2023-2024 PMHNP Certification Exam with Answers (479 Solved Questions)
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PMHNP Certification Exam with
complete solution 2024/2025
VERIFIED 100% CORRECT
ANSWERS GUARANTEED PASS
1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci-
nations
2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital
(12 +)
3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC
STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty
things
• This is NORMAL for children this age.
4. What do you do when a patient has an increased prolactin level?: • Stop
prolactin (stop the agent that cause increase prolactin)
5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks -
UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
6. What would you do if a 5-year-old tells you his brother sodomized him?: •
Tell mom don't leave him alone with patient and call CPS implement crisis
7. If a child is playing with doll in a sexual way, what do you do first?: •
You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER
ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You
HAVE to report but you have to have something (assessment data) to report -
PMHNP Certification Exam with
complete solution 2024/2025
VERIFIED 100% CORRECT
ANSWERS GUARANTEED PASS
1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci-
nations
2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital
(12 +)
3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC
STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty
things
• This is NORMAL for children this age.
4. What do you do when a patient has an increased prolactin level?: • Stop
prolactin (stop the agent that cause increase prolactin)
5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks -
UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
6. What would you do if a 5-year-old tells you his brother sodomized him?: •
Tell mom don't leave him alone with patient and call CPS implement crisis
7. If a child is playing with doll in a sexual way, what do you do first?: •
You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER
ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You
HAVE to report but you have to have something (assessment data) to report -
1 / 58
PMHNP Certification Exam with
complete solution 2024/2025
VERIFIED 100% CORRECT
ANSWERS GUARANTEED PASS
1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci-
nations
2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital
(12 +)
3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC
STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty
things
• This is NORMAL for children this age.
4. What do you do when a patient has an increased prolactin level?: • Stop
prolactin (stop the agent that cause increase prolactin)
5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks -
UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
6. What would you do if a 5-year-old tells you his brother sodomized him?: •
Tell mom don't leave him alone with patient and call CPS implement crisis
7. If a child is playing with doll in a sexual way, what do you do first?: •
You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER
ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You
HAVE to report but you have to have something (assessment data) to report -
PMHNP Certification Exam with
complete solution 2024/2025
VERIFIED 100% CORRECT
ANSWERS GUARANTEED PASS
1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci-
nations
2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital
(12 +)
3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC
STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty
things
• This is NORMAL for children this age.
4. What do you do when a patient has an increased prolactin level?: • Stop
prolactin (stop the agent that cause increase prolactin)
5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks -
UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
6. What would you do if a 5-year-old tells you his brother sodomized him?: •
Tell mom don't leave him alone with patient and call CPS implement crisis
7. If a child is playing with doll in a sexual way, what do you do first?: •
You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER
ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You
HAVE to report but you have to have something (assessment data) to report -
2 / 58
Assess = FIRST
8. If a 13-year-old tells you he want to smoke, what would be an appropriate
response?: • Ask him of his plan to stop smoking
9. If a 14-year-old girl clenching her teeth, what cranial nerve would you
suspect?: • Cranial nerve V-Trigeminal nerve (FIVE)
10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis
11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7
12. What cranial nerves do you assess for papillary reaction to light and
accommodation?: Nerves 3,4,& 6
13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc-
ular movements?: Nerves 3, 4, & 6
Assess = FIRST
8. If a 13-year-old tells you he want to smoke, what would be an appropriate
response?: • Ask him of his plan to stop smoking
9. If a 14-year-old girl clenching her teeth, what cranial nerve would you
suspect?: • Cranial nerve V-Trigeminal nerve (FIVE)
10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis
11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7
12. What cranial nerves do you assess for papillary reaction to light and
accommodation?: Nerves 3,4,& 6
13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc-
ular movements?: Nerves 3, 4, & 6
2 / 58
Assess = FIRST
8. If a 13-year-old tells you he want to smoke, what would be an appropriate
response?: • Ask him of his plan to stop smoking
9. If a 14-year-old girl clenching her teeth, what cranial nerve would you
suspect?: • Cranial nerve V-Trigeminal nerve (FIVE)
10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis
11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7
12. What cranial nerves do you assess for papillary reaction to light and
accommodation?: Nerves 3,4,& 6
13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc-
ular movements?: Nerves 3, 4, & 6
Assess = FIRST
8. If a 13-year-old tells you he want to smoke, what would be an appropriate
response?: • Ask him of his plan to stop smoking
9. If a 14-year-old girl clenching her teeth, what cranial nerve would you
suspect?: • Cranial nerve V-Trigeminal nerve (FIVE)
10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis
11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7
12. What cranial nerves do you assess for papillary reaction to light and
accommodation?: Nerves 3,4,& 6
13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc-
ular movements?: Nerves 3, 4, & 6
3 / 58
14. What cranial nerves do you assess for corneal light reflex?: 3, 4, & 6
15. Cranial Nerve 1: Olfactory (smell)
16. Cranial Nerve 2: Optic - vision
17. Cranial Nerve 3: Oculomotor (eye movement): The occulomotor nerve is re-
sponsible for motor enervation of upper eyelid muscle, extraocular muscle and
pupillary muscle.
18. Cranial Nerve 4: Trochlear (eye movement): The trochlear nerve controls an
extraocular muscle.
19. Cranial Nerve 5: Trigeminal: The trigeminal nerve is responsible for sensory
enervation of the face and motor enervation to muscles of mastication (chewing).
20. Cranial Nerve 6: Abducens (motor): The abducent nerve enervates a muscle,
which moves the eyeball.
21. Cranial Nerve 7: Facial nerve: The facial nerve enervates the muscles of the
face (facial expression).
22. Cranial Nerve 8: Vestibulocochlear (hearing and balance): The vestibulo-
cochlear nerve is responsible for the sense of hearing and balance (body position
sense).
23. Cranial Nerve 9: Glossopharyngeal: The glossopharyngeal nerve enervates
muscles involved in swallowing and taste. Lesions of the ninth nerve result in
difficulty swallowing and disturbance of taste.
