Download PMHNP Exam Review: Cultural Considerations, Medications, and Psychiatric Disorders and more Exams Biology in PDF only on Docsity!
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What do you provide for a patient if they lost their job or house - correct answer ✔ Brief supportive therapy Cultural expected responses to a stressor = meaning/context - correct answer ✔ Cultural syndrome 3 steps to cultural formulation of interviews - correct answer ✔ Clarify meaning of illness/predicament Contextualize their situation in their local world Empower the patient Somatic complaints of pain interpret patient symptoms based on what - correct answer ✔ Cultural Context Serving multicultural population is called multicultural teaching what should you use - correct answer ✔ Ethno specific assessment parameters Seen in the Latino population. Result from a shocking, unpleasant or frightening experience that is believed to cause the soul to leave the body - correct answer ✔ Susto (fright)
Attack of nerves, uncontrollable shouting, attacks of crying, trembling, heat in chest that raises to the head, verbal/physical aggression - correct answer ✔ Ataque de nervios aka Puerto rican syndrome What is considered the evil eye causing fatigue, HA, weight loss, exhaustion, and malaise - correct answer ✔ Mal de ojo Empacho means what - correct answer ✔ Blocked intestine, indigestion (bloating/nausea) mollera caida - correct answer ✔ sunken fontanel A patient develops symptoms with eye contact due to culture syndrome. How do you tx them? - correct answer ✔ Brief supportive therapy Education to multicultural population you must provide ________ teaching - correct answer ✔ multicultural What culture can have an imbalance between an individual relationship with the world - correct answer ✔ Native Americans What ethnicity has the highest risk of suicide - correct answer ✔ Native Americans If a nurse tries to take away a healing stick what should you do - correct answer ✔ Teach the nurse cultural competency
TSH of 7 - correct answer ✔ Hypothyroidism A patient on Depakote presents with abdominal pain in the RUQ, reddish/brown urine, yellowing of skin, fatigue - correct answer ✔ Signs of hepatotoxicity Intervention for a pt on depakote and presenting with hepatotoxicity - correct answer ✔ D/C, check LFT (AST, ALT) AST and ALT levels - correct answer ✔ AST: 5- ALT: 5- Therapeutic range for depakote - correct answer ✔ 50-125, toxicity starts at what level S/S of depakote toxicity? - correct answer ✔ Disorientation, lethargy, decreased respiratory rate, and N/V Intervention for depakote toxicity - correct answer ✔ DC, check depakote level, LFT, and ammonia A patient on depakote presents with upper abd pain radiating to back, abd tenderness, fever, rapid pulse, NV, oily stools - correct answer ✔ Pancreatitis What can depakote cause if a pregnant patient is taking it - correct answer ✔ Spina Bifida NT defect
What can KAVA cause - correct answer ✔ liver damage Why do people take KAVA - correct answer ✔ anxiety, stress, insomnia What happens if you take xanax and kava - correct answer ✔ Drowsiness What medications can you not take KAVA with - correct answer ✔ Sedatives like CNS depressants Clonazepam, lorazepam, phenobarbital, zolipedm What are s/s of steven johnson syndrome which can occur with lamotrigine - correct answer ✔ Fever, boxy aces, red rash, peeling of skin, face/tongue swelling What mood stabilizer causes the least amount of weight gain - correct answer ✔ Lamotrigine What mood stabilizers cause the least amount of weight gain - correct answer ✔ Ziprasidone, aripiprazole (least sedating) and lurasidone (ZAL) What labs should be checked for pt's who are taking antipsychotics that can cause weight gain - correct answer ✔ BMI, his waist ratio (checks abd obesity) glucose and lipids
What medication is the neuroprotective treatment of choice for bipolar disorder
- correct answer ✔ Lithium Gold standard for treating manic episodes - correct answer ✔ Lithium What mood stabilizer has evidence of anti suicidal effects - correct answer ✔ Lithium What medication has been scientifically shown to reduce the sick of suicide in pt's with schizophrenia - correct answer ✔ Clozapine What labs should you assess for lithium (5) - correct answer ✔ TSH- 0.5-5. CRT: 0.6-1. BUN:10- UA: assess for proteins (large = +4) can ID kidney disease Pregnancy test: HCG 12-51 yr old Side effects of lithium - correct answer ✔ Hypothyroidism, fine hand tremor, maculopapular rash, GI upset (diarrhea, vomiting, cramps, anorexia) DI (polyurua, polydipsia, t wave inversion, leukocytosis What can lithium cause in pregnancy - correct answer ✔ Epstein anomaly (congenital heart defect)
S/S of lithium toxicity - correct answer ✔ Severe N/V/D, confusion, drowsiness, muscle weakness, heart palpitations, coarse hand tremors, unsteadiness while standing/walking (ataxia) Intervention for Li toxicity - correct answer ✔ D/C and check a level What medication can reduce renal clearance - correct answer ✔ NSAIDs, thiazides, ACEs (prils) Reduced renal clearance can cause what - correct answer ✔ Increased serum concentration levels, toxicity If a pt is on lithium and going on a hike remind them to do what - correct answer ✔ Drink lots of water, dehydration can increase Li levels What would hyponatremia cause in a patient on lithium - correct answer ✔ Increase lithium level Pt on medication presents with
- Mutism
- Hyperthermia
- Tachycardia
- Diaphoresis
- Altered LOC What do you suspect - correct answer ✔ NMS- will have muscle rigidity as well.
