PMHNP-BC Flashcards
(186 cards)
1
Q
At what age should children be screened for Autism?
A
18 & 24 months
2
Q
What is most commonly paired with Bipolar I disorder in adolescents?
A
ADHD
3
Q
If a patient is experiencing symptoms three weeks after a trauma, which condition is most likely occurring?
A
Acute Stress Disorder
4
Q
If an adolescent expresses suicidal ideations, do you include parents?
A
Talk with parents and adolescent about findings and plan.
5
Q
A patient is charged with sexual misconduct after rubbing and grabbing a woman on the bus. What condition is most likely?
A
Frotteuristic disorder
6
Q
At what stage do older adults reflect on life choices and how things might have been different?
A
Ego integrity vs. Despair
7
Q
What is the Vanderbilt Assessment Scale?
A
ADHD for children
8
Q
What medication has been shown to significantly reduce relapse rates in bipolar disorder?
A
Lithium
9
Q
At what age can social anxiety disorder be diagnosed?
A
Any age
10
Q
Which antipsychotic has a black box warning for seizure risk?
A
Clozapine/Clozaril
11
Q
What does Medicare Part D cover?
A
D for “Drugs”
12
Q
What is Kernberg’s approach to treating narcissistic personality disorder?
A
Treat like borderline personality organization
13
Q
In men, what condition is most likely to be paired with Fragile X?
A
ADHD
14
Q
Is phenytoin an inducer or an inhibitor and what does that do?
A
Inducer; increases metabolism of the drug which reduces serum levels faster
15
Q
Which is more effective for initial treatment of MDD, therapy or meds?
A
Same efficacy for both
16
Q
An older adult with no prior history has new onset depressed mood and impaired memory. Which assessment is recommended?
A
MRI/CT
17
Q
How many non-overlapping symptoms must be present to include the “mixed features” specifier in the diagnosis of a major depressive episode, hypomania episode, or manic episode?
A
3
18
Q
What antidepressent has been shown to be effective in treating stress incontinence in females?
A
Duloxetine/Cymbalta
19
Q
Which medication in the mother can cause displacement of heart valves and malformation of atria and ventricles in the fetus?
A
Lithium
20
Q
The United States Preventive Task Force (USPSTF) recommends what screening in adults based on a grade of A or B?
A
Unhealthy alcohol use in adults
21
Q
What therapy modality is best for eating disorders?
A
CBT
22
Q
If a patient has a mass pressing on CN VII, what additional findings would also be likely to be found?
A
Loss of taste on the anterior 2/3 of tongue
23
Q
How long does buspirone have to be trialed at the maximum tolerated dose before efficacy decision can be made?
A
2-3 months
24
Q
What term is defined as “poverty of speech”?
A
Alogia
25
What neurodevelopmental factor would be mostly likely in schizophrenia?
Intrauterine oxygen deprivation
26
What effect do steroids have on bipolar disorder?
Likely to cause mania
27
What is "kindling"?
The process of neuronal membrane threshold sensitivity dysfunction
28
What effect does lithium have on an EKG?
Inverted T-waves
29
Does Medicaid cover psychiatric hospitalization?
No
30
Which common medication can induce mania?
Steroids, disulfiram, isoniazid, antidepressants
31
What is the PDQ-4?
Personality Diagnostic Questionnaire - 4 (PDQ-4)
The PDQ-4 is a self-report questionnaire that is specifically designed to assess personality traits and potential personality disorder diagnoses.
32
What term is used to describe patients who injure themselves by self-mutilation but do not wish to die?
Parasuicide
33
What is the most commonly used therapy modality for clients suffering from post-traumatic stress disorder?
Eye movement desensitization and reprocessing (EMDR)
34
Which of the following statements regarding Medicaid reimbursement for nurse practitioner (NP) services is accurate?
The presence of NPs in a healthcare practice increases the likelihood that the practice accepts Medicaid, improving community access to health care
35
Which inferential statistic tests the relationship between two variables?
Pearson's r correlation
36
Which deficiency, occurring in vegetarian and vegan diets is likely to present with both neuropsychiatric and medical symptoms?