24. Cranial Nerve 10: vagus nerve: The vagus nerve enervates the gut (gastroin-
testinal tract), heart and larynx.
25. Cranial Nerve 11: accessory: The accessory nerve enervates the sternoclei-
domastoid muscles and the trapezius muscles.
26. Cranial Nerve 12: Hypoglossal (tongue movement): The hypoglossal nerve
enervates the muscles of the tongue.
27. What is the best action for a 16 y/o with conduct disorder that refuses
tx?: • Send to psych specialist for acting out kids - Referrals - Have to see if you are
going to refer the same patient to the same provider - Cannot refer the patient to
another provider that is the same as you (ie psych) - you must refer to a neurologist
or another specialist or PCP
28. What is a priority consideration for a 16-year-old that shows up with
mother for first therapy?: • Confidentiality (ex. mom sits in lobby)
14. What cranial nerves do you assess for corneal light reflex?: 3, 4, & 6
15. Cranial Nerve 1: Olfactory (smell)
16. Cranial Nerve 2: Optic - vision
17. Cranial Nerve 3: Oculomotor (eye movement): The occulomotor nerve is re-
sponsible for motor enervation of upper eyelid muscle, extraocular muscle and
pupillary muscle.
18. Cranial Nerve 4: Trochlear (eye movement): The trochlear nerve controls an
extraocular muscle.
19. Cranial Nerve 5: Trigeminal: The trigeminal nerve is responsible for sensory
enervation of the face and motor enervation to muscles of mastication (chewing).
20. Cranial Nerve 6: Abducens (motor): The abducent nerve enervates a muscle,
which moves the eyeball.
21. Cranial Nerve 7: Facial nerve: The facial nerve enervates the muscles of the
face (facial expression).
22. Cranial Nerve 8: Vestibulocochlear (hearing and balance): The vestibulo-
cochlear nerve is responsible for the sense of hearing and balance (body position
sense).
23. Cranial Nerve 9: Glossopharyngeal: The glossopharyngeal nerve enervates
muscles involved in swallowing and taste. Lesions of the ninth nerve result in
difficulty swallowing and disturbance of taste.
24. Cranial Nerve 10: vagus nerve: The vagus nerve enervates the gut (gastroin-
testinal tract), heart and larynx.
25. Cranial Nerve 11: accessory: The accessory nerve enervates the sternoclei-
domastoid muscles and the trapezius muscles.
26. Cranial Nerve 12: Hypoglossal (tongue movement): The hypoglossal nerve
enervates the muscles of the tongue.
27. What is the best action for a 16 y/o with conduct disorder that refuses
tx?: • Send to psych specialist for acting out kids - Referrals - Have to see if you are
going to refer the same patient to the same provider - Cannot refer the patient to
another provider that is the same as you (ie psych) - you must refer to a neurologist
or another specialist or PCP
28. What is a priority consideration for a 16-year-old that shows up with
mother for first therapy?: • Confidentiality (ex. mom sits in lobby)
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29. What is important to know about ACE inhibitors (Meds for Heart fail-
ure/HTN): • This medication can cause increased lithium levels to toxic levels -
must collaborate with PCP to determine whether to change ACE or change Lithium
- Can't use both
30. What medication INCREASES Lithium serum level up to double: Ibuprofen
31. Why is Lithium used?: • First-line neuro-protective for bipolar
32. • Lab Values concerning for patient on Lithium:: • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• + Pregnancy Test
33. • Lithium (Eskalith/Lithobid) Toxicity: • Normal Range of LITHIUM LEVEL -
0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
34. Common side effects of Lithium (Eskalith/Lithobid): Nausea, fine-hand
tremors (start monitoring for toxicity), increased urination and thirst
35. What pregnancy category is Lithium (Eskalith/Lithobid): CATEGORY D:
AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect
36. What increases risk of lithium (Eskalith/Lithobid) toxicity?: NSAID, dehy-
dration and Thiazides
37. What co-morbid risk in increased with Lithium (Eskalith/Lithobid)?: • Risk
of Hypothyroidism
38. What do symptoms of hypothyroidism (decreased T4 & increased TSH)
mimic?: Unipolar mood disorders:
- confusion
- decreased libido
- impotence
- decreased apetite
- memory loss
- lethargy
- constipation
- headaches
29. What is important to know about ACE inhibitors (Meds for Heart fail-
ure/HTN): • This medication can cause increased lithium levels to toxic levels -
must collaborate with PCP to determine whether to change ACE or change Lithium
- Can't use both
30. What medication INCREASES Lithium serum level up to double: Ibuprofen
31. Why is Lithium used?: • First-line neuro-protective for bipolar
32. • Lab Values concerning for patient on Lithium:: • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• + Pregnancy Test
33. • Lithium (Eskalith/Lithobid) Toxicity: • Normal Range of LITHIUM LEVEL -
0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
34. Common side effects of Lithium (Eskalith/Lithobid): Nausea, fine-hand
tremors (start monitoring for toxicity), increased urination and thirst
35. What pregnancy category is Lithium (Eskalith/Lithobid): CATEGORY D:
AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect
36. What increases risk of lithium (Eskalith/Lithobid) toxicity?: NSAID, dehy-
dration and Thiazides
37. What co-morbid risk in increased with Lithium (Eskalith/Lithobid)?: • Risk
of Hypothyroidism
38. What do symptoms of hypothyroidism (decreased T4 & increased TSH)
mimic?: Unipolar mood disorders:
- confusion
- decreased libido
- impotence
- decreased apetite
- memory loss
- lethargy
- constipation
- headaches
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- slow or clumsy movements
- syncope
- weight gain
- fluid retention
- muscle aches and stiffness
- slowed reflexes
- somatic discomfort including aching and joint stiffness
- slowed speech and thinking
- sensory disturbances including hearing
- cerebellar ataxia (may present with symptoms of an inability to coordinate
balance, gait, extremity and eye movements)
- loss of amplitude in ECG
39. What do symptoms of hyperthyroidism (decreased TSH & increased T4)
mimic?: Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias
40. What does ADPIE stand for?: • Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
41. Recommend CBT for: Depression & Anxiety (keep a daily log)
42. pg 209 and every PB pages for each dx: all thing for each disorder
43. What medication is best for an aggressive patient?: IM Geodon
- slow or clumsy movements
- syncope
- weight gain
- fluid retention
- muscle aches and stiffness
- slowed reflexes
- somatic discomfort including aching and joint stiffness
- slowed speech and thinking
- sensory disturbances including hearing
- cerebellar ataxia (may present with symptoms of an inability to coordinate
balance, gait, extremity and eye movements)
- loss of amplitude in ECG
39. What do symptoms of hyperthyroidism (decreased TSH & increased T4)
mimic?: Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias
40. What does ADPIE stand for?: • Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
41. Recommend CBT for: Depression & Anxiety (keep a daily log)
42. pg 209 and every PB pages for each dx: all thing for each disorder
43. What medication is best for an aggressive patient?: IM Geodon
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44. Medications to improve anxiety...: act directly or indirectly on GABA system
- SSRIs
- Benzodiazepines
- Tricyclics (TCA)
- Buspirone
- Tiagabine (Gabitril)
- gabapentin
- propranolol
in children:
- alpha agonists : clonidine (catapres) & guanfacine (tenex)
45. advantages of Benzodiazepines with short have lives: - less daytime se-
dation
- less drug accumulation
- quick onset
- useful for tx of insomnia
46. disadvantages of Benzodiazepines with short have lives: increase risk of
addiction
47. non-pharmacological Management for anxiety: - behavioral therapy
- CBT
- interpersonal therapies
- community self help groups
- alternate therapies as adjunct tx
48. SSRI's: - first line tx for anxiety
- act on serotonin and indirectly on GABA
- takes 3-4 weeks to reach symptom control
- black box warning for kids is SI
49. Agoraphobia treatment: • BZs: Short term symptom relief
• SSRIs: long term maintenance
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• SNRIs: long term maintenance
• Venlafaxine (Effexor)
TCAs: long term maintenance
44. Medications to improve anxiety...: act directly or indirectly on GABA system
- SSRIs
- Benzodiazepines
- Tricyclics (TCA)
- Buspirone
- Tiagabine (Gabitril)
- gabapentin
- propranolol
in children:
- alpha agonists : clonidine (catapres) & guanfacine (tenex)
45. advantages of Benzodiazepines with short have lives: - less daytime se-
dation
- less drug accumulation
- quick onset
- useful for tx of insomnia
46. disadvantages of Benzodiazepines with short have lives: increase risk of
addiction
47. non-pharmacological Management for anxiety: - behavioral therapy
- CBT
- interpersonal therapies
- community self help groups
- alternate therapies as adjunct tx
48. SSRI's: - first line tx for anxiety
- act on serotonin and indirectly on GABA
- takes 3-4 weeks to reach symptom control
- black box warning for kids is SI
49. Agoraphobia treatment: • BZs: Short term symptom relief
• SSRIs: long term maintenance
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• SNRIs: long term maintenance
• Venlafaxine (Effexor)
TCAs: long term maintenance
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• Beta blockers (off-label use) used for discrete episodes of social anxiety -
contraindicated for clients with asthma
50. Alprostadil (PGE1): • Ductal-dependent Congenital Heart disease (all forms)
• Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring
prostaglandin which is used as a medication. In babies with congenital heart
defects, it is used by slow injection into a vein to open the ductus arteriosus until
surgery can be carried out. By injection into the penis or placement in the urethra,
it is used to treat erectile dysfunction.
• 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO
51. Amygdala: • A limbic system structure involved in memory and emotion,
anxiety, particularly fear and aggression
52. Anorexia nervosa: • Anorexia (SAFETY = KEY)
• BMI less than 18.5
• BMI < 16 = AUTOMATIC ADMISSION
• An eating disorder in which an irrational fear of weight gain leads people to starve
themselves
• Anorexia admission criteria for hospitalization
- Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36
C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less
than 70 mm hg, and hypokalemia (less than 3 mEq/L).
• Set up family therapy (especially adolescent pts since they have no control over
food choices)
53. • ANOVA (analysis of variance): • 3 or more
• An inferential statistical test for comparing the means of three or more groups
54. PROZAC Causes What?: • Increase Anxiety in Elderly
55. • Apoptosis: • Cell death in aging/elderly
56. • Appreciative inquiry: • An organizational change philosophy and process
building organizations around what works, rather than focusing on and trying to fix
what doesn't work
• An organizational change strategy that directs the group's attention away from
its own problems and focuses participants on the group's potential and positive
elements
• Beta blockers (off-label use) used for discrete episodes of social anxiety -
contraindicated for clients with asthma
50. Alprostadil (PGE1): • Ductal-dependent Congenital Heart disease (all forms)
• Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring
prostaglandin which is used as a medication. In babies with congenital heart
defects, it is used by slow injection into a vein to open the ductus arteriosus until
surgery can be carried out. By injection into the penis or placement in the urethra,
it is used to treat erectile dysfunction.
• 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO
51. Amygdala: • A limbic system structure involved in memory and emotion,
anxiety, particularly fear and aggression
52. Anorexia nervosa: • Anorexia (SAFETY = KEY)
• BMI less than 18.5
• BMI < 16 = AUTOMATIC ADMISSION
• An eating disorder in which an irrational fear of weight gain leads people to starve
themselves
• Anorexia admission criteria for hospitalization
- Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36
C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less
than 70 mm hg, and hypokalemia (less than 3 mEq/L).
