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LMR FINAL EXAM COMPLETE QUESTIONS & DETAILED
ANSWERS (WELL VERIFIED) ALREADY GRADED A+
What is another name for a cultural assessment? - CORRECT ANSWER >>> cultural
formulation interview
For a cultural syndrome what is our intervention? - CORRECT ANSWER >>> brief supportive
therapy
What ethnicity has the highest rate of suicide and suicide attempts in the US? - CORRECT
ANSWER >>> native americans
What comes before assessment and interventions in cultural quetsions? - CORRECT
ANSWER >>> respect
Native Americans can view mental illness as... - CORRECT ANSWER >>> an imbalance
between the individuals' relationship with the world While completing a education in a community with lots of cultures.. what type of assessment
parameters would you use? - CORRECT ANSWER >>> ethnospecific assessment parameters
What is the range for TSH - CORRECT ANSWER >>> 0.5- 5
Symptoms of hypothyroidism - CORRECT ANSWER >>> weigh gain, fatigue, slow heart
rate and respiration rate, cold intolerance, low libido
symptoms of hyperthyroidism - CORRECT ANSWER >>> agitation, heat intolerance,
anxiety, irritability, tachycardia, weight loss, mood swings
When T4 and T3 are low, TSH secretion - CORRECT ANSWER >>> increases
When T4 and T3 are high, TSH secretion: - CORRECT ANSWER >>> decreases
Therapeutic drug range for Depakote - CORRECT ANSWER >>> 50 - 125
Signs of hepatotoxicity - CORRECT ANSWER >>> dark colored urine, abdominal pain in the
right abdomen, yellowing of skin and whites of eyes, fatigue
If a patient taking depakote presents with symptoms of hepatotoxicity, what test should I run? -
CORRECT ANSWER >>> Liver function test (ALT and AST)
What are signs of depakote toxicity? - CORRECT ANSWER >>> disorientation, lethargy,
respiratory depression, N/V
Interventions in Depakote Toxicity? - CORRECT ANSWER >>> DC the med, check valproic acid
level Check LFT Check amonia levels
What is Kava Kava used for? - CORRECT ANSWER >>> anxiety, stress, insomnia
What can kava kava casue? - CORRECT ANSWER >>> liver damage?
If lithium levels are 1.3-1.4 with signs of tox what do you do? - CORRECT ANSWER >>> DC
what medication is neuroprotective in bipolar disorder? - CORRECT ANSWER >>> lithium
Which meds have anti suicidal effects? - CORRECT ANSWER >>> clozaril and Lithium
Why do we check a UA for kidney dysfunction - CORRECT ANSWER >>> proteins... 4+ can
indicate risk for toxicity (decreased renal clearance of medication)
side effects of lithium - CORRECT ANSWER >>> hypothyroidism, fine hand tremors,
maculopapular rash, GI upset, polyruia, polydipsia, diabetes insipidus, T wave inversions, leukocytosis
Signs of lithium toxicity - CORRECT ANSWER >>> severe nausea, vomiting, diarrhea, ataxia,
confusion, drowsiness, muscle weakness, coarse hand tremors, heart palpitations
Patient presents with signs of lithium tox what is first action?? -^ CORRECT ANSWER
>>> DC MED
even before vitals
Hyponatremia can do what to lithium levels? - CORRECT ANSWER >>> increase
What migrane medications can cause SS? - CORRECT ANSWER >>> triptains (Imitrex)-
sumatriptan
If a patient is taking a triptan medication what should you not give and why? - CORRECT
ANSWER >>> antidepressants with serotonin effects due to SS
You could give wellbutrin (NDRI)
What antidepressant is good in cancer patients and why? -^ CORRECT ANSWER
>>> citalopram and Escitalopram less
drug drug interactions If your patient is depressed and has neuropathic pain what should you give first? What are two
other alternative options? - CORRECT ANSWER >>> SNRI
TCAs or GABA meds
You start a 16 year old on prozac... you want to assess for what at every visit? - CORRECT
ANSWER >>> suicidal thoughts
If your patient is depressed what should you assess for that could be a barrier to treatment? -
CORRECT ANSWER >>> alcohol use
used to self medicate depressive symptoms
Should you take prozac in the morning or at night? - CORRECT ANSWER >>> morning instead
of adding a medication for insomnia, switch prozac to the morning
What dx is the highest risk for suicide? - CORRECT ANSWER >>> Depression... followed
second by bipolar and third by alcohol abuse
What dx is the highest risk for homicide? - CORRECT ANSWER >>> Antisocial personality
disorder followed by schizoaffective second and BPD third
mental status exam of a preschooler (3-5 years old) relys on - CORRECT ANSWER >>> clinical
observation
What is another name for the MMSE? - CORRECT ANSWER >>> Folstein scale
What area of the brain is implicated in an abnormal clock drawing test? - CORRECT ANSWER
>>> right hemisphere, specifically the parietal lobe
Decreased dopamine in the mesocortical projection to the ............ is postulated to be
responsible for negative symptoms - CORRECT ANSWER >>> dorsolateral prefrontal cortex
What other medication can cause TD? - CORRECT ANSWER >>> Reglan (metoclopramide)
