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23
Q

The 1976 case O’Connor vs. Donaldson ruled that

A

harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.

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24
Q

In 1979, Rennie vs. Klein determined that

A

patients have the right to refuse any treatment and use an appeal process.

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25
Q

In 1981, Roger vs. Oken determined that

A

patients have an absolute right to refuse treatment but that a guardian may authorize their treatment.

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26
Q

Durham vs. United States

A

determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.

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27
Q

Patients with obsessive-compulsive personality disorder are

A

perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.

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28
Q

Patients with paranoid personality disorder are

A

suspicious, have few friends, and read hidden meaning into innocent remarks

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29
Q

Patients with narcissistic personality disorder

A

act self-important. They are preoccupied with envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.

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30
Q

A nurse practitioner has the duty to protect identified victims from imminent danger. When a patient threatens to harm someone, your course of action should follow these steps:

A

Contact the party at risk
Notify the police
Take appropriate action to protect the party at risk

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31
Q

There are three phases of a therapeutic relationship between a nurse practitioner and his or her patient:

A

Introduction
Working
Termination

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32
Q

During the introduction phase, the following actions usually take place:

A

Creating a trusting environment
Establishing professional boundaries
Establishing the length of anticipated interaction
Providing diagnostic evaluation
Setting mutually agreed-upon treatment objectives

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33
Q

Mind-body interventions under the umbrella of complementary and alternative therapies (CATS) include the following:

A

Guided imagery
Meditation
Yoga
Biofeedback

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34
Q

Massage therapy and acupressure are

A

manipulative body-based therapies.

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35
Q

Vitamins and supplements are a

A

biological-based therapy.

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36
Q

From a systems perspective, the goal is to optimize rather than maximize what?

A

the goal is to optimize the quality recommendations from the Institute of Medicine (safe, effective, patient-centered, timely, efficient, and equitable) rather than maximize them.

From a systems perspective, the goal is to optimize rather than maximize the performance of each of its components in order to bolster the system’s overall production.

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37
Q

When involuntarily admitted to an inpatient psychiatric facility,

A

the client is not able to come and go as they please, which is a civil liberty.

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38
Q

Preventative factors are factors that protect a person from

A

developing a psychiatric condition.

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39
Q

Preventative factors fall into three categories:

A

biological, psychological, and social.

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40
Q

Biological preventative factors:

A

Without a history of mental illness in the family
Healthy nutritional status
Good general health

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41
Q

Psychological preventative factors:

A

Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses

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42
Q

Social preventative factors:

A

Low-stress occupation
Higher socioeconomic status
Higher level of education

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43
Q

Both serotonin and norepinephrine are removed from the synaptic cleft and returned to storage

A

via an active reuptake process.

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44
Q

Dopamine, on the other hand, is removed from the synaptic cleft by

A

monoamine oxidase enzymatic action.

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45
Q

The Institutional Review Board

A

protects the rights and welfare of human research participants. They have the authority to approve, require modifications, or disapprove of any research activities.

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46
Q

The Institutional Review Board ensures that

A

Risks to participants are minimized
Participant selection is equitable
Adverse events are reported
Risks and benefits are evaluated
Informed consent is obtained and documented
Data safety monitoring plans are implemented when indicated

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47
Q

In a medical malpractice suit, the plaintiff must establish all of the following

A

The nurse practitioner owed the plaintiff a duty
The nurse practitioner’s conduct fell below the standard of care
The nurse practitioner’s conduct caused the plaintiff injury

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48
Q

Proof beyond reasonable doubt applies to

A

criminal cases.

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49
Q

Medical malpractice suits are

A

civil cases.

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50
Q

To establish a medical malpractice suit, the plaintiff must establish that a

A

dereliction of duty directly caused damage (also known as the four Ds of medical malpractice).

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51
Q

The burden of proof in medical malpractice suits is by

A

a preponderance of evidence (greater than 50%).

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52
Q

Specifiers used to describe mood disorders include the following:

With atypical features:

A

These patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection.

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53
Q

With melancholic features:

A

These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions.

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54
Q

With anxious distress:

A

These patients have high levels of tension, restlessness, worry, and fear.

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55
Q

With catatonic features:

A

These patients exhibit either motor hyperactivity or inactivity.

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56
Q

With mixed features:

A

These patients are experiencing a mixture of both manic and depressive symptoms.

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57
Q

With peripartum onset:

A

These patients develop a mood episode during pregnancy or within a month of having their baby.

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58
Q

With psychotic features:

A

These patients develop delusions or hallucinations along with their mood symptoms.

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59
Q

With rapid cycling:

A

These patients have experienced at least four mood episodes in the past year.

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60
Q

With seasonal pattern:

A

These patients regularly become ill at a certain time of the year.

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61
Q

Patients with obsessive-compulsive personality disorder are

A

perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.

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62
Q

Patients with paranoid personality disorder are

A

suspicious, have few friends, and read hidden meaning into innocent remarks.

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63
Q

Patients with narcissistic personality disorder act self-important. They are preoccupied with

A

envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.

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64
Q

Patients with dependent personality disorder

A

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.

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65
Q

An atypical presentation is characterized by the following:

A
Mood reactivity
Weight gain
Increased appetite
Hypersomnia
Leaden paralysis
Long-standing pattern of interpersonal rejection sensitivity
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66
Q

Anhedonia is

A

the inability to feel pleasure, and it occurs in both typical and atypical presentations of major depressive disorder.

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67
Q

Vietnamese describe panic attacks

A

“Hit by the wind”

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68
Q

Latin Americans:

A

Attack of the nerves”

C

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69
Q

“Cambodians

A

“Soul loss”

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70
Q

What term most accurately describes a group of members of Congress or a political party created to support a defined political ideology?

A

caucus. A caucus is a group of members of Congress or a political party created to support a defined political ideology

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71
Q

Common herbals with psychoactive effects used to treat insomnia:

A

Valerian
Catnip
Chamomile, which also helps with anxiety

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72
Q

Ginkgo,

A

which helps with delirium, dementia, and sexual dysfunction

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73
Q

Black cohosh,

A

which is used to treat menopausal symptoms, premenstrual syndrome, and dysmenorrhea

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74
Q

Belladonna,

A

which is used to treat anxiety

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75
Q

Ginseng,

A

which helps with depression and fatigue

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76
Q

Most psychotropic medications are hepatic

A

cytochrome P450 inhibitors. Furthermore, most psychotropic medications are both lipophilic and highly protein-bound

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77
Q

Because many older adults have more body fat and less protein,It takes approximately five half-lives to completely eliminate most psychotropics from the body.

A

they are at increased risk for toxicity.

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78
Q

It takes approximately______________________ to completely eliminate most psychotropics from the body.

A

five half-lives

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79
Q

Bulimia does not usually affect

A

thyroid function;

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80
Q

laboratory findings in patients with bulimia might include the following:

A

Hypokalemia
Hypochloremia
High serum amylase
Hypomagnesemia

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81
Q

Preventative factors are those that They fall into three categories: biological, psychological, and social.