• Set up family therapy (especially adolescent pts since they have no control over
food choices)
53. • ANOVA (analysis of variance): • 3 or more
• An inferential statistical test for comparing the means of three or more groups
54. PROZAC Causes What?: • Increase Anxiety in Elderly
55. • Apoptosis: • Cell death in aging/elderly
56. • Appreciative inquiry: • An organizational change philosophy and process
building organizations around what works, rather than focusing on and trying to fix
what doesn't work
• An organizational change strategy that directs the group's attention away from
its own problems and focuses participants on the group's potential and positive
elements
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8 / 58
• Discovery (best of what is)
• Dream (wishes or dreams of organization)
• Design (decide what you want to change)
• Destiny (make it happen, implanting change)
• Identify the problem
• Analyze the problem
• Generate solutions
• Implement best solution
57. • Assertive Community Treatment (ACT): • Community-based programs that
provide many of the services that are necessary for successful community living;
include case management, problem solving, social skills training, support teaching
on a 24/7 basis
58. • Assertive questions: • Use "I want", "I need", or "I feel" to convey basic
assertions and get your point across firmly. For example "I feel strongly that we
need to bring in a third party to medicate this disagreement" another example
"Dave, your request has caught me off guard. I'll get back to you within the half
hour".
59. Transtheoretical Model of Change: • States that change such as in health
behaviors occurs in six predictable stages
• Precontemplation: The person has no intention to change.
• Contemplation: The person is thinking about changing; is aware that there is a
problem but not committed to changing.
• Preparation: The person has made the decision to change; is ready for action.
• Action: The person is engaging in specific, overt actions to change.
• Maintenance: The person is engaging in behaviors to prevent relapse.
60. erectile dysfunction medications: • Avanafil (Stendra) 15 minutes prior to
sex
• Tadalafil (Cialis) 45 minutes prior to sex
• Vardenafil (Levitra) 45 minutes prior to sex
• Sildenafil (Viagra) 1 hour prior to sex - brand-name version of the generic drug.
It is a phosphodiesterase type 5 (PDE5) inhibitor.
61. • Beck depression inventory: • A questionnaire useful for determining the
level of depression
• 0-13 minimal depression
• 14-19 mild depression
• Discovery (best of what is)
• Dream (wishes or dreams of organization)
• Design (decide what you want to change)
• Destiny (make it happen, implanting change)
• Identify the problem
• Analyze the problem
• Generate solutions
• Implement best solution
57. • Assertive Community Treatment (ACT): • Community-based programs that
provide many of the services that are necessary for successful community living;
include case management, problem solving, social skills training, support teaching
on a 24/7 basis
58. • Assertive questions: • Use "I want", "I need", or "I feel" to convey basic
assertions and get your point across firmly. For example "I feel strongly that we
need to bring in a third party to medicate this disagreement" another example
"Dave, your request has caught me off guard. I'll get back to you within the half
hour".
59. Transtheoretical Model of Change: • States that change such as in health
behaviors occurs in six predictable stages
• Precontemplation: The person has no intention to change.
• Contemplation: The person is thinking about changing; is aware that there is a
problem but not committed to changing.
• Preparation: The person has made the decision to change; is ready for action.
• Action: The person is engaging in specific, overt actions to change.
• Maintenance: The person is engaging in behaviors to prevent relapse.
60. erectile dysfunction medications: • Avanafil (Stendra) 15 minutes prior to
sex
• Tadalafil (Cialis) 45 minutes prior to sex
• Vardenafil (Levitra) 45 minutes prior to sex
• Sildenafil (Viagra) 1 hour prior to sex - brand-name version of the generic drug.
It is a phosphodiesterase type 5 (PDE5) inhibitor.
61. • Beck depression inventory: • A questionnaire useful for determining the
level of depression
• 0-13 minimal depression
• 14-19 mild depression
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• 19-29 Moderate depression
• 30-63 severe depression
Intimate therapy for child with a score 10
62. Big Freaking Problems: • Bupropion Fluoxetine Paxil
• Those are strong inhibitors of 2D6
63. • Borderline personality disorder treatment: • Dialectical behavior therapy
64. If a boy patient states that he wishes to be a girl and tells you not to tell
his parent, what do you do?: Don't tell
65. If you see a bruise on the padded part of patient's arm, what do you do?: •
Say I see you have bruises on your arm
• Ask what happened
66. • Can an advanced directive ever be revoked?: • Yes, at any time
67. Can asthma medications cause depression?: • Yes
• Examples: INTERFERON
68. • Can you take Buspar during pregnancy?: • Category B: OK if really needed
69. • Can you take Klonopin during pregnancy?: • Category C: Avoid if possible;
does excrete into breast-milk and infant could get withdrawal symptoms
• Floppy baby
70. • Carb and Barb (Carbamazepine and Phenobarbital): • Strong inducers of
3A4
• Decrease INR
71. • Change agent: • The person formally in charge of guiding a change effort
• Administrator - Usually the person on top in the facility is responsible for being
the change agent.
72. • Charge of DEA: • State and federal
73. A child in foster home 5 years poor eye contact, isolated self, eat without
difficulty.. what is dx: autism
74. A child in foster home since birth, eats without interest, shows little
emotion.. what is dx?: REACTIVE ATTACHMENT DISORDER = Look for NO
Emotion
75. • Child reports Sexual abuse: • Interview the young child and infants with
parent
• 19-29 Moderate depression
• 30-63 severe depression
Intimate therapy for child with a score 10
62. Big Freaking Problems: • Bupropion Fluoxetine Paxil
• Those are strong inhibitors of 2D6
63. • Borderline personality disorder treatment: • Dialectical behavior therapy
64. If a boy patient states that he wishes to be a girl and tells you not to tell
his parent, what do you do?: Don't tell
65. If you see a bruise on the padded part of patient's arm, what do you do?: •
Say I see you have bruises on your arm
• Ask what happened
66. • Can an advanced directive ever be revoked?: • Yes, at any time
67. Can asthma medications cause depression?: • Yes
• Examples: INTERFERON
68. • Can you take Buspar during pregnancy?: • Category B: OK if really needed
69. • Can you take Klonopin during pregnancy?: • Category C: Avoid if possible;
does excrete into breast-milk and infant could get withdrawal symptoms
• Floppy baby
70. • Carb and Barb (Carbamazepine and Phenobarbital): • Strong inducers of
3A4
• Decrease INR
71. • Change agent: • The person formally in charge of guiding a change effort
• Administrator - Usually the person on top in the facility is responsible for being
the change agent.
