Question: All of the following are risk factors for sexual assault EXCEPT
Question: Which of the following is consistent with what is known about postpartum depression?
Question: Affirmatively acting to benefit another or others, going beyond what is required by law is known as which of the following?
Question: Which of the following is used for treating alcohol-dependent individuals seeking to continue to remain alcohol free after they have stopped drinking?
Question: The NP can impact health policy and healthcare by doing which of the following?
Question: The treatment of others equitably and distribution of benefits/burdens fairly is known as which of the following?
Question: Which of the following is inconsistent with current literature about victims of sexual abuse?
Question: Which of the following would constitute negligence? Select all that apply.
Question: Which of the following developed a Biblically-based cultural competence model for healthcare professionals?
Question: The ARNP recognizes which of the following as long-term effects of sex trafficking on victims?
Question: A patient appears odd, with a pervasive history of magical thinking, ideas of reference, illusions and de realization. This is consistent with which of the following personality disorders?
Question: Which of the following are criteria for a particular suicide to be considered inevitable?
Question: A patient with a history of alcohol use presents to the emergency department with oculo motor disturbances, cerebellar ataxia, and confusion. The ARNP recognizes these symptoms as consistent with which of the following psychiatric emergencies?
Question: The emotional burnout and lack of empathy towards clients that healthcare providers experience after treating victims of trauma is known as which of the following?
Question: The Adverse Childhood Experience Study(Felittietal.,1998)found which of the following relationshipsbetweenchildtraumaticeventsandhigh-riskbehaviorsexhibitedbyadults?
Question: “Walking on eggshells” and appeasement and avoidance behaviors by the victim is characteristic of which phase of the cycle of domestic violence?
Question: The only approved therapy in the United States for moderate to severe Alzheimer’s disease is which of the following?
Question: A term that defines a person who has distress with clinical symptomatology because their gender identity is not consistent with gender assigned at birth is which of the following?
Question: Narcissistic, borderline, antisocial, and histrionic subtypes are associated with which of the following Personality disorders?
Question: Which of the following is not consistent with recommendations for psychiatric history taking and the mental status evaluation of older adults?
Low health literacy has been linked with which of the following?
A claim of malpractice requires that a patient/plaint iff prove which of the following? Select all that apply.
According to USDHHS and the Federal Bureau of Primary Health Care, which of the following individuals would be considered homeless?
Question: A particular form of psychotherapy used for patients with borderline personality disorder, especially those with para suicidal behavior such as frequent cutting in known as which of the following?
Question: As a PMHNP, one of the most common areas you will counsel your patients about is the importance of sleep hygiene. Which of the following is NOT consistent with common recommendations for good sleep hygiene?
Question: he need for nurse practitioners to practice to the full extent of their education and training is necessary for which of the following reasons? Select all that apply.
Question: According to Freud, stubborn, parsimonious, and highly conscientious traits are associated with which stage of development?
Question: Features that point to a medical cause of a mental disorder include which of the following?
Question: A patient currently on risperidone presents to the emergency department with increased agitation, restlessness, muscle discomfort, and dysphoria. The APRN recognizes these symptoms of akathisia and recommends which of the following? Select all that may apply.
Question: Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT:
Question: Which of the following professionals would be able to precept a nurse practitioner student?
Question: The ARNP is treating a 27-year-old female with bipolar disorder who is obese and has renal dysfunction. Which of the following is true?
Question: Patients with this personality disorder are described as excitable and emotional, and behave in a colorful, dramatic, extroverted, attention-seeking fashion, often with an inability to maintain deep long-lasting attachments.
Apersonalitydisordercharacterizedbyemotionalconstriction,orderliness,perseverance, stubbornness, indecisiveness, and a pervasive pattern of perfectionism and inflexibility is known as which of thefollowing?
Question: Apatientpresentsandisunapproachable,withpooreyecontact,reportingalifelongpattern of isolation, uncomfortable with human interaction, and constricted affect. This presentation is consistent with which of the following personalitydisorders?
Question: Which of the following core competencies are quality competencies?
Non-pharmacological treatment for abuse includes all of the following EXCEPT:
Question: A personality disorder characterized by extraordinarily unstable affect, mood, behavior, object relations, and self-image is known as which of the following?
Question: A particular form of psychotherapy based on Otto Kernberg’s object relations theory is known as which of the following?
Question: Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels?
Question: The term “suicide survivor” refers to which of the following?
Question: At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all that apply.
Question: A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the patient likely has which of the following personality disorders?
Question: The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following?
Question: In about half of the cases in which suicides occur while patients are on a psychiatric unit, a lawsuit results. Which of the following is not consistent with what courts expect related to inpatient psychiatric unit suicide events?
Question: Using the LIAASE: A General Cultural Competence Tool, the ARNP would do which of the following?
Question: Which of the following is not consistent with what is known about postpartum psychosis?
Question: Concerns when treating geriatric patients with psychotherapeutic drugs include all of the following EXCEPT:
Question: A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specified number of days is known as which of the following?
Question: Standards of care are now being set, modified, monitored, and publicized by certain self- appointed consumer-oriented agencies, as well as government agencies, including which of the following?
Question: The differences in the quality of healthcare across individuals or groups in regard to access, treatment options, and preventative services is known as which of the following?
Question: The differences in the quality of healthcare across individuals or groups in regard to access, treatment options, and preventative services is known as which of the following?
Question: A term used to describe individuals and families who are found to live in overcrowded homes, relocate frequently, and struggle to pay rent and monthly expenses is which of the following?
Question: Risk factors for school violence include which of the following? Select all that apply.
Question: Being knowledgeable about one’s own thoughts, feelings, and sensations as well as the ability to reflect on how these can affect one’s interactions with others is known as which of the following?
Question: A patient with an inability to conform to the social norms that ordinarily govern many aspects of a person’s behavior is consistent with which of the following personality disorders?
Question: Which of the following medications is associated with neural tube defects when givenduring pregnancy?
Question: Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply.
Question: Self-injurious behavior with a nonfatal outcome, accompanied by explicit or implicit evidence that the person intended to die, is most specifically known as which of the following?
Question: The ARNP is working with a patient who has a heightened sense of self-importance and grandiose feelings of uniqueness. The patient also lacks empathy for others, although is very sensitive to minor criticism. The ARNP recognizes these symptoms as consistent with which of the following personality disorders?
Question: The degree to which individuals have the cognitive and social capacity to access, process, and utilize basic health information and services to maintain good health, make appropriate health decisions, and meet their goals is knowns as which of the following?
Question: Risk factors for physical abuse include all of the following EXCEPT:
Question: According to Freud, passive and dependent personality traits are associated with which stage of development?
Question: Sexual assault is most often which of the following?
Question: Which of the following is the treatment of choice for patients with depressive personality?
Question: Which of the following medications is associated with Ebstein’s anomaly when given during pregnancy?
Question: In Canterbury v. Spence the U.S. Court of Appeals for the District of Columbia Circuit listed physician responsibilities for disclosure. Which of the following is not listed as a responsibility?
Question: Ethnocentrism results in which of the following?
Question: Which of the following demographic characteristics is consistent with high suicide risk?
Question: An ARNP takes a position in which the ARNP is guaranteed a set salary but can make additional salary if he or she generates practice income over some set amount. This is known as what type of pay structure?
Question: Which of the following is not consistent with guidelines for a mentor?
Question: Which stage of the cycle of domestic violence is characterized by overt aggressive behavior towards the victim?
Question: In educating the patient beginning to take Lithium, the ARNP explains which of the following related to diet and fluid intake?
Question: A patient on Lithium and Quetiapine presents to the emergency room with anorexia, persistent nausea and vomiting, blurred vision, choreoathetoid movements, muscle fasciculations, and hyperactive deep tendon reflexes. The ARNP should do all of the following EXCEPT:
Question: Which of the following are symptoms consistent with patients with passive-aggressive personality?
Question: Which of the following is consistent with current literature regarding the epidemiology of dependent personality disorder?
Question: The treatment of choice for patients with paranoid personality disorder includes which of the following?
Question: According to the AANP Process of Care Standards, performing or ordering preventative and diagnostic procedures based on the patient’s age and history is part of which of the following components?
Question: Treatment aimed at reducing intimate partner violence and domestic violence includes which of the following?
Question: Which of the following are important measures by which to evaluate a benefits package while negotiating employment benefits?
Question: The goal of psychotropic treatment is to eliminate all manifestations of a disorder to below the syndromal threshold, which is defined as which of the following?
Question: Type of employment in which either party may terminate for any reason at any time is known as which of the following?
Question: A somatopsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about one week before the onset of menses characterized by irritability, emotional lability, HA, anxiety, and depression is known as which of the following?
Question: NP core competencies for INDEPENDENT practice include all of the following EXCEPT:
Question: The conditions in which people are born, grow, work, live, and age are known as which of the following?
Question: In order to qualify for ANCC board certification testing you must have a minimum of how many supervised clinical hours in the respective specialty for which you are seeking certification?
Question: Which of the following is consistent with current perspectives on nurse practitioner competencies?
Question: ARNPs caring for vulnerable populations are responsible for which of the following?
According to the AANP Process of Care Standards, determining the effectiveness of the treatment plan with documentation of patient care outcomes is part of which of the following components?
Question: The ARNP assessing lifestyle as a social determinant of health would ask about which of the following?
Question: The NP preceptor should have which of the following?