A

protect a person from developing a psychiatric condition.

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82
Q

Preventative factors fall into three categories:

A

biological, psychological, and social.

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83
Q

Biological preventative factors:

A

Without a history of mental illness in the family
Healthy nutritional status
Good general health

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84
Q

Psychological preventative factors:

A

Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses

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85
Q

Social preventative factors:

A

Low-stress occupation
Higher socioeconomic status
Higher level of education

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86
Q

According to Freud, during what psychosexual stage of development are sexual concerns largely unimportant?

A

Latency stage. The latency stage is characterized by a time in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.

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87
Q

Freud’s stages of psychosexual development:

A

birth to 12-18 monthsAnal 12-18 months to 3 yearsPhallic_ 3 to 5-6 yearsLatency_ 5-6 years to adolescenceGenital_ adolescence to adulthood

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88
Q

According to Erik Erikson, during which psychosocial stage would you expect a person to develop a sense of unity in life’s accomplishments?

A

Ego Integrity vs. Despair.

Ego Integrity vs. Despair is the final stage of psychosocial development. Successful resolution of this stage is characterized by a sense of unity in life’s accomplishments. Failure to resolve this stage leads to regret over lost opportunities of life.

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89
Q

What is the most commonly used clinician-administered anxiety rating scale?

A

The Hamilton Anxiety Scale (HAM-A) is the most commonly used clinician-administered anxiety rating scale. It is best used in the evaluation of anxiety severity and tracking the efficacy of anxiety treatments over time.

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90
Q

The HAM-A is based on various domains of anxiety including

A

anxious mood, fears, sleep disturbance, somatic complaints, tension, and observed behavior.

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91
Q

The severity of each domain in HAM A is ranked from

A

0 (not present) to 4 (severe).

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92
Q

HAM A scoring

A

Score of 14-17: Mild anxiety
Score of 18-24: Moderate anxiety
Score of 25-30: Severe anxiety

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93
Q

Calcium values can be decreased during treatment with

A

anticonvulsants, aspirin, corticosteroids, heparin and oral contraceptives.

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94
Q

is a common non-psychoactive supplement used to cure symptoms of illness and maintain health.

A

Fish oil

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95
Q

Common non-psychoactive dietary supplements with physiological (not psychological) effects used to cure illnesses and maintain health are as follows:

A
Omega-3 fatty acids
Tryptophan
Vitamin E
Melatonin
SAM-e
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96
Q

What 1960 legal precedent approved a test of competence that determines if a criminal defendant is competent to stand trial?

A

Dusky vs United States

The 1960 case of Dusky vs. United States approved a test of competence that seeks to ascertain whether a criminal defendant has the ability to consult with a lawyer and to rationally understand the proceedings against him or her. This case established competence to stand trial.

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97
Q

Durham vs. United States

A

determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.

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98
Q

O’Connor vs. Donaldson

A

The 1976 case ruled that harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.

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99
Q

In 1979, ____________ determined that patients have the right to refuse any treatment and use an appeal process.

A

Rennie vs. Klein case

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100
Q

Altitude sickness might be included in the differential diagnosis of

A

panic disorder.

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101
Q

Mitral valve prolapse might be included in the differential diagnosis of

A

mania and severe anxiety.

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102
Q

Myasthenia gravis might be included in the differential diagnosis of

A

anxiety.

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103
Q

Oppositional defiant disorder (ODD) is an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least

A

six months with at least four of the following associated symptoms:

Loses temper
Touchy or easily annoyed
Angry or resentful
Argues with authority
Actively defies or refuses to comply with requests or rules from authority figures
Blames others
Deliberately annoys others
Spiteful or vindictive
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104
Q

Physical exam findings and associated features of Rett syndrome are as follows:

A
Seizures
Irregular respirations
Scoliosis
Loss of purposeful hand skills
Stereotypic hand movements
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105
Q

Rett syndrome’s etiology is unknown. However, it is believed that children suffering from Rett syndrome have

A
  1. A known, progressive, and deteriorating course of illness after an initial period without apparent disability
  2. A potential metabolic disorder
  3. Genetic mutation(s)
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106
Q

A client taking clozapine is presenting with elevated body temperature. You recognize this potential serious side effect as:

A

Agranulocytosis

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107
Q

Agranulocytosis is a

A

serious acute condition involving severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, thus causing neutropenia in the circulating blood.

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108
Q

Hyperprolactinemia is a

A

condition in which a person has higher-than-normal levels of the hormone prolactin in the blood, potentially causing the stimulation of breast milk.

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109
Q

Anemia is a condition in which

A

a person lacks enough healthy red blood cells to carry adequate oxygen to the body’s organs and tissues.

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110
Q

Hemophilia is a condition

A

where the body’s ability to form blood clots is reduced.

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111
Q

Physical exam findings in posttraumatic stress disorder (PTSD) are

A

nonspecific in nature.

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112
Q

Primary prevention is aimed at

A

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.

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113
Q

Secondary prevention is aimed

A

at decreasing the number of existing cases of mental disorder. Examples of secondary prevention include telephone hotlines, crisis intervention, and disaster response.

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114
Q

Tertiary prevention is aimed at r.

A

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.

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115
Q

The deductible is

A

the amount that people spend before their health insurance pays for the cost of health care services.

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116
Q

The insurance premium is

A

the amount charged for insurance coverage, usually paid on a monthly basis by both the employer and the employee.

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117
Q

The loading charge is .

A

the amount charged by the health insurance company on a person’s renewal premium when they make claims on their policy

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118
Q

The latency stage is characterized by a time

A

in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.

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119
Q

Freud’s stages of psychosexual development:

A

birth to 12-18 monthsAnal 12-18 months to 3 yearsPhallic_ 3 to 5-6 yearsLatency_ 5-6 years to adolescenceGenital_ adolescence to adulthood

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120
Q

Enuresis refers to the repeated voiding of urine (either voluntarily or involuntarily) into bedding or clothing when

A

five years old or older.

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121
Q

Which piece of legislation established the prescription drug coverage (Part D) option under Medicare?

A

The Medicare Prescription Drug Improvement and Modernization Act of 2003 established the prescription drug coverage (Part D) option under Medicare. This legislation replaced Medicare + Choice with Medicare Advantage.

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122
Q

The Technology Informatics Guiding Education Reform (TIGER) initiative developed

A

a 10-year plan for nursing’s path toward computer and information literacy.

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123
Q

In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA) (Pub. L. 111-5). The ARRA includes

A

the Health Information Technology for Economic and Clinical Health (HITECH) Act, which attempts to update the American infrastructure, including the use of electronic health records.

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124
Q

Patients with obsessive-compulsive personality disorder are

A

perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.

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125
Q

Minipress (prazosin) is

A

FDA-approved for the treatment of nightmares associated with PTSD.