72. • Charge of DEA: • State and federal
73. A child in foster home 5 years poor eye contact, isolated self, eat without
difficulty.. what is dx: autism
74. A child in foster home since birth, eats without interest, shows little
emotion.. what is dx?: REACTIVE ATTACHMENT DISORDER = Look for NO
Emotion
75. • Child reports Sexual abuse: • Interview the young child and infants with
parent
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76. TRICYCLIC ANTIDEPRESSANTS (TCAs): Not commonly used due to side
effects and overdose toxicity risk; however, TCAs should be considered for appro-
priate patients who do not respond to other antidepressants.
There are nine TCAs approved by the FDA for depression (amitriptyline, amoxap-
ine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trim-
ipramine), and one approved for OCD - clomipramine (Anafranil).
Tertiary TCAs (more sedating):
Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg.
Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125
mg, 150 mg.
Secondary TCAs (less sedating):
Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150
mg.
Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5
mL oral solution.
Side Effects:
Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects,
urinary hesitation, blurred vision.
Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT
prolongation, AV block.
77. Clozaril (Clozapine): • DC Clozapine at
- ANC < 1000
- WBC 2000-3000
ANC & WBC WEEKLY for 6 months:
• When a patient is on Clozapine monitor for signs for agranulocytosis such as:
• Sores in the mouth, throat,
• Chronic infections of the gums, throat, or skin,
• Fever
• Chills
78. • Co-morbidities of bipolar: • Anxiety, alcohol and substance abuse
79. • Inducer; Pushes the substrate out of the exit pathways, < the serum level
of other drugs, < therapeutic effect.: I'll Come See Pumpkin Pie Tomorrow or
Monday And Chow
76. TRICYCLIC ANTIDEPRESSANTS (TCAs): Not commonly used due to side
effects and overdose toxicity risk; however, TCAs should be considered for appro-
priate patients who do not respond to other antidepressants.
There are nine TCAs approved by the FDA for depression (amitriptyline, amoxap-
ine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trim-
ipramine), and one approved for OCD - clomipramine (Anafranil).
Tertiary TCAs (more sedating):
Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg.
Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125
mg, 150 mg.
Secondary TCAs (less sedating):
Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150
mg.
Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5
mL oral solution.
Side Effects:
Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects,
urinary hesitation, blurred vision.
Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT
prolongation, AV block.
77. Clozaril (Clozapine): • DC Clozapine at
- ANC < 1000
- WBC 2000-3000
ANC & WBC WEEKLY for 6 months:
• When a patient is on Clozapine monitor for signs for agranulocytosis such as:
• Sores in the mouth, throat,
• Chronic infections of the gums, throat, or skin,
• Fever
• Chills
78. • Co-morbidities of bipolar: • Anxiety, alcohol and substance abuse
79. • Inducer; Pushes the substrate out of the exit pathways, < the serum level
of other drugs, < therapeutic effect.: I'll Come See Pumpkin Pie Tomorrow or
Monday And Chow
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• Carbamazepine/Oxcarba (1A2, 2C19 and 3A4)
• St. John's Wart (3A4)
• Phenytoin
• Phenobarbital
• Tobacco (1A2)
• OCP (1A4) (watch with use of Topamax/Tegretol)
• Methadone (1A2)
• Antiretroviral
• Cyclosporine
Or Bull Shit CRAPGPS
• Barbiturates
• St. Johns Wart
• Carbamazepine
• Rifampin
• Alcohol (chronic use)
• Phenytoin
• Griseofulvin
• Phenobarbital
• Sulfonylureas
80. • Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion,
Increase the serum level of other drugs, Increase toxic risk: Sickfaces.com
• Sodium Valproate
• Isoniazid
• Cimetidine
• Ketoconazole
• Fluconazole
• Alcohol
• Chloramphenicol
• Erythromycin
• Sulfonamides
• Ciprofloxacin
• Omeprazole
• Metronidazole
Plus Grapefruit juice
81. • DBT (Dialectical behavior therapy): • Relaxation muscle prior to DBT
• Borderline Patients - NO meds - DBT therapy
• Carbamazepine/Oxcarba (1A2, 2C19 and 3A4)
• St. John's Wart (3A4)
• Phenytoin
• Phenobarbital
• Tobacco (1A2)
• OCP (1A4) (watch with use of Topamax/Tegretol)
• Methadone (1A2)
• Antiretroviral
• Cyclosporine
Or Bull Shit CRAPGPS
• Barbiturates
• St. Johns Wart
• Carbamazepine
• Rifampin
• Alcohol (chronic use)
• Phenytoin
• Griseofulvin
• Phenobarbital
• Sulfonylureas
80. • Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion,
Increase the serum level of other drugs, Increase toxic risk: Sickfaces.com
• Sodium Valproate
• Isoniazid
• Cimetidine
• Ketoconazole
• Fluconazole
• Alcohol
• Chloramphenicol
• Erythromycin
• Sulfonamides
• Ciprofloxacin
• Omeprazole
• Metronidazole
Plus Grapefruit juice
81. • DBT (Dialectical behavior therapy): • Relaxation muscle prior to DBT
• Borderline Patients - NO meds - DBT therapy
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82. what therapy uses a diary log: • CBT
83. what medication is used for ENURESIS: • DDAVP (Desmopressin)
Works in the SAME manner of ANTIDIEURTIC HORMONE
• Makes less urine - Used for ENURESIS
84. what medications increase INR?: Depakote and Disulfiram
85. What medication causes Spina bifida?: Depakote, so check HCG level
86. • DIGFAST for Mania: • Distractibility
• Indiscretion
• Grandiosity
• Flight of ideas
• Activity increase
• Sleep deficit
• Talking increase
87. • Disseminated Encephalomyelitis: • Assess for asymmetry of extremities
• Along with this pattern, the patient usually get neurological symptoms which may
include
• Confusion, drowsiness, and even coma
• Unsteadiness and falling
• Visual blurring or double vision (occasionally)
• Trouble swallowing
• Weakness of the arms or legs
• Fever
• Headache
88. Disulfiram: Disulfiram (sold under the trade name Antabuse) is a drug used to
support the treatment of alcohol use disorder by producing an acute sensitivity to
ethanol (drinking alcohol). Disulfiram works by inhibiting the enzyme acetaldehyde
dehydrogenase, causing many of the effects of a hangover to be felt immediately
following alcohol consumption.