Niacin
37
Name a rare behavioral disorder caused by damage to both sides of the anterior temporal lobe by head trauma or encephalitis. It is characterized by hypersexuality, putting things in the mouth, distractibility, visual agnosia, and possibly seizures.
Kluver-Bucy syndrome
38
Which hypnotic sleep aid has a short half-life and therefore has the least change of daytime grogginess?
Zaleplon (Sonata)
39
What is it called when mental health treatment is interdisciplinary and takes place in the patient's current living situation, such as a shelter for patients without housing?
Assertive Community Treatment
40
Reconciling two opposing perspectives into a unified solution is a basic tenet of what theory?
Dialectical Behavior Therapy (DBT)
41
How long do symptoms have to last for a patient to meet the criteria of persistent depressive disorder?
At least 24 months
42
What is a rare but serious adverse reaction associated with mirtazepine use?
Agranulocytosis
43
What is the mechanism of action for varenicline (Chantix)?
It binds to alpha-4-beta-2 nicotinic acetylcholine to produce a partial agonistic effect
44
How long must symptoms be present to diagnose a specific phobia?
6 months
45
What are the requirements for utilizing psychoanalysis?
Therapist trained at a psychoanalysis institute and has had a personal psychoanalysis
46
What diagnosis is an absolute contraindication for electroconvulsive therapy (ECT)?
Pheochromocytoma
47
How is lithium managed in the third trimester of pregnancy?
Discontinue 2-3 days before delivery date and resume preconception dose after delivery
48
Which cranial nerve is responsible for corneal reflex?
CNV
49
What can often be concomitant in pediatric OCD?
Tourette's Syndrome
50
If a treatment-resistant panic disorder patient fails an SSRI, SNRI, a benzo, and a TCA, what is the next line of treatment?
Phenelzine (Nardil)
51
When a child is five years old or older and cannot be reliably assessed due to a physical or mental impairment, what is the diagnosis?
Unspecified intellectual disability
52
What i the diagnosis for a child under the age of five who seems to be falling behind developmentally, but the practitioner cannot reliably assess the degree of impairment?
Global developmental delay
53
What is the diagnosis for a person with nominally ranked IQ of 71 to 84 who does not have the coping problems associated with an intellectual disability?
Borderline intellectual functioning
54
According to Harry Stack Sullivan's interpersonal theory, what is the primary motive of human behavior?
The satisfaction of interpersonal needs
55
Define SCAS
The Spence Children's Anxiety Scale
56
Define EPDS
The Edinburgh Postnatal Depression Scale
57
Define BDI
The Beck Depression Inventory
58
Define the HAM-D
The Hamilton Depression Rating Scale
59
What psychiatric condition is characterized by the presence of delusions but no other symptoms of schizophrenia?
Delusional disorder
60
What condition is characterized by at least one psychotic symptom present for less than one month?
Brief psychotic disorder
61
What condition is characterized by patients experiencing symptoms of schizophrenia but who have been ill for only one to six months?
Schizophreniform disorder
62
What condition is characterized by patients experiencing symptoms of schizophrenia along with either depression or mania?
Schizoaffective disorder
63
What is the most commonly used tool to assess for alcohol abuse?
CAGE: Cut down, annoyed, guilty, eye-opener
64
Who originally developed interpersonal therapy?
Gerald Klerman and Myrna Weissman
65
Which mental illness is more common in high-income countries than in low-income countries?
Bipolar disorder
66
What nonpharmacologic intervention can be indicated for treatment-resistant depression that involves implanting a pace-maker type device in the left side of the chest?
VNS (vagal nerve stimulation)
67
What involves creating a magnetic field in the scalp for 40-minute sessions.=?
TMS (transcranial magnetic stimulation)
68
What did the Technology Informatics Guiding Education Reform (TIGER) initiative successfully define for nurse practitioners?
Required technology curriculum for colleges
69
How does biofeedback produce its therapeutic effects?
It teaches a patient to control their physiological responses
70
71
Which neurotransmitter systems are most likely involved in depression and anxiety?
Serotonin and Norepinephrine
## Footnote
Serotonin regulates mood and anxiety; norepinephrine is tied to alertness and energy.