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126
Q

SSRIs FDA approved for the treatment of PTSD

A

Zoloft and Paxil

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127
Q

The benefits of group therapy include the following:

A

Increases insight about oneself
Increases one’s social skills
Is cost-effective
Develops sense of community

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128
Q

Screening for developmental delays is a critical component of assessing for ASD. Checklists for this include the following:

A

Modified Checklist for Autism in Toddlers (Age-Specific)
Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Ages and Stages Questionnaires

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129
Q

Parents may also report the following symptoms in child with ASD:

A

No cooing by age one year, no single words by age 16 months, no two-word phrases by age 24 months
Loss of language skills
No imaginary play
Little interest in playing with other children
Extremely short attention span
No response when called by name
Little or no eye contact
Intense tantrums
Fixations on single objects
Unusually strong resistance to changes in routines
Oversensitivity to certain sounds, textures, or smells
Appetite or sleep-rest disturbance, or both
Self-injurious behavior

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130
Q

For an act to be considered criminal, it must have two components:

A

actus reus and mens rea.

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131
Q

Actus reus refers to

A

voluntary conduct. Voluntary conduct is deemed impossible if the offender’s mental status is deficient, abnormal, or diseased in a way that inhibits rational intent.

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132
Q

Mens rea refers

A

to evil intent. Evil intent is defined as the resolve to do harm.
Neither behavior nor intent alone is enough to convict a person of a crime.

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133
Q

is the only state where nurse practitioners bill at 100% of the allowable physician rate.

A

Iowa

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134
Q

Circadian rhythm sleep-wake disorders are characterized by

A

a mismatch between a person’s biological clock and the environment.

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135
Q

There are five subtypes of circadian rhythm mismatch:

A

Delayed sleep phase type

Advanced sleep phase type

Irregular sleep-wake type

Non-24-hour sleep-wake type

Shift work type

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136
Q

Delayed sleep phase type:

A

falling asleep and waking later than desired

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137
Q

Advanced sleep phase type:

A

falling asleep and waking earlier than desired

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138
Q

Irregular sleep-wake type:

A

falling asleep and waking at random times

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139
Q

Non-24-hour sleep-wake type:

A

falling asleep and usually waking progressively later than desired

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140
Q

Shift work type:

A

sleepiness associated with changes in work schedule

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141
Q

Jet lag refers to

A

feeling sleepy or “hungover” after crossing time zones. It is no longer considered a sleep disorder.

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142
Q

Which anxiety disorder is characterized by brief episodes of intense dread accompanied by physical symptoms like chest pain, chills, shortness of breath, and an irregular heartbeat?

A

Panic d/o

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143
Q

Privilege refers to

A

the patient’s right to prevent disclosure of confidential information in judicial hearings.

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144
Q

Nonmaleficence refers to the principle of .

A

bioethics that asserts an obligation not to inflict harm intentionally.

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145
Q

Beneficence refers to

A

an action done for the benefit of others.

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146
Q

Confidentiality refers to

A

the nurse practitioner’s responsibility to not release patient information learned in the course of treatment to third parties

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147
Q

The National Institutes of Health (NIH) created the National Center for Complementary and Alternative Medicine (NCCAM) in ____with mission to ___________

A

in 1998. The mission of NCCAM is to study therapies outside of traditional medicine.

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148
Q

Decreased levels of sodium (Na) can cause

A

Diuresis

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149
Q

Increased, levels of sodium (Na) can cause

A

dehydration, diabetes insipidus, and gastroenteritis.

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150
Q

laboratory findings in patients with bulimia might include the following:

A

Hypokalemia
Hypochloremia
High serum amylase
Hypomagnesemia

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151
Q

Forensic risk assessments are specifically for those with a

A

violent, dangerous, and/or criminal record and often take place in a judicial arena such as jail, prison, or court.

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152
Q

Failure to resolve the Generativity vs. Stagnation stage is associated with the

A

development of a mid-life crisis.

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153
Q

Failure to resolve the Industry vs. Inferiority stage is associated with

A

creative inhibition.

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154
Q

Failure to resolve the Initiative vs. Guilt stage is associated with

A

conversion disorder, phobias, and psychosomatic disorders.

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155
Q

during the DNA sequencing process single nucleotide polymorphisms detect

A

Single nucleotide polymorphisms detect single based changes

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156
Q

The FDA has approved both ______ for the treatment of ADHD in children.

A

stimulants and non-stimulants

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157
Q

The following medications are FDA approved but are not classified as stimulants:

A

Strattera (atomoxetine)
Intuniv (guanfacine)
Kapvay (clonidine)

158
Q

The following are stimulants:

A

Adderall (amphetamine salts)

Dexedrine (dextroamphetamine)

159
Q

Wellbutrin XL (bupropion) is an SNRI but is indicated in the treatment of

A

ADHD in adults.

160
Q

The trigeminal nerve CN _________ assessment tests for tactile perception of the facial skin.

A

(cranial nerve V, sensory division)

161
Q

The facial nerve CN_________assessment checks for flaccid paralysis.

A

(cranial nerve VII, motor division)

162
Q

The hypoglossal nerve CN_____ assessment tests for tremors and other involuntary movements when the client protrudes their tongue.

A

(cranial nerve XII)

163
Q

The most common suicide site in the world is the

A

Golden Gate Bridge in San Francisco, California.

164
Q

Suicide rates are lowest in and highest in Monta

A

New Jersey

165
Q

Suicide rates are highest in

A

Montana

166
Q

Panic disorder is significantly comorbid with many general medical conditions, including the following:

A
Irritable bowel syndrome
Dizziness
Cardiac arrhythmias
Hyperthyroidism
Asthma
COPD
167
Q

Brain tissue is categorized as either

A

white matter or gray matter.

168
Q

White matter is the

A

myelinated axons of neurons

169
Q

Gray matter is composed

A

of nerve cell bodies and dendrites.

170
Q

Gray matter is found in the

A

working area of the brain and contains the synapses.

171
Q

A Medicare medical savings account plan is

A

a health plan that allows individuals to establish tax-free savings funds to finance their medical care.

172
Q

Medicare + Choice was

A

part of the Balanced Budget Act of 1997 that significantly increased the number of managed care insurance plans available to Medicare recipients. This program was replaced with the Medicare Advantage plan in 2003.

173
Q

The Medicare Advantage plan

A

created regional Preferred Provider Organizations (PPO) and gave Medicare enrollees the option of enrolling in private insurance plans.

174
Q

Medigap insurance policies are

A

private policies purchased by elderly individuals to cover some or all of their medical expenses not paid for by Medicare.

175
Q

Medicare + Choice was replaced by

A

This program was replaced with the Medicare Advantage plan in 2003.

176
Q

Psychoanalytic theory originated with

A

Sigmund Freud, who believed that behavior is determined by unconscious motivations and instinctual drives. This theory posits that change occurs through the development of greater insight and awareness of maladaptive defenses. Psychoanalytic-focused therapy attends to past developmental and psychodynamic factors, which shape present behaviors.

177
Q

Cognitive therapy,

A

helps patients view reality more clearly by examining their distorted cognitions.

178
Q

A patient presents with oculomotor disturbances, cerebellar ataxia, and mental confusion. What psychiatric emergency would you suspect?