Question: Cluster A personality disorders are more common in biological families of patients with which of the following disorders?
Question: A form of child abuse in which a parent or caretaker repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought, often in an emergency setting, is known as which of the following
Question: Nurse practitioner preceptors should have at least how much experience as a nurse practitioner in the relevant specialty prior to precepting?
Question: In educating the patient beginning to take Lithium, the ARNP explains which of the following related to the need for blood tests?
Question: The incidence of suicide is highest for which of the following populations?
Question: Which of the following defense mechanisms does the abuser use during the honeymoon phase of the cycle of violence?
Question: Obsessive-compulsive, dependent, and avoidant personality traits are associated with which of the following personality clusters?
Question: Which of the following is not advised to prevent a lawsuit?
Discrepancy between anatomical sex and gender is known as?
B) Gender Discordance
Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply
Rapid dose escalation; parental route of administration; higher potency typical antipsychotics
Antipsychotic medication provides D2 blockage in the meso-coritcal pathway causing which of the following effects?
B) Increases EPS
Incorrect: reduces negative s/s, causes prolactinemia, reduces positive symptoms
Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors?
D) NMDA type receptors
Incorrect: GABA, serotonin, dopamine “receptors”
The diagnosis used to describe a syndrome characterized by specific s/s resulting from recent ingestion or exposure to a substance is known as which of the folllowing?
C) Substance use disorder
Incorrect: substance intox, substance withdrawal, all of the above
Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue jaw is known as which of the following?
C) Tardive dyskinesia
Incorrect: akathisia, dystonia, EPS
A deeply held belief despite evidence to the contrary, lasting at least 1 month, without prominent hallucinations, with functional impairment that relates to the delusional system disorder called?
Delusional disorder
Which of the following is true about preoccupation with castration?
A) This can be serious and life threatening if castration is carried out without medical supervision
Incorrect: consistent with transvestiatic disorder, other specified paraphillic disorder, or sexual machochism disorder
Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostics services rendered by clinicians?
CPT
Incorrect: HIPPA, DSM5-, DRG
A patient on Chlorpromazine states his orgasm is dry and afterwards he will commonly have milky urine. The APRN realizes this is which of the following?
A) This is likely a harmless response to the Chlorpromazine
“Thorazine”
A condition which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus and infertility is known as which of the following?
B) Turners Syndrome
Turners syndrome:
tx involves hormone therapy; fertility treatments for women when they decide to have a baby
Which of the following would be characterized as a negative s/s of schizophrenia?
B & C only
B) impaired social and occupational functioning
C) isolation and impaired self-care
Which of the following are keys to distinguishing OCD from psychosis?
Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms
A federal program administered nationally and locally which covers enrolled individuals 65+ who pays premiums and disabled individuals
Both A& B (Medicare and Medicaid)
Having an adequate legal description of nurse practitioner (NP) scope of practice according to state law is important for which of the following reasons?
All of the above (to avoid any charges of practicing medicine without a license, to place accountability for both benefits and harm to patients squarely on the NP, to get reimbursed for physician services when provided by a NP
Which of the following is the most widely consumed psychoactive substance?
B) Caffeine
Incorrect: alcohol, heroin, cannabis
Which of the following is used to tx TD?
None of the above
(cogentin, artane, catapress)
The APRN consensus model did which of the following?
B & C
B) adult and gerontology were merged and identified as PCP or acute care
C) psychiatric mental health foci were stipulated as across the lifespan
Which of the following behaviors are associated with an alcohol blood level of 0.05%?
B) Thought judgement and restraints are impaired
According to HIPPA, which of the following must the NP share their NPI with? Check all the above
A) Health Plans
B) Other providers
C) Any entity that may need it for a billing purpose
A patient presents with delusions, disorganized thoughts, and speech with poor self care all of which has persisted for the past 7 months. The APRN knowns this presentation means what diagnosis?
Schizophrenia
Major neurotransmitters possibly involved in developing substance abuse and substance dependence are which of the following?
A) Dopamine
Incorrect: GABA, serotonin, A& B only
The dopamine hypothesis of schizophrenia, which of the following?
A) Schizophrenia results from too much dopaminergic activity
incorrect: results from a deprivation of dopamine
A patient reports a panic attack several years ago in an elevator and since then has avoided elevators. The pt meets the criteria for:
B) Specific phobia
A patient with a substance use disorder who does not meet clinical criteria for hospitalization but lacks sufficient social and vocational skills and lack substance-free social supports is to
D) All of the above
(Residential tx, partial hospitalization, outpt tx)
Obscene phone calling to an unsuspecting partner for sexual arousal is known as?
C) Telephone Scatologia
(not telephillia, partialism, normal adolescent prank)
The main psychological difference between fear and anxiety is best described by which of these statements?
B) Anxiety is insidious, fear is sudden
A diffuse, unpleasant, vague sense of apprehension often accompanied by autonomic symptoms varies upon persons is commonly known as which of the following?
C) Normal anxiety
(incorrect- fear, stress, pathological anxiety
If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired during which trimester is the least hazardous?
D) Withdrawal from methadone should never be done while the woman is pregnant
Neurochemical or neurophysiological changes in the body that results from the repeated administration of a drug is known as which of the following?
C) Neuroadaption
incorrect: cross-tolerance, neurotransformation, neurocognitive adjustment
The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following?
C) Sexual sadism
Which of the following is not consistent with the onset of OCD?
D) The onset of OCD is typically preceded by OCD personality traits
True answers about OCD:
-more than 1/2 of pts with OCD have a sudden onset of symptoms
-the onset of symptoms for about 50-70% of patients occurs after a stressful event
-most patients keep their symptoms secret initially
The recurrent urge to expose one’s genitals to a stranger is known ass which of the following?
C) Exhibitionism
Which of the following patients would be appropriate for hospitalization for substance use disorder? Select all that apply
D) A&B only
(Patients who have a substance overdose who cannot be safely tx in an outpt setting & pts who are at risk for severe or medically complicated withdrawal symptoms
The nursing practice model recommendation for NPs by the NAtional Academy of Medicine and the National Council of State Boards of Nursing is which of the following?
A) Full practice
Which of the following groups does medicare cover? Select all the above
A) Individuals 65+ years and older who have enrolled and pay premiums
B) Disabled individuals who quality for social security disability payments and benefits
Which of the following neurotransmitters increases libidio?
D) Dopamine
Incorrect: GABA, serotonin, oxytocin
Which of the following factors are associated with poor prognosis for patients with OCD?
D) A & C
(Childhood onset & Co-existing major depressive disorder)
Which of the following is inconsistent with current knowledge about schizophrenia?
C) Dopamine level is a laboratory tests that assists in the diagnosis of schizophrenia
A chronic disorder characterized by repetitive hair pulling leading to variable hair loss that may be..to others known as?
C) Trichotillomania
Which of the following are risk factors for neuroleptic malignant syndrome?
B) Rapid dose escalation
C) Parental route of admin
D) High potency typical antipsychotics
A method of therapy used to tx individuals with substance use based on the fundamental principle of a psychology that reinforced behaviors are likely to be..is known as the following?
B) Contingency Management
The conditions in which people are born, grow, work, live and age are known as?
Social determinants of health
All of the following is consistent with the ANCCs rules regarding recertification EXCEPT:
A) You are required to have a maximum of 25 credit hours during each certification period
Correct:
B) you can start the recert process 1 year before your expiration date, but no later than 3 months before
C) You must have 1000 clinical practice hours in a clinical speciality within the preceding 5 years
D)you must have at least 25 contact hours in pharmacotherapy
Risks factors for school violence include which of the following? Select all that apply
A) Bullying
B) Being bullied
C) Isolation
Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas in the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics with which of the following personality disorders?
C) Dependent personality disorder
Incorrect: avoid PD, passive PD, antisocial PD
Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels?
D) >25 mEq/L
(TOXICITY)
A form of child abuse in which a patient or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought in an ER is known as which of the following?
D) Munchausen Syndrome by Proxy
Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT?
D) plan to study for short periods over a longer period of time
A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with..trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects that the pt likely has which of the following PDs?
B) Paranoid PD
Incorrect: schizoid PD, BDP, Antisocial PD
A pt will a hx of alcohol use presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. Symptoms are consistent with which of the following psychiatric emergencies?
C) Wernickes Encephalopathy
Incorrect: akathisia, korsakoff’s syndromes, idiosyncratic alcohol intoxication
Cluster A personality disorders are more common in biological families of pts with which of the following disorders?
D) Schizophrenia
Incorrect: depression, OCD, alcohol use disorder
NP core competencies for INDEPENDENT practice includes all of the following EXCEPT:
B) Demonstrates the highest level of accountability for professional practice
NP competencies for independent practice:
A) Maintain a collaboration agreement with physician
C) Practices independently managing previously diagnosed and under-diagnosed pts
D) Practices patient centered care recognizing culture diversity and the pt or designee as a full practice in decision making
Cluster A personality traits consists of which of the following?
A) Schizotypal, schizoid, and paranoid subtypes
The misuse of the charge’s funds for personal gain is known as which of the following?
C) Financial abuse /exploitation
the ARNP recognizes which of the following as long term effects of sex trafficking on victims?
D) All of the above
A) Severe depression
B) Spiritual questions
C) Trauma bonding
In about half of the cases in which suicides occur while pts are on a psychiatric unit, a lawsuit results; which of the following is NOT consistent with what courts..related to impatient psychiatric unit suicide events?