St. Johns wort can cause Se syndrome but can also cause what - correct answer ✔ Impaired glucose tolerance by reducing insulin response How long to wait when switching from an SRI to an MAOI - correct answer ✔ 2 weeks When switching from fluoxetine to MAOI wait how long - correct answer ✔ 5- weeks When switching from an MAOI to fluoxetine wait how long - correct answer ✔ 2 weeks What is a wash out period - correct answer ✔ A washout period (5 ½ lives) between cessation of previous drug and intro of new drug the safest switching strategy from the point of view drug interaction What dx increase thoughts of self harm - correct answer ✔ Depression, bipolar, ETOH abuse, eating disorder, schizophrenia Dx highest risk of HI - correct answer ✔ Antisocial personality disorder schizoaffective disorder, Borderline, paranoid personality disorder, schizophrenia, obsessive compulsive personality disorder, brief psychotic disorder, psychosis, avoidant personality disorder, schizoid personality disorder, delusional disorder, and other psychotic disorders - correct answer ✔ Dx with highest risk of HI
Do children or adults have a reduced placebo rate - correct answer ✔ Children Age of onset for males with schizophrenia - correct answer ✔ 18- Age of onset for schizophrenia women - correct answer ✔ 25- In most people with schizophrenia, symptoms generally start in the mid to late 20's though it can start later up to - correct answer ✔ Mid 30's Schizophrenia neurobilogical defect - correct answer ✔ Enlarged ventricles, cerebral cortex atrophy, smaller frontal/temporal lobes, reduced symmetry in temporal/frontal/occipital lobes, decreased cerebral blood flow, hippocampal and amygdala reduction Ventircles in patients with schizophrenia are - correct answer ✔ enlarged What lobes are smaller in schizophrenia - correct answer ✔ Frontal/ Temporal Is the hippocampus and amygdala enlarged or reduced in schizophrenia - correct answer ✔ reduced Pt w/ schizophrenia will have cerebral cortext _____ - correct answer ✔ atrophy
When a patient is ready for a less restrictive residential or hospital setting for people experiencing serious mental illness - correct answer ✔ ACT- assertive community treatment What component of the MSE assesses the organization of the pt's thoughts and ideas - correct answer ✔ Thought process How to describe a normal thought process - correct answer ✔ Logical, linear, coherent, goal oriented How to describe abnormal thought process - correct answer ✔ Associations are not clear/organized/coherent Move from thought to thought that may or may not relate in some way but never gets to the point - correct answer ✔ Tangentiality Provides unnecessary detail but eventually gets to the point - correct answer ✔ Circumstantial Refers to themes that occupy the pt's thoughts and perceptual disturbances - correct answer ✔ Thought content Where to document SI/HI/ plan, VH/AH - correct answer ✔ Thought content How to assess thought content on a preschooler (3-5) - correct answer ✔ Clinical observation-listen and observe clues
A screening tool that provides qualitative evaluation of cognitive impairment and records cognitive changes overtime in adults - correct answer ✔ MMSE What test can screen for dementia, assess severity, and measure progression over time - correct answer ✔ MMSE- Folstein scale What are the components of the MMSE - correct answer ✔ Concentration/attention/calculation Orientation Registration/ability to learn new material Recall (memory) Fund of knowledge What section of the MMSE would you chart this I would like you to count back from 100 by 7's or do serial 7's, or subtract 7 from 100, or list all 12 months in reverse order - correct answer ✔ Concentration/attention/calculation What section of the MMSE would you chart this What is the year? Season? Date? Day? Month? Where are we (state, country, town, hospital, floor)s - correct answer ✔ Orientation What section of the MMSE would you chart this
What may be present in a patient who has lesions in the parietal lobe following stroke or severe indicator of alzheimers - correct answer ✔ Constructional apraxia An increase of dopamine in what pathway causes the positive symptoms of schizophrenia (hallucinations, delucions) - correct answer ✔ Mesolimbic Mesolimbic dopamine pathway arises where and ends where - correct answer ✔ VTA to NA In schizophrenia there is a ______ of dopamine in the mesocortical pathway - correct answer ✔ Decrease A decrease of Da in the _________ pathway causes the negative symptoms associated with schizophrenia - correct answer ✔ mesocortical Mesocortical pathway arises where and projects to where - correct answer ✔ VTA to the cortext Both MESO dopamine pathways arise where - correct answer ✔ VTA
- limbic projects to NA
- Cortical projects to cortex Without DA going from VTA to the cortex we are not going to be what - correct answer ✔ Happy
Antipsychotics increase or decrease Da - correct answer ✔ DECREASE Da = worsening negative symptoms and EPS What dopamine pathway is responsible for coordination of movement - correct answer ✔ Nigrostriatal In the nigrostriatal pathway Da cell bodies project from and to where - correct answer ✔ Prject from the substantia nigra to the striatum The caudate and putamen is also know as - correct answer ✔ The striatum Low Da in the nigrostriatal pathway can cause what - correct answer ✔ Parkinsonism Parkinsonism s/s - correct answer ✔ S/S: Cogwheel rigidity, mask like face, resting tremor, shuffling gait Dopmaine blockade in the nigrostriatal pathway can increase what NT - correct answer ✔ Ach Increased ach can cause what - correct answer ✔ Salvation, teary eyes, diarrhea Metoclopramide (Reglan) can cause what - correct answer ✔ EPS- TD and parkinsonism
D2 receptor inhibitors also block - correct answer ✔ Histamine 1, alpha 1, muscarinic (ANTIHAM) Blocking H1 receptors can cause - correct answer ✔ Weight gain and sedation Blocking Alpha 1 receptors causes : - correct answer ✔ Vasodilation- orthostasis, hypotension, priapism Blocking M-1 receptors (muscarinic) causes - correct answer ✔ Dry mouth Risperdal, olanzapine, ziprasidone clozapine, quetiapine, aripiprazole, lurasidone - correct answer ✔ SGA/Atypical SGA cause D2 inhibition and what else - correct answer ✔ 5HT2a Blocking how much dopamine can get rid of positive s/s of schizophrenia - correct answer ✔ 60% Blocking what percept of Da receptors can cause EPS - correct answer ✔ 80% How does 5ht2a inhibition help dopamine blockade - correct answer ✔ Inhibiting 5HT2a give a little bit of Da back to avoid EPS Clozapine can cause what - correct answer ✔ Agranulocytosis check ANC
Risperdal can cause what - correct answer ✔ Hyperprolactinemia What antipsychotic is the most effective but has the worst S/E - correct answer ✔ Clozapine What neurotransmitters are associated with EPS - correct answer ✔ Acetylcholine is increased and dopamine is decreased What EPS typically happens first and causes sustained muscular contraction - correct answer ✔ Dystonia A stuck upward gaze, muscle of the eye is pulling the eyes up What EPS does this occur with - correct answer ✔ Oculogyric crisis, dystonia Neck/Head is turned to the side and turned away from the muscle that is contracted What EPS does this occur with - correct answer ✔ Torticollis Treatment for dystonia - correct answer ✔ Anticholinergic- Benzotropine or benadryl EPS causing restlessness, pacing, tapping, knees are bouncing