A

Wernicke’s encephalopathy

Give thiamine IM or IV 100mg

179
Q

has the lowest risk of sedation of all antipsychotics, and it is recommended as the treatment of choice for those wanting to avoid side effects of fatigue and sleepiness.

A

Aripiprazole

180
Q

Extrapyramidal symptoms are associated with a deficiency of .

A

dopamine and an excess of acetylcholine in the nigrostriatal pathway.

181
Q

A common type of extrapyramidal symptom is called pseudo-Parkinson’s, which presents

A

with a shuffling gait, motor slowing, mask-like facial expression, tremors, and muscle rigidity.

182
Q

Muscarinic 1 agonist medications reduce the effects of

A

excess acetylcholine and relieve extrapyramidal symptoms

183
Q

Biofeedback teaches a patient

A

to control their physiological responses

184
Q

Acupuncture and acupressure aid in the activity of

A

endorphins by manipulating points of energy flow in the body.

185
Q

Aromatherapy stimulates

A

the olfactory system to elicit feelings and memories.

186
Q

Massage increases

A

blood circulation, improves lymph flow, and enhances musculoskeletal tone.

187
Q

The overall goal of case management is

A

to promote quality, cost-effective patient care.

188
Q

Mentoring is the process of

A

guiding and supporting junior colleagues in the development of new roles, competencies, and skills.

189
Q

The acoustic nerve (cranial nerve)

A

CN VIII) vestibulocochlear is assessed by checking the client’s hearing using an audiometer or by simply whispering in the client’s ear. Hearing loss is tested with the Weber and Rinne tests.

190
Q

The oculomotor nerve

A

(cranial nerve III) assessment checks the five extrinsic eye muscles; it is tested together with the trochlear (cranial nerve IV) and abducens (cranial nerve VI). This test checks for equality of pupils, their reaction to light, and accommodation. This test also checks for the corneal light reflex.

191
Q

The trochlear assessment

A

(cranial nerve IV) uses the same process as the oculomotor (cranial nerve III) and abducens (cranial nerve VI) and tests for synergy of the eyes working together and in tandem.

192
Q

The ten common withdrawal symptoms assessed on the CIWA scale are as follows:

A
Nausea and vomiting
Tremors
Paroxysmal 
sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbances
Visual disturbances
Headaches
Altered sensorium
193
Q

The four major dimensions of recovery include

A

health, home, purpose, and community.

194
Q

What is the most common sexual dysfunction side effect reported by women who are prescribed a selective serotonin reuptake inhibitor (SSRI)?

A

Anorgasmia is the most commonly reported sexual dysfunction side effect in women who are taking SSRIs. This is defined as the persistent inability to achieve orgasm despite responding to sexual stimulation.

195
Q

To prevent medical malpractice suits, nurse practitioners should follow these guidelines:

A

Be careful about establishing a patient-provider relationship.
Know the standard of care and practice within it.
Follow the practice guidelines and protocols adopted by the office or agency and follow them.
When in doubt, take a conservative approach.
Rule out the worst diagnosis early on.
Know the limits of training and expertise.
Follow up.

196
Q

At 40 weeks of age, landmarks of normal behavioral development include the following:

A

Sits alone with good coordination
Creeps
Pulls self to standing position
Points with index finger
Matches two objects at midline
Attempts to imitate scribble
Develops separation anxiety when away from mother
Responds to social play such as peek-a-boo
Feeds self a cracker and holds own bottle

197
Q

For a person to be diagnosed with Tourette’s (TS), they must

A

Have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.
Have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
Have tics that begin before he or she is 18 years of age.
Have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).

198
Q

Attention-deficit/hyperactivity disorder is characterized

A

by hyperactivity, impulsivity, and inattentiveness.

199
Q

Stuttering, also called

A

childhood-onset fluency disorder, occurs when the normal fluency of speech is frequently interrupted.

200
Q

Oppositional defiant disorder is characterized by

A

multiple examples of negativistic behavior persistent for at least six months, usually beginning when a child is three or four years old.

201
Q

Computer competency is the

A

ability to demonstrate proficiency in the use of software applications, such as Microsoft Word, Excel, and PowerPoint, and knowledge of computer terminology, hardware selection, and simple maintenance functions.

202
Q

Computer literacy is

A

the level of expertise and familiarity someone has with computers. It generally refers to the ability to use an application rather than to write code. Individuals who are very computer literate are called power users.

203
Q

Information literacy involves

A

recognizing when information is needed and being able to efficiently locate and use it.

204
Q

Information competency is

A

often used as a synonym for information literacy.

205
Q

Megasystem:

A

American health care system

206
Q

Metasystem:

A

economic, political, and social level of society

207
Q

Privilege

A

refers to the patient’s right to prevent disclosure of confidential information in judicial hearings

208
Q

Nonmaleficence

A

refers to the principle of bioethics that asserts an obligation not to inflict harm intentionally.

209
Q

Beneficence

A

refers to an action done for the benefit of others.

210
Q

The hypothalamus is part of the limbic system. It plays a key role in

A

various regulatory functions including appetite, water balance, circadian rhythms, body temperature, and libido.

211
Q

The hippocampus regulates .

A

memory and converts short-term into long-term memory.

212
Q

The amygdala regulates

A

mood, fear, emotion, and aggression.

213
Q

The thalamus regulates

A

the flow of sensory information to the cortex

214
Q

Ninety-five percent of lithium is excreted through the kidneys; therefore, you should check

A

the patient’s kidney function by ordering electrolytes, creatinine, BUN, and a urinalysis. Lithium also inhibits the synthesis of thyroid hormone, so you should always check thyroid studies as well.

215
Q

Target symptoms of antidepressant treatment include

A

depressed mood, sleep/rest disturbance, anxiety, irritability, impaired concentration, impaired memory, appetite disturbance, agitation, anhedonia, and impaired energy and motivation.

216
Q

What psychoactive substance is most widely used in the United States?

A

Cannabinoids, particularly cannabis, are the most widely used psychoactive substances in the United States. The 12-month prevalence of cannabis use disorder is 3.4%. The rates of cannabis use disorder are highest among adult and adolescent males.

217
Q

Which term describes a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market?

A

Health alliance

A health alliance is a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market.

218
Q

A special interest agency is

A

a group of people seeking or receiving special advantages through political lobbying.

219
Q

Public interest groups

A

promote issues of general public concern.

220
Q

A political action committee is

A

an organization that raises money privately to influence elections or legislation, especially at the federal level.

221
Q

Nursing science is the domain of knowledge concerned with

A

The adaptation of individuals and groups to actual or potential health problems
The environments that influence health in humans
The therapeutic interventions that promote health and affect the consequences of illness

222
Q

When initiating treatment with clients who have newly diagnosed bipolar disorder, clients should be seen monthly for titration of medications and monitoring of serum blood levels.

A

new diagnosed bipolar should be seen weekly. When initiating treatment with clients who have newly diagnosed bipolar disorder, clients should be seen weekly for titration of medications and monitoring of serum blood levels.

