Study sets, textbooks, questions Start the new year right! - Get Quizlet Plus 50% off 50% off Quizlet Plus Adult quiz questions Terms in this set (100) What are the elements of Peplau's theory of Orientation, identification, exploitation, resolution interpersonal relations? Theory, research and evidence based practice What 3 elements are important to integrate into practice Evidenced based practice considers expert True clinical research as well as experience T or F Working with a patient on a mutually agreed on treatment plan Define Concordance Describe the physiological response to the Norepinephrine distributed throughout the body causes physiological perception of a threat, leading to the responses such as tachycardia and muscle tension experience of anxiety Asthma, cardiovascular events, diabetes Which of the following medical comorbidities are associated with anxiety? Jeff is a 24 year old male college student who presents with symptoms consistent with anxiety. He is having difficulty functioning at his job as a cashier at a grocery store. He takes most of his classes online because attending classes at the main campus triggers feelings of anxiety and fear. Knowing his symptoms and the statistics about gender and anxiety disorders, which diagnosis is he most likely to be experiencing? -Social Anxiety - PTSD -OCD -Panic Disorder Adult quiz questions Social anxiety disorder 1 What distinguishes Generalized Anxiety GAD causes a frequent or constant fear or worry, whereas panic disorder Disorder from Panic Disorder? is episodic, though can be equally as debilitating Is Dose of 25mg Sertraline effective? No 25mg rarely effective in adults. Needs 50 mg Angela is a 44 year old woman who presents Insist on medical clearance from cardiac event in the ER after collapsing while at court for a child custody hearing. She is obese (360#) It is the trauma we experience as a result of repeatedly caring for those in with a history of CAD, s/p CABG, Type II DM crisis in poor control (last A1c=9.9), HLD, and chronic back pain. EMS reports that she collapsed after being told that she would not be able to maintain custody of her children. She had complained of acute chest pain, feeling faint and dizzy, shortness of breath, and had told EMS "I think I'm going to throw up." She has a known history of panic disorder and frequently presents to the ER with panic attacks. Therefore the ER physician asked you to see her first to treat her suspected panic attack because he felt that a workup for an AMI would be unnecessary due to her past history. What is most appropriate Rx? Describe vicarious trauma Patients who have a diagnosis of Panic True Disorder will often present with a completely normal mental status exam. T or F? One of the most effective treatments for nightmares associated with posttraumatic stress disorder is to use a sedating second generation antipsychotic, such as quietiapine (Seroquel). T or F? Adult quiz questions False Morgan is a 19 year old unmarried female Aces score of 8 who just learned through a home pregnancy test that she is pregnant with her second Sertraline is safe for pregnancy child. Her LMP was approximately 6 weeks ago. She was raised in foster care, having been emancipated at 16 after her first pregnancy. She has a history of major depression and is currently taking sertraline (Zoloft). Her pregnancy was unplanned and she has not yet seen her ob/gyn for her initial prenatal visit. She is seeing you today in the community mental health center for a routine follow up visit. Which risk factor are you most concerned about in regards to her pregnancy? - Aces score of 8 - Not seen OB yet - under 24 yrs - use of sertraline during pregnancy Jennifer is a 32 year old married woman with Generalized anxiety. two children. About a year ago, she was rear ended at a four-way stop. Her two children were in the car. While neither she nor her children were injured, her car was significantly damaged. She presents to your office today stating that since her accident, she has been experiencing anxiety, especially while driving. She avoids the intersection where the accident occurred, even though it often adds a few more minutes to her morning commute. She worries frequently about the safety of her children and she feels that is having a negative impact on her relationships at home. Knowing this information, which diagnosis would best describe her symptoms? -OCD -PTSD - Panic Disorder - Generalized anxiety Adult quiz questions Not PTSD Although anxiety is more prevalent in the True geriatric population, benzodiazepines should be used with greater caution due to their True lipophilic properties, association with Alzheimer's, and increased risk of ataxia. EMDR When prescribed appropriately, buspirone (Buspar) can be as effective as using a benzodiazepine for relief of symptoms of anxiety. Type of psychotherapy w PTSD that retrains the brain to interpret triggering stimuli? Explain 4 types of health beliefs 1. Deferential Compliant 2. Directive reactive 3. Experimental Reflective * 4. Consolidative Why do sexual side effects occur with many 1. Person defers to the provider at all times, generally takes meds no matter what 2. Stops meds all at once 3. Person