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PMHNP Exam Reported Questions
with Answers latest 2025
What is dissemination? ✔ Getting the research information out to those who need to know it! Publication - highest level Presenting at National Conference Presenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? ✔ Moderate cognitive impairment What is Tegretol in the CYP450 system? ✔ Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? ✔ Inducer - will lower dose of Lamictal What is a Type I research error? ✔ There IS a difference but you say there isn't a difference. What is a Type II research error? ✔ There is NO difference but you say there is a difference. What is pseudo-dementia? ✔ Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve. Is it normal for a 1 month old to have a palmar grasp? ✔ Yes. What is a drug 1/2 life? ✔ The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? ✔ Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? ✔ Serotonin Syndrome as it is very serotonergic.
What is the allele seen in Asians that increase the risk of SJS? ✔ HLAB- When might you see toxic epidermal necrolysis? ✔ With worsening of SJS How many generations do you include for a genogram? ✔ 1st degree - mother, father, siblings 2nd degree - grandparents & cousins 3rd degree - What does messenger RNA code for? ✔ Amino Acids What is epigenetics? ✔ Factors that affect genes - environmental, smoking, stress, etc... What part of the brain is involved with OCD? ✔ Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? ✔ Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? ✔ 10-25 yo When do females typically present with schizophrenia? ✔ 25-35 yo What does Erythromycin to trileptal? ✔ You will need to decreases the level because Trileptal(inducer) and erythromycin is a inhibitor ACE Inhibitors are the drug of choice for what? ✔ Heart Failure HTN What are some psychiatric side effects seen with some asthma drugs ✔ Leukotriene receptor agonists - singulair, accolade, zyflo = agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor
✔ Inflammation (ESR - Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour. What is a normal sed rate or ESR? ✔ 0-22 males 0-29 females What is a retic count? ✔ Measures % of reticulocytes in blood (immature RBC's) Indicates whether enough RBC's are being produced by bone marrow. What does a decreased retic count indicate? ✔ Anemia - acute or chronic bleeding What does an increased retic count indicate? ✔ Bone marrow disorder or Vitamin Deficiency What does an abnormal retic ount indicate in general? ✔ Doesn't diagnose anything. First step is ID source of the issue. What happens when you mix tegretol and macrolides? ✔ Increase tegretol levels. What happens if a pregnant women takes Accutane? ✔ Birth defects. What labs do you get with RA? ✔ Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP - helps confirm diagnosis. CRP and ESR are both increased in RA but NOT in osteoarthritis. Where does the NP Code of Ethics come from? ✔ ANA When do you assume informed consent? ✔ Unconscious Incompetent Life Threatening Situation What are the legal ramifications of treating w/o informed consent? ✔ Same as with informed consent Who can declare a patient incompetent and appoint a guardian? ✔ Only a court
Does impaired judgment mean one is incompetent? ✔ No. Can an advanced directive ever be revoked? ✔ Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? ✔ Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? ✔ No. How do Asians see HC providers? ✔ As in a position of authority. Expect to give instructions and help make decisions What does it mean when an Asian patient does not make eye contact with the NP? ✔ SIgn of respect What is the evil eye? ✔ When a stronger or more powerful person looks at a weaker person - often infant/child resulting in a hex which presents in illness such as HA, fever, diarrhea, disturbed sleep, increased fussiness. How do you protect from the evil eye? ✔ Red ribbon on an infant Amulet for adults How do you treat for evil eye? ✔ Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? ✔ Relationship What is a proximate cause? ✔ Connection between A + B. For there to be damages, what must exist first? ✔ Negligence What is an occurrence basis liability insurance? ✔ "occurred" during the policy period, no matter when the claim is brought against the insured
Is dental care included in Medicaid? ✔ Yes, <21 gets basic dental as part of the Medicaid plan. What is the purpose of HIPAA? ✔ National standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state ✔ Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? ✔ Can decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? ✔ Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment Is it ok to announce a patient's name in a waiting room? ✔ Yes, no other way to give care. Is it ok to leave a message on a patient's vm? ✔ Yes, but should be limited. What is the impact of steroid inhalers on children? ✔ Slows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? ✔ Cataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? ✔ Sleeping meds Antidepressants Pain meds What psychoactives are first line treatment for fibro? ✔ Cymbalta, Effexor Elavil, Pamelor Lyrica, Gabapentin Ultram, Benzo's
What is the purpose of telepsychiatry? ✔ Increase the ability to reach rural and underserved areas. What is the purpose of Motivational Interviewing? ✔ Explore ambiguity Maintain passive position What is required for Medicare submission? ✔ ICD 10 and narrative or CPT What is the neurotransmitter problem in Schizophrenia? ✔ Excess dopamine in mesolimbic pathway. What is the neurotransmitter problem in ADHD? ✔ Dopamine, norepinephrine and serotonergic dysfunction What is the benefit of play therapy? ✔ Don't have to confront emotions head on. What neurotransmitters are involved in the bioamine hypothesis of depression? ✔ Noradrenaline Serotonin Dopamine MAOi's inhibit MAO's which break down neurotransmitters so allow increase in the amount in the synapse. How do you test CN XII? ✔ Stick out your tongue. What CN are you testing when you have a patient clinch their jaw and assess temporal muscles? ✔ CN V - Trigeminal What are two important things to measure when using Zyprexa? ✔ Lipid level and abdominal circumference What is included in the mini-cognitive exam? ✔ Clock, memory questions from MSE. What is HIV related dementia often mistaken for, especially at the beginning? ✔ Depression What do you do when a patient is on tegretol and their ANC (Absolute Neutrophil count) <1000?
✔ HLAB-1502 Allele increase risks of SJS. Trileptal, Tegretol and other AED's. Amgdyla ✔ Fear, Anxiety, and Aggression Neurotransmitter for Addiction ✔ Dopamine and GABA Neurotransmitter for Mood Disorder ✔ Serotonin and norepinephrine Which drug affects Carbamazepine/tegretol ✔ Erythromycin will cause toxic levels. Decrease Carbamazepine/tegretol Signs and Symptoms of stimulant abuse ✔ insomnia and tremor Depakote check ✔ HCG levels Depakote causes ✔ Spinal bifida Grasp reflex. ✔ an infantile reflex in which an infant closes her hand into a fist when her palm is touched Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until about 5 to 6 months of age. Moro reflex. ✔ The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months. pincer grasp ✔ 9 months Uses thumb and index finger (pincer grasp) to pick up small objects like Cheerios. Pt has MI looses his job stable on psych medications ✔ Provide brief supportive therapy
Latida and Geodon ✔ Take with food Moro reflex absent ✔ Do xray Health Care Policy Model ✔ Access, Cost, Quality Pt wants to stop medications ✔ explore reason for stopping Its their right 16 year old falls with the wrong crowd ✔ Conduct disorder change agent ✔ the person formally in charge of guiding a change effort Administrator 14 year old girl clenching her teeth ✔ Cranial Nerve V-Trigeminal nerve Infant dying ✔ Give child to parents and comfort parents borderline personality disorder Treatment ✔ dialectical behavior therapy Aggressive patient give ✔ IM geodon SIGECAPS of Depression ✔ Sleep Interest Guilt Energy Concentration Appetite psychomotor retardation Suicide
✔ Teach staff about culture competence Problems in the parietal lobe can lead ✔ Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) PDSA cycle ✔ For Plan-Do-Study-Act. Describes how to test a change: by trying it, observing the consequences, and then learning from those consequences. Appreciative Inquiry ✔ an organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements Appreciative Inquiry ✔ an organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work Appreciative Inquiry (AI) ✔ Identify the problem Analyze the problem Generate Solutions Implement Best Solutions Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) Appreciative Inquiry ✔ Discovery (Best of what is ) Dream (Wishes or dreams of Org) Design (Decide what you want to change) Destiny (Make it happen, Implenting Change) CIWA-Ar ✔ Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention Hispanic patient lost his parent complain stomach ache his pop couldn't fix what do you do ✔ Validate his experience and provide care in a culturally specific way to that patient
Native American wants his healer present ✔ Involve mother of the patient and healer, mom was cleared for you to involve her 16 year old shows up with mother for first therapy is ✔ confidential mom sits in lobby Patient acts out due to missing session what do you do ✔ You relate to childhood abandonment and talk about it with the patient How do you assess the competency of a medical procedure ✔ Identify a pen and recall 3 words Patient thinks someone has infiltrated the church because he watched it on TV 2 years ago, what diagnosis ✔ Delusional disorder Increase ICP (signs and symptoms) ✔ Baby Neuro cry Menopausal woman ✔ Hormone therapy and replacement Patient on antidepressants for 3 weeks and attempted Suicide ✔ Stop medication immediately You want to decrease seclusion on your unit who considered the primary change agent ✔ Unit staff You are a lead NP over other NPs in a rural setting how would you go about the change ✔ Make online form and have them vote on it 16 year old refuse treatment ✔ Send to psych specialist for acting out kids Positive Trendelenburg Sign ✔ Refer to Ortho/specialist Pelvis drops to when patient raises one foot off the floor. Drug affects Flonase ✔ Zantac (Histamine 2 Blocker) Antagonist Little boy wet his sheets, What kind of therapy would you suggest ✔ Behavior therapy