223
Q

Beta blockers, benzodiazepines, and retroviral agents cause an exacerbation of,

A

depressive symptoms

224
Q

presentations of hyponatremia include the following:

A
Apprehension
Seizures
Coma
Hypotension
Tachycardia
Decreased urine output
Weight gain
Edema
Ascites
Jugular vein distension
225
Q

Presentations of hypernatremia:

A
Convulsions
Pulmonary Edema
Thirst
Fever
Dry mucous membranes
Hypotension
Tachycardia
Low jugular venous pressure
Restlessness
226
Q

Tryptophan puts a patient on psychotropics at risk

A

for serotonin syndrome and is not advised when a patient is taking selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs).

227
Q

The major characteristics of the phallic stage include

A

seeking gratification through the genitals, coming to terms with the Oedipal conflict, and identifying with the same sex parent.

228
Q

The latency stage is

A

characterized by a time in which sexual concerns are largely unimportant.

229
Q

During the genital phase, sexual interests

A

reemerge and individuals begin to establish mature sexual relationships.

230
Q

Global developmental delay describes a child under

A

the age of five who seems to be falling behind developmentally, but the practitioner cannot reliably assess the degree.

231
Q

Unspecified intellectual disability is a term used when a c

A

hild is five years old or older and cannot be reliably assessed due to a physical or mental impairment.

232
Q

Borderline intellectual functioning describes a person with a nominal IQ

A

ranking of 71 to 84 who does not have the coping problems associated with an intellectual disability.

233
Q

Autism spectrum disorder forms in

A

early childhood and results in impaired social interactions and communication. These patients usually demonstrate stereotyped behaviors and interests.

234
Q

Bipolar I disorder:

A

These patients experience at least one manic episode and may or may not experience a major depressive episode.

235
Q

Bipolar II disorder:

A

These patients experience at least one hypomanic episode and at least one major depressive episode.

236
Q

Cyclothymic disorder:

A

These patients experience mood swings, but they are not severe enough to be called major depressive episodes or manic episodes.

237
Q

Schizoaffective disorder is a psychotic disorder

A

characterized by patients experiencing symptoms of schizophrenia along with either depression or mania.

238
Q

Vitamin E is a

.

A

dietary supplement used in treating neurological disorders, diabetes, and premenstrual syndrome. It is also used for enhancing the immune system and protecting cells against the effects of free radicals.

239
Q

Vitamin B is an

A

important dietary supplement that plays important roles in cell metabolism.

240
Q

Vitamin D is an

A

important dietary supplement for maintaining strong bones and aiding the body in calcium absorption.

241
Q

Vitamin C is an

A

important dietary supplement involved in the repair of tissue and the enzymatic production of certain neurotransmitters

242
Q

The reticular formation is the part of the brain stem that regulates

A

involuntary movement, muscle tone, blood pressure, and respiratory rate.

243
Q

The parietal lobe is the

A

primary sensory area and is responsible for regulating taste, reading, and writing.

244
Q

The limbic system’s amygdala

A

regulates mood, fear, emotion, and aggression.

245
Q

The limbic system’s hypothalamus

A

regulates appetite, water balance, body temperature, and libido.

246
Q

Symptoms of neurosyphilis include the following:

A
Wide-based gait
Positive Romberg sign
Loss of vibratory and proprioceptive senses in lower extremities
Decreased deep tendon reflexes
Pupil abnormalities
Tremors
Dyscoordination
Spasticity in lower extremities
247
Q

Possession syndrome is

A

an umbrella English-language term used to describe South Asian presentations of involuntary possession trances. These episodes usually begin with a somatic complaint like a headache or abdominal pain. Next, patients appear as though they are possessed by a secondary personality, usually either a culturally famous figure or a recently deceased family member. Often, the patient will develop partial or total amnesia related to the altered state.

248
Q

Health care system describes

A

the organizational and institutional structures through which an economy makes choices regarding the production, consumption, and distribution of medical services.

249
Q

Health production function

A

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.

250
Q

A health alliance is

A

a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market.

251
Q

Health economics is related

A

to the value, effectiveness, and efficiency of care received.

252
Q

the act of discussion among two or more people with the goal of reaching an agreement.

A

Negotiation

253
Q

EMDR is

A

the gold standard in treating PTSD and involves having the patient recall distressing events/images while generating one type of bilateral sensory input such as hand tapping or side-to-side eye movements.

254
Q

DBT is used in

A

treating borderline personality disorder.

255
Q

In 1981, the case of ___________ determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment.

A

Roger vs. Oken

256
Q

Pretraumatic risk factors:

A
Female gender
Emotional disturbances prior to age six
Childhood mental illness
Externalizing behaviors
Lower socioeconomic status
Low education
Childhood adversity
Fatalistic or self-blaming coping mechanisms
Minority social/ethnic status
Low intelligence
Poor social support
Family history of psychiatric disorders
257
Q

Peritraumatic risk factors:

A

Severity of trauma
Duration of trauma
Perceived life threat
Personal injury
Trauma perpetrated by a loved one or caregiver
Witnessing a threat directed toward a loved one or caregiver
Dissociation during trauma
For military personnel, witnessing atrocities or killing the enemy

258
Q

Posttraumatic risk factors:

A
Negative appraisals
Inappropriate coping strategies
Development of an acute stress reaction
Subsequent exposures to reminders
Subsequent adverse life events and financial losses
Lack of social support
259
Q

.gastrointestinal finding suggestive of alcohol dependency

A

Splenomegaly is a gastrointestinal finding suggestive of alcohol dependency. Other gastrointestinal findings include hepatomegaly and intestinal tenderness

260
Q

endocrine findings suggestive of alcohol dependency.

A

Testicular atrophy, gynecomastia, and sexual dysfunction are all endocrine findings suggestive of alcohol dependency.

261
Q

Dementia with Lewy bodies is usually accompanied by s.

A

extrapyramidal symptoms

262
Q

Huntington’s disease is accompanied by

A

spasmodic movement and incoordination.

263
Q

Patients with frontotemporal dementia are

A

usually extremely talkative and disinhibited.

264
Q

There are five subtypes of Circadian rhythm sleep-wake disorders

A

Delayed sleep phase type: falling asleep and waking later than desired
Advanced sleep phase type: falling asleep and waking earlier than desired
Irregular sleep-wake type: falling asleep and waking at random times
Non-24-hour sleep-wake type: falling asleep and usually waking progressively later than desired

265
Q

Anticholinergic side effects include

A

dry mouth, blurred vision, constipation, and memory problems.

266
Q

Orthostatic hypotension is an

A

antiadrenergic side effect.

267
Q

Sedation and weight gain are

A

antihistaminergic side effects.

268
Q

If a nurse practitioner is sued, she should follow these guidelines:

A

Call her professional liability insurance company and report the lawsuit.
Never talk to the patient or the plaintiff’s attorney.
Consider retaining her own attorney if the suit is against a group of providers.
Never change a patient’s record after learning of a lawsuit.
Think carefully before settling a case because settlement awards will appear on the nurse practitioner’s record.