experiments to find the approach that they feel is most beneficial, "recovery testing" 4. The person has found an effective way to utilize meds Inhibition of dopamine by serotonin in the mesolimbic pathway. antidepressants? Quetiapine Which antipsychotic med is not available in LA-also haloperidol, risperidone, paliperidone long acting form? Olanzapine(Zyprexa), aripiprazole, Quetiapine, Fluphenazine (Prolixin) A patient who is involuntarily committed to False psychiatric treatment is by nature not able to be concordant with treatment plan. T or F D2 Which neurotransmitter is responsible for the positive symptoms ( added hallucinations, delusions) in schizo 6 neurotransmitters for psych meds Serotonin, dopamine, NE, Gaba and glutamate, acetylcholine Why do people stop taking antipsychotics? Cost, lack of insight, sedation, metabolic syndrome Decreased libido is effect of_____________ Systemic serotonin receptor activation Therefore is it a SE or an unintended effect? Adult quiz questions Typicals/SGA's Additional effect of serotonin antagonism Main difference between atypicals and D2 Blockade typicals? EPSE Primarily work through__________________________ Decreased incidence of _______________________ Treatment protocols (Star D) 1. SSRI Phase 1- 2. 2nd SSRI or switch to another antidepressant - could be SNRI, Phase 2- bupropion, mirtazapine, or MAOI Phase 3 - 3. Augment with mood stabilizer, lithium, levothyroxine Phase 4 - 4. Other Options - PGx testing, TMS, ECT, ketamine ect 2 Pearls- Always consider your dx, integrate therapy at every step Lithium - gold standard for suicide prevention 3 mood stabilizers Anticonvulsant - valproate, carbamazepine, oxcarbazepine, lamotrigine Atypicals- Quetiapine, lurasidone (Latuda), aripiprazole Which statement is true? All correct - All answers are correct - Suicide is a leading cause of death in persons with serious mental illness - Persons with serious mental illness die 10-20 years sooner than the general population - Up to 80% of persons with serious mental illness use nicotine regularily Identify Negative symptoms of schizophrenia 1. Taken away from person- "Removed from life experience" - Flat affect, depressed mood, social Flat affect, depressed mood, social intolerance intolerance Others- Apathy, disorganization, social withdrawl - mood lability, hallucinations, social anxiety - delusions, illusions, and anxiety - paranoia, pseudo-autistic traits, poor sleep Positive sx of schizophrenia- Positive- Hallucinations, Delusions, Formal thought disorder (language), Negative sx of schizophrenia- Bizarre behavior Negative -Alogia, Affective blunting, Avolition, Anhedonia, Attentional impairment The positive symptoms of schizophrenia have been correlated with __________ abnormalities -temporal lobe such as volume reduction and increased - prefrontal blood flow. Conversely, negative symptoms have been associated with decreased ____________ blood flow. Adult quiz questions Judy is a 54 yr old divorced female with a Continue current regimens her sx are stable and adverse effects are not lifelong hx of schizophrenia. She has been evident stable on haloperidol 10 mg bid for past 15 yrs. She receives public assistance. BMI-22.4, last hgbA1c-6.6, AIMS-0. Reports takes meds most of the time, rarely exhibits hallucinations or paranoia any more,. First visit with you. Given current presentation what would you do? - Continue current regimens her sx are stable and adverse effects are not evident - Cross titrate to a 2nd generation antipsychotic to decrease metabolic risk - Transition to haloperidol deaconate because long acting injections offer more stability in chronic schizophrenia - Add benztropine (Cogentin) to reduce risk of EPSE In order to manage metabolic syndrome - Weight, BMI, lipids, HgbA1C which should be monitored on regular basis with antipsychotics? - AIMS, MMSE, PHQ-9 - Weight, BMI, lipids, HgbA1C - Therapeutic drug levels, AIMS, BMI - Liver enzymes, wt, RR Persons with serious mental illness such a False schizophrenia or schizoaffective disorder do not typically respond to traditional True psychotherapy approaches? T or F Parkinson's Disease is not a subtype of Dementia. Tor F What are possible causes of delirium? - Severe anxiety, catatonia - Chronic pain, schizophrenia - Pneumonia, Lewis Body Disease, - UTI, extremely elevated TSH Adult quiz questions - UTI, extremely elevated TSH Word Bank - Auditory hallucination, Ideas of 1. Auditory hallucination reference, Illusion, Poverty of speech, 2. Somatic delusion Somatic delusion, tactile hallucination, Visual 3. Tactile hallucination hallucination 4. Illusion 1. Hearing audible voice of satan 5. Poverty of Speech 2. Feeling as though worms are crawling 6. Ideas of reference inside ones body 3. Physically feeling worms crawl on ones skin 4. Hearing voices from faucet additional 5. Answers question with brief or monosyllabic answer 6. Beliefs the ring you are wearing belonged to his mother Possible risk factors for development of 1st degree relative with AD, 10 yr hx chronic clonazepam use Alzheimer's dementia? - Cardiac disease, hx breast cancer - 6 mo hx of alprazolom use, hx bipolar - 1st degree relative with AD, 10 yr hx chronic clonazepam use - Hx hip fracture, Caucasian ethnicity According to research what 2nd generation - quetiapine antipsychotic is likely to offer the least benefit in managing aggressive behavior in dementia? - quetiapine - aripiprazole - olanzapine - risperidone Dementia with behaviors(F02.8) is new False diagnosis in DSM-V and is appropriate True criteria for inpt admission? T or F True A diagnosis of Alzheimer's can only definitely be made on autopsy? T or F Clozapine (Clozaril) can be very effective with schizophrenia but can lead to significant weight gain T or F Adult quiz questions What monitoring is impt on a regular basis - EKG, because both can increase QTc interval with Ziprasidone (Geodan) or lurasidone (Latuda)? - MOCA, because both can cause dementia if used long term - EKG, because both can cause episodes of SVT - EKG, because both can increase QTc interval - EKG, because both can cause absence seizures Basic treatment algorithm for thought Step 1- Single SGA disorders(Psychosis) Step 2 - Different SGA Step 1 Step 3 - Different SGA/FGA or clozapine Step 2 Step 4- Clozapine + FGA/SGA/ ECT Step 3 Step 5- Multi antipsychotic therapies Step 4 Step 5 Increased Dopamine results inIncreased serotonin results in- D-"Drive"- increased motivation, accomplishment, productivity. "Feels great" S- "Smile" - increased happiness, calmer and focus improves Schizophrenia 4 Types of thought disorders Schizoaffective - Bipolar or Depressed type Schizophreniform disorder (Precursor to above) Schizotypal personality disorder 3 types of neurocognitive disorders Delirium 1. Dementia 2. -Alzheimer's a. - Vascular dementia b. - LBD. Picks disease c. Others 3. - Huntington's, PD a. - TBI, CTE b. Adult quiz questions Personality disorders Cluster A- Odd or eccentric Word bank - Antisocial, Avoidant, Borderline, Paranoid, Schizoid, Schizotypal Dependent, Histrionic, Narcissistic, Obsessive Cluster B - Dramatic, emotional, erratic compulsive, Paranoid, Schizoid, Schizotypal Antisocial, Borderline, Histrionic, Narcissistic Cluster C - Anxious and fearful Cluster A, B, or C Avoidant, Dependent, Obsessive compulsive What is each cluster known as? Post partum has unique diagnostic code that 1. True differentiates it from major depressive disorder. Tor F 2. PHQ-9 Which of the following tool is used to diagnose depression? - MMSE -PHQ-9 - AIMS - GAD-7 Which of the following is False Suicide is the leading cause of death between ages 10-34 - Suicide is the leading cause of death between ages 10-34 - The WHO estimates worldwide a person dies by suicide every 40 sec - Up to 5-10% of the worlds population suffers from a mood disorder at any given time - Depression rates in the elderly can be as high as 34% Which is not considered a cause of depression? - genetic predisposition - excessive dopamine in the mesolimbic pathway - estrogen interaction with GABA, glutamate, and monoamines - stress, grief ,trauma Adult quiz questions excessive dopamine in the mesolimbic pathway You are an outpatient PMHNP who is seeing Depression is either unipolar or bipolar, not both a pt 28 yrs. He has hx of psychosis but this hospitalization is for suicide attempt and severe depressed mood. He was stable on Olanzapine and lithium. His paperwork lists diagnosis of Major Depression, and Bipolar disorder most recent episode depressed. Knowing what you know about his history and diagnostic precision, why is this inaccurate? -His history of psychosis means he is most likely to have schizophrenia - Lithium is only appropriate in treating mania, therefore MDD would not be accurate - Depression is either unipolar or bipolar, not both - Given his age it is more likely his symptoms are related to substance abuse Major difference between mania and Manic episodes last at least a week and have marked effect on hypomania based on DSM-5? functioning, hypomanic episodes are 4 days or less and do not typically have major effect on functioning - Manic episodes last at least a week and have marked effect on functioning, hypomanic episodes are 4 days or less and do not typically have major effect on functioning -Sleep is severely impacted with manic episodes . In hypomanic episodes sleep is generally not significantly impaired - Manic episodes typically require hospitalization, whereas hypomanic episodes do not - Manic episodes require use of lithium, hypomanic episodes are typically more responsive to 2nd generation antipsychotics Which method of suicide is guaranteed fatal? None. No method has been shown to be fatal 100% - None. No method has been shown to be fatal 100% True Scoring: - Lithium overdose 5 – 9 Mild, - Jumping off the Golden Gate bridge 10 – 14 Moderate, - Gunshot to the head 15 – 19 Moderately Severe , 20 – 27 Severe A PHQ-9 score of 21 suggests severe Depression T or F? Adult quiz questions What are some nonmodifiable risk factors for - Age, Gender, history of TBI suicide? - History of Bipolar, access to firearms - Access to treatment, uncontrolled pain - Age, Gender, history of TBI - Age, gender, access to fire arms The Star*D trial suggests which of the - All answers are correct following augmentation methods when first and second line antidepressants have failed? - levothyroxine - second generation antipsychotics - All answers are correct - Lithium According to 2018 CANMAT guidelines, Paliperidone (Invega) which medication would be considered first line in the treatment of acute mania in bipolar depression? - Paliperidone (Invega) - Bupropion - Haloperidol (Haldol) - Oxcarbazepine (Trileptal) 2018 CANMAT guidelines - Symptoms with Anxious distress - B bipolar Mixed features - B Manic episode, Depressive episode, both, Rapid cycling - I illness course Melancholic features -D Atypical features- D Anxious distress - psychotic features - B Mixed features - Catatonia - B Rapid cycling - Seasonal pattern - I Melancholic features - Remission- B Atypical featurespsychotic features Catatonia Seasonal pattern RemissionCANMAT -Mania - Lithium, Quetiapine, Divalproex, Asenaphine, Aripiprazole, 1st Line acute Mania - Paliperidone, Risperidone, Carprazaline. 2nd line - olanzapine - Bipolar - Lithium, lamotrigine, Trintellix 1st line agents for Bipolar Depression (2), - m/t bipolar - Lithium, Quetiapine, Divalproex, Asenaphine, Aripiprazole, M/T Bipolar Q and aripip w DVP LI Adult quiz questions CANMAT - Quetiapine Acute Bipolar 2 management- Which is not an A that would be assessed for Attitude with depression? -Anhedonia (Reduced motivation or reduced ability for pleasure) True -Avolition (lack of motivation) -Attitude -Apathy A patient with over 3 depressive episodes in his or her life has over a 90% chance of yet another depressive episode. T or F __________ is how a person feels internally; mood, affect whereas __________ is how one's feelings are expressed externally. Which personality disorder? Antisocial James is a 32 yo male with a history of trauma and violent behavior starting at age 10. As an adult, he has been in and out of legal trouble. He believes that the law is for people with a lower IQ than himself and that as a result, he is free to live his life however he chooses. He has been known to be abusive in relationships and feels that when women don't listen to him, it is justifiable to physically punish them. Which personality disorder? Carrie is a 21 year old female with a history of trauma and self injurious behavior. She struggles with chronic suicidal thoughts as well. She has struggled keeping jobs as she tends to angrily lash out whenever she feels overwhelmed. She has had numerous boyfriends as cannot tolerate men who are friends with other females. The few friends she has accuse her of being "bipolar." Adult quiz questions Borderline Which personality disorder? Narcissistic Dell is a 56 year old male small business owner. He often flies first class and eats at 4 star restaurants because he feels, as a business owner, that he belongs in an elite crowd. He frequently belittles others who don't agree with him or are "below him." He has been divorced x3 as he felt each wife was not aging gracefully enough to be by his side any longer. Discipline themselves to work diligently and ensure tasks are completed Obsessive-compulsive personality disorder accurately consuming too much time. Behavior highly polite and formal avoid showing emotions and uncomfortable around others showing emotion. Controlling, cant see or hear others ideas Adult quiz questions Which personality disorder? Scott is A forty-six year old Scott is the regional manager at a local paper company, where he has worked for the last fifteen years. There are no known medical conditions .He claims to be of English, Irish, German, Scottish, and Native American descent, though this is unconfirmed, and perhaps an exaggeration. The patient's outward appearance is well put together, as he presents as a business professional, Despite his seemingly composed demeanor, Scott displays exaggerated emotions and reactions. In addition to this, romantic relationships have proven turbulent as he goes from one relationship to the next with the other person usually being the one to end it. He has few close friends or relatives, and tends to perceive new friendships as closer than they actually are. Scott believes his subordinates to be his family, and often times gets involved in their personal lives without their consent. His parents divorced when he was young (age unknown), and he displays clear resentment towards his stepfather and sister, whom he once didn't talk to for fifteen years. Scott has a very close relationship with his mother now, though this was not case when he was a child. Though Scott seems to be lacking in managerial style, responsibility, and delegation, he demonstrates above average sales abilities due to his personable qualities. Scott does not have a history of drug or alcohol abuse, though he will drink in social situations and when pressured to do so by coworkers. Adult quiz questions Histrionic personality disorder What personality disorder? Dependent Personality Disorder Mona is 32 years old , she talks about her relationship with her partner, even though he is unstable financially, undecided on many aspects of life, has cheated on her and is all around not a good person she feels as if she cannot live without him. Although all of these aspects have been pointed out to her she can't face losing the relationship she has with him. Even though the relationship is one that