✔ Get EKG. Trazodone (Desyrel) ✔ Get an eye exam can cause Glaucoma Grapefruit juice or grapefruit ✔ Increase trazodone PICOT ✔ Patient population of interest Intervention of interest Comparison of interest Outcome Time limbic system ✔ A doughnut-shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus, amygdala, and hypothalamus. Amygdala ✔ A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression. PANDAS ✔ Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections OCD Mental Health Parity Act 1996 ✔ ensure equal coverage for mental and physical illness equal life time and annual limits charge of DEA ✔ state and federal Stereogenesis ✔ identify an object without sight a sense that allows a person to recognize the size, shape, and texture of an object Sterogenesis abnormality in ✔ parietal lobe
Clozaril (Clozapine) ✔ WBC- ANC LESS than 1000 (950) dc medication how treat child with depression ✔ Zoloft and therapy 3 year old masturbates, plays with self, says naught things ✔ normal for Piaget NMS treatment ✔ Dantrolene: MUSCLE RELAXTION D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles mesolimbic system ✔ POSITIVE symptoms of schizophrenia due to high dopamine negative symptoms of schizophrenia ✔ the absence of appropriate behaviors (expressionless faces, rigid bodies) negative symptoms of schizophrenia ✔ mesocorticol pathway mesocortical pathway ✔ VTA to prefrontal cortex negative symptoms Nigrostriatal pathway ✔ EPS DUE TO LOW DOPAMINE IN THIS AREA Communication from SnPC of the basal ganglia to the striatum (caudate + putamen) of the BG via DA; used to initiate movement PDSA model ✔ PLAN- Do-carry out Study -examine results Act-decide what action
18-24 Moderate Anxiety 25-30 Severe Anxiety Yale-Brown Obsessive Compulsive Scale (Y-BOCS) ✔ OCD 0-7 subclinical 8-15 Mild 16-23 Moderate 24-31 Severe 32-40 Extreme PTSD (Post Traumatic Stress Disorder) ✔ EMDR EMDR (eye movement desensitization and reprocessing) ✔ eye movement desensitization and reprocessing Dilated pupils ✔ Stimulant intoxication constricted (pinpoint) pupils ✔ Opiods nystagmus ✔ Phencyclidine conjuctival injection, muchies (super hungry), psychomotor slowness? ✔ Marijuana Marijuana ✔ a drug, often smoked, whose effects include euphoria, impairment of judgment and concentration and occasionally hallucinations; rarely reported as addictive Boy states that he wishes to be a girl and tells you not to tell his parent s ✔ Don't tell ODD what will you do to prevent it from becoming Conduct disorder ✔ Therapy to target mood and aggression Herpes rooster 3 weeks later sleep difficulties and sad mood ✔ Depression Schizophrenia in males ✔ 18-25 years old
Schizophrenia in Women ✔ 25-35 years old signs of amphetamine intoxication ✔ Tears, Runny nose, restlessness, HTN, Tremors, Insomnia Co-morbidities of bipolar ✔ Anxiety, alcohol and substance abuse Big Freaking Problems ✔ Bupropion Fluoxetine Paxil Medicare ✔ A federal program of health insurance for persons 65 years of age and older Medicare Advantage ✔ a program by which eligible Medicare beneficiaries may choose to receive their health care through a qualified managed care plan, which in turn receives capitation payments from Medicare for each enrollee Medicare A, B, C, D ✔ A: Inpatient services B: Outpt services C: Private insurance can provide medicare benefits D: Drugs WATCHERS for GAD 3 of these *** for 6 months ✔ worry anxiety tension in muscles concentration hyperarousal energy loss, fatigue restlessness sleep trouble Transtheoretical Model of Change ✔ 1. Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