269
Q

**S/S of anticholinergic intoxication

A

Psychosis, dry mouth, hyperpyrexia, mydriasis, restlessness, and tachycardia are symptoms of anticholinergic intoxication

270
Q

*******If anticholingeric intoxication the NP should

A

The nurse practitioner should discontinue the offending medication or substance and consider IV physostigmine and benzodiazepines. **Remember, antipsychotics are contraindicated in this situation.

271
Q

Alcohol withdrawal would present with

A

irritability, nausea, vomiting, insomnia, malaise, autonomic hyperactivity, and shakiness.

272
Q

Benzodiazepine intoxication would present with

A

sedation, somnolence, and ataxia

273
Q

Catatonic schizophrenia would present with

A

marked psychomotor disturbance (either excitement or stupor) and exhaustion.

274
Q

Vitamin E interacts with warfarin by

A

increasing anticoagulant effects of antiplatelet drugs and statins, increasing additive effects and the risk of rhabdomyolysis (muscle wasting).

275
Q

There are three phases in EMDR:

.

A

desensitization, installation, and body scan.

276
Q

Describe each phase of EMDR

A

Desensitization: The patient visualizes the trauma, verbalizes negative or maladaptive beliefs, and remains attentive to physical sensations. The patient also blocks out negative thoughts, breathes deeply, and verbalizes what he or she is imagining.
Installation: The patient installs and strengthens the positive thought that he or she has declared as a replacement of the original negative thought.
Body scan: The patient visualizes the trauma along with the positive thought and then scans his or her body mentally to identify any tension within

277
Q

In EMDR use fro trauma therapy the patient

A

The patient visualizes the trauma, verbalizes negative thoughts, and remains attentive to physical sensations

278
Q

EMDR developed by

A

Eye movement desensitization and reprocessing (EMDR) is a form of behavioral therapy that was developed by Francine Shapiro. It is most commonly used in posttraumatic stress disorder, and its goal is adaptive resolution.

279
Q

****For an act to be considered criminal, it must have two components: actus reus and mens rea.

A

actus reus and mens rea.

280
Q

***Actus reus refers to

A

voluntary conduct. Voluntary conduct is deemed impossible if the offender’s mental status is deficient, abnormal, or diseased in a way that inhibits rational intent.

281
Q

**Mens rea refers.

A

to evil intent. Evil intent is defined as the resolve to do harm

282
Q

A person is more likely to develop antisocial personality disorder if they were diagnosed with

A

conduct disorder and attention-deficit/hyperactivity disorder before the age of 10

283
Q

Cluster A 4 characterization and includes 3 types

A

Cluster A patients are characterized as withdrawn, cold, suspicious, and irrational. Cluster A includes paranoid, schizoid, and schizotypal personality disorders.

284
Q

Cluster B 3 characterization and includes 4 types

A

Cluster B patients are characterized as theatrical, emotional, and attention-seeking. They often experience intense interpersonal conflicts and exhibit an extremely labile mood. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders.

285
Q

Cluster C 4 characterization and includes 3 types

A

Cluster C patients tend to be anxious, fearful, tense, and overcontrolled. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders.

286
Q

Clonazepam dosing

A

start at 0,25mg and titrate to 1mg/day after 3 days.

287
Q

Neurotransmitters fall into four categories:

A

Monoamines
Amino acids
Cholinergics
Neuropeptides (divided into nonopioid type and opioid type)

288
Q

examples of monoamine neurotransmitters

A

Dopamine, norepinephrine, and serotonin. These are also called biogenic amines.

289
Q

examples of amino acids

A

Glutamate, GABA, aspartate, and acetylcholine

290
Q

Substance P and somatostatins are examples of

A

nonopioid-type neuropeptides

291
Q

Endorphins, enkephalins, and dynorphins are examples of

A

opioid-type neuropeptides.

292
Q

Irvin Yalom was the first person to put a theoretical perspective on group work. He believed that all groups go through specific phases:

A
Pre-group
Forming
Storming
Norming
Performing
Adjourning
During the performing phase:

The group’s work becomes more focused
Solutions begin to emerge through creative problem-solving
Experiential learning takes place
Group energy is directed toward completion of goals

293
Q

Retinal pigmentation can occur in patients prescribed

A

> 1,000 mg of thioridazine. Even when thioridazine is stopped, this side effect may persist and lead to blindness.

294
Q

Hyperprolactinemia, priapism, and tardive dyskinesia can occur as side effects

A

of any antipsychotic medication.

295
Q

When assessing judgment, the provider is determining whether the patient’s judgment is

A

grossly impaired for both self and social judgment.

296
Q

A nurse practitioner’s scope of practice is legally the most secure when it is

A

clearly defined by a statute. Physicians’ organizations often try to prevent nurse practitioners from providing patient care by pointing to state law and asking for a strict interpretation. When a nurse practitioner’s scope of practice is clearly defined by statute, it is most secure against physician special interest groups.

297
Q

Mental status exam findings of ADHD include all of the following:

A
Restlessness
Inattention
Distractible speech patterns
Overproductive speech patterns
Affective lability
Poor memory
Poor concentration
298
Q

Bupropion is a

A

norepinephrine-dopamine reuptake inhibitor (NDRI),

299
Q

phenelzine is a

A

monoamine oxidase inhibitor (MAOI)

300
Q

Galactorrhea, is a

A

milky nipple discharge unrelated to the normal milk production of breastfeeding.

301
Q

Hyperprolactinemia is an indication of

A

elevated prolactin levels, which can cause galactorrhea and is a risk factor for those taking antipsychotics, especially second-generation antipsychotics such as Invega or Risperdal.

302
Q

The general function of glutamate involves

A

memory and sustained autonomic functions.

303
Q

The general function of dopamine involves

A

normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition.

304
Q

The general function of norepinephrine involves

A

alertness, orientation, fight-or-flight, learning, memory, and focus and attention.

305
Q

The general function of serotonin involves

A

regulation of sleep, pain perception, mood states, temperature, aggression, and libido

306
Q

The services covered under Medicaid:

A

Inpatient medical hospitalizations
Outpatient services
Family planning services
Home health services when there is no local home health agency
Home health aides
Skill nursing facilities services for those age 21 and older
Services rendered by nurse practitioners and nurse midwives
Medical supplies for use in-home
Pregnancy-related services up to 60 days postpartum

307
Q

The services not covered under Medicaid:

A
Vision care
Eyeglasses
Dental care
Dentures
Hearing exams
Hearing aids
Routine physical exams
Inpatient psychiatric hospitalizations
308
Q

Individuals with chronic alcohol misuse often consume most of their calories from alcohol and are at high risk for

A

thiamine deficiency. A thiamine-deficient person can develop Wernicke encephalopathy if they attempt to metabolize food. You must administer thiamine immediately for this patient.

309
Q

The evidence-based practice movement gained popularity in 2001 when the Institute of Medicine (IOM) published

A

Crossing the Quality Chasm, which exposed the unacceptable gap between scientific knowledge and clinical practice: “Between the health care we have and the care we could have lies not just a gap but a chasm.” They estimated that nearly 200,000 patients die from avoidable medical errors every year, and 40% of patients do not receive scientifically proven treatments.