B) Courts provide ZERO suicide rates in inpt setting
Cultural Dimensions Therapy is a framework for cross-cultural communication that describes the effects of a society’s culture on the values of its members..by which of the following therorists?
A) Hofstede
The tx of choice for pts with paranoid PD includes which of the following?
D) B&C
B) Behavioral Therapy and
C) Psychotherapy
The differences in quality of healthcare actions across individuals or groups regard to access, tx options and p..following?
B) Health disparities
The incidence of suicide is highest for which of the following populations?
D) Older African American men
The pt on lithium with a hx of alcohol use disorder presents with dry mouth, ataxia, dizziness, abdominal pain, and slurred speech. The ARNP should do which of the following?
C) The ARNP recognizes the symptoms of moderate lithium toxicity, discontinues the lithium immediately, orders lithium level, serum electrolytes and renal function tests
The ARNP takes a position in which a specific amount is paid according to a set job description. The ARNP should do which of the following?
C) The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, discontinues the lithium immediately, orders a lithium level, serum electrolytes and renal function tests
The ARNP takes a position in which a specific amount is paid according to a set job description. This type of pay structure is known as?
D) Hourly rate
A PD characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness, a inflexibility as which of the following?
Obsessive compulsive PD
Which of the following is consistent with what is known about the epidemiology of anxiety?
B) Women have a higher lifetime prevalence of anxiety than men
Which of the following is consistent with NP practice parameters when prescribing buprenorphine?
D) the NP is require to complete specific training to prescribe and dispense buprenorphine
Which of the following are consistent with current data related to the prevalence of drinking alcohol?
B) Men and women with higher education and income are more likely to drink alcohol
A pt with hx of hypoglycemia reports feelings of fear, worry and restlessness that has persisted over the past 6 months. The pt states these feelings are worse when glucose is low. the ARNP suspects the pt has which of the following dx?
A_) GAD attributable to another medical condition
Which of the following is not consistent with benzo withdrawal?
B) The best way to proceed with benzo withdrawal is to stop it immediately and tx withdrawal s/s
Which of the following is true about the legal practice of the PMHNP?
D) A&B only
A) all have some degrees of prescriptive privileges in all states and the district of columbia
B) all are considered primary providers in all states and the district of columbia
Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical features of PTSD?
A) Intrusion Symptom
B) Symptom of Avoidance
In which ways are NPs and PAs different?
D) A&B
A) NPs differ from PAs in legal definition, scope of practice, licensure, and independence of practice
B) NPs practice under their own license and independent of the physician, PAs always work under the supervision of a physician
Which of the following initials would a PMHNP use to designate appropriate credentials?
PMHNP-BC
Variations from norms in gender roles such as toy preferences, rough and tumble play, aggression, or playmate gender is known as which of the following?
B) Gender role behavior
3 major neurotransmitters associated with anxiety, based on animal studies and response to drug tx include?
B) GABA, norepinephrine and serotonin
Which of the following is consistent with the epidemiology of schizophrenia in the US?
D) Onset of schizophrenia before the age of 25 is extremely rare
Clinical findings that may indicate abuse include which of the following? Select all that apply
B) Explanation by the pt which is inconsistent with the type of injury
C) Psychological distress such as depression, anxiety, SI, and/or sleep disorder
D) Explanation by the parent that is inconsistent with the type of injury
According to the APA, which of the following is consistent with the EBP for telepsych?
B) In populations with severe anxiety, tele psychiatry is preferred
Which of the following is consistent with literature regarding the term psychosexual?
D) None of the above
-psychosexual is used to describe personality development and functioning
-psychosexual is synonymous with libidio in the Freudian sense
-Psychosexual basically refers only to sexual feelings and behavior
Bleuler identified 4 fundamental s//s of schizophrenia, known as the 4 A’s, which include which symptoms?
A) Associations, Affect, Autism, Ambivalence
The fear/anxiety regarding places from which escape may be difficult is known as which of the following:
C) Agoraphobia
All of the following are one of the 5 major categories of third-party payers EXCEPT:
D) only A & B
A) Medicare/medicaid
B) Managed care organization (MCOs)
Which of the following are risk factors for sexual assault EXCEPT:
A) Religion
Incorrect: serious mental illness, substance use disorder, family hx of sexual abuse
Which of the following is consistent with what is known about PP depression?
D) All of the above
(feelings of guilt/ and inadequacy are often present and excessive; thoughts of harming the baby are often present; typical onset is within 3-06 months of delivery)
Affirmatively acting to benefit another or others, going beyond what is required by law is known as which of the following?>
C) Beneficence
Which of the following is used for treating alcohol dependence individuals seeking to continue to remain alcohol free after they have stopped drinking?
D) Acamprosate
The NP can impact health policy and healthcare by doing which of the following?
D) All of the above
-becomes an active member of local, state, and/or national NP
-becomes familiar with the resources available on NP organization websites
-Volunteer to serve on legislature committees within professional NP organizations
The tx of others equitably and distribution of benefits/burdens fairly is known as?
B) Justice
Which of the following is INCONSISTENT with current literature about victims of sexual abuse?
C) The pre-existing relationship and\ familiarity with the abuser may impeded the victim’s ability to make rational decisions
Which of the following would constitute negligence? Select all that apply
A) Failure to give necessary care
B) Failure to refer when necessary
C) Failure to follow up with a patient
D) Failure to disclose necessary info to a patient
Which of the following developed a biblically-based cultural competence model for healthcare professionals?
B) Camipinha-Cacote`
the ARNP recognizes which of the following as long term effects of sex trafficking on victims?
D) All of the above
-severe depression
-spiritual questions
-trauma bonding
A patient appears odd, with a pervasive hx of magical thinking, ideas of reference, illusions or derealization. This is consistent with which of the folllowing PDs?
C) Schizotypal PD
Which of the following are criteria for a particular suicide to be considered inevitable?
D) All of the above
-strong genetic hx of suicide in one or more family members
-a strong genetic loading of mental illness in the family
-the pt may have received the highest standard of tx and that txd failed
A pt with a hx of alcohol use disorder presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. The ARNP recognizes these symptoms as consistent with which of the following psych emergencies?
C) Wernicke’s encephalopathy
The emotional burnout and lack of empathy towards clients that healthcare providers experience after treating victims is known as the following?
B) Primary traumatization
The ACE study found that which of the following relationships between child traumatic events and high-risk behaviors exhibited by adults?
D) The study revealed an indirect relationship between child traumatic events and high risk adult behaviors
Walking on eggshells and appeasement/avoidance behaviors by the victim is characteristic of which phase of the cycle of DV?
A) Honeymoon phase
What are the different phases of DV?
- Tension building phase
- Incident
- Reconciliation
- Calm
The only appproved therapy in the US for moderate to severe Alzheimers Disease is which of the following?
B) Memantine
Memantine is?
A) Namenda,
cognition enhancing medication for alzheimers/dementia
A term that defines a person who has distress with clinical symptomology because their gender identity is not consistent with gender assigned at birth is which of the following?
D) Gender Dysphoria
Narcissistic, borderline, antisocial, and histrionic subtypes are associated with which cluster of PDs?
B) Cluster B
Odd, eccentric cluster of PDs?
Cluster A
a. Paranoid PD
b. Schizoid PD
C. Schizotypal PD
Characterized by appearing dramatic, emotional, or erratic PD?
Cluster B
a., antisocial
b. borderline
c. histrionic
d. narcissistic
inner emptiness, unstable relationships and emotional dysregulation?
BPD
Attention seeking and excessive emotionability?
Histrionic
Social irresponsibility, diregard for others, deceitfulness, and manipulation of others for personal gain
Antisocial
Self-grandiosity, need for admiration and lack of empathy
Narcissistic PD
Eccentric ideas and behaviors PD?
Schizotypal PD
Disinterest in others PD?
Schizoid
Mistrust and suspicion PD?
Paranoid PD
Characterized by appearing anxious or fearful. it includes which PDs?
Cluster C
a. avoidant PD
b. dependent PD
c. obsessive compulsive PD
Perfectionism, rigidity and obstinacy traits PD?
OCD PD
Avoidance of interpersonal contact due not rejection sensitivity PD?
`Avoidant
Submissiveness and a need to be taken care of PD?
Dependent PD
Which of the following is NOT consistent with recommendations for psychiatric hx taking and the MSE of older adults?
B) Pt should be seen alone even in cases of clear evidence of impairment to persevere the privacy of a doctor/pt relationship
Low health literacy has been linked with which of the following?
D_ All of the above
-poor health outcomes
-lower rates of hospitalization
-less frequent use of preventative services
A claim of malpractice requires that a patient/plaintiff prove which of the following? Select all that apply
A) The existence of a client-professional relationship–duty ti care
C) a causal link b/t the provider’s failure to confirm to tx standards and harm to the pt
D) Actual injury to the pt
According to USDHHS and the Federal Bureau of Primary Health Care, which of the following individuals would be considered homeless?
D) All of the above
-an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations
-an individual who is a resident in transitional housing
-a person who is living w /a friend`
A particular form of psychotherapy used for pts with BPD, especially those with parasuicidal behaviors, such as frequent cutting is known as which of the following?
A) DBT
incorrect: mentalization based tx; transference focused psychotherapy and exposure therapy`
As a pmhnp, one of the most common areas you will counsel your patients about is the importance of sleep hygiene. Which of the following is NOT consistent with common recommendations for good sleep hygiene?