Increased levels of prolactin in the tuberoinfundibular pathway can case... - CORRECT
ANSWER >>> ammenorhea, sexual dysfunction, gynecomastia and galactorhea
What are normal prolactin levels? - CORRECT ANSWER >>> Men less than 20
Women less than 25 If your patient is taking an antipsych and you are looking for effects in the tuberoinfundibular
pathway what would you assess for? - CORRECT ANSWER >>> galactorhea, ammenorhea,
sexual dysfunction, osteopersosi
Tegretol is an inducer or an inhibitor? - CORRECT ANSWER >>> inducer
Clarithromycin is an inducer or inbibitor? - CORRECT ANSWER >>> inhibitor
If your patient is taking Tegretol and Clarithromycin what will happen to the drug levels of
Tegretol? - CORRECT ANSWER >>> Tegretol will increase leading to increased risk for tox or
side effects becuase the inhibitor properties of clarithromycin will take over
Acutane can cause both... - CORRECT ANSWER >>> depression and birth defects
If your patient is pregnant and presents on acutane what do you do? -^ CORRECT ANSWER
>>> tell them to stop due to birth defects
What two neurotransmitters are involved in addiction? - CORRECT ANSWER >>> dopaine
and GABA An anorexic patient complains of bloating and feeling extra full after eating.. this could be
caused by what? - CORRECT ANSWER >>> delayed gastric emptying
What medications can delay gastric emptying? - CORRECT ANSWER >>> ranitidine,
famotidine, omeprazole
Give medications how long apart between PPIs/Antacids and other meds - CORRECT
ANSWER >>> 2 hours
In oppositional defiant disorder they are not aggressive, just.... -^ CORRECT ANSWER
>>> defiant
What meds can you give in conduct disorder? - CORRECT ANSWER >>> antipsychotics and
mood stabilizers to try and treat agression and agitation, while SSRIs and alpha agonists to try and target symptoms
When do tics usually disappear? - CORRECT ANSWER >>> 12 years old (motor)
Primary neurotransmitters involved in tourettes - CORRECT ANSWER >>> DNS
FDA approved pharmacological management of Tourettes? -^ CORRECT ANSWER^ >>> Haldol,
Pimozide, Aripiprazole
If patient has tics what med do you want to eliminate that is contraindicate? - CORRECT
ANSWER >>> stimulants
Time frame with acute stress disorder - CORRECT ANSWER >>> within 4 weeks of event
symptoms are occurring. Can look like PTSD but HAS TO BE LESS THAN 4 WEEKS A nurse was assaulted by a patient 3 weeks ago and has symptoms of insomnia, increased
startle response and avoidance.. .what is the dx - CORRECT ANSWER >>> acute stress
disorder
Phases of EMDR - CORRECT ANSWER >>> DIB
Desensitation: visualizing the event, verbalizing negative thoughts, attentive to physical sensations. Happens while patient is moving their eyes rhythmically. They block out negative thoughts and breath deeply, verbalize feelings Installation: installs and increases the strength of positive thought that will replace negative thought related to traumatic event Body scan: visual trauma while thinking of positive thought. Scan body to idenitfy any tension
ADHD has problems in what three areas of the brain - CORRECT ANSWER >>> prefrontal
IF patient presents with depressed, irritable or labile mood.. administer what? - CORRECT
ANSWER >>> mood questionnaire
If a child presents with nightmares what do you assess for first? -^ CORRECT ANSWER
>>> familial history of nightmares
what neurotransmitters are implicated in ASD? - CORRECT ANSWER >>> glutamate, GABA
and Serotonin
What is the broken mirror theory of autism? - CORRECT ANSWER >>> Dysfunction of the
mirror neuron system may be a cause of poor social interaction and cognition
Treating Delerium with what med - CORRECT ANSWER >>> low dose haldol
If an older adult presents depressed what is an important thing to assess for? - CORRECT
ANSWER >>> cognitive screening/assessment
What levels need checked in dementia? - CORRECT ANSWER >>> folic acid and vitamin B
preferred treatment for HIV dementia - CORRECT ANSWER >>> anti retroviral drugs (refer
to PCP to start)
How to treat psychosis and agitation in dementia? - CORRECT ANSWER >>> atypicals first
For psychosis in DEMENTIA use atypicals
For psychosis in DELIRIUM use Haldol
Hippocampus function - CORRECT ANSWER >>> emotions, stress, learning and memory
Where is Norepinephrine produced? - CORRECT ANSWER >>> locus coeruleus and
medullary reticular formation
Where is dopamine produced? - CORRECT ANSWER >>> substantia nigra and ventral
tegmental area, and nucleus acumens
Signs of lead poisoning - CORRECT ANSWER >>> developmental delay and learning
disabilities, irritability, loss of appetite, weight loss, sluggishness/fatigue, abd pain, vomiting, constipation, hearing loss, seizures, pica. order lead test if presenting with these symptoms
An intact family leads to... - CORRECT ANSWER >>> easier adaptation
naurotransmitters implicated in mood - CORRECT ANSWER >>> DNS, Glutamate and
GABA
(G squared and DNS)