310
Q

Competency is a

A

legal concept but not a medical one.

311
Q

Cigarette smoking induces

A

the cytochrome p450 1A2 enzyme.

312
Q

Olanzapine is metabolized

A

by cytochrome P450 1A2; therefore, its plasma levels would decrease if an individual began taking a p450 1A2 inducer.

313
Q

The two phases of the action potential are .

A

depolarization and repolarization

314
Q

Depolarization is characterized by:

A

The initial phase of the action potential;
An excitatory response; and
An influx of sodium and calcium ions into the cell.

315
Q

Repolarization is characterized by:

A

The restoration phase;
An inhibitory response; and
Potassium leaving the cell or chloride entering the cell.

316
Q

The services covered under Medicaid include the following:

A

Inpatient medical hospitalizations
Outpatient services
Family planning services
Home health services when there is no local home health agency
Home health aides
Skill nursing facilities services for those age 21 and older
Services rendered by nurse practitioners and nurse midwives
Medical supplies for use in-home
Pregnancy-related services up to 60 days postpartum

317
Q

The services not covered under Medicaid:

A
Vision care
Eyeglasses
Dental care
Dentures
Hearing exams
Hearing aids
Routine physical exams
Inpatient psychiatric hospitalizations
318
Q

The 8 goals of DBT are as follows:

A
Decrease suicidal behaviors
Decrease therapy-interfering behaviors
Decrease emotional reactivity
Decrease self-invalidation
Decrease crisis-generating behaviors
Decrease passivity
Increase realistic decision-making
Increase accurate communication of emotions and competencies
319
Q

Credentialing is

A

a process used to protect the public by ensuring a minimum level of professional competence.

320
Q

Licensure is a process by which an

A

agency of state government grants permission to individuals to engage in the practice of that profession. Licensure prohibits all unlicensed persons from engaging in a legally protected practice.

321
Q

Certification is a process by which a professional organization

A

certifies that an individual has met certain predetermined standards specified by that specialty practice. The nurse practitioner’s certification determines his or her scope of practice, and it assures the public that he or she has mastered a body of knowledge in a particular medical specialty.

322
Q

The American Medical Association’s Scope of Practice Partnership (SOPP) initiative lobbies the federal government to limit patients’ chiropractors, social workers, and others.

A

choice of which health care provider they can see for treatment.

323
Q

a group of 35 non-physician organizations created the Patients’ Access to Responsible Care Alliance (PARCA). PARCA aim is

A

This alliance aims to provide federal policymakers with more accurate information from all health care disciplines. PARCA is committed to ensuring patients have a choice of providers. PARCA includes nurses, nurse practitioners, audiologists, optometrists,

324
Q

Individuals who are very computer literate are called

A

power users.

325
Q

Cognitive therapy was originated by ______________ and purports that

A

by Aaron Beck. This therapy purports that external events do not cause anxiety, but rather a person’s expectations or perceptions. Cognitive therapy helps patients view their reality more clearly by examining their central distorted conceptions. The goal is to change patients’ irrational beliefs, faulty conceptions, and negative cognitive distortions.

326
Q

Patients suffering from anhedonia present with a decrease in

A

dopamine activity.

327
Q

Patients suffering from psychosis and schizophrenia present with an increase in

A

dopamine activity.

328
Q

Patients suffering from anxiety disorders present with a decrease in

A

gamma-aminobutyric acid, or GABA.

329
Q

Patients suffering from obsessive-compulsive disorders present with a decrease in

A

serotonin activity.

330
Q

The mini-mental status exam (MMSE) is a brief instrument designed to assess the patient’s overall cognitive functioning.

A

Asking the patient to spell the word “world” backward assesses their attention.
Asking the patient to say this “no ifs, ands, or buts” assesses their ability to repeat what they hear.
Asking the patient remember the three objects apple, table, and penny assesses their short-term memory.
Asking the patient tell the year, season, month, date, and day assesses their orientation.

331
Q

Informatics researchers are those who develop methods in areas such

A

as data mining, text processing, human interface design, decision support, and other tools for data analysis.

332
Q

Decrease levels of sodium (Na) can cause

A

Addison’s disease, renal disorders, and gastrointestinal fluid loss from vomiting and diarrhea.

333
Q

What did the Technology Informatics Guiding Education Reform (TIGER) initiative successfully define for nurse practitioners?

A

The Technology Informatics Guiding Education Reform (TIGER) initiative developed a 10-year plan for nursing’s path toward computer and information literacy. It involved more than 1,100 nursing content experts, and it took three years to complete. This initiative successfully defined the basic technology competencies and required curriculum for nurse practitioner education. The TIGER initiative declared that it is a nurse practitioner’s responsibility to understand and shape the landscape of health care technology in order to improve access, quality, and the patient experience.

334
Q

Which term describes the use of a software application for placing medical orders in both inpatient and outpatient settings?

A

Computerized provider order entry (CPOE) is the use of a software application for the ordering of medications, laboratory and radiology testing, consultation, and referral requests. The CPOE is a replacement for written orders in both inpatient and outpatient settings. It is cited as an important tool in avoiding medical errors and improving patient safety.

335
Q

Nursing informatics is

A

the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.

336
Q

Systemic effects of hypernatremia include which of the following?

A

Restlessness

337
Q

Negative symptom clusters of schizophrenia include

A

affective flattening, alogia or poverty of speech, avolition, apathy, abstract thinking problems, and anhedonia, Attention deficits

338
Q

Positive symptom clusters of schizophrenia include

A

hallucinations, delusions, disorganized behaviors, hostility, grandiosity, mania, and paranoia.

339
Q

Associated symptom clusters of schizophrenia include

A

inappropriate affect, dysphoric mood, depersonalization, derealization, and high anxiety.

340
Q

****Piaget’s cognitive behavioral theory states that

A

humans develop through learning, comprehending, and cognition. Piaget also believed that the course of a child’s development is shaped through native endowment and biological and environmental factors.

341
Q

*****Introduced the interpersonal theory.

A

Harry Stack Sullivan

342
Q

*** developed the hierarchy of needs theory.

A

Abraham Maslow

343
Q

**proposed the health belief model.

A

Marshall Becker

344
Q

**Bipolar disorder is believed to be related to an increase in what neurotransmitter?

A

Glutamate. Glutamate is an excitatory amino acid neurotransmitter. While the exact connection between glutamate and bipolar disorder remains unclear, proton magnetic resonance spectroscopy studies have found increased glutamate in those with bipolar disorder compared with healthy controls. Glutamate is also implicated in seizure disorders and schizophrenia.

345
Q

*****developed structured family therapy, which emphasizes how, when, and to whom family members relate in order to understand and change the family’s structure.

A

Salvador Minuchin

346
Q

The primary treatment goal of structured family therapy is to

A

produce structural change in the family organization and to alter transactional patterns.