• Increase Coumadin
89. • Does impaired judgement mean one is incompetent?: No
90. • Does the de facto rule of proxy apply in same sex marriages?: • No
91. Drug affects with Flonase: (just know that Flonase has interaction with Zan-
tac & Tegretol)
82. what therapy uses a diary log: • CBT
83. what medication is used for ENURESIS: • DDAVP (Desmopressin)
Works in the SAME manner of ANTIDIEURTIC HORMONE
• Makes less urine - Used for ENURESIS
84. what medications increase INR?: Depakote and Disulfiram
85. What medication causes Spina bifida?: Depakote, so check HCG level
86. • DIGFAST for Mania: • Distractibility
• Indiscretion
• Grandiosity
• Flight of ideas
• Activity increase
• Sleep deficit
• Talking increase
87. • Disseminated Encephalomyelitis: • Assess for asymmetry of extremities
• Along with this pattern, the patient usually get neurological symptoms which may
include
• Confusion, drowsiness, and even coma
• Unsteadiness and falling
• Visual blurring or double vision (occasionally)
• Trouble swallowing
• Weakness of the arms or legs
• Fever
• Headache
88. Disulfiram: Disulfiram (sold under the trade name Antabuse) is a drug used to
support the treatment of alcohol use disorder by producing an acute sensitivity to
ethanol (drinking alcohol). Disulfiram works by inhibiting the enzyme acetaldehyde
dehydrogenase, causing many of the effects of a hangover to be felt immediately
following alcohol consumption.
• Increase Coumadin
89. • Does impaired judgement mean one is incompetent?: No
90. • Does the de facto rule of proxy apply in same sex marriages?: • No
91. Drug affects with Flonase: (just know that Flonase has interaction with Zan-
tac & Tegretol)
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• Zantac (histamine 2 blocker) antagonist
• Per ANCC study material -Flonase (ALL Steroids) can induce MANIA and
DEPRESSION - If you have a patient with bipolar disorder who is stable on a mood
stabilizer and becomes manic after prescription of a steroid, the mood stabilizer
will need to be increased. If you have a patient with MDD who is stable on an
antidepressant and becomes depressed after starting a steroid, you may need to
increase the antidepressant - just remember though, make sure you understand
what the question is asking - safety first
92. • Early onset of HIV dementia: • Apathy : lack of interest
• Abnormal of MRI_ slow
• Cognitive functions: memory, reasoning, judgment, concentration, and problem
solving
• Other common symptoms are changes in personality and behavior, speech
problems, and motor (movement) problems such as clumsiness and poor balance
• Show brain atrophy (shrinkage)
93. therapies & dx: • EMDR - PTSD - Shapiro
• DBT - Borderline Personality D/O - Linehan
• Interpersonal therapy - Interpersonal conflict - Klerman and Weismann
• CBT - if nothing fits CBT works for most.
94. • Encopresis Treatment: Behavior management:
• Toilet refusal behavior,
• scheduled toileting time,
• incentives
• prevention of constipation
95. EPS: • Clients who experience any form of EPS are at increased risk of TD
- Acute dystonia: is the first symptom that an individual will develop, and it can
occur within hours of taking the medication. It usually presents as involuntary
contractions of the face and neck muscles and can be painful.
- akathisia: Once the patient has been taking an antipsychotic for a few days, they
can start to experience another side effect of consistently feeling restlessness or
jittery
- Parkinsonism: typically occur withing a few weeks after starting an antipsychotic.
Parkinsonism can include muscle motor deficits such as rigidity, postural shuffle,
tremors, a shuffling gait, and difficulty initiating movements
• Zantac (histamine 2 blocker) antagonist
• Per ANCC study material -Flonase (ALL Steroids) can induce MANIA and
DEPRESSION - If you have a patient with bipolar disorder who is stable on a mood
stabilizer and becomes manic after prescription of a steroid, the mood stabilizer
will need to be increased. If you have a patient with MDD who is stable on an
antidepressant and becomes depressed after starting a steroid, you may need to
increase the antidepressant - just remember though, make sure you understand
what the question is asking - safety first
92. • Early onset of HIV dementia: • Apathy : lack of interest
• Abnormal of MRI_ slow
• Cognitive functions: memory, reasoning, judgment, concentration, and problem
solving
• Other common symptoms are changes in personality and behavior, speech
problems, and motor (movement) problems such as clumsiness and poor balance
• Show brain atrophy (shrinkage)
93. therapies & dx: • EMDR - PTSD - Shapiro
• DBT - Borderline Personality D/O - Linehan
• Interpersonal therapy - Interpersonal conflict - Klerman and Weismann
• CBT - if nothing fits CBT works for most.
94. • Encopresis Treatment: Behavior management:
• Toilet refusal behavior,
• scheduled toileting time,
• incentives
• prevention of constipation
95. EPS: • Clients who experience any form of EPS are at increased risk of TD
- Acute dystonia: is the first symptom that an individual will develop, and it can
occur within hours of taking the medication. It usually presents as involuntary
contractions of the face and neck muscles and can be painful.
- akathisia: Once the patient has been taking an antipsychotic for a few days, they
can start to experience another side effect of consistently feeling restlessness or
jittery
- Parkinsonism: typically occur withing a few weeks after starting an antipsychotic.
Parkinsonism can include muscle motor deficits such as rigidity, postural shuffle,
tremors, a shuffling gait, and difficulty initiating movements
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- tardive dyskinesia: Long term continuation of antipsychotics for three months or
more, which can sometimes be irreversible if it is not attended to quickly enough.