B) Set a cool room temp
True sleep hygiene tips:
-avoid alcohol and caffeine
-set TV to turn off within 1 hr of falling asleep
-go to bed at the same time each night
The need for NPs to practice to the full extent of their education and training is necessary for which of the following reasons? Select all of the above
A) The growth in number and proportion of older Americans
B) The projected PCP shortages by 2025
C) increased number of individuals who have access to healthcare
according to Freud, stubborn, parsimonious and highly conscientious traits are associated with?
B) Anal stage
Freud’s Psychosexual Theory and 5 Stages of Human Development?
1.Oral stage
- Anal stage
- Phallic stage
- Latent stage
- genital stage
The mouth, sucking, swallowin ect
Stage 1- oral stage
EGO develops in which phase?
ORAL phase 1
The penis or vagina-sexual intercourse?
Stage 5 genital
`The anus- withholding or expelling feces
- Anal stage
Little to no sexual motivation present?
Stage 4. Latent phase
The penis or clitoris- masturbation
Stage 3 Phallic
the SUPEREGO develops at what phase?
Stage 3 Phallic
Features that point to a medical cause of a mental disorder includes which of the following?
D) A& C
A) Acute onset
C) Visual hallucinations
A patient currently on risperidone presents to the ED with increased agitation, restlessness, muscle discomfort and dysphoria. the ARNP recognizes these symptoms of akathisia and recommends which of the following? Select all that apply
B) Benztropine IM only
incorrect: reduce antipsychotic dosage, Benadryl PO or IM, B&C only
Self-care strategies in preparation for the certificate exam includes all of the following EXCEPT:
C) Drink lots of caffeine and eat high concentrated sugars
good self care strategies:
-plan to study for short periods over a long time
-study in a distraction free environment
-6-8 hours of sleep is recommended
Which of the following professionals would be able to precept a NP student?
D) A&B
A) ARNP
B) Physician
the ARNP is txing a 27 year old female who bipolar disorder who is obese and has renal; dysfunction. Which of the following is true?
C) An atypical antipsychotic such as olanzapine or risperidone should be used
Pts with this PD are described as excitable, emotional and behave in a colorful, dramatic, extroverted, attention-seeking fashion, often with an inability to maintain deep long-lasting attachments
B) Histrionic PD
a PD characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness and a pattern of perfectionism and inflexibility is known as which of the following?
D) OCD PD
Which of the following core competencies are quality competencies?
D) A&C
A) use best available evidence to continually improve quality of practice
C) evaluates the relationship among access cost quality safety and their influence on health care
Non-pharmacologic tx for abuse includes all of the following EXCEPT:
D) Involve the abuser in the tx planning
Non-pharmacologic tx options for abuse victims?
-CBT
-build a community of support
-assist pt to devise a safe escape plan
a PD characterized by extraordinarily unstable affect, mood, behavior, object relations and self-image is known as?
BPD
A particular form of psychotherapy based on Otto Kernbeg’s object relations theory is known as which of the following?>
C) Transference-focused psychotherapy
generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following Lithium levels?
C) > 2.5 mEq/L
nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, oliguria and renal failure
Moderate Lithium toxicity: 2.0-2.5
Lithium therapeutic window
0.6-1.2 mEq/L
first med approved for bipolar d/o
lithium
Common side effects of Lithium,
tremor, nausea., fatigue, increased thirst, slowed thinking
Important serious side effects of Lithium:
hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity
How do we decrease the risk of lithium toxicity?
Blood level monitoring
therapeutic range: 0.6 – 1.2
Lithium levels are known to (increase/decrease) when used concurrently with diuretics, thiazides, ACE inhibitors and NSAIDs?
Increase
ACE inhibitors: lisinopril, catopril, enalapril
Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline
Decrease
concurrent use of lithium and antidepressants and/or antipsychotics can cause what?
Serotonin syndrome & Neuroleptic malignant syndrome
The term “suicide survivor” refers to which of the following?
A) those who have lost a loved one to suicide
At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all the above
C) is the problem organic, functional or a combination?
A pt presents with a formal, tense manner. He reluctantly responds a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the pt likely has which of the following PDs?
B) Paranoid PD
The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following?
B) Beneficence
`In about 1/2 the cases in which suicides occur while pts are in a psychiatric unit, a lawsuit occurs. Which of the following is NOT consistent with what court expects related to inpt psych unit suicide events?
D) Evidence of formulation of a tx plan with a high level of security
Using the LIAASE: A general cultural competency tool, the ARNP would do which of the following?
D) all of the above
-agree to disagree on differences in values
-solicit other options or points of view
-acknowledge and validate powerful emotions when expressed
Which of the following is NOT consistent with what is known about PP psychosis?
A) symptoms of PP psychosis can often begin within days of delivery
Concerns when treating geriatric patients with psychotherapeutic drugs includes all of the following EXCEPT:
B) Elderly persons may be more susceptible to adverse effects of psychotherapeutic drugs
A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specific number of days is known as which?
C) Termination clause
Standards of care are now being set, modified, monitored and publicized by certain self-appointed consumer-oriented agencies as well as government agencies, including which of the following?
D) All of the above
-Medicare
-the Joint Commission
-The agency for healthcare research and quality
The differences in the quality of healthcare across individuals and groups in regards to access of care, treatment options, and preventative services is known as?
B)Health disparities
incorrect: racism, vulnerable populations, SDOH
Which of the following medical conditions can present with prominent mental status changes that mimic common psychiatric illnesses. Select all that apply
B) Thyroid diseases
C) Head trauma
Incorrect: DM, AIDS
Risks factors for school violence include which of the following? Select all the above
A) bullying
B) being bullied
C) Isolation
Being knowledgeable about one’s own thoughts, feelings and sensations as well as the ability to reflect on how these can affect one’s interactions with others is known as?
A) Cultural awareness
A pt with an inability to conform to the social norms that ordinarily govern many aspects of a person’s behavior is consistent with which of the following PDs?
D) Narcissistic PD
Which of the following meds are associated with neural tube defects when given during pregnancy?
C. Valproic acid
curriculum content supports the NP scientific competency area includes which of the following? Select all that apply
A) Comparison of pt data sets with evidenced based standards to improve care
B) Science from other disciplines relevant to heath care
Self-injurious behaviors with a nonfatal outcome, accompanied by explicit or implicit evidence that the person intended to die, is most specifically known as what?
C) Suicide attempt
The ARNP is working with a pt who has heightened sense of self-importance and grandiose feelings of uniqueness. The pt also lacks empathy for others, although is very sensitive to minor criticisms. The ARNP recognizes these s/s as consistent with which of the following PD?
C) Narcissistic PD
The degree to which individuals have the cognitive and social capacity to access, process, and utilize basic health info and services to maintain good health, make appropriate health decisions and meet their goals is known as?
A) Health Literacy
Risk factors for physical abuse includes all of the following EXCEPT:
A) Literacy
Risk factors for physical abuse?:
-pregnancy, serious mental illness, hx of victimization during the developmental years
According to Freud, passive and dependent personality traits are associated with which stage of development?
B) Anal stage
Sexual assault is most often which of the following?
C) family member
incorrect: stranger, acquaintance, professional
Which of the following is the tx of choice for pt’s with depressive personality?
A) Exposure therapy
incorrect: light exposure therapy, insight oriented psychotherapy, transmagnetic stimulation (TMS)
Which of the following medications is associated with Ebstein’s anomaly when gievn during pregnancy?
B) Lithium
*Actually a very small risk to pregnancy– should be used more
In Canterbury v Spence in the US Court of Appeals for the District of Columbia Circuit listed physician responsibilities for disclosure. Which of the following is NOT listed as a responsibility?
D) inform the pt about precautionary therapy that he or she should seek in the future
Ethnocentrism results in which of the following?
C) Provides caregivers with the ability to better care for pt’s of various culture
Which of the following demographic characteristics is consistent with high suicide risk?
D) Over 45 years of age
An ARNP takes a position in which the ARNP is guaranteed a set salary but can make additional salary if he/or she generates practice income over some set amount; this is known as what type of pay structure?
C) Base salary plus percentage
Which of the following is NOT consistent with guidelines as a mentor?
D) Be specific and kind when giving constructive feedback that ay not be what the mentee might want to hear
Which stage of the cycle of DV is characterized by overt aggressive
Cluster A PD includes which 3 disorders?
Schizotypal, schizoid, paranoid subtypes
Cultural dimensions therapy:
Hofstede
describes the effects of a society’s culture on the values of its members
Tx of choice with a pt with paranoid PD?
B&C
-behavioral therapy
-psychotherapy
Which of the following is NOT a common physical effect of cannabis?
B) Mild bradycardia
s/.s of cannabis physical effects?
Mild tachycardia, orthostatic hypotension, dilation of the conjunctival blood vessels
A conscious standard recurrent behavior such as counting, checking, avoiding that interferes with the person’s normal routine and functioning is known as?
A_ Compulsion
Most everyone has a firm conviction that they are male or female by which age range?
B) 2-3 years of age
A pt who presents absent movements with difficulty starting activities, flat affect and avolition would be assessed as having?
D)_ Pseduo-parkinsonism
What of the following is consistent with current epidemiology literature about gender and OCD?
D) Adult men and women are equally likely to have OCD
A type of schizophrenia in which the individual has a marked disturbance of motor function and may involve stupor, negativism, rigidity, excitement or posturing or mutism is?