72
What is the PMHNP's first action for a patient stabilized on lithium reporting muscle weakness, diarrhea, and confusion with a lithium level of 1.6?
Discontinue lithium and switch to an alternative mood stabilizer
## Footnote
Symptoms and level indicate lithium toxicity; discontinue and switch is indicated.
73
Which neurotransmitter system is most implicated in bipolar disorder?
Serotonin and Dopamine
## Footnote
Serotonin affects mood; dopamine is involved in reward and elevated mood states.
74
What is the appropriate action for a lithium patient presenting with coarse hand tremors and confusion?
Discontinue lithium
## Footnote
These are classic signs of lithium toxicity requiring immediate discontinuation.
75
What is the concern for a patient with alcohol use disorder and bipolar disorder on lithium?
Higher lithium levels due to reduced renal clearance
## Footnote
Alcohol use can reduce renal function, leading to lithium accumulation.
76
Why is lithium preferred for bipolar depression with suicidality?
Modulates glutamate receptors and reduces impulsivity
## Footnote
Lithium has anti-suicidal properties via glutamate modulation and mood stabilization.
77
What should the PMHNP do first for a patient on lithium reporting thirst and urination?
Order serum lithium level
## Footnote
These are early signs of toxicity or nephrogenic DI; level must be checked first.
78
What is the most appropriate action for a 38-year-old stabilized on lithium presenting with tremor and elevated WBC?
Assess for other toxicity signs and adjust dose
## Footnote
Tremor may indicate early toxicity; elevated WBC can be benign. Assess and adjust.
79
How does dehydration affect lithium levels?
Increases levels by reducing renal clearance
## Footnote
Dehydration leads to lithium retention and toxicity risk.
80
How do NSAIDs affect lithium levels?
Increase levels via reduced renal clearance
## Footnote
NSAIDs impair lithium excretion by reducing renal perfusion.
81
What is the impact of hyponatremia on lithium levels?
Increases lithium levels
## Footnote
Low sodium increases lithium reabsorption in the kidneys, raising levels.
82
How does hypokalemia affect lithium levels?
Decreases lithium levels
## Footnote
Low potassium may increase renal clearance of lithium, reducing its level.
83
Which patient statement indicates poor understanding of lithium therapy?
I can stop lithium once I feel better.
## Footnote
Stopping lithium abruptly can lead to relapse; patient needs further education.
84
What is the best time for lithium level blood draw?
Morning before dose
## Footnote
Trough level should be drawn in the morning, 12 hours after the last dose.
85
What is the most appropriate dietary guidance for a patient on lithium?
Keep sodium intake consistent
## Footnote
Fluctuating sodium levels can destabilize lithium balance.
86
What is the hydration guidance for lithium patients?
Increase water on hot days
## Footnote
Water intake prevents dehydration and lithium toxicity.
87
How much fluid should be taken with lithium to prevent GI upset?
Full glass of water
## Footnote
Full glass helps reduce gastric irritation.
88
What is the cognitive benefit of lithium?
Improves cognition and reduces decline
## Footnote
Lithium has neuroprotective effects, especially in bipolar disorder.
89
What is the next step for a patient on lithium showing tremor, nausea, and thirst?
Discontinue and draw lithium level
## Footnote
These are signs of possible toxicity; level should be checked immediately.
90
Which lab change may signal early lithium toxicity?
Low sodium
## Footnote
Hyponatremia can precede and potentiate lithium toxicity.
91
How does cigarette smoking affect risperidone metabolism?
Enhances metabolism, increase dose
## Footnote
Smoking induces CYP1A2, increasing risperidone metabolism.
92
What is the most abundant inhibitory neurotransmitter in the brain?
GABA
## Footnote
GABA is the chief inhibitory neurotransmitter in the CNS.
93
What is the most abundant excitatory neurotransmitter in the brain?
Glutamate
## Footnote
Glutamate is the most abundant excitatory neurotransmitter.
94
Which brain lobe is primarily responsible for balance and coordination?
Cerebellum
## Footnote
Cerebellum coordinates voluntary movement, posture, and balance.
