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Pmhnp certification Exam 2022 Actual test verified A .pdf
Pharmacology (NUR 3145)
Santa Fe College
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ANSWERS 2022
A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus: Hypothalamus A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encour- age?: Bring a support person like a husband Thyroid-Stimulating hormone normal level: 0.5-5 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis: HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance: Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance: Hypothyroidism Hyperthyroid can mimic: Mania Hypothyroid can mimic: Depression A patient on depakote complains of RUQ pain and has reddish/brown urine: Hepatoxicity -Check LFTs Signs of Depakote toxicity: Disorientation, confusion, lethargy You suspect depakote toxicity what do you do?: Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity?: Kava Kava When taking Kava Kava in combinations with other medications you should caution about: Risk of Hepatoxicity and Sedation TCAs carry a risk of: Hepatotoxicity
ANSWERS 2022
Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome: lamictal and tegretol What nationality is most suseptible of getting steven johnson?: Asians When treating asians with tegretal screen for?: HLAB-1502 Allele What two medications cause agranulocytosis?: Clozaril & Tegretal Agranulocytosis when to discontinue medication: Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what?: - Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check?: HCG Which two medications may decrease the risk of suicide?: clozaril and lithium Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for?: Heart Failure Certain medications are known to increase lithium level, but HOW?: by reducing renal clearance When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise Normal Lithium Level: 0-1. Lithium Toxicity: 1 or above Discontinue and re-order lithium level Lithium level of 1: Monitor for toxicity Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY
ANSWERS 2022
If a cancer patient has depression what should you consider?: Treating with a medication with minimal drug/drug side effects like Lexapro Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin Primary symptoms of depression include fatigue and low energy what med would you chose?: Wellbutrin Wellbutrin is contraindicated in patients with: Seizures and anorexia Which medications are best for neuropathic pain?: SNRI Gabapentin TCA Secondary to the black box warning providers caring for patients on anti- depressants should assess for?: Suicidality, frequency, and severity at EVERY appointment Which meds have the worse serotonin discontinuation syndrome: Those with short half lives such as zoloft Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET
Shits and Shivers Ages of onset for schizophrenia in males vs females: -MALES 18- years
-FEMALE 25-35 years Schizophrenia increases the risk for: SUICIDE HIGH RISK OF SI in SCHIZOPHRENIA Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts) What increases the causes or increases the risk or schizophrenia: exces- sive pruning of synapses -inadequate synapse formation, -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation, -first order relative (mom/dad)
ANSWERS 2022
MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREAS- ES EXCEPT VENTRICLES
-You will see VENTRICULAR ENLARGEMENT Stimulants can potentiate the release of what neurotransmitter?: - Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT): a form of rehabilitation post hospi- talization, in home treatment What level of prevention is ACT?: Tertiary What adjunctive treatment is important in schizophrenia: -social skills training -Exercise Exercise for mental health patients can promote: Cognition Quality of Life Long-term health ACT is ideal for patients with a history of: Treatment non-compliance
-Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality: Antisocial In the MMSE how do you test for abstraction?: proverb interpretation (every- one that lives in glass houses shouldn't throw stones) Are they able to think abstractly Thought Process-Tangential: means that their response has nothing to do with the question Circumstantial: means that their response goes in circles instead of getting to the point of the question Mental Status-Thought Content includes: SI/HI/AH/VH Another name for MMSE: Folstein Scale How to assess concentration on MMSE: Serial 7s or perform an activity backwards i list the days of the week backwards Assess ability to learn new material: repeat 3 words after me Assess ability to recall: repeat 3 words after 5 minutes Assess fund of knowledge: Who is the president
ANSWERS 2022
-Treatment is IM COGENTIN + continue PO COGENTIN for several days Akathisia + Treatment: may mimic anxiety, restlessness, can't sit still, rocking, pacing
-First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal) -Second line treatment is COGENTIN -Third line treatment is benzos Beta-Blockers such as Inderal are contraindicated with what type of asthma medication: -DO NOT GIVE WITH BROCHODIALATOR such as AL- BUTERAL this combination can cause bronchospasm akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness of movement -Treatment Cogentin PSEUDOPARKINSON or PARKINSONIAN + Treatment: caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing -Treatment COGENTIN tardive dyskinesia + Treatment: abnormal facial movements, grinding teeth, lip smacking, protruding tongue
-Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT Does Cogentin Treat TD: COGENTIN MAKES TD WORSE Typical onset of TD: OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO What non-psych med can cause TD?: REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discon- tinue reglan if TD develops InDucers CYP450: DECREASE
Carbamazepine Rifampin Alcoholics (chronic) Phenytoin
ANSWERS 2022
Grisiofulvin Phenobarb Sulphonylureas
Crap GPS Induces me to Madness! InhIbitors of CYP450: INCREASE
Ciprofloxacin Ritonavir Amiodarone Cimetidine Ketoconazole
Acute Etoh Macrolides INH Grapefruit Juice Omeprazole
