PMHNP LMR - Important set 11 Flashcards
(130 cards)
1
Q
A pt having weakness in unilateral part of the body?
A
Cerebral
2
Q
A pt taking alcohol, heroin, cocaine, and methylphenidate?
A
Methylphenidate, cocaine and heroin
3
Q
You know that the symptoms of Tics is due to?
A
Excess dopaminergic
4
Q
A schoolboy of 12 is planning on — hypothesis?
A
Formal operational stage
5
Q
Immune infection causes → ?
A
Increase in cytokines
6
Q
Labs for dementia?
A
Folic acid and Vit B12
7
Q
Dopamine pathway in schizophrenia?
A
Mesolimbic
8
Q
Switching from SSRI to MAOI?
A
5-6 weeks
9
Q
Kava Kava?
A
Warn of hepatotoxicity
10
Q
Kava Kava + Meds?
A
Cannot be combined with benzos
11
Q
Hispanic pt w/ irritability, insomnia?
A
Empty Nest Syndrome (cultural clue might suggest “Ataque de nervios,” but current context suggests adjustment)
12
Q
A man cannot draw a clock?
A
Executive dysfunction
13
Q
Suicide rating scales: Columbia (0), HAM-A (34), Beck (10)?
A
Concern for anxiety
14
Q
Therapy for medication adherence?
A
Psychoeducation
15
Q
Erickson stage?
A
Industry vs. inferiority
16
Q
Symptoms: irritable, pressured speech?
A
Hypomanic
17
Q
CIWA-AR tremors, agitation =?
A
high score
18
Q
DSM-5 alcohol tolerance:?
A
Need for increased amounts to achieve same effect
19
Q
Lithium + Indocin →?
A
Tremors, confusion, dizziness
20
Q
Lithium concern →?
A
Creatinine 3.5
21
Q
Effexor monitoring →?
A
Vital signs
22
Q
Anorexic pt bloated after meals →?
A
Delayed gastric emptying
23
Q
Schizophrenia pt refuses meds →?
A
He has the right to refuse
24
Q
Tegretol effect on OCP →?
A
Decreases effectiveness
25
Pt refuses pain meds →?
Refer to acupuncture
26
Valium oversedation ?
Switch to Zoloft or Lexapro
27
Confused on Depakote ?
Stop med, order labs
27
Child w/ Tics and ADHD?
Guanfacine (less risk of worsening tics)
28
Child holding finger at 20 months?
Developmental delay (Palmar grasp reflex should be gone by ~6 months)
29
17-year-old taking on adult roles, suicidal when told to stop?
Overstepping boundaries/enmeshment
30
Boy refuses Huntington’s test?
Respect his autonomy
31
Pregnant bipolar mom?
Family hx increases generational risk
32
MMSE 27 → 26?
Reconsider dementia diagnosis
33
Medicare request for info?
Send the information, no patient consent needed
33
Advocating for PMHNP?
Show cost-effectiveness, journal articles
34
Research on depression cost?
Would screening reduce cost?
35
Mom referring to deceased child in present terms?
Thought disorder
36
Couple discussing adolescent behavior?
Subsystem
37
Yalom group therapy components?
Hope, altruism, catharsis
37
Habeas Corpus?
Held against will
37
Caregiver burnout?
Recommend respite care
38
Nurse advocating for PMHNPs?
Evidence-based support for cost-effectiveness and outcomes
38
Connor vs. O’Donnell?
Legal standard: restoration to competency before trial
38
A diabetic patient concerned about weight. What mood stabilizer will you order?
Lamictal
Rationale: Lamotrigine (Lamictal) is weight-neutral, making it a safer choice for patients with diabetes or weight concerns.
Tegretol (Carbamazepine) may cause hyponatremia, weight gain, and has more metabolic side effects.
39
A patient diagnosed with schizophrenia. What is the least sedating antipsychotic you would prescribe?
Abilify
Rationale: Aripiprazole (Abilify) is activating and among the least sedating atypical antipsychotics, often used when sedation is undesirable.
40
Calculating months in reverse order is testing for:
Attention
Rationale: Tasks like reciting months backward assess attention and concentration, not memory. Memory tests often involve recall.
41
A paranoid patient tells you he wants to burn his group home because he thinks they want to poison him. What is your initial action?
Call the group home and the police
Rationale: This is a duty to warn/Tarasoff situation. You must protect potential victims and notify appropriate authorities.
42
An 8-year-old boy plays sexually with a toy and says “this is how uncle plays with me.” What’s your first action?
Call CPS
Rationale: You are a mandated reporter. Suspected abuse must be reported immediately without needing parental consent.
43
A patient says her mother had a fracture and she's worried about osteoporosis. You educate her that:
Correct statement should be:
Avoiding smoking, reducing caffeine, and weight-bearing exercises can help prevent osteoporosis.
(Note: Original option is confusing and seems to mention “obesity” instead of osteoporosis.)
44
In a structural system, things are defined by:
Boundaries and hierarchy
Rationale: Structural family therapy focuses on family organization, including boundaries, roles, and hierarchy.
45
A patient has neck and back muscle rigidity. What is this?
Acute dystonia
Rationale: Acute dystonia is a sudden, painful muscle spasm, especially in the neck, back, face. Akathisia is inner restlessness and pacing.
46
A 5-year-old is wetting the bed. Best intervention?
Set an alarm clock
Rationale: Enuresis treatment includes behavioral strategies like enuresis alarms and scheduled voiding. A family contract is less effective in this case.
47
According to DSM-5, Autism includes lack of socialization and:
Repetitive movements
Rationale: Autism Spectrum Disorder includes social communication deficits and restricted, repetitive behaviors.
48
A suicidal diabetic patient frequently visits ER and leaves without a psych eval. What should you do?
Collaborate with ER to obtain psych history and eval
Rationale: Coordination of care is key. Work with ER to ensure appropriate psychiatric evaluation and follow-up.
49
A patient on Adderall improves but crashes before evening. Why?
There is not enough buildup of the medication in her blood
Rationale: IR formulations of Adderall often wear off in 4–6 hours. Consider longer-acting or split dosing.
50
A patient isolates and avoids social interaction. Diagnosis?
Schizoid personality disorder
Rationale: Schizoid personality disorder involves detachment and limited emotional expression, unlike schizophrenia or borderline.
51
A patient on antipsychotics is given 4000 calories/day while others get 2000. What is the priority action?
Meet with staff, dietitian, and management to form a QI committee
Rationale: A system-level quality improvement initiative ensures equitable care and prevents overfeeding and metabolic syndrome.
52
What is the Zung Self-Rating Anxiety Scale used for?
Self-assessment of anxiety levels (subjective measure).
53
What does HAM-A measure?
Clinician-rated scale for severity of anxiety symptoms.
54
What does the Yale-Brown Obsessive Compulsive Scale assess?
Severity of obsessions and compulsions in OCD.
55
What therapy is effective for OCD and anxiety disorders?
Exposure therapy.
56
What is PANDAS?
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—sudden onset OCD or tics after strep.
57
Difference between panic attack and panic disorder?
Panic attack is sudden, discrete episodes of intense fear; panic disorder involves recurrent attacks and fear of future attacks.
58
What is Trichotillomania?
Compulsive hair pulling.
59
What is Body Dysmorphic Disorder?
Preoccupation with imagined or slight defects in appearance.
60
What is Hypochondriasis now called?
Illness Anxiety Disorder.
61
Difference between anorexia and bulimia?
Anorexia: weight loss, restriction, body image distortion. Bulimia: binge-purge cycles, usually normal weight.
62
Difference between ASD and PTSD?
ASD < 1 month; PTSD > 1 month.
63
Which dopamine pathway is responsible for positive symptoms of schizophrenia?
Mesolimbic pathway (↑ dopamine).
64
Which pathway is responsible for negative symptoms?
Mesocortical pathway (↓ dopamine).
65
What happens in the nigrostriatal pathway with antipsychotics?
D2 blockade → ↓ dopamine → ↑ ACh → EPS.
66
What causes hyperprolactinemia with antipsychotics?
D2 blockade in tuberoinfundibular pathway.
67
What is "folie à deux"?
Shared psychotic disorder (delusion shared between two individuals).
68
What is akathisia?
Motor restlessness, often mistaken for anxiety.
69
What is akinesia?
Absence of movement, mistaken for laziness.
70
What is dystonia?
Painful muscle spasms, often in neck/back.
71
What is pseudo-parkinsonism?
Symptoms like tremor, rigidity, shuffling gait.
72
What is tardive dyskinesia?
Irreversible abnormal movements, often of mouth/tongue.
73
What medication is first-line for acute mania worldwide?
Carbamazepine.
74
Which combo is approved for bipolar depression?
Olanzapine + Fluoxetine.
75
What antidepressant should be avoided in bulimia nervosa?
Bupropion (Wellbutrin) – lowers seizure threshold.
76
How should lithium be discontinued?
Gradually over 3 months to avoid relapse.
77
What increases risk of lithium toxicity?
Dehydration, NSAIDs, thiazides, ACE inhibitors.
78
What therapy was developed by Marsha Linehan for BPD?
Dialectical Behavior Therapy (DBT).
79
What are the 5 core domains of the Recovery Model?
Hope, autonomy, collaboration, strengths-focus, holistic care.
80
What therapy focuses on solving problems using direct interventions?
Strategic Therapy.
81
What therapy focuses on magical thinking and brief interventions?
Solution-Focused Therapy.
82
Where is serotonin synthesized?
Raphe nuclei.
83
Where is dopamine synthesized?
Ventral tegmental area and substantia nigra.
84
Where is GABA synthesized?
Nucleus accumbens.
85
Where is norepinephrine synthesized?
Locus coeruleus.
86
Moro and Startle Reflex disappear by?
3–4 months.
87
If reflexes persist beyond 6 months, what does that suggest?
Possible neurological issue.
88
Tanner Stage II puberty signs?
Sparse, long, pigmented pubic hair along labia.
89
Why is Seroquel associated with eye exams?
Risk of cataracts.
90
Risk factors for suicide?
Male, <45 years, depression, hopelessness, unemployed, recent hospitalization, noncompliance, substance use.
91
What is the BMI range for normal weight?
18.5–24.9.
92
What is the significance of fine vs coarse tremors in lithium therapy?
Fine: common side effect. Coarse: sign of toxicity.
93
What labs should be monitored for patients on Depakote (valproic acid)?
LFTs, CBC (platelets), ammonia, and serum valproic acid level.
94
What is the therapeutic range of valproic acid (Depakote)?
50–125 mcg/mL.
95
What are early signs of lithium toxicity?
GI upset (nausea, vomiting, diarrhea), fine tremors, polyuria.
96
What are late signs of lithium toxicity?
Confusion, coarse tremors, ataxia, seizures.
97
Which antipsychotic has the highest risk of weight gain and metabolic syndrome?
Olanzapine (Zyprexa).
98
What is the black box warning for all antipsychotics in elderly patients with dementia-related psychosis?
Increased risk of death.
99
What distinguishes Schizoaffective Disorder from Schizophrenia?
Mood symptoms (depression or mania) are prominent and present for a significant portion of illness in schizoaffective disorder.
100
What is the key feature of Delusional Disorder?
Presence of one or more non-bizarre delusions without other significant psychotic symptoms.
101
What is the difference between MDD with psychotic features and Schizoaffective Disorder?
In MDD with psychosis, psychotic symptoms only occur during depressive episodes
102
What scale is used to monitor tardive dyskinesia?
AIMS (Abnormal Involuntary Movement Scale).
103
What scale is used to monitor EPS symptoms?
Simpson-Angus Scale.
104
What is the MOCA used for?
Montreal Cognitive Assessment – screening for mild cognitive impairment/dementia.
105
What is the MMSE used for?
Screening cognitive function; useful in dementia evaluation.
106
What is the CAGE questionnaire for?
Alcohol use screening.
107
What lab finding is associated with serotonin syndrome?
Elevated CPK, leukocytosis, metabolic acidosis.
108
Symptoms of serotonin syndrome?
Mental status changes, autonomic instability, neuromuscular abnormalities, hyperreflexia, clonus.
109
What is the first step in managing serotonin syndrome?
Stop the offending agent(s) and provide supportive care.
110
What is Neuroleptic Malignant Syndrome (NMS) associated with?
Dopamine antagonist use (e.g., antipsychotics).
111
Key features of NMS?
Lead pipe rigidity, fever, autonomic instability, elevated CPK.
112
What ethical principle emphasizes "do no harm"?
Nonmaleficence.
113
What principle supports patient autonomy in making decisions?
Autonomy.
114
What principle focuses on doing good for the patient?
Beneficence.
115
What does "veracity" mean in ethics?
Truth-telling.
116
What does "fidelity" mean in healthcare?
Keeping one's promises; loyalty to the patient.
117
What is the gold standard test for sleep apnea?
Polysomnography (sleep study).
118
What med is FDA approved for narcolepsy?
Modafinil (Provigil).
119
What SSRIs are associated with vivid dreams or insomnia?
Fluoxetine and sertraline.
120
What sleep stage is reduced by benzodiazepines?
REM sleep.
121
What reflex appears at birth and disappears by 2–3 months?
Rooting reflex.
122
At what age should a child have a 50-word vocabulary?
By 2 years old.
123
What is the most common psychiatric disorder in children?
Anxiety disorders.
124
What is the first-line treatment for childhood ADHD?
Behavioral therapy, then stimulant medications.