95
Visual disturbances such as flashing lights are most likely due to dysfunction in which lobe?
Occipital
## Footnote
The occipital lobe processes visual information.
96
Which structure processes and relays most sensory information to the cortex?
Thalamus
## Footnote
The thalamus acts as a relay station for sensory information.
97
Which structure is most associated with fear and anxiety responses?
Amygdala
## Footnote
The amygdala processes emotions like fear and anxiety.
98
Atypical antipsychotics differ from typicals primarily by what mechanism?
Serotonin 5HT2A receptor antagonism
## Footnote
Atypicals block serotonin receptors in addition to dopamine.
99
Which dopamine pathway is associated with positive symptoms of schizophrenia?
Mesolimbic
## Footnote
Mesolimbic pathway overactivity leads to positive symptoms.
100
Which pathway is associated with negative and cognitive symptoms of schizophrenia?
Mesocortical
## Footnote
Mesocortical dysfunction relates to negative and cognitive symptoms.
101
Which dopamine pathway is associated with extrapyramidal symptoms (EPS) when blocked?
Nigrostriatal
## Footnote
Nigrostriatal pathway blockade leads to EPS, including parkinsonism.
102
Blockade of which pathway is responsible for antipsychotic-induced hyperprolactinemia?
Tuberoinfundibular
## Footnote
Tuberoinfundibular pathway inhibits prolactin; blockade causes hyperprolactinemia.
103
Which medication is used to treat acute dystonia caused by antipsychotics?
Benztropine
## Footnote
Anticholinergic agents like benztropine relieve acute dystonic reactions.
104
Which medication is used to treat neuroleptic malignant syndrome (NMS)?
Bromocriptine
## Footnote
Dopamine agonists like bromocriptine are used in treating NMS.
105
What is the diagnosis for a patient on SSRI presenting with agitation, clonus, and hyperreflexia?
Serotonin syndrome
## Footnote
These are hallmark signs of serotonin syndrome.
106
Before starting lithium, which test is essential for women of childbearing age?
Urine pregnancy test
## Footnote
Lithium is teratogenic; pregnancy must be ruled out first.
107
What should the PMHNP do for a patient on valproic acid developing jaundice and RUQ pain?
Discontinue valproic acid and order LFTs
## Footnote
Symptoms suggest hepatotoxicity; immediate discontinuation is warranted.
108
What should the PMHNP do for a patient on valproic acid presenting with nausea, abdominal pain, and elevated amylase?
Discontinue valproic acid and check pancreatic enzymes
## Footnote
These symptoms suggest pancreatitis; valproic acid must be stopped.
109
Which lab must be monitored regularly for patients on carbamazepine (Tegretol)?
CBC with differential
## Footnote
Risk of agranulocytosis requires monitoring of WBCs.
110
What should the PMHNP do for a patient on lamotrigine (Lamictal) developing a new rash and fever?
Discontinue Lamictal immediately
## Footnote
These are signs of possible Stevens-Johnson syndrome; stop immediately.
111
What’s the next step for a resolved rash after starting Lamictal?
Continue Lamictal and monitor
## Footnote
If the rash resolved without complication, Lamictal may be continued cautiously.
112
What should the PMHNP do for a patient on Depakote reporting abdominal pain, fever, and elevated amylase?
Discontinue Depakote and evaluate for pancreatitis
## Footnote
Symptoms suggest pancreatitis; Depakote should be stopped.
113
What supplementation is recommended for a PMHNP initiating lithium in a woman of childbearing age?
Folic Acid
## Footnote
Folic acid reduces risk of neural tube defects.
114
Which antipsychotic has the highest risk of agranulocytosis?
Clozapine
## Footnote
Clozapine requires REMS monitoring due to agranulocytosis risk.
115
What does Medicare Part A cover?
Hospitalization (< 90 days), SNF ( < 100 days), Hospice (< 6 months), some home healthcare
116
What does Medicare Part B cover?
Ambulatory practitioner service, PT, OT, ST, DME, diagnostic tests, some preventative care
117
What does Medicare Part C cover?