B) Catatonic
A pt who presents with the inability to remain still with motor restlessness, would be assessed to have?
B) Akathisia
method of therapy used to tx individuals with substance use disorders?
B) Contingency Management
Ethnocentrism results in which of the following?
C) provides care givers the ability to care for pts of various cultures
Which of following demographic characteristics is consistent with high suicide risk?
D) Over age 45
In educating the pt beginning to take Lithium, the ARNP explains which of the following is related to diet and fluid intake?
D) All of the above
-caffeine and alcohol act as hydration agents and can raise your lithium concentrations
-drink @ least 1 gal of water or more each day & limit your salt intake
-if you go on A diet, your doctor may need to increase the frequency of blood tests
Three major neurotransmitters associated with ANXIETY, based on animal studies and response to drug tx include?
B) GABA, norepinephrine and serotonin
What neurotransmitter increases libidio?
D) Dopamine
Concerns when treating geriatric pts with psychotherapeutic drugs includes all of the following EXCEPT?
C) Elderly persons may metabolize psychotherapeutic drugs more rapidly
Concerns when treating geriatric pts with psychotherapeutic drugs?
A) Elderly people can be more susceptible to adverse effects of drugs
B) Elderly persons may metabolize drugs more slowly
D) Elderly people may excrete psychotherapeutic drugs more slowly.
Persons who subordinate their own needs to those of others, get other to assume responsibility for major areas of their lives, lack self-confidence and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics consistent with what PD?
C) Dependent PD
According to Sullivan, which of the following are consistent with a mentor/mentee relationship?
C) Goals for the mentoring relationship are set mutually
incorrect: mentors are assigned; mentor relationships are shorter term; A&B only
The need for NPs to practice to their full extent of their education and training is necessary: select all of the above
ALl of the above
3 MULTIPLE CHOICE OPTIONS
The ARNP assessing lifestyle as a social determinant of health would ask about which of the following?
A) Diet
3 MULTIPLE CHOICE OPTIONS
What are social determinants of health and lifestyle choices?
The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.
In educating the pt about Lithium, the NP explains which of the following is related to diet and fluid intake?
D) All of the above
3 MULTIPLE CHOICE OPTIONS
The goal of psychotropic tx is to eliminate all manifestations of a disorder to below the syndromal threshold, which is defined as which of the following?
B) Remission
3 MULTIPLE CHOICE OPTIONS
The NP can impact health policy and healthcare by doing which of the following?
D) All of the above
3 MULTIPLE CHOICE OPTIONS
A term used to describe individuals and families who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following?
D) A& B
3 MULTIPLE CHOICE OPTIONS
Which of the following is consistent with current literature regarding the epidemiology of dependent PD?
C) Persons with chronic physical illness in childhood may be the most susceptible to this disorder
3 MULTIPLE CHOICE OPTIONS
Pts who injure themselves by self-mutalization but usually do not wish to die are said to have which of the following?
C) Parasuicidial behaviors
3 MULTIPLE CHOICE OPTIONS
The NP preceptor should have which of the following?
D) All of the above
3 MULTIPLE CHOICE OPTIONS
The tx choice of pts with histrionic PD include which of the following?
D) A & B
3 MULTIPLE CHOICE OPTIONS
The antipsychotics that are most likely to cause neuroleptic induced parkinsonism have which of the following effects?
C) High potency drugs with high levels of anticholinergic activity
3 MULTIPLE CHOICE OPTIONS
Tx aimed at reducing intimate partner violence and DV includes which of the following?
D) A&B only
3 MULTIPLE CHOICE OPTIONS
Pt presents with a formal, tense manner. He reluctantly reports a longstanding pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns that others are deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP; we suspect the pt most likely has the following PDs?
B) Paranoid PD
3 MULTIPLE CHOICE OPTIONS
Which of the following is consistent with current perspectives on NP competencies?
A) The National Organization of NPs Faculties have developed a list of core competencies that all students should have upon graduation from a master’s program
3 MULTIPLE CHOICE OPTIONS
Which of the following core competencies are quality competencies?
D) A& C
3 MULTIPLE CHOICE OPTIONS
Which of the following are criteria for a particular suicide to be considered inevitable?
D) All of the above
3 MULTIPLE CHOICE OPTIONS
According to Freud, passive and dependent personality traits are associated with what stage of development?
A) Oral stage
3 MULTIPLE CHOICE OPTIONS
SIB with a nonfatal outcome, accompanied by explicit or implicit evidence that the person intended to die, is known as?q
B) Suicide intent
3 MULTIPLE CHOICE OPTIONS
“Assumes complex and advanced leadership roles to initate and guide change” is a NP core competency for which area?
C) Leadership competencies
3 MULTIPLE CHOICE OPTIONS
At a minimal, a psych eval in an Emergency should include what? Select all that apply
A, B, C
3 MULTIPLE CHOICE OPTIONS
Which stage of the DV cycle is characterized by the abuser subconsciously implementing defense mechanisms and cognitive distortions to alleviate the ego dystonic implication of the abuse?
D) Defensive phase
3 MULTIPLE CHOICE OPTIONS
A pt with a hx of schizophrenia, currently prescribed Haldol, presents to the ED with hyperthermia, muscle rigidity, autonomic instability and elevated phosphokinase. The ARNP recognizes these symptoms are consistent with?
D) Neuroleptic malignant syndrome
3 MULTIPLE CHOICE OPTIONS
Pts with extreme sensitivity to rejection who are socially withdrawn because they consider themselves to be socially inept, although they are not antisocial, and show a great desire for companionship are demonstrating symptoms most consistent with which of the following PDs
B) Avoidant PD
3 MULTIPLE CHOICE OPTIONS
OCD PD, dependent PD and avoidance PD traits are associated with which class of PDs?
C) Cluster C
3 MULTIPLE CHOICE OPTIONS
Therapeutic blood level range for lithium?
0.8 – 1.2
-can be as low as 0.6 for some and be therapeutic
The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as?
C) Non-maleficence
3 MULTIPLE CHOICE OPTIONS
Acknowledging a person’s right to make choices, to hold views and take actions based on personal value is known as which of the following?
D) Respect for autonomy
3 MULTIPLE CHOICE OPTIONS
Narcissistic, BPD, antisocial and histrionic subtypes are part of what cluster of PDs?
B) Cluster B
Being knowledgeable about one’s own thoughts, feelings and sensations as well as the ability to reflect on how these can affect one’s interactions with others is known as?
A) Cultural awareness
The NP recognizes which are the long-term effects of sex trafficking on victims?
D) All of the above
3 MULTIPLE CHOICE OPTIONS
wernickles encephalopathy= considered a medical emergency or not?
is a medical emergency
Is a degenerative brain disorder caused by lack of vitamin B1
Aim of tx for wernickles encephalopathy
Prompt and quick correction of the thiamine deficiency in the brain
Is wernickles encephalopathy reversible?
it is considered reversible
Wernickles encephalopathy is caused from?
Alcohol abuse, dietary deficiencies, prolon ged vomiting, eating disorders, effects of chemotherapy
=s/s mental confusion, vision problems, coma, hypothermia, low bp, lack of muscle coordination (ataxia)
lack of muscle coordination?
Ataxia
Clinical triad of ophthalmoplegia, ataxia and confusion?
Wernickles encephalopathy = acute neurological condition
Korsakoff’s Syndrome:
neuropsychiatric disorder associated with confabulation and significant deficits in anterograde and retrograde memory
This disorder is associated with pts fabricating stories in the setting of clear consciousness
Korsakoff’s
A common inciting event that precepitates WE is?
an acute infection
other triggers include: prolonged carb or glucose loading in the presence of thiamine deficiency
Hallmark sign of WE?
is ocular abnormalities especially nystagmus
other oculomotor s/s: include cranial nerve involvement of oculomotor, abducens and vestibular nuclei causing conjugate gaze palasises; pupillary sluggishness, ptsosis and anisocoria is also common
Some pts can present with hyperactive delirium secondary to possible alcohol withdrawal symptoms alongside this disorder?
WE
Can WE cause death?
Yes- less than 5% of pts with WE can present with a severely depressed level of consciousness that will eventually lead to coma or death
Warning s/s of WE that could indicate coma or death?
Hyperthermia and hypotension
other s/s include peripheral neuropathy–lower extremities are normally involved and the exam would reveal distal sensory los
clinical dx of WE is present if the pt has two of the following features:
A) eye signs
B) Dietary deficiency in thiamine
C) AMS
D) Cerebellar dysfunction
Normal brain imaging cannot rule out?
WE -therefore not very beneficial
What does thiamine do?
help brain cells produce energy from sugar
Korsakoff’s syndrome is often, but not always, preceded by an episode of?
WE
however, it can occur in someone who has never had a prior episode of WE
S/s of Korsakoff’s syndrome?
problems learning new information, inabilty to remember recent events and long-term memory gaps.
=confabulation
-hallucinations may be present
Cornerstone of effective long term tx of Korsakoffs /WEs?
Abstaining fro alcohol and maintaining a healthy diet
pt on lithium with a hx of ETOH presents with dry mouth, ataxia, dizziness, abdominal pain and slurred speech-the NP should do what?
B) recognizes these are s/s of mild to moderate lithium toxicity–the NP decreases the lithium by half and encourages the pt to drink more fluids
walking on eggshells, appeasement and avoidance behaviors by the victim is characteristic of what phase of DV?