347
Q

developed experiential therapy

A

Virginia Satir

348
Q

developed family systems therapy

A

Murray Bowen

349
Q

developed strategic therapy

A

Jay Haley

350
Q

EMDR, originated by, is a form of exposure therapy meant to help the patient address past trauma and work through it for long-term stabilization.

A

Francine Shapiro

351
Q

ENDR is a form of

A

is a form of exposure therapy meant to help the patient address past trauma and work through it for long-term stabilization.

352
Q

Cognitive therapy is used in

A

situations when clients have irrational beliefs, faulty conceptions, and negative cognitive distortions about themselves.

353
Q

Dialectical behavioral therapy (DBT) is used.

A

with patients suffering from borderline personality disorder

354
Q

Existential therapy is an approach

A

in which the client reflects on life, and self-confrontation is encouraged.

355
Q

Eye movement desensitization and reprocessing (EMDR) is used on patients suffering from

A

PTSD,

356
Q

Activities or systems designed to recognize and intervene to reduce the risk of injury to clients are in the category of:

A

Risk management

357
Q

Risk assessment is

A

continuous monitoring for high-risk situations and assessing persons for non-healthy behaviors.

358
Q

Risk mitigation is

A

the act of process change in order to mitigate the risk finding.

359
Q

Risk intervention a task performed

A

in real time in order to prevent an immediate risk.

360
Q

Risk management interventions are implemented to reduce

A

non-healthy behaviors in clients and high-risk situations. Risk management is also the process of recognizing and intervening in order to reduce subsequent claims against healthcare providers.

361
Q

Nurse practitioners have the legal authority to dispense controlled substances in ____ states

A

34

362
Q

The 16 states where NP can’t dispense controlled substances

A

Alabama, Arizona, Arkansas, Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Nebraska, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas.

363
Q

a movement disorder that can occur after long-term use of antipsychotic medication like haloperidol (Haldol). It is characterized by abnormal motor movements including lip smacking, facial grimacing, and choreoathetosis-like movements of the limbs and trunk.

A

tardive dyskinesia

364
Q

Anticholinergic toxicity would be accompanied by

A

delirium

365
Q

an oral facial dystonia that involves blinking and chin thrusting.

A

Meige syndrome

366
Q

is associated with rheumatic fever and occurs in children.

A

Sydenham chorea

367
Q

Herbal supplements such as St. John’s Wort are contraindicated as adjunctive therapy when taking

A

an SSRI. Prozac is an SSRI.

368
Q

Hyperparathyroidism is caused by i

A

ncreased levels of calcium.

369
Q

Decreased levels of calcium can cause

A

alkalosis and pancreatitis.

370
Q

If a patient is taking sertraline at the time of a drug screen, they may falsely test positive

A

for benzodiazepines.

371
Q

If the patient is taking amoxicillin or NSAIDS, they may falsely test positive for

A

cocaine

372
Q

If a patient is taking codeine, they may falsely test positive for

A

methadone or PCP.

373
Q

In hyperthyroidism,

A

T4 is increased and TSH is decreased, which produces excitatory and labile/anxious-like symptomatology.

374
Q

Other presentations of hyperthyroidism include the following:

A
Motor restlessness
Emotional lability
Tremors
Insomnia
Impotence
Weight loss
Increased appetite
Abdominal pain
Excessive sweating
Flushing
Elevated upper eyelid leading to decreased blinking, staring, and fine tremors of the eyelid
Tachycardia
Dysrhythmias
375
Q

In hypothyroidism,

A

T4 is decreased and TSH is increased, which produces slowed processes and depressive-like symptomatology.

376
Q

Patients with hypothyroidism may present with the following symptoms:

A
Confusion
Decreased libido
Impotence
Decreased appetite
Memory loss
Lethargy
Constipation
Headaches
Slow or clumsy movements
Syncope
Weight gain
Fluid retention
Muscle aching and stiffness
Slowed reflexes
Somatic discomfort including aching and joint stiffness
Slowed speech and thinking
Sensory disturbances, including hearing
Cerebellar ataxia
Loss of amplitude in ECG
377
Q

Panic disorders mimic.

A

fight-or-flight episodes and potentiate a response from the central nervous system

378
Q

Devaluation is a defense mechanism that

A

attributes excessive negative qualities to another.

379
Q

Idealization is a defense mechanism that

A

attributes excessive positive qualities to another.

380
Q

Repression is a defense mechanism that

A

expels disturbing wishes from conscious awareness.

381
Q

A decrease in serotonin is related to .

A

major depressive disorder, obsessive-compulsive disorder, and schizophrenia

382
Q

Alzheimer’s disease is related to a decreased in

A

acetylcholine,

383
Q

Examples of mental health promotion and education:

A

Teaching patients about interventions and ways to cope with specific life-stressors
Validating “normalcy” of feelings and ensuring patients that they are not “crazy”
Helping patients recognize and identify their feelings and behaviors
Helping patients identify resources in their community

384
Q

Case management involves

A

coordinating care across treatment settings to ensure quality outcomes.

385
Q

Inattentive traits of ADHD include all of the following:

A
Fails to give attention to details
Has difficulty sustaining attention
Does not listen when spoken to
Does not follow through on instructions
Is disorganized
Avoids or dislikes tasks that require sustained mental effort
Loses things
Is distracted
Is forgetful
386
Q

Hyperactive and impulsive traits of ADHD are as follows:

A
Fidgets
Leaves seat
Runs or climbs
Is unable to engage in quiet activities
Is always on the go
Talks excessively
Blurts out information
Has a difficult time waiting their turn
Interrupts others
387
Q

Evidence-based practice demands the use of the best knowledge. The evidence hierarchy ranks sources of knowledge according to the strength of information they provide. The best evidence comes from Level 1 of the evidence hierarchy, which includes meta-analyses. All levels are listed below.

A

Level 1 (strongest): Systematic review of randomized controlled trials or systematic review of nonrandomized trials
Level 2: Single randomized controlled trial or single nonrandomized trial
Level 3: Systematic review of correlational or observational studies
Level 4: Single correlational or observational study
Level 5: Systematic review of descriptive, qualitative, or physiologic studies
Level 6: Single descriptive, qualitative, or physiologic study
Level 7 (weakest): Opinions of authorities and expert committee

388
Q

Positive symptom clusters of schizophrenia include

A

hallucinations, delusions, disorganized behaviors, hostility, grandiosity, mania, and paranoia Hostility and referential thinking

389
Q

Negative symptom clusters of schizophrenia include

A

affective flattening, alogia or poverty of speech, avolition, apathy, abstract-thinking problems, anhedonia, and attention deficits.

390
Q

The strongest and most consistent risk factor for developing bipolar disorder is

A

a family history of bipolar disorder. These individuals are 10 times more likely to develop the condition.

391
Q

When monoamine oxidase is inhibited, tyramine

A

exerts a strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and norepinephrine, which can increase blood pressure and heart rate.

392
Q

Foods containing high levels of magnesium, calcium, and tryptophan do not puts.

A

the patient at risk for a hypertensive crisis when taken with MAOI