Optional coverage that all for the patient to receive all of their health care services through one of the provider organizations covered under the Medicare Advantage Plan
118
Which of the following ECG changes can be seen with tricyclic antidepressant use?
Widened QRS complex
119
According to Freud, during what psychosexual stage of development are sexual concerns largely unimportant?
Latency: 5-6 years to adolescence
120
Which herbal substances are most likely to be used in the treatment of insomnia?
Catnip, Valerian, Chamomile
121
What herb is used to help with delirium, dementia, an sexual dysfunction?
Ginkgo
122
What herb is used to treat menopausal symptoms, premenstrual syndrome, and dysmenorrhea?
Black cohosh
123
Which herbs are used to treat anxiety?
Belladonna, Chamomile
124
Which herb is used to help with depression and fatigue?
Ginseng
125
A body mass index (BMI) higher than which percentile places children at an increased risk of becoming overweight?
85%
126
What cluster are antisocial, borderline, histrionic, and narcissistic personality disorder?
Cluster B
127
What cluster are paranoid personality types, schizoid and schizotypal personality disorders?
Cluster C
128
What cluster are avoidant, dependent, and obsessive-compulsive personality disorders?
Cluster A
129
What are the Cluster D disorders?
There is no Cluster D
130
What is a common non-psychoactive supplement that is most likely to be used for either depression, osteoarthritis, or liver disease?
SAM-e
131
Who authored the report Crossing the Quality Chasm, which emphasized the need for interprofessional collaboration in order to improve the quality of health care?
Institute of Medicine
132
When prescribing antipsychotic medication, the NP may consider a dopamine receptor antagonist (DRA) instead of a serotonin-dopamine antagonist (SDA) with fewer extrapyramidal symptoms for what reason?
Lower risk of metabolic abnormalities
133
What risk does a child have for schizophrenia if both parents are affected?
40%
134
What chromosomes are implicated in schizophrenia?
6p24-22
135
What disorder is characterized by a persistent regurgitation and chewing of food already eaten?
Rumination disorder
136
137
What therapy expands on CBT to improve distress tolerance, emotional regulation, and mindfulness?
Dialectical behavior therapy (DBT)
138
What are the four parts of Medicare?
Part A: hospitalizations; Part B: outpatient and preventive care; Part C: Medicare Advantage; Part D: prescription drugs
139
Which process involves a neutral third party who facilitates a 'win-win' resolution?
Conflict resolution
140
What is the primary goal of mentalization-based treatment (MBT)?
To improve the patient's ability to understand their and others' mental states and intentions
141
Who identified 10 curative factors of group therapy and its phases?
Irvin Yalom
142
What is the most common potentially law-breaking sexual behavior?
Voyeuristic acts
143
What is commonly added for acute mania when lithium alone is insufficient?
Serotonin-dopamine antagonist (SDA) or dopamine receptor antagonist (DRA)
144
In which group is autism spectrum disorder more common?
Boys
145
What is the burden of proof required in medical malpractice suits?
Preponderance of evidence (greater than 50%)
146
Which theorist believed native endowment shapes child development?
Jean Piaget
147
Which technique used in solution-focused therapy helps clients envision a future without their problem?
Miracle questions
148
What are the four major dimensions of recovery in the biopsychosocial framework?
Health, home, purpose, community
149
Failure to resolve which Eriksonian stage is linked to conduct disorder?
Identity vs. Role Confusion
150
What Supreme Court case established competency to be executed?
Ford vs. Wainwright
151
What are the three phases of the therapeutic relationship?
Introduction, Working, Termination
152
What is a health production function?
A mathematical expression showing the relationship between health and variables like health care consumed
153
What kind of metabolism does desvenlafaxine (Pristiq) undergo?
Significant hepatic metabolism
154
What is a major risk factor for HIV-associated dementia (HAD)?
The presence of an AIDS-defining illness
155
What group is the MOCA screening tool primarily used for?
Individuals with mild cognitive impairment symptoms
156
Which thyroid function level can be increased during treatment with propranolol?
Free thyroxine (T4). Propranolol inhibits the conversion of T4 to T3, causing T4 levels to increase.
157
Which statement is NOT true regarding managed care?
