GEORGETTE'S LMR (GEORGETTE'S PMHNP CERTIFICATION) EXAM 300 QUESTIONS AND CORRECT DETAILED ANSWERS WITH EXPERT FEEDBACK 2ALREADY A GRADED|BRAND NEW!!

What should you not do when advocating for a patient?

Judge or confront

What class of medication is contraindicated with tics?

Stimulants

What should you provide for prior to assessing abuse victims?

A safe environment

What are your actions if a child reports abuse?

First interview separately from parents then report to CPS

What should you do if a child plays with toys in a way that you suspect abuse?

Report to CPS

In what setting as an inpatient provider should you interview a patient?

Use a private room with the door partially open

How should you begin your interview with adolescents?

By building rapport with them by ensuring confidentiality absent exceptions

Should you interview adolescents with or without parents?

Without

What if an adolescent tells you they are homosexual and they don't want their parents to know?

This is confidential

The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action?

Get informed consent/ROI

What do you do if a medical evaluation is needed?

Refer out - this is out of scope

What do you do if a patient is takes something and is feeling really funny/unwell in your office?

Collect UDS and then refer out

Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment?

No; brief supportive therapy - not medication

A mother states her child is experiencing a cultural illness. What is your initial action?

Respect the mother's cultural understanding of illness prior to assessment

Native Americans view mental illness and SUDs as?

An imbalance between the individual and the world

What ethnic group has the highest rate of suicidality in the US?

Native Americans

If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do?

Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1:1

Psychoeducation should be based on?

Cultural context

How do you promote health in a location with multiple ethnicities and education levels?

Multiple cultural education and ethnospecific assessment parameters

What if a patient wants a traditional healer?

Allow this - remember ROI/informed consent

Normal TSH?

0.5-5.0

TSH < 0.5 = ?

Hyperthyroidism

TSH > 5.0 = ?

Hypothyroidism

Relationship between TSH & T3/T4?

Inverse

Hyperthyroidism can present as?

Mania

Hypothyroidism can present as?

Depression

Normal depakote level?

50-125

Toxic depakote level?

150+

Birth defect caused by depakote?

Spina Bifida

S/S of depakote toxicity?

Disorientation, lethargy, decreased respiratory rate, and N/V

What to do if there is depakote toxicity?

D/C depakote and check VPA level, LFTs, and ammonia

S/S of hepatotoxicity?

RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs

Normal AST?

5-40

Normal ALT?

5-35

Kava kava can cause?

Liver damage and heavy sedation

Kava kava is c/i with?

Benzos or sedatives

Mood stabilizer most associated with SJS?

Lamictal

Mood stabilizer with least weight gain?

Lamictal

SGAs with least weight gain?

ziprasidone, abilify, and latuda

Least sedating SGA?

Abilify

Routine labs with SGAs?

BMI, hip to waist ratio, glucose, A1C, and lipid panel

Management of metabolic syndrome with SGAs?

1. Nonpharm = exercise or nutritional counseling

2. Pharm = switch to other SGA with lower chance of metabolic syndrome

Carbamazepine can cause?

Agranulocytosis and aplastic anemia

What should you screen for prior to starting Asians on carbamazepine and why?

HLAB1502 Allele; risk of SJS

When should you d/c carbamazepine if agranulocytosis is suspected?

If ANC is < 1000 with or without s/s of infection

Lithium range?

0.6 - 1.2

What to do if lithium is 1.3 or 1.4?

Monitor

What to do if lithium is 1.5+?

D/C

Benefits of lithium?

Gold standard for mania, neuroprotective, and antisuicidal effects

S/S of lithium toxicity?

Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor

What to do if lithium toxicity is suspected?

D/C and check serum levels prior to checking VS

Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs?

NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ)

What demonstrates understanding of education on lithium?

Taking extra water with patient when they go hiking

NMS s/s?

Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs

Treatment of NMS and MOAs?

D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant)

Serotonin syndrome s/s?

Hyperreflexia and myoclonic jerks

Serotonin syndrome causes?

SSRIs, SNRIs, MAOIs, -triptans (for migraines like sumatriptan/imitrex)

Treatment for serotonin syndrome?

D/C med and administer cyproheptadine

Wash out from SSRI to MAOI or vice-versa?

14 days

Wash out from Prozac to MAOI?

5-6 weeks

Drug choice for patient that is depressed and also has cancer?

Celexa or lexapro d/t fewer drug to drug interactions

Drug choice for patient with low energy and fatigue with depression?

Wellbutrin

Drug choice for patient with sexual problems d/t medication or depression?

Wellbutrin

C/I for Wellbutrin?

Seizure disorder or hx or present eating disorder

Drug choices for patient with chronic neuropathic pain and depression?

1. SNRI (cymbalta)

2. TCA (amitriptyline)

3. Alpha 2 delta ligand (gabapentin or lyrica)

Black box warning for SSRIs in children, adolescents, and young adults? Intervention for this?

Increased risk of SI; always assess SI, frequency, and severity

Alcohol is a form of _______-_________ and a __________ to the treatment of depression.

self-medication; barrier

Prozac can cause? Intervention?

Insomnia; take in AM

Disorder that most greatly increases thoughts of self-harm?

Depression

Disorder that most greatly increases homicidal ideation?

Antisocial personality

Why is there less evidence available supporting the use of antidepressants in children?

Lower placebo rates

Schizophrenia age of onset in men? Women?

18-25; 25-35

Findings on PET scan or MRI in schizophrenia?

INCREASED ventricle size; DECREASED everything else

No stimulants in schizophrenia due to?

Increased dopamine release

Tertiary prevention for schizophrenia?

Social skills training

Why should you refer a patient with schizophrenia to exercise programs, especially aerobic exercise?

It improves cognition, quality of life, and long term health

Benefits of assertive community treatment (ACT)?

Rehab post-hospitalization, case management approach, and good for long term hx of noncompliance

Oral haldol to IM conversion?

20x daily dose of oral dose

Max IM dose of haldol per visit? How long until next injection?

100 mg; 5-7 days

5 mg oral haldol BID = ? IM

200 mg

Firm belief that is maintained despite lack of evidence?

Delusion

Example of a delusion?

Believing church members or class members are a cult

MSE in preschooler (3-5 yo)?

Listen and observe; dependent on clinical observation

Thought process?

Organization of patients thoughts and ideas

Circumstantial speech?

Go in circles but eventually answers

Tangential speech?

Never gets to answer of question

Thought content?

What themes occupy patient's mind; i.e. SI, HI, and A/VH

MMSE also known as?

Folstein scale

Serial 7s or months backwards assesses patient's?

Concentration, attention, and calculation

Name 3 objects assesses?

Registration

Name 3 objects after 5 minutes assesses?

Recall/memory

Asking patient to name president of governor assesses?

Fund of knowledge

If a clock drawing test is abnormal this indicates?

Right parietal lobe/hemisphere damage

What makes SGAs different from FGAs?

5HT2A = less likely to experience EPS

SGAs that can be administered IM?

Invega, geodon, zyprexa, and abilify

Mesolimbic DA pathway?

Increased DA leads to + symptoms

Mesocortical DA pathway?

Decreased dopamine leads to - symptoms

Nigrostriatal DA pathway?

Decreased dopamine and increased acetylcholine lead to EPS (dystonia, akathisia, and TD)

Tuberoinfundibular pathway?

Decreased dopamine and increased prolactin lead to amenorrhea, galactorrhea, sexual dysfunction, and gynecomastia

Long term increased prolactin causes?

Osteoporosis