is unhealthy for her Which statement is most true? Patients with personality disorders may benefit from meds that assist with -Patients with a personality disorder have a specific symptoms such as sleep poor prognosis due to lack of pharmacologic agents -Patients with personality disorders may benefit from meds that assist with specific symptoms such as sleep - Psychotropic medications are counter indicated in personality disorders because they can lead to dependence - Patients with personality disorders are often noncompliant with treatment therefore medications would be unsafe to use do to inconsistency Based on your knowledge of suicide risk Age 55yr, male, White, hx of depression which patient is at highest risk for suicide Gender- Male > Female -Age 55yr, female, divorced, obese Status - Single > Married -Age 55yr, female, latino, recent diagnosis of Dx- Increases with some med or psych -like Depression or chronic pain diabetes Behav - Increased risk with severe anxiety or impulsivity -Age 55yr, female, African American, trauma Substance use - increases with intox hx Family hx- increases risk esp w teens -Age 55yr, male, White, hx of depression What is the only FDA medication approved Clozapine (Clozaril) for suicide prevention with schizophrenia? False Mental illness is leading cause of gun violence in US? T or F It is impossible to predict who will become violent in a clinical setting? T or F Adult quiz questions False What are possible causes of aggression or All answers are correct agitation in ER? - A person with schizophrenia actively receiving command hallucinations - All answers are correct - A person under influence of PCP - A distraught mother who's son was just shot - An elderly patient with severe UTI An example of a chemical restraint would be True administering haloperidol 10 mg IM now in a 75 yr pt who becomes combative starting an IV? T or F A person with bulimia nervosa tends to be True average weight or overweight T or F? False Persons with Anorexia Nervosa define their worth through outward appearance where as True those with bulimia nervosa see food as comfort T or F Binging and purging behaviors occur with both anorexia and bulimia T or F Which of the following are less likely to occur Diabetes type 2 with anorexia or bulimia? Dental carries False Diabetes type 2 Mallory Weiss tear (Esophageal) Osteoporosis Morbid obesity is a diagnostic criteria for bulimia? T or F In addressing ADHD in adulthood the person False must have been diagnosed before 12 years of age? T or F Which of the following is not consistently seen with ADHD? - constantly losing keys - forgetting to pay bills - criminal behavior - constantly late for appointments Adult quiz questions criminal behavior It is within the PMHNP scope of practice to True address nicotine use disorder with patients who use nicotine? T or F False Is it beyond the PMHNP scope of practice to prescribe naloxone (Narcan) to those with opiate disorder without a DEA Waiver (X number). T or F Alcohol use disorder is definitively diagnosed False with lab work - hepatic enzymes, GGT, AST and ALT? T or F inpatient detox unit pt. He has hx alcohol use disorder, in detox, drinks 12-15 beers daily. Last drink 8 hours ago. CIWA score 15. Which med is best for symptom based protocol? Hydroxyzine 25-50 mg q2-4 hrs based on CIWA scores Acamprosate 333-666 mg TID PRN Lorazepam(Ativan) 2-4 mg q2-4 hrs based on CIWA scores Phenytoin (Dilantin 200mg tid prn based on CIWA scores Adult quiz questions Lorazepam(Ativan) 2-4 mg q2-4 hrs based on CIWA scores Nausea/vomiting (0 - 7) 0 - none; 1 - mild nausea ,no vomiting; 4 intermittent nausea; 7 - constant nausea , frequent dry heaves & vomiting. Tremors (0 - 7) 0 - no tremor; 1 - not visible but can be felt; 4 - moderate w/ arms extended; 7 - severe, even w/ arms not extended. Anxiety (0 - 7) 0 - none, at ease; 1 - mildly anxious; 4 - moderately anxious or guarded; 7 - equivalent to acute panic state Agitation (0 - 7) 0 - normal activity; 1 - somewhat normal activity; 4 moderately fidgety/restless; 7 - paces or constantly thrashes about Paroxysmal Sweats (0 - 7) 0 - no sweats; 1 - barely perceptible sweating, palms moist; 4 - beads of sweat obvious on forehead; 7 - drenching sweat Orientation (0 - 4) 0 - oriented; 1 - uncertain about date; 2 - disoriented to date by no more than 2 days; 3 - disoriented to date by > 2 days; 4 disoriented to place and / or person CIWA scale looks at: 9 things Tactile Disturbances (0 - 7) 0 - none; 1 - very mild itch, P&N, ,numbness; 2-mild itch, P&N, burning, numbness; 3 - moderate itch, P&N, burning ,numbness; 4 - moderate hallucinations; 5 - severe hallucinations; 6 – extremely severe hallucinations; 7 - continuous hallucinations Auditory Disturbances (0 - 7) 0 - not present; 1 - very mild harshness/ ability to startle; 2 - mild harshness, ability to startle; 3 - moderate harshness, ability to startle; 4 - moderate hallucinations; 5 severe hallucinations; 6 - extremely severe hallucinations; 7 continuous.hallucinations Visual Disturbances (0 - 7) 0 - not present; 1 - very mild sensitivity; 2 mild sensitivity; 3 - moderate sensitivity; 4 - moderate hallucinations; 5 severe hallucinations; 6 - extremely severe hallucinations; 7 - continuous hallucinations Headache (0 - 7) 0 - not present; 1 - very mild; 2 - mild; 3 moderate; 4 - moderately severe; 5 - severe; 6 - very severe; 7 extremely severe CIWA less than__________ is low risk CIWA > __________ is moderate risk and treat with ___________ CIWA > ____________ consider transfer to ICU Adult quiz questions CIWA <8 and Low Risk Monitor CIWA q shift for 2 days If CIWA >8, OR Moderate Risk Ativan stability, IF CIWA> 15 or High Risk Consider transfer to ICU What is an example of concordance in A patient chooses Celebrate Recovery as her support group to help with substance abuse treatment? sobriety -The nurse tells the patient he must agree to Vivitrol prior to being discharged for inpt unit -A patient chooses Celebrate Recovery as her support group to help with sobriety - The NP tells the pt attending AA groups is their only chance of staying sober -The NP restricts a patients smoking privilege's since won't attend a group Elevated vital signs, diaphoresis, tremors, Alcohol anxiety, and agitation are signs of acute ____________ withdrawl opioid flu-like illness, dysphoria, insomnia, pupillary dilation, piloerection, yawning, muscle aches, lacrimation, rhinorrhea, nausea, fever, sweating, vomiting and diarrhea are signs of ______________ withdrawl A college student completes AUDIT screen General education about the overall risks and reassess each visit and scores 3. What intervention might this score suggest? Alcohol Use Disorders Identification Test (AUDIT) A score of 8 or more is considered to. indicate hazardous or harmful - Immediate referral to substance specialist alcohol use. - General education about the overall risks and reassess each visit -Encourage inpatient detox immediately - Provide info on AA group Which of the following statements is true A person must not take any opiates while on it regarding oral Naltrexone( Revia)? Disulfiram (Antabuse)? Naltrexone - C Acamprosate (Campral) Disulfiram - A,D Acamprosate - B A. It will activate the enzyme aldehyde dehydrogenase, thereby causing violent reaction if combined with alcohol or opiates B. It requires TID dosing making compliance difficult C. A person must not take any opiates while on it D. Its purely aversion therapy Adult quiz questions How does methadone differ from Methadone is a long acting full agonist where as buprenorphine is a long buprenorphine? acting partial agonist - Methadone is only now used in detox centers and buprenorphine is meant for long term maintenance - Methadone is a long acting full agonist where as buprenorphine is a long acting partial agonist - Methadone is a long acting opioid where as buprenorphine is a long acting opioid antagonist - Methadone cannot be prescribed by NP, whereas buprenorphine can with X waiver What is an example of a risk reduction - Clean needle exchange strategy to combat the effects of opiate use in the community? -Drug free policy in homeless shelters - Enacting Casey's Law ie involuntary hospitalization for those with severe use - Clean needle exchange -Mandatory sentences for 1st time drug offenders What would not be an appropriate Topiramate (Topamax) medication to treat nicotine disorder? - Topiramate (Topamax) - Bupropion (Wellbutrin) - Nicotine replacement therapy - Varenicline (Chantix) Emotional. Feeling that one needs more and more of a substance to reach the same effect Psychological dependence is associated with numerous emotional and cognitive symptoms, Define psychological dependence Define physiological dependence Using more of drug to achieve same pleasurable result "High" Physical dependence is typically associated with the development of tolerance and withdrawal symptoms Using more drug to avoid withdrawl symptoms common signs of physical dependence is rapid weight loss, as well as digestive issues including diarrhea, loss of appetite, nausea, and stomach Adult quiz questions cramps. Cluster A personality disorders - not seen A. Schizotypal- wore gloves all the time often because doesn't disrupt B. Schizoid C. Paranoid Word bank - Paranoid, Schizoid, Schizotypal A. Odd, peculiar behavior, paranoid, social detachment, often pre schizophrenia B. Social detachment WITHOUT s/s or thought disorder or ASD C. Paranoia WITHOUT s/s of a thought disorder Blatant disregard for others - Ted Bundy antisocial personality disorder Exhibit ________________________________________ 3 or > Failure to conform to social norms Characteristics (5) Deceitful, lying, conning others Impulsive, irritable, aggressive to others Occurs since age of ______but diagnosis is Consistent irresponsibility given at __________ Lack of remorse >15 years evidence of ______________________ 15, 18 Conduct disorder - fire started, animal Can have traits without diagnosis! Will see a lot in practice. relationships self -Franic effort to avoid abandonment Borderline personality disorder - Disorder of _____________ and lack of _____________ other traits______% are woman versus men Can coexist with _______________ Rx- -Patterns of extremes in relationships (love/hate) - impulsive, self destructive behaviors - Recurrent SI or self injury behavior - affective instability/ extreme emotions - chronic emptiness - transient paranoia