The insurer pays all of the bills submitted by healthcare providers. In managed care, insurers limit coverage, monitor service use, and pay flat fees.
158
What is the mission of NCCAM?
To study therapies outside of traditional medicine.
## Footnote
Examples include biological-based (herbal, vitamins), mind-body (meditation, yoga), and manipulative therapies (acupuncture, massage).
159
Which drug is FDA-approved to treat cataplexy in narcolepsy?
Sodium oxybate (Xyrem). A Schedule III prescription approved for narcolepsy-related cataplexy.
160
What are the phases of object relations theory in infant development?
Normal autism, symbiosis, differentiation, practicing, rapprochement, object constancy.
161
What subtype of delusional disorder involves believing someone famous is in love with you?
Erotomanic type. Often involves stalking and is known as De Clérambault syndrome.
162
What is an example of a social preventative factor for psychiatric illness?
Low-stress occupation. Preventative factors also include high SES and education (social), good health (biological), and good self-esteem (psychological).
163
Which cultural phrase refers to panic attacks?
'Fearful spells'.
## Footnote
Vietnamese: 'hit by the wind'; Latin Americans: 'attack of the nerves'; Cambodians: 'soul loss'.
164
Which common medication interacts with melatonin?
Aspirin. Others include NSAIDs, beta-blockers, corticosteroids, valerian, kava, and alcohol.
165
What accurately describes schizoid personality disorder?
They have a restricted emotional range. They avoid social relationships and appear indifferent to praise or criticism.
166
What is the role of divalproex sodium (Depakote) in pediatric bipolar disorder?
It is used as an adjunctive treatment, not monotherapy, due to limited efficacy and potential adverse effects.
167
What is systematized amnesia?
A type of dissociative amnesia involving memory loss related to a specific category of information, such as people or places.
168
Which defense mechanism is described when a parent expresses resentment privately but acts overly loving and involved publicly?
Reaction formation.
169
Which antidepressant is an atypical agent with few drug interactions and acts via alpha-2 antagonism?
Mirtazapine (Remeron).
170
Which phenomenon explains worsened behavior after a reduced reward from $5 to $2 in a child?
Negative contrast.
171
Which brain structure is key for emotion, sexual stimulation, and smell?
Limbic system.
172
Why are patients assigned female at birth more vulnerable to ethanol intoxication complications?
They have less alcohol dehydrogenase.
173
What is the mechanism of action of stimulant medications in ADHD treatment?
They increase the availability of dopamine and norepinephrine in the synaptic cleft.
174
Which school of family therapy focuses on the here-and-now and encourages change through creative growth?
Experiential-humanistic.
175
What are the key features of schizoid personality disorder?
Detachment from social relationships and restricted emotional expression; patients prefer solitude and appear indifferent to others.
176
What are the barriers to implementation of meaningful use?
Staff training, usability, workflow changes, altered patient-provider interaction, clinician resistance to change
177
What theory suggests that people who experience repeated negative events, especially events that they cannot control, may learn to feel helpless and powerless to improve their situation?
Learned helplessness theory
178
What amino acid can be added to a Depakote regimen to decrease ammonia levels?
L-carnitine
179
What disturbances are frequently associated with a physical or medical condition?
Nonauditory disturbances of perception
180
Graduates from the first nurse practitioner program were educated in what medical specialty?
Pediatrics
181
What virtue is associated with the successful resolution of the psychosocial stage Ego Integrity vs. Despair?
Wisdom
182
A PMHNP is conducting a mental status exam on a patient and asks them to explain the similarities between a car and a bicycle. What is the PMHNP most likely assessing in the patient's cognition?
Abstract reasoning
183
What percent of the population of the US is diagnosed with autism?
1%
184
What are the locations and functions of Alpha-1 Receptors?
Locations: Blood vessels, brain, bladder, smooth muscle
Functions: Vasoconstriction, alertness, sympathetic tone
185
What are the locations and functions of Histamine-1 Receptors?
Locations: Brain (hypothalamus), periphery
Functions: Wakefulness, appetite regulation, inflammation
186
What are the locations and functions of Muscarinic Receptors?
Locations: Brain (cortex, hippocampus)