Symptoms of tardive dyskinesia can include involuntary rhythmic movements such
as grimacing, lip smacking, chewing, tongue flicking, as well as excessive eye
blinking
96. what mood stabilizer is least cause metabolic syndrome: lamictal
97. depakote can cause: hepatoxicity (liver) = RUQ pain & reddish brown urine
98. valproic acid: range is 50 - 125, toxicity is greater than 150
99. depakote toxicity: confusion, lethargy, and respiratory depression
- do you liver function test
- check ammonia levels - increase ammonia causes confusion
100. patients taking Kava for anxiety or insomnia need?: A liver function test,
can cause hepatoxicity
there is a drug to drug interaction with kava and Benzodiazepines
101. TCA can cause: hepatoxicity
102. What can Steven Johnson syndrome: lamictal and carbamazepine (tegre-
tal)
Tegretal increases risk for SJS in Asians
S/S: fever and rash
103. Tegretal (Carbamazepine) and clozaril: can cause agranulocytosis
d/c for ANC for less than 1,000 and monitor for s/s of infection
104. Clozaril (Clozapine) can..: decrease SI in PTs with schizophrenia
105. what is gold standard medication for bipolar: Lithium - it can decrease SI
for bipolar PT's
106. check what levels with lithium: TSH, HCG, bun, creatinine, UA
107. what medication can increase lithium toxicity: NSAIDS, thiazides, and
ACE inhibitors (lisinopril)
they reduce renal clearance
108. why should you not take lithium in pregnancy?: causes ebstein anomaly
(especially in the first trimester)
- tardive dyskinesia: Long term continuation of antipsychotics for three months or
more, which can sometimes be irreversible if it is not attended to quickly enough.
Symptoms of tardive dyskinesia can include involuntary rhythmic movements such
as grimacing, lip smacking, chewing, tongue flicking, as well as excessive eye
blinking
96. what mood stabilizer is least cause metabolic syndrome: lamictal
97. depakote can cause: hepatoxicity (liver) = RUQ pain & reddish brown urine
98. valproic acid: range is 50 - 125, toxicity is greater than 150
99. depakote toxicity: confusion, lethargy, and respiratory depression
- do you liver function test
- check ammonia levels - increase ammonia causes confusion
100. patients taking Kava for anxiety or insomnia need?: A liver function test,
can cause hepatoxicity
there is a drug to drug interaction with kava and Benzodiazepines
101. TCA can cause: hepatoxicity
102. What can Steven Johnson syndrome: lamictal and carbamazepine (tegre-
tal)
Tegretal increases risk for SJS in Asians
S/S: fever and rash
103. Tegretal (Carbamazepine) and clozaril: can cause agranulocytosis
d/c for ANC for less than 1,000 and monitor for s/s of infection
104. Clozaril (Clozapine) can..: decrease SI in PTs with schizophrenia
105. what is gold standard medication for bipolar: Lithium - it can decrease SI
for bipolar PT's
106. check what levels with lithium: TSH, HCG, bun, creatinine, UA
107. what medication can increase lithium toxicity: NSAIDS, thiazides, and
ACE inhibitors (lisinopril)
they reduce renal clearance
108. why should you not take lithium in pregnancy?: causes ebstein anomaly
(especially in the first trimester)
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109. lithium can cause: leukocytosis, hypothyroidism, maculopapular rash,
t-wave inversion, tremors (fine hand Tremors), GI upset,
- course hand tremors = can indicate toxicity
110. Signs of lithium toxicity: muscle weakness, confusion, incoordination, pal-
pitations, severe GI upset, drowsiness, find hand tremors
priority action - d/c lithium and check serum levels
111. NMS (neuroleptic malignant syndrome): Can be caused by antipsychotics
- extra muscle rigidity that can lead to mutism
- increase CPK levels
- myoglobinuria (muscle contractions and muscle destruction which is what is
responsible for increase CPK levels
- increase WBC & LFT
*If the patient goes to the gym a lot with a reddish/cherry color that would indicate
myoglobinuria
Tx:
- stop med
- give bromocriptine (dopamine agonsit)
- give dantrolene (muscle relaxant)
112. Serotonin Syndrome: Caused by antidepressants - SSRIs, TCA, SNRIs,
MAOIs
- Triptans - migraine medications, also are risk for SS
- hyperflexia (myoclonic jerks)
TX:
- stop med
- give cyproheptadine
*NDRIs (Wellbutrin) do not increase serotonin levels
113. How long should you wait to switch medications that are serotonin
meds: 2 weeks (ex. SSRIs to MAOI)
109. lithium can cause: leukocytosis, hypothyroidism, maculopapular rash,
t-wave inversion, tremors (fine hand Tremors), GI upset,
- course hand tremors = can indicate toxicity
110. Signs of lithium toxicity: muscle weakness, confusion, incoordination, pal-
pitations, severe GI upset, drowsiness, find hand tremors
priority action - d/c lithium and check serum levels
111. NMS (neuroleptic malignant syndrome): Can be caused by antipsychotics
- extra muscle rigidity that can lead to mutism
- increase CPK levels
- myoglobinuria (muscle contractions and muscle destruction which is what is
responsible for increase CPK levels
- increase WBC & LFT
*If the patient goes to the gym a lot with a reddish/cherry color that would indicate
myoglobinuria
Tx:
- stop med
- give bromocriptine (dopamine agonsit)
- give dantrolene (muscle relaxant)
112. Serotonin Syndrome: Caused by antidepressants - SSRIs, TCA, SNRIs,
MAOIs
- Triptans - migraine medications, also are risk for SS
- hyperflexia (myoclonic jerks)
TX:
- stop med
- give cyproheptadine
*NDRIs (Wellbutrin) do not increase serotonin levels
113. How long should you wait to switch medications that are serotonin
meds: 2 weeks (ex. SSRIs to MAOI)
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wait 5-6 weeks for fluoxetine to MAOI
*prozac has a long half life
114. Why are SSRIs first line?: They are safer and less potential for causing injury
with potential overdose
115. depression + cancer, give what meds: Give a SSRI like citalopram or
escitalopram because they have less potential for drug to drug interactions
116. depressed + neuropathic pain: SNRI - duloxetine (Cymbalta)
TCAs
Gabapentin
117. Schizophrenia: Age on onset:
18-25 in males
25-35 in females
- the dx has the highest rate of dx's that increases risk for self harm - even more
than depression or bipolar
- can aggression, impulsivity, abstract thinking problems,