and dissociation - risky sexual behavior 75% PTSD, MDD and Bipolar DBT and symptoms Adult quiz questions -Uncomfortable if not the center of attn -Inappropriately seductive/ provocative Histrionic personality disorder Cluster __________ Characteristics - 5+ HPD looks alot like__________________ -Rapidly shifting/ shallow expression of emotions -Uses physical appearance to draw attn to self -Speech is impressionistic/ lacking in detail -Shows theatricality/exaggerated expression or emotion -Considers relationships to be more intimate than they are Borderline personality disorder In the DSM-5 postpartum depression has False unique diagnostic criteria that specifically Considered a qualifier to other mood disorders. Season affective distinguishes it from major depression. T or F? disorder is also in this category -Mood swings of at least 2 years duration. Numerous episodes of Define cyclothymic disorder Define dysthymic disorder hypomania and depressed moods. Symptoms are of insufficient severity or duration to meet the criteria for bipolar I or II disorder. - a low mood occurring for at least two years, along with at least two other symptoms of depression. -Other anxiety disorders , Personality disorders MDD (major depressive disorder) can coexist Substance use disorders (though screen for cause), Schizophrenia, Eating with ( 6 ) disorders, ADHD and cannot coexist with ( 3) - Bipolar disorder, Schizoaffective disorder Other unipolar mood disorders Difference in Bipolar 1 and 2 1 - Depression and mania Episodes of _____________________ and 2- Predominantly DPN and hypomania _______________________ Episodic Both are ___________________ 1- present and may include psychosis Mania ________________and _______________ psychosis 2- No full mania and no psychosis Remember Mania symptoms are ___________________ hypomania: a milder form of elevated mood that are less severe and hypomania vs mania define cause less impairment than full mania and (usually) don't require hospitalization Hypo mania episodes last__________________ 4 days or less Adult quiz questions Bipolar RX- Mood stabilizers, anticonvulsants, SGA's 1st line - Lithium Gold standard- Can be used with caution Use of antidepressants- ADHD: Facts and Statistics T up to 50% Genetic risk ? Frontal lobe and frontal-striatal abnormalities Impaired _______________ and _______________ (brain Dopamine and NE area) Transmitters affected __________ and ___________ A new patient arrives at the office for one medication is a CYP450 3A4 substrate and one is a CYP450 3A4 treatment for depression. The patient reports inhibitor. taking simvastatin (Zocor) and lisinopril (Zestril). When selecting an antidepressant, Fluoxetine is inhibitor the psychiatric-mental health nurse Most statins are substrates practitioner eliminates fluoxetine (Prozac), based on the knowledge that the combination can lead to increased plasma levels of the statin, resulting in an increased risk of muscle damage and rhabdomyolysis. The nurse practitioner's reason is that: - both medications are CYP450 3A4 inhibitors. - both medications are CYP450 3A4 substrates - one medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inducer. - one medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inhibitor. Laboratory findings for a patient with an increased MCV and elevated triglyceride levels. alcohol use disorder indicate increased liver function values and: Liver function values - AST > twice ALT GGT elevated - a decreased mean corpuscular volume (MCV) and normal triglyceride levels. - elevated potassium and chloride levels. -increased MCV and elevated triglyceride levels. - increased urine and serum creatinine levels. Adult quiz questions A 14-year-old patient has ... nonspecific complaints about pain in his or her legs. The physical examination is unremarkable. Laboratory results are within normal limits except for a markedly elevated alkaline phosphatase level. The psychiatric-mental health nurse practitioner: -interprets the findings as normally occurring during a rapid adolescent growth spurt. -obtains a rheumatoid profile because elevated alkaline phosphatase is a sign of early rheumatic fever. - orders a repeat blood test. - suspects that the patient has acute pancreatitis. During a mental status examination, an 18- a perceptual disturbance, and suspects the use of cocaine year-old patient reports feeling bugs crawling under the skin. The psychiatric- Hypnagogic hallucinations are imagined sensations that seem very real. mental health nurse practitioner documents They occur as a person is falling asleep, often with narcolepsy, may be this statement as: caused by Parkinson’s disease or schizophrenia. -a developmental disorder, and suspects cocaine use. hypnopompic describes the period when a person wakes up. -a hypnagogic hallucination, and suspects schizophrenia. - a hypnopompic hallucination, and suspects schizophrenia. -a perceptual disturbance, and suspects the use of cocaine. The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to: -analyze the data from epidemiological studies -conduct a root cause analysis. -interview patient families. -use a survey to elicit patient satisfaction responses. Adult quiz questions ... The psychiatric-mental health nurse ... practitioner evaluates a new adult patient via telemedicine. The patient has questions about a new medication that he or she recently started. The nurse practitioner decides to provide psychoeducation and to: -e-mail drug information and resources. -encourage the patient to seek information on the internet. -have a phone conference with a family member. -refer patient to a local primary care provider. Any court of law that evaluates the standards of care provided by the psychiatric-mental health nurse practitioner: -compares the actions to the standard of care provided by a psychiatrist. -considers what a reasonably prudent health care provider would do. -evaluates patient satisfaction data. -reviews the nurse practitioner's charts for similar patients. Adult quiz questions ... 8. The psychiatric-mental health ... nurse practitioner and a team of local mental health professionals are asked to provide crisis counseling service, after a gunman recently took a class hostage at a local elementary school, wounded several students, and then shot himself. In preparing for this assignment, the nurse practitioner recognizes that: -a child's developmental stage will influence his or her response to catastrophic stress. -a child's lack of an emotional response to a catastrophic event is a predictor of negative long-term consequences. -it is necessary for the child's guardian to be present. -the event is more important to the child than whether he or she suffered physical harm. A 32-year-old female patient informs the SSRIs are generally considered an option during pregnancy, including psychiatric-mental health nurse practitioner citalopram (Celexa) and sertraline (Zoloft). Potential complications that she is three months pregnant. She has include maternal weight changes and premature birth. Most studies show been stable on fluoxetine (Prozac) for the that SSRIs aren't associated with birth defects. last two years. The patient asks whether she may safely continue this medication during SNRIs also are considered an option during pregnancy, including her pregnancy. The nurse practitioner duloxetine (Cymbalta) and venlafaxine (Effexor XR). Bupropion responds: (Wellbutrin). isn't generally considered a first line treatment for depression during pregnancy, it might be an option for women who -"At this time, Prozac is safe for you to haven't responded to other medications. continue during your pregnancy. -"Cognitive-behavioral therapy has proven to Antidepressants that are considered safer include: be successful during pregnancy with no risk Fluoxetine (Prozac, Sarafem) to the fetus, so let's discontinue your Prozac." Citalopram (Celexa) -"Let's review the risks and benefits of Sertraline (Zoloft) continuing or discontinuing Prozac for you Amitriptyline (Elavil) and the fetus. Desipramine (Norpramin) -"This medication is unsafe for the fetus, so Nortriptyline (Pamelor) we'll wean you off this medication during your pregnancy." Adult quiz questions Established clinical guidelines suggest that DBT suicidality is decreased by treating patients who have borderline personality disorder with: A six-year-old patient with autism ... spectrum disorder has not responded to six months of psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The psychiatricmental health nurse practitioner prescribes: -carbamazepine (Tegretol) 200 mg once a day. -haloperidol (Haldol) 2 mg once a day -risperidone (Risperdal) 0.25 mg once a day. -venlafaxine ER (Effexor XR) 37.5 mg once a day. he psychiatric-mental health nurse practitioner uses a cognitivebehavioral approach to help a patient address self-defeating behaviors. After identifying the stressor that causes the inappropriate behavior, the initial strategy is to explore: -alternative positive responses to the stressor. -negative consequences of the responses to the stressor. -possible outcomes of alternative responses. -rational and irrational beliefs about the stressor. Adult quiz questions ... A patient who has borderline ... personality disorder experiences intense anxiety when the psychiatric-mental health nurse practitioner goes on vacation. The most appropriate explanation for this reaction is that the patient: -employs primitive idealization. -employs projective identification. -has not developed clear ego boundaries -has not developed object constancy. The psychiatric-mental health nurse practitioner sees a 12-year-old patient who takes lisdexamfetamine (Vyvanse) 50 mg daily for attentiondeficit hyperactivity disorder. The nurse practitioner observes a tic, which the parents report began after the patient began taking the psychostimulant, and it has been increasing in severity. Both the parents and the school report that the medication is helpful. The nurse practitioner: -continues the psychostimulant and has the parents and school observe the patient. - discontinues the psychostimulant, prescribes guanfacine extended release (Intuniv), and monitors the patient. -increases the dose of the psychostimulant and schedules a follow-up appointment in three months. -prescribes methylphenidate extended release (Vyvanse) on a dose appropriate for the patient's age and monitors the patient. ...