C) Tension building phase
what stage of the cycle of DV is characterized by overt aggressive behavior towards the victim?
B) Abusive incident
inability to conform to the social norms that ordinarily govern many aspects of a person’s behavior? (PD)
B) Antisocial PD
Which of the following medical conditions can present with prominent mental health status changes that mimic common psych illnesses? select all that apply
A, B, D
3 MULTIPLE CHOICE OPTIONS
According to teh AANP Process of Care Standards, performing or ordering prevenatjve and diagnostic procedures based on the pt’s age and hx is part of what component?
A) Assessment of health status
3 MULTIPLE CHOICE OPTIONS
A pt on lithium and quetiapine presents to the ED with anorexia, persistent nausea, persistent vomiting, blurred vision, choreoathetoid movements, muscle fasciculations and hyperactive deep tendon reflexes- the ARNP should do all of the following EXCEPT:
A) DC the lithium
3 MULTIPLE CHOICE OPTIONS
A pt on risperidone presents to the ED with increased agitation, restlessness, muscle discomfort, and dysphoria. The NP recognizes these symptoms of _ and recommends which of the following? Select all that applies
D) B& C Only
3 MULTIPLE CHOICE OPTIONS
In order to qualify for ANCC BC testing you must have a minimal amount of supervised clinical hours in the specialty you are seeking certification in?
B) 500 supervised clinical hours
3 MULTIPLE CHOICE OPTIONS
in the judical system, 1 organization may publish one standard of care and an expert may testify to an alternative version of the standard of care. In this scenario who is the final arbiter of the standard of care?
A) The organization where the NP worked for at the time
3 MULTIPLE CHOICE OPTIONS
A pt appears odd with a pervasive hx of magical thinking, ideas of reference, illusions and derealization. This is consistent with which of the following?
C) Schizotypal PD
3 MULTIPLE CHOICE OPTIONS
Which of the following symptoms of BPD assist in differetianting BPD from schizophrenia?
D) A& C only
3 MULTIPLE CHOICE OPTIONS
pt is exhibiting being unapproachable, poor eye contact, reporting a lifetime pattern of isolation, uncomfortableness with human interaction and constricted affect. This presentation is consistent with which of the PDs?
A) Schizoid PD
3 MULTIPLE CHOICE OPTIONS
NP preceptors should have at least how much experience as a NP in the specialty prior to precepting?
D) Minimum of 2 years as an experienced NP in the specialty
Heightened sense of self-importance, grandiose feelings of uniqueness, lacking empathy for others and is very sensitive to minor criticism?
C) Narcissistic PD
the NP recognizes which of the following are short-term effects of sex trafficking on victims?
D) A&C only
3 MULTIPLE CHOICE OPTIONS
according to Freud, stubborn, parsimonious (frugal) and high conscientious traits are associated with what stage of development?
C) Phallic stage
3 MULTIPLE CHOICE OPTIONS
Which of the following is NOT consistent with common recommendations for good sleep?
B) Set up a cool room temp
3 MULTIPLE CHOICE OPTIONS
Curriculum content that supports the NP scientific foundation competency areas includes which of the following? Select all that apply
A&C
3 MULTIPLE CHOICE OPTIONS
In Canterbury V Spence, listed physician responsibilities for disclosure–which is not listed?
D) Inform the pt about precautionary therapy that he/she should seek in the future
3 MULTIPLE CHOICE OPTIONS
Which of the following is the tx of choice for pts with depressive personality?
C) Insight-oriented psychotherapy
3 MULTIPLE CHOICE OPTIONS
Which of the following should be avoided when working with practice guidelines?
A) write guidelines with minute details that everyone will follow in the exact same way
A claim of malpractice requires a pt/plaintiff prove which of the following? select all that apply
B, C & D
C) a casual link between the NPs failure to conform to tx standards and harm to the pt
D) actual injury to the pt
3 MULTIPLE CHOICE OPTIONS
Which of the following is consistent with what is known about terrorist-bomber suicides?
D) A&B
3 MULTIPLE CHOICE OPTIONS
NP working as an at will employee realizes which of the following.
Unless the NP has a contract for a specified term of employment, the employee:
D) A&C only
3 MULTIPLE CHOICE OPTIONS
The US supreme court upheld the psychotherapist-pt privilege in which of the following cases?
A) Jaffee vs Redmond
3 MULTIPLE CHOICE OPTIONS
Loyalty, fairness, truthfulness, advocacy and dedication in professional relationships is known as?
B) Fidelity
3 MULTIPLE CHOICE OPTIONS
Which of the following is consistent with PDs?
C) Involves impairment in at least 1 out of 4 areas of cognition, affectivity, interpersonal function or impulse control
3 MULTIPLE CHOICE OPTIONS
A late appearing adverse effect of neuroleptic drugs is known as?
D) Neuroleptic induced tardive dyskinesia
the failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession is known as?
B) Malpractice
3 MULTIPLE CHOICE OPTIONS
a somatpsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about one week before the onset of menses characterized by irritability, emotional liability, HA, anxiety and depression is known as?
D) Premenstrual psychosomatic disorder
3 MULTIPLE CHOICE OPTIONS
persons who exhibit impulsive traits also show high levels of which of the following hormones? select all that apply
D) A& C only
3 MULTIPLE CHOICE OPTIONS
in educating a pt beginning on lithium, the NP explains which of the following related to need for blood tests?
D) A&B only
3 MULTIPLE CHOICE OPTIONS
the incidence of suicide is highest for which of the following populations?
B) Older white men
3 MULTIPLE CHOICE OPTIONS
Which of the following defense mechanisms does the abuser use during the honeymoon phase?
B) Projection
3 MULTIPLE CHOICE OPTIONS
SIB patients should be engaged in what type of therapy (BPD individuals who engage in SIB)
A) DBT
3 MULTIPLE CHOICE OPTIONS
the _____stage begins at 18 months of age and lasts until the age of 3
Anal Stage
3 MULTIPLE CHOICE OPTIONS
Freud believed that the libidio source shifted from the mouth (in stage 1) to the anus in what stage of development?
Anal stagen(stage 2)
At what point does a child begin to understand that they have some degree of control over their lives, including when and where they defacate?
Anal stage
this can lead to difficulties with potty training
*primary erogenous zone is pleasure derived from controlling bladder and BMs
Adults who are anal retentive tend to be:
Stubborn, very neat, rigid and stingy
Adults who are anal expulsive tend to be:
messy, wasteful and harsh
During the __ stage, the child develops an attraction to the parent of a different sex to them, which is caused the Oedipus Complex for boys and the Electra Complex for girls
Phallic stage (stage 3)
Phallic stage occurs at what age?
lasting from the ages of 3-6
*the libido centers upon the genitalia and children become aware of their bodies
when a child recognizes that the parent of another sex is unavailable, the child learns to model their own behavior after the same-sex parent?
Phallic stage
According to Freud, those who do not exhibit gender appropriate behavior have not completed this stage of psychosexual development?
Phallic stage
Introjection
learning right fro wrong
-how children incorporate values from others into their value set
Introjection occurs at what phase?
Phallic stage
The development of play is an important milestone to early childhood because:?
great way for children to express their thoughts, emotions, fears and anxieties
Erikson: Initiative vs Guilt
influenced by Freud, Erikson believed that the relationships that people have, not psychosexual stages, are what influence personality development
Johann is five years old and even though he really struggles with shoe tying, he protests when his parents try to help him. According to Erikson, Johann does this because?
A) Johann is exploring his autonomy
3 MULTIPLE CHOICE OPTIONS
Stage 1: Trust vs Mistrust is associated with what age and virtue?
infant -18 months,
hope
Stage 2: Autonomy vs Shame/doubt is associated with what age and virtue?
18 months to 3 years
will
Stage 3: Initiative vs Guilt is associated with what age and virtue?
3-5 years
purpose
Stage 4: Industry vs Inferiority is associated with what age and virtue?
ages 5-13
competency
Stage 5: Identity vs Confusion is associated with what age and virtue?
13-21 years
fidelity
Stage 6: Intimacy vs isolation is associated with what age and virtue?
21-39 years
love
Stage 7: Generativity vs Stagnation is associated with what age and virtue?
40-65 years
care
Stage 8: Integrity vs Dispair is associated with what age and virtue?
65 + older
wisdom
at the beginning of early childhood (18 months to 3 years old), the child is still in the _ stage (Erikson)
stage 2: autonomy vs shame
By age 3, the child begins what stage?
Stage 3: initiative vs guilt
-children take initiative to talk to think of ideas and act
-beginning to use their imagination* build forts, play magic & issue tickets for who wants to come
-children are curious at this age, start to ask questions so they can learn about the world
Which of the following is not consistent with the purpose of the ANAs code of ethics?
D) It clearly determines how ethical obligations are met
3 MULTIPLE CHOICE OPTIONS
Which of the following meds are approved by the FDA for the tx of excessive sleepiness in narcolepsy?
C) Pitolisant (Wakix)
3 MULTIPLE CHOICE OPTIONS
Which of the following s/s are assoicated with MDD with melancholic features?
D) B&C
3 MULTIPLE CHOICE OPTIONS
sleep related hallucinations that occur at sleep onset are known as?
A) Hypnagogic hallucinations
3 MULTIPLE CHOICE OPTIONS
sleep related hallucinations that occur while waking up from sleep are known as?