Crack Amigos Erythromycin and Clarithromycin can cause: Increased tegretol levels Patient started on Clozaril or Zyprexa and two months later starts smoking: as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey: as a provider you know that you must now decrease the dose of the antipyshcotic Medications that cause mania: Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar
-If a patient must take steroids, the provider should increase the mood stabilizer Medications that cause depression: steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodi- azepines, progesterone
ANSWERS 2022
Patient with bipolar disorder presents with depressed mood & emotion- al lability: Give Depakote Hallmark sx of Borderline Personality: Recurrent self harm Treatment for Borderline Personality: DBT Creator of DBT: Marsha Linehan What activity is helpful in making a diagnosis of borderline personality- : Journaling or diary keeping Conversion Disorder: STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism Adjustment Disorder: adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying) -Symptoms occur within 3 months of the stressor If question states recently moved, recent death... ADJUSTMENT factitious disorder: when patients introduce foreign substances into their body or contaminate their food -Faking illness but NO MOTIVE BEHIND IT Malingering: Faking illness for financial gain Reactive Attachment: common in children in foster care, abuse from parents -Withdrawn and shows no emotion towards caregiver ODD: They deliberately annoy others, no aggression, defiance of authority -Family Therapy is mainstay -Child management /Parent management skills is the focus in therapy -Positive reinforcement -Boundary Setting Conduct Disorder: violence, criminal, fire setting, killing animals, gang activ- ity, +AGGRESSION, NO REMORSE -May need meds and therapy -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsy- chotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine) -Monitor BP with guanfacine and clonidine Acute Stress Disorder: similar to PTSD but the timeline differs -heightened arousal, nightmares, flashbacks
ANSWERS 2022
-LESS THAN ONE MONTH
PTSD: -OVER ONE MONTH
-3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoid- ance -May also have NIGHTMARESà GIVE PRAZOSIN -Non-pharm tx of PTSD- EMDR, CBT Panic attack vs Panic disorder (treatment): Panic attack = BZ Panic disorder = SSRI
Panic Attack is ACUTE Panic Disorder is CHRONIC
Feels like impending doom Tourette's Syndrome: Criteria for diagnosis -TWO moto tics and ONE vocal tics -LASTS more than ONE YEAR -By age 18 CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL Child presents with one tic and the parent is worried: CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL Neurotransmitters involved in Tourettes: DNS: Dopamine, Norepineph- rine, Serotonin Treatment for tourettes: Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine What type of medication can cause tics or exacerbate them: Stimulants Neurotransmitters involved in mood disorders: DNS: Dopamine, Norepi- nephrine, Serotonin + GABA Neurotransmitters involved in ADHD: DNS: Dopamine, Norepinephrine, Serotonin part of brain implicated in ADHD: prefrontal cortex basal ganglia reticular activating system ADHD inattentive type is caused in what part of the brain: Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION
ANSWERS 2022
So what should you assess if a parent reports that a child is having night- mares: GENETIC ask if someone in the family has a similar issue with sleep.. for family patterns of sleep problems GAD: Worry, apprehension, fear must LAST ATLEAST 6 MONTHS Delirium: -ACUTE (within hours to days) onset of disturbance of LOC, COG- NITION, inattention -Urinary Tract Infections are common cause for DELIRIUM always check UA -Treatment is antipsychotics like HALDOL Dementia: -Chronic and slow onset (months to years to develop) -Mental decline in cognition, irritability, personality changes -When asked questions they may try to answer or MAKE UP ANSWERS (confab- ulate) Low levels of what labs may mimic dementia: Vit B12 and Folic Acid Cortical Dementia: Language and memory (aphasia and amnesia) Subcortical Dementia: Motor abnormalities/Mood issues like apathy, de- pression, irritability
HIV Dementia is a type of subcortical dementia Early signs of HIV dementia: subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordina- tion, unsteady gait Treatment for HIV dementia: Antivirals Pseudo Dementia: Depression causes the memory issues, common in older adults
-Also assess onset of symptoms, pseudo dementia is more acute onset -When asked questions they often say "I DON'T KNOW" Instruments to use to differentiate between dementia and pseudo de- mentia: -Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE -Older individuals with depression may present with irritability and agitation
ANSWERS 2022
If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present: hallmark of lewy body dementia: visual hallucinations Frontotemporal lobe Dementia: PICKs Disease -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes -May see slurred speech or difficulty getting words out What lobe is associated with ability to understand what others are saying (comprehending speech): Temporal Lobe Neurotransmitters involved in Autism: GABA, Glutamate, Serotonin Autism: a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement When play they often like to line up their toys, stack them in tidy rows Broken Mirror Theory of Autism: Explains that the child's presentation is caused by the mirror neuron i dysfunction in the mirror neuron Risk Factors for Autism: Male gender, genetic loading, intellectual disability, parents ages, preterm Screening tools for Autism: ADOS-G (autism diagnostic observation schedule-genetic) ASQ (ages and stages questionnaire) M-CHAT (modified-checklist for autism-toddler) Where is Norepinephrine produced?: locus coeruleus and medullary retic- ular formation Where is serotonin produced?: raphe nuclei Where is dopamine produced?: substantia nigra, ventral tegmental area, nucleaus accumbens Where is acetylcholine synthesized?: Basal nucleus of Meynert Hippocampus: a neural center located in the limbic system; helps process memory and manage stress Limbic System: The limbic system is the part of the brain involved in our behavioral and emotional responses, especially when it comes to behaviors we need for survival: feeding, reproduction and caring for our young, and fight or flight responses.