Risk factors for osteoporosis - CORRECT ANSWER >>> smoking, obesity, lack of exercise
(weight bearing), lack of diet rich in calcium and D, drinking caffiene
A patient part of group therapy is not participating what do you do? -^ CORRECT ANSWER
>>> encourage them to keep coming to group therapy but add on individual therapy to promote
interpersonal learning
If a child is unable to construct a narrative in the MSE what do you do? - CORRECT
ANSWER >>> used closed ended or yes/no questions
Use this before going to parents for information
If a patient has Rheumatoid Arthritis you need to check for what -^ CORRECT ANSWER
>>> ESR level
why might an infant have a shrill cry? - CORRECT ANSWER >>> increased intracranial
pressure
What stage is a child in when they play with their genitals -^ CORRECT ANSWER^ >>> phallac
and this is normal
Is it normal for boys 9-16 to develop swelling and tenderness under nipples? - CORRECT
ANSWER >>> yes and it goes away with 6 months
why might elderly female patients have decreased sex drive? -^ CORRECT ANSWER
>>> decreased blood flow to pelvic region and decreased testosterone
Where is alcohol dehydrogenase found - CORRECT ANSWER >>> mucosal lining of the
stomach men have more of it meaning women get drunk faster and have increased risk for liver problems compared to men
When does the grasp/palmer reflex dissapear - CORRECT ANSWER >>> 5 - 6 months
When does the moro/startle reflex disappear? - CORRECT ANSWER >>> 5 - 6 months
When does the babinski reflex dissapear - CORRECT ANSWER >>> 2 years
Viagra does what - CORRECT ANSWER >>> rapidly absorbs after oral administration What do
you check for in normocytic macrocytic anemia? - CORRECT ANSWER >>> folic
acid levels, B12 and iron levels
acupuncture is used for both - CORRECT ANSWER >>> pain and depression
what is Habeas Corpus - CORRECT ANSWER >>> legal concept that protects patients with
mental illness against unlawful hospitalization. They can use this to leave AMA if they were involuntarily admitted and want to leave
What is disseminated encephalomyelitis? - CORRECT ANSWER >>> nervous system is
affected and can cause fatigue, paresthesias, asymmetrical movements of extremities Important to do a neuro exam if they have this disease
What technique do you use if your patient is unable to report an accurate timeline of events? -
CORRECT ANSWER >>> Ask them specific anchor questions
You want to anchor memory or link memorable events
what is an iatrogenic disease - CORRECT ANSWER >>> disease produced by drugs
If they present with this ASSESS MED HISTORY
If a patient is pregnant and presents with alcohol or opioid intox/withdrawal what do you do? -
CORRECT ANSWER >>> send them to residential treatment center
do not report to cps FIRST
Scope of practice vs standard of practice - CORRECT ANSWER >>> scope: determined by
each state. Defines roles and actions Standard: does not vary between state. Determined by ANA. Judges nature of care provided If you have to start a pt on a medication and they cannot sign for consent or are very sick what
do you do? - CORRECT ANSWER >>> assess the patient for involuntary treatment
Justice - CORRECT ANSWER >>> doing what is fair despite social status, financial status,
sexual orientation or ethnicity
Non-maleficence - CORRECT ANSWER >>> do no harm
beneficence - CORRECT ANSWER >>> doing good
fidelity - CORRECT ANSWER >>> faithfulness; loyalty
veracity - CORRECT ANSWER >>> truthfulness
autonomy - CORRECT ANSWER >>> right to self-determination
A nurse made a medication error and you are employing a just culture... what do you do first -
CORRECT ANSWER >>> assess the patient
A patient is using the recovery model after a relapse from drinking... what do they do? -
CORRECT ANSWER >>> share what they have learned from the experience
In the recovery model you let your patient know... - CORRECT ANSWER >>> they are the
center!!!
four components of health policy - CORRECT ANSWER >>> 1. process: formulation,
implementation, and evaluation
- policy reform: changes in programs and practices
- policy environment: Arena of the process takes place in- government, media, public 4. policy makers: key players and stakeholders
Donaldson vs. O'Connor - CORRECT ANSWER >>> 1975 - Supreme Court case that ended in
the decision to deinstitutionalize patients in state mental hospitals; barred mental instatutions from committing patients involuntarily if they were not a threat to themselves or others
Rennie vs Klein - CORRECT ANSWER >>> In 1979, Rennie vs. Klein determined that patients
have the right to refuse any treatment and use an appeal process if they have not been found incompetent, absent an emergency
Tarasoff principle - CORRECT ANSWER >>> Duty to warn if there is danger to self and/or
others.
universality - CORRECT ANSWER >>> participants discover that others have similar
problems, thoughts and feelings and they are not alone