Hypnopompic hallucinations
hypnopompic hallucinations are primarily what type of hallucination?
visual (86%). between 8-34% involve auditory hallucinations
Applied behavioral analysis is typically indicated for which disorder?
C) Autism
3 MULTIPLE CHOICE OPTIONS
ADHD, impulse contorl, conduct disorder and intellectual disabilities with anxiety disorders are predominant during which age range?
B) ages 6-12
3 MULTIPLE CHOICE OPTIONS
Which of the following is consistent with what is known about Bipolar I disorder?
D) Equal prevalence among men and women
Psychotherapy is important tx strategy for young people for which of the following reasons? select all that apply
C & D
3 MULTIPLE CHOICE OPTIONS
When evaluating a child with poor academic performance, which of the following diagnostic catergories should be considered first?
B & D
3 MULTIPLE CHOICE OPTIONS
Which of the following meds is FDA approved for the tx of MDD with seasonal variation?
D) Buproprion HCL ER
3 MULTIPLE CHOICE OPTIONS
a period of at least one week in which both a manic episode and a major depressive episode occur almost daily is consistent with which dx?
C) Bipolar I disorder, mixed episode
3 MULTIPLE CHOICE OPTIONS
According to APA “psychologists seek to promote accuracy, honesty and truthfulness in the practice of psychology’ reflecting which of the following ethical principles?
A) Integrity
3 MULTIPLE CHOICE OPTIONS
Promoting the Welfare of children and adolescents addresses which of the following ethical issues?
C) beneficence
3 MULTIPLE CHOICE OPTIONS
Which of the following disorders is characterized by episodic bouts of intake of excessive amount of food without purging or similar compensatory behavior
C) Binge eating
The ARNP working w a 5 year old child in a busy pediatric practice is seeking to use levl 1 and level 2 cross-cutting symptoms measures. Which of the following is true in this situation?
B) These level 1 and 2 assessments can help the NP identify the presenting problem for the kid
3 MULTIPLE CHOICE OPTIONS
Which of the following meds are approved by the FDA for treating OCD in children ages 6-17?
C) Zoloft (age 6+)
3 MULTIPLE CHOICE OPTIONS
A form of CBT that requires attending skills group in addition to individual therapy sessions are known as which of the following?
D) DBT
3 MULTIPLE CHOICE OPTIONS
Manic episodes are considered distinct when they are separated by what length of time without significant symptoms of mania or hypomania?
C) 2 months
3 MULTIPLE CHOICE OPTIONS
Which of the following meds are NOT FDA approved to tx restless leg syndrome?
B) Modafinil
3 MULTIPLE CHOICE OPTIONS
Persistant Depressive Disorder lasts at least?
2 years
MDD episodes are separated by how long?
at least 2 months
The clinician asks the adolescent how long they have been sad–greater than 1 year?
C) MDD
A dissociation between the pt’s experience of sleeping and the objective polygraph measures of sleep is known as which of the following?
A) Sleep state misperception (now known as paradoxial insomnia)
-disorder which causes people to feel awake even while they are asleep, leading them to underestimate how many hours they sleep at night
Which of the following is NOT consistent with the code of ethics for the profession of nursign?
C) The code of ethics explicit the primary obligations of nursing profession
3 MULTIPLE CHOICE OPTIONS
Which of the following is approved by the FKA to tx OCD in children ages 10-17? Check all that apply
D) Clomipramine (Anafranil)
-TCA
(serotonin and norepinephrine reuptake inhibition)
-more SE than SSRIs
-considered a second-line med for OCD
A variant of Bipolar I disorder characterized by episodes of MDD and hypomania is known as which of the following?
D) Bipolar I disorder, hypomanic type
3 MULTIPLE CHOICE OPTIONS
Which of the following hormone levels is increased in anorexia nervosa?
A) Corticotrophin-releasing hormone
3 MULTIPLE CHOICE OPTIONS
Hormone released in response to starvation?
Corticotrophin-releasing hormone (CRH)
Lithium toxicity?
The chronic form of lithium toxicity can occur when you take lithium daily but your serum blood level has crept up into the toxic range.
-Possible causes for this level increase?:
A) a dosage increase,
B) being dehydrated,
C) interactions with
other medications, and
D) problems with kidney function
In addition to elevated lithium levels, what other laboratory values are associated with lithium toxicity?
BUN, creatinine
What are drugs that should not be taken with lithium?
-ACE inhibitors
-Angiotensin II receptor antagonists (statins)
-Diuretics
-NSAIDS
Nightmares and night terrors are associated with disorganization and arousal during which stage of sleep?
Stage 3
The right to assent of dissent from tx for a child or adolescent is reflected in which American Academy of Children & Adolescent ethical issues?
Autonomy
A 10-year-old child presents with
developmentally inappropriate and persistent
difficulty with inattention with symptoms
which are interfering with academic goals and
in social settings. This is consistent with which
of the following diagnoses?
Attention-deficit/hyperactivity disorder
A patient presents endorsing persistent low-
grade (sub-acute) depression for the last
several years, uncertain of when it started,
thinks he has always been depressed but still
goes through the motions. These symptoms are
consistent with which of the following
diagnoses?
Dysthymia
-persistent mild depression.
examples of atypical features of a pt with MDD?
overeating and oversleeping
Somnambulism is characterized by?q
Repeated episodes of rising from bed and walking about for/between several minutes to a half hour during nocturnal sleep
A 15-year-old girl presents with symptoms that
include restrictive eating and food avoidance,
with a desire to avoid obesity, which persists
despite negative consequences. This
presentation is consistent with which of the following?
Anorexia nervosa
which of the following antidepressants are FDA approved to tx depression in children 8-17?
B) Fluoxetine (Prozac)
When assessing for substance use in an adolescent, the clinician should initially assess for which of the following?
A) Safety
The main risk factor for developing NMS?
Taking an antipsychotic
Risk factors for NMS?
Dehydration, agitation, exhausting, malnutrition, organic brain syndromes, nonschizophrenia mental illness, lithium use, past hx of ECT
The mesocortical pathway is responsible for (3):
Cognitive function
Reward
Motivation
Antipsychotics provide D2 blockage in what pathway?
Mesocoritical
this causes: increased EPS
SAD?
SSRIs tx this
Short term side effects of the medications that tx RLS? (Rotigotine, Pramipexole)
mild: cause nausea, lightheadedness and fatigue
Rotigotine= Neupro (tx RLS)
Pramipexole= Mirapex (tx RLS)
Dopamine agonists?
First medicines used to tx RLS (Mirapex, Neupro, Requip)
Do bananas help RLS?
yes- eating more vegetables including leafy greens can help
Ziprasidone injection is used to tx occurrences with severe agitation in pts with schizophrenia?
help[s restore the balance of neurotransmitters- quick relief
antipsychotic ATYPICAL
Maximum IM dosage of Zipraisdone?
40 mg/day
Indicators for a good prognosis in MDDD includes which of the following? select all that apply
B & D
3 MULTIPLE CHOICE OPTIONS
During an initial interview with a 15 year old female, the PMHNP notes the presence of peripheral edema & Russell’s sign; what do these indicate?
Anorexia Nervosa
peripheral edema can be caused by a variety of conditions, but the presence of Russell’s sign indicates possible anorexia.
What is Russell’s sign?
scarring or callouses on the dorsal surface of the hand caused by self-induced vomiting
anorexia
82 year old woman arrives at the office with her son; over the past year, she has had trouble remembering once-familiar things, such as phone #s and friends names. She also does not recognize family members who visit often; she has become unusually moody and struggles with written tasks. What is the most likely dx?
A) Alzheimers Disease
alzheimers can be associated with: deficits in language, motor function and recognition
3 MULTIPLE CHOICE OPTIONS
Dementia with Lewy Bodies typically is accompanied by?
EPS
Huntington’s disease is accompanied by?
spasmodic movement and incoordination
Frontotemporal dementia is normally accompanied by?
extremely talkative and disinhibited
_ is one of the most usual symptoms of anxiety and a direct response to the activation of your sympathetic NS
shaking
The comorbid psychiatric dx frequently associated with anorexia is?
OCD
OCD-PD is also another comorbidity of those with anorexia
Ethical questions about what we “ought” to do or be are addressed within which domain of ethics?
Normative ethics
looks into the questions that arise regarding how one ought to act in a moral sense. It is also the study of ethical behavior
Which of the following meds are approved by the FDA for tx of mania in children 12-17?
Lithium
first FDA approved med for children ages 12-17 with mania
Which of the following is important to realize when tx a child with an anxiety disorder?
B. Repeated exposures of a feared situation will always help the child to unlearn the fear response
Developmental impairments and disruptive behavior problems are predominant issues during which of the age ranges?
A. 0-5
Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical fts of PTSD
A) Intrusive s/s
3 MULTIPLE CHOICE OPTIONS
AFAB
assigned female at birth
AMAB
assigned male at birth
_____is good for older adults with anxiety and depression?
Remeron
the smaller the dose of Remeron, the more __?
sedating
What medication decreases psychotic s/s, & ruminating thoughts?
A) Seroquel
3 MULTIPLE CHOICE OPTIONS
What medication decreases psychotic s/s, decreases peservation, decreases ruminating thoughts while treating delusional/mixed beliefs and mood disorders/txs bipolar I disorder?
A) Zyprexa
Drug used to tx NMS?