ANSWERS 2022
Behavioral Therapy: -Arnold Lazarus focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors -Exposure -Relaxation -Skills training -Role Playing Humanistic Therapy: -Carl Rogers person-centered therapy -Self-actualization -Self-Directive Growth -Everyone has the potential to actualize and find meaning in life Existential Therapy: Victor Frankl -an insight therapy that focuses on the ele- mental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices. -Emphasizes accepting freedom and making responsible choices -Focus on the present
Why am I here, What is my purpose Interpersonal Therapy: Gerald Kierman & Myrna Weissman --Used for people who have trouble interacting with others, relationship distress -Marital conflict -12-16 weeks (3-4 months) EMDR Phases: Desensitization Phase: visualize the trauma, verbalize neg- ative thoughts but remain attentive to physical sensations
Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement
Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within Group therapy: Installation of hope: participants develop hope for creating a different life; they gain hope from others Group therapy: Universality: people have similar problems, thoughts, and feelings and they are NOT ALONE Group Therapy: Altruism: sharing of oneself with another and helping an- other
ANSWERS 2022
Group Therapy: Imitative Behavior: Patients can increase their skills by imitating the bx of others Group Therapy: Interpersonal learning: interacting with others increases adaptive interpersonal relationships Group Therapy: Group Cohesiveness: Patients develop an attraction to the group and other members as well as a sense of belonging Group Therapy: Catharsis: Patients openly express their feelings which were previously suppressed Group Therapy: Existential Factors: Groups enable participants to deal with the mean of their own existance Group Therapy: Corrective Refocusing: Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic Group Phases: forming, storming, norming, performing, adjourning Family Systems Therapy: Murray Bowen -a person's problematic bx may serve a function for the family or be a symptoms of dysfunctional patterns KEY WORDS* Self-Differentiation, Triangulation, Triangles Structural Family Therapy: Salvador Minuchin -How, when, and who whom family members relate KEY WORDS* Mapping Hierarchies Boundaries Strategic Therapy: Jay Haley -Symptoms are a way to communicate metaphorically in a family -Symptom focused KEY WORDS* Straightforward directive Paradoxical directive (reverse psychology) Reframing (you are not jealous of your sister you just care for her so much) Solution Focused Therapy: -MIRACLE QUESTIONS -EXCEPTION-BASED FINDING -SCALING QUESTIONS
ANSWERS 2022
often have NORMAL BREAST ENLARGEMENT which disappears within 6 months *reassure them that this is normal Elderly female presents with decreased sex drive: Check Testosterone level Sex Hormone-Testosterone is involved in sex drive -MUST KNOW THAT WOMAN have TESTOSTERONE TOO alcohol dehydrogenase: an enzyme active in the stomach and the liver that metabolizes alcohol -WOMAN HAVE LOWER ALCOHOL DEHYDROGENASE (metabolizes alcohol) -This is why woman get drunk faster -Lower levels of this enzyme may also cause a higher propensity to develop LIVER DISEASE When OB wants to hire psych providers: they want to increase mental health access to those that need it the most Normalizing grief and loss in children: Don't tell them what to do because grief responses vary -i Don't tell them to stop working that is prescriptive advise -With children the most important thing is to reinforce FAMILY support an support- ive therapy such as group therapy so they can learn from other children who have experienced similar events palmar grasp reflex: normal up to 5- months If older baby still has this reflex->refer to specialist Moro (startle) reflex: Normal till 5- months If present past normal range->refer to specialist If not present within the normal age->Xray may be a sign of a broken bone, nerve injury, or spinal injury Babinski reflex: Normal up to 2 years If present past normal range->refer to specialist PDE-5 inhibitors: Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis)
RAPIDLY ABSORBED Used for erectile disfunction
ANSWERS 2022
Difference between BMI in anorexia vs Bulemia: Anorexia-Low BMI Bulemia-Normal BMI Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and you determine the patient needs to be sent for medical evaluation but the parents refuse: Contact CPS You read and article that says that most children with ADHD abuse substances... -To translate this information into practice what should you do?: -Screen ALL children for ADHD for SUBSTANCE USE -OR Screen ALL children with SUBSTANCE USE for ADHD accupuncture: used for pain and depression Habeas Corpus: legal concept that protects patients from unlawful hospital- ization -May be a reason to leave AMA
Pmhnp certification Exam 2022 Actual test verified A .pdf
Course: Pharmacology (NUR 3145)
University: Santa Fe College
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