- changes or abnormalities in the prefrontal cortex, amygdala, basal ganglia,
hippocampus, and limbic regions of the brain can cause aggression & impulsivity
- MRI/PET will show a decrease in size of the lobes of the brain, and an INCREASE
is the ventricles d/t increased cerebral blood flow
- Do not give stimulants - increased dopamine
- positive symptoms of schizo is due to too much dopamine
- Tx:
- assertive community treatment
- Long term non-compliance of meds then should refer to ACT team (ACT is a form
or rehabilitation post hospitalization in the home)
- social skills rehabilitation (is a tertiary level of prevention)
wait 5-6 weeks for fluoxetine to MAOI
*prozac has a long half life
114. Why are SSRIs first line?: They are safer and less potential for causing injury
with potential overdose
115. depression + cancer, give what meds: Give a SSRI like citalopram or
escitalopram because they have less potential for drug to drug interactions
116. depressed + neuropathic pain: SNRI - duloxetine (Cymbalta)
TCAs
Gabapentin
117. Schizophrenia: Age on onset:
18-25 in males
25-35 in females
- the dx has the highest rate of dx's that increases risk for self harm - even more
than depression or bipolar
- can aggression, impulsivity, abstract thinking problems,
- changes or abnormalities in the prefrontal cortex, amygdala, basal ganglia,
hippocampus, and limbic regions of the brain can cause aggression & impulsivity
- MRI/PET will show a decrease in size of the lobes of the brain, and an INCREASE
is the ventricles d/t increased cerebral blood flow
- Do not give stimulants - increased dopamine
- positive symptoms of schizo is due to too much dopamine
- Tx:
- assertive community treatment
- Long term non-compliance of meds then should refer to ACT team (ACT is a form
or rehabilitation post hospitalization in the home)
- social skills rehabilitation (is a tertiary level of prevention)
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- refer to exercise program (aerobic exercises can help improve cognition and
quality of life and long term health
118. what is the dx that increases HI the most: antisocial personality disorder
119. How do you calculate dose of monthly IM haldol: You multiply their daily
dose by 20
ex. if a PT is taking 5mg BID, you would multiply 10X20= 200 but you can only give
100mg, so give 100mg and tell them to come back in two weeks for their other
100mg
120. What is a delusion?: Is the false belief firmly maintained despite the evi-
dence to the contrary (ex. their family member is part of a cult)
121. Mini Mental Status Exam: Thought process - you want to assess your PT's
thoughts if they are normal or abnormal - organization of thoughts
122. Tangential thinking- Thought process: the patient never gets to the point.
they move from thought to thought with never getting to the point
123. Circumstantial thinking - thought process: a PT goes in circle and provide
unnecessary details before getting to the point
124. What is another name for the MMSE: Folstein Scale
125. What areas of the brain does the clock function test target?: If cannot
draw the clock it can indicate a problem with the right hemisphere/right parietal
lobe
126. Hyperactivity of dopamine in the mesolimbic pathway mediates what
type of psychotic symptoms: positive symptoms = mesolimbic pathway
127. decreased dopamine in the mesocortical projection to the dorsolateral
prefrontal cortex is postulated to be responsible for what types of schizo-
phrenia symtoms?: negative and depressive symptoms = mesocortical pathway
128. What are the positive symptoms of schizophrenia?: delusions, hallucina-
tions, disorganized speech, disorganized or catatonic behavior
129. What are the negative symptoms of schizophrenia?: flat affect, social
withdrawal, lack of motivation, lack of speech or thought, anhedonia
130. Nigrostraital Pathway: - mediates motor movements
- when dopamine is blocked in this pathway it can lead to increased acetylcholine
levels
- blocked dopamine can lead to EPS
-long standing D2 blockade in this pathway can lead to tar dive dyskinesia
- refer to exercise program (aerobic exercises can help improve cognition and
quality of life and long term health
118. what is the dx that increases HI the most: antisocial personality disorder
119. How do you calculate dose of monthly IM haldol: You multiply their daily
dose by 20
ex. if a PT is taking 5mg BID, you would multiply 10X20= 200 but you can only give
100mg, so give 100mg and tell them to come back in two weeks for their other
100mg
120. What is a delusion?: Is the false belief firmly maintained despite the evi-
dence to the contrary (ex. their family member is part of a cult)
121. Mini Mental Status Exam: Thought process - you want to assess your PT's
thoughts if they are normal or abnormal - organization of thoughts
122. Tangential thinking- Thought process: the patient never gets to the point.
they move from thought to thought with never getting to the point
123. Circumstantial thinking - thought process: a PT goes in circle and provide
unnecessary details before getting to the point
124. What is another name for the MMSE: Folstein Scale
125. What areas of the brain does the clock function test target?: If cannot
draw the clock it can indicate a problem with the right hemisphere/right parietal
lobe
126. Hyperactivity of dopamine in the mesolimbic pathway mediates what
type of psychotic symptoms: positive symptoms = mesolimbic pathway
127. decreased dopamine in the mesocortical projection to the dorsolateral
prefrontal cortex is postulated to be responsible for what types of schizo-
phrenia symtoms?: negative and depressive symptoms = mesocortical pathway
128. What are the positive symptoms of schizophrenia?: delusions, hallucina-
tions, disorganized speech, disorganized or catatonic behavior
129. What are the negative symptoms of schizophrenia?: flat affect, social
withdrawal, lack of motivation, lack of speech or thought, anhedonia
130. Nigrostraital Pathway: - mediates motor movements
- when dopamine is blocked in this pathway it can lead to increased acetylcholine
levels
- blocked dopamine can lead to EPS
-long standing D2 blockade in this pathway can lead to tar dive dyskinesia
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Psychiatric-Mental Health Nurse Practitioner