Dantrolene + Bromocriptine mesylate
Bromocriptine is given to reverse the hypodopaminergic state and is administered orally (or via nasogastric tube), starting with 2.5 mg 2 or 3 times daily and increasing doses by 2.5 mg every 24 hours until a response or until reaching a maximum dose of 45 mg/d.
Dantrolene sodium uncouples the heat-generating mechanism in muscle and is the drug of choice in treating malignant hyperthermia and neuroleptic malignant syndrome, which cause excessive muscular heat production. The potential benefit of this drug in treating heat stroke has been debated.
S/S of NMS occur within?
rapid onset of 24-72 hours
“cis”
matching
“Trans”
moving across the range
Blockade of muscarinic M3 is linked to?
cardio-metabolic risk
but is NOT linked to weight gain specifically
Amantadine is a medication that is used to tx?
EPS
ex. 100 mg @ bedtime
Amantadine is a _ medication primarily used to tx parkinson’s disease but is alos used to help drug-induced parkinsonism
dopaminergic agent; also is a weak NMDA antagonist (similar to Namenda)
Fewer anticholinergic SE of cognitive impairment, dry mouth & constipation?
Amantadine
Benztropine has increased amount of anticholinergic SE
Amantadine (Symmetrel)’s dopaminergic effects can theoretically worsen?
Psychosis
however @ doses used to tx EPS, this is not a normal occurance
An “analogue” of Amantadine?
Memantine (Namenda) used to tx dementia (NMDA antagonist)
When giving Amantadine to older individuals, one may need to __ the dose of the medication due to impaired renal function
ADJUST
Benztropine (Cogentin)
Anticholinergic medication/antihistamine that is to go-to for tx and preventing antipsychotic induced EPS
“drys things up”
FDA approved to tx EPS and parkinson;’s disease?
Cogentin & Amantadine
Common SE of cogentin?
dry mouth, constipation, urinary retention, sedation, blurred vision
Tx of Tardive Dyskinesia?
A) Deutetrtabenazine (Austedo)—FDA approved
B) Tetrabenazine (Xenzine)—-off label, FDA to tx huntington’s disease
C) Valbenazine
____second of the VMAT inhibitors to be approved for the tx of TD in 2017
A) Deitetrabenazine (Austedo)
reversible inhibitor of VMAT2–this prevents dopamine from being present
-this tx TD as TD s/s are likely caused by hypersensitivity to dopamine
*VERY EXPENSIVE, 1 year= 70,000+; approximately $6K/month
Tetrabenazine (Xenazine)
original VMAT inhibitor for the tx of HD
off label used for TD tx
Tetrabenazine is less expensive than deutetrabenazine
but requires more frequent dosing and may have higher likelihood to causing depression & suicidiality
____is an anticholinergic medication FDA approved to tx EPS but requires TID dosing
Trihexyphenidyl (Artane)
*Second line tx choice due to TID dosage
*only available in PO formulations
Common SE of Artane?
anticholinergic/antihistamine
dry mouth, constipation, urinary retention, sedation, blurred vision
(Trihexyphenidyl)
Valbenazine (Ingrezza) was the first VMAT inhibitor to?
be approved for the tx of TD in 2017
Valbenazine (Ingrezza) is FDA approved to tx:
TD; off label to tx HD and tourettes
Which medication used to treat TD is used in once daily dosing and is less likely to cause depression?
Valbenazine (Ingrezza)– once daily dosage, start @ 40 mg /day, then after 1 week, can increase to 80 mg/day
*EXPENSIVE 6,000/month
Avoid with use of _ when taking any VMAT2 medication, such as Valbenazine (Ingrezza), Tetrabenazine (Xenazine) and duetetrabenazine (Austedo)?
MAOIs
what medication is used to tx antipsychotic induced weight gain and type 2 diabetes?
Metformin
average of 3k weight loss
Metformin works by _ appetite while _____insulin sensitivity?
decreasing appetite while increasing insulin sensitivity
MOA: decreases glucose production by liver and increases insulin sensitivity
common se of metformin?
GI side effects
diarrhea, nausea, abdominal bloating, flatuence and discomfort
Typical dose of Metformin used to reduce weight related to antipscyhotics?
500-1000mg BID –average of 3k of weight loss in pts
How can you decrease the nausea and diarrhea side effect of Metformin? (affects 50% of patients)
take with food or use ER formulation
Best tool for assessing TD?
AIMS
12 item test, takes approx 10 minutes. Best tool for monitoring the severity of TD
What causes TD?
antipsychotics
but other medications (nausea and reflux meds) can cause TD as well: reglan, compazine and other agents that block dopamine
Medications used to tx TD? (3)
FDA approved: Valbenazine (Ingrezza) + Deutrabenazine (Austedo)
Not FDA approved for TD, but FDA approved for HD: tetrazbenazine (Xenazine)
Meds that cause severe weight gain?
Antipsychotics- especially clozapine, olanzapine, quetiapine
Antidepressants- mirtazepine, TCAs, Paxil
Mood stabilizers- Lithium, Valproic Acid
meds that cause moderate weight gain?
risperidone and invega
meds that cause less weight gain?
ability, haldol, geodon, lurasidone
First line tx for weight gain for psych meds?
A. Topamax —-se: cognitive dulling
B. Metformin ER
C. Olanzapine/Samidorphan (Lybalvi)–used as an alternative to zyprexa to help reduce weight gain
D. Orlistat (Xenical). —se: diarrhea
E. Abilify–may be useful for olanzapine induced weight gain as an adjunct
Second line tx for weight loss?
A. Wellburin SR
B. Any stimulant
C. Naltrexone/Bupropion (Contrave). —antiobesity drug D. Phentermine (Suprenza)-antiobesity drug
E. Phentermine/topimate (Qsymia). —*antiobesity drug
F. Glucagon like peptide agonists—such as Liraglutide or Ozempic (Semaglutide)
G. Nizatidine (Axid) —antacid OTC
H. Amantadine (symmetrel)
Tx of akathisia?
First line: propanolol, inderal LA, benzos
second line: cogentin, amandtadine, clonidine, gabapentin, trazodone, mirtazepine, Cyproheptadine
Blocks D2 blockade?
decreases akathisia
high potency antipsychotics increase risk of?
Akathisia
ex. Haldol, Abilify, Invega, Risperidone, Brexipiprazole
Akathisia typically has an onset of?
can be within a few hours, but normally takes days to weeks to appear
__ invol grinding of teeth
Bruxism
How to tx Bruxism?
1st line= Buspar
2nd line= benzos, gabapentin
Botox is another tx option that is effective (in the masseter)
Xerostomia?
Dry mouth
caused by antipsychotics, antidepressants, lithium, stimulants, and meds used to tx EPS (cogentin, Artane, ect)
first line tx of Xerostomia?
A) Biotene line prouces
2nd line= Procholinergic drugs ex. Pilocarpine (Salagen)
__ can worsen dry mouth?
Caffeine products, so recommendation is to decrease caffeine dose
Another common cause of dry mouth?
old age
Involuntary contractions of muscles due to antipsychotics
Dystonia
D2 blockade
First line tx= cogentin, benadryl
second line= benzos, Amantadine, Artane
90% of what reactions in EPS?
occur within the first 5 days, although can occur hours to days after an antipsychotic is started
Hyperhidrosis?
excessive sweating
caused by antidepressants, espcially SNRIs (venlafaxine, duloxetine, and levomilnacipran) and bupropion
tx for hyperhidrosis?
1st line=
A) Terazosin (Hytrin) alpha1 blocker
B) Clonidine
C) Cogentin
D) Glycopyyrolate (Robinul)
2nd line=
A) Oxybutrin
B) Mirtazepine
C) Cyproheptadine
D) Abilify
Antipsychotics rarely cause Nausea– T or F
True , most are antiemetic options for nausea
How to decrease prolactinemia?
Reduce dosage
DC offending med
(Prolactin doses tend to normalize after 2-4 days)
If stopping the causation agent is NOT possible?
first line= add abilify. 5-20 mg daily
2nd line= add oral contraceptives
First line tx of serotonin syndrome?
benzos
second line= cyproheptadine
Fun fact: MNDA in combination with any SSRI
can cause serotonin syndrome
Sialorrhea?
Hypersalivation
What drug causes the most sialorrhea?
Clozapine is the most common cause (30-80%)
other causes: zyrepxa, risperidone or quetiapine
First line tx of Sialorrhea?
1= glycopyrrolate (Robinul).
–unlike other anticholinergics, glycopyrrloate does not cross the BBB, so ferwer central anticholinergic SE
2nd= Atrovent, Oxybutrin, Cogentin, Clonidine, Atropine, Artane
Reducing the dose of Clozapine normally does what to hypersalivation?
not helpful in diminishing symptoms
epidemology characterstics?
observe in age <50
Greatest abnormalities occurs in schizophrenia are related to what structures (2)
A. Basal ganglia
B. Cerebellum
*involved in the control of movement
excessive dopamine is associated with
Schizophrenia
Propanolol (Inderal) treats
A. tremors
B. Akathisia
C. Prevents migraines
D. Decreases test anxiety
E. Anxiety
F. HTN
Risk of neutropenia is greatest when taking Clozaril during this time frame?
within first 6 months
then incidents can occur but are decreased risk
Smoking increases Clozaine clearance by?
30-50%
Oculogyric crisis?
dystonic like reaction where this is abnormal invol movements /deviation of the eyes
How to tx an oculogryic crisis?
benadryl