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Psychiatric Nurse Practitioner
Assessment Questions with Answers
latest 2025
Explain the clinical signifcance of the Stystematic Treatment Enhancement Program for Bipolar Disorder: STEP-BD) ✔ As more contempts are tried with SSRIs to relieve depressive symptoms, the client becomes more treatment resistant leading to poor outcomes. Explain the clinical significance of the Sequenced Treatment Alternative to Relieve Depression STAR D ✔ Strong behavioral therapy combined with medications lead to 30% better outcomes as compared to monotherapy or medication or therapy alone. Describe the mechanism of action of Typical Antipsychotics ✔ Blocking D2 receptors in the mesolimbic and mesocortical The Blocking D2 receptors in the mesolimbic and mesocortical tract ✔ tract reducing positive symptoms of psychosis, does effect the negative symptoms of the disorder, can create EPS symptoms in the nigro-striatal tract, Nigrostriatal ✔ involved with muscular movement Mesolimbic ✔ source of visual hallucinations and auditory hallucinations, Mesocortical ✔ mesocortical area holds affective symptoms, Blocking Alpha 1 adrenergic receptors through down regulation causing orthostatic hypotention ✔ Pharmacological strategies in addressing EPS symptoms ✔ Change medication Lower the dose Prescribe cogentin Second generation antipsychotics are pharmacology directed to ✔ blocking both D2 and 5HT receptors in the brain and also relieve the negative symptoms of psychosi
down regulation blocking Alpha! receptors ✔ Orthostatic hypotension and dizziness which comes down regulation of blocking Muscarinic and Histamine receptors ✔ Weight gain, dizziness serontin down regulation in the gut ✔ constipation Neuroleptic malignant syndrome ✔ cause by increased medication changes or treatment naive patients What are notable side effects of Clozapine ✔ Induced by cigarette smoking which is through the 1A2 pathway Recommended dosing schedule for clozapine ✔ Start at 12.5 first day, then in divide doses of 25-50 mg/day up to 300-400 mg per day. Clozapine maxes ✔ Maximum dose is 900 mg per day. No single dose should exceed 450 mg Clozapine monitoring ✔ Need to register at the clozapine website as a provider Normal levels of WBCs > 3500 Normal levels of ANC > 2000 wbc ✔ WBC with differentials, Absolute Neutrophil Count Blood draws are done weekly for the first 6 months, then every other week for 6 months, then monthly Notable side effects of Risperidone ✔ Increase risk of seizure Contraindicated for pregnancy Increased prolactin Metabolic syndrome diagnostic criteria ✔ Combination of any three of the following Abdominal circumference > 37 in males > 31.5 in femaies Plus any two of the following: Elevated Triglycerides > 150 mg/dl
Sertraline (Zoloft) ✔ Dose dependent, need to increase the dose Venlafaxine ✔ Elevated blood pressure Signs and symptoms of serotonin syndrome ✔ High serotonin levels can cause agitation, confusion, hallucinations, tachycardia, fever, anxiety, muscle rigidity, hyperreflexia, tremors, diarrha, hypo/hypertension Treatment for Serontonin Syndrome ✔ Withdraw from the SSRI, Stabilizing temperature, Use benzodiazepines for muscle relaxation, Beta-blocker for the tachycardia Notable side effects of Lithium ✔ Muscle weakness, tiredness, slurred speech, fine hand tremor, thirst nausea, diarrhea / vomiting Maintenance value for Lithium is ✔ 0.8 to 1. When do you check the Lithium level ✔ Check serum level 12 hours after the last dose and after 5 days of steady dosing. What antipsychotic can not be used with Lithium ✔ Haldol, linked to mild encaphalopathy and mimics NMS Lithium is contraindicted in pregnancy- why ✔ causes Epstein anomaly, heart defect in the fetus Depakote is contraindicted in pregnancy- why ✔ Birth defects: spina bifida are found in this medication What over the counter pain relievers can be used with lithium ✔ aspirin and tylenol What over the counter pain reliever is contraindicated
✔ ibuprofen What diuretic should be avoided with the use of the Lithium ✔ Thiazides, but all diuretics should be monitored closely due to risk of toxicity What heart medicines are contraindicated with lithium ✔ calcium channel blocker are contraindicated with this mood stabilizer Notable side effect of depakote ✔ hair loss, alopecia ADHD medication targets ✔ accelerating "slow rate behaviors" such as paying attention and sitting still, Blocks the reuptake of the dopamine Stress Diathesis Model ✔ vulnerability, inheritted vulnerability when acted on by a stressor produces the disease/dysfunction Criteria for Generalized Anxiety Disorder (GAD) ✔ Present more days than not for 6 months Must have 3 or more symptoms causes impairment Criteria for Panic Disorder ✔ Intense state, must have at least 4 of the symptoms: "I am going to die" palpatations, need to rule out a heart condition Phobias criteria ✔ intense, irrational, avoidance is persistent last 6 months, fear is out of proportion to the situation Obsessive/compulsive Disorder critieria ✔ Presence of obsessions, compulsions, or both, body dysmorphic falls into this category Major Depression stats ✔ Present in 3-5% of the population, Affects women more than men, Affects women when menstruating, Higher incidence in lower economic status, Single and divorced individuals Bipolar stats
Increase risk of affective episodes such as mania or hypomania Define the discontinuation phase of Depression treatment ✔ 12 months or longer with no symptoms before discontinuing medication What group poses the greatest risk for suicide? ✔ Bipolar disorder Bipolar I prevalence in the population ✔ 1%-1.5% of the population and is equal among men and women Bipolar II prevalence in the population ✔ 0.5% of the population and is predominately female Define a manic episode ✔ distinct period last 7 days and hospitalization is necessary, STOP LISTENING HERE ✔ STOP LISTENING HERE Define a hypo-manic episode ✔ distinct period lasting 4 days, does not require hospitalization, but may be indicative of a mood disorder Defining factor of Bipolar II ✔ at least one hypomaniac episode Lithium bipolar profile ✔ Indicated for mania Lithium dosage 200-2400 mg/day Takes 5-10 days Blood level acute (0.8-1.5) Blood level maintenance (0.6-1.2) watch for side effects Valproic Acid (Depakene) / Divalproex (Depakote) bipolar profile ✔ Often used in addition to lithium Side effects are hair loss (use zinc and selenium supplements) Lamotrigine bipolar profile ✔ Typically given in dose packs when titrating Depakote interactions: the lamotrigine raises the level of depakote, do not exceed 200 mg of depakote, this should be avoided
Indicated for managing depression lamictal ✔ 10% incidence of rash and can develop into Stevens-Johnson Syndrome 20% of the Asian population contain a gene that cannot metabolize this drug effectively, genetic testing is required Anorexia prevalence in the population is: ✔ 0.9% and is more female than male 9:1, age of onset is 12 to 16 years of age (puberty) Hallmark features of anorexia ✔ starvation, amenorrhea is common but a diagnostic, can vomit and laxatives, but the main way is through starvation Bulemia hallmark feature ✔ use of vomiting an laxatives to control the weight is the primary way of weight loss rathar than restricting Personality disorders At least once a week for 3 months Metabolic syndrome in labs results Binge eating disorder hallmark feature ✔ Similar symptoms of other eating disorders but lack the vomiting or laxative to control the weight. The client is often over weight At least two binge episodes per week for 3 months Labs for eating disorder ✔ Fluid and electrolyte imbalances Inflammation ESR Cardiac (low potassium) leading cause of death TSH imbalance Low sodium in bulemia Chloride (up in bulemia) CO2 is down Eating Disorder treatment in acute ✔ Restore electrolye balance Correct body disturbance
Rating scales and assessment for Psychotic Disorder ✔ Brief Psychiatric Rating scale Positive and Negative Symptoms Scale Content of Thought regarding psychosis ✔ Delusions Religiosity Paranoia Magical thinking: posses magical powers Form of thought regarding pyschosis: terms ✔ Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms ✔ Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense cont ✔ Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms ✔ Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality Tagnentiality Mutism
Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms ✔ Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms ✔ Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms ✔ Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Characterisitics of Persons with MI who are risk for chronicity ✔ Schizophrenia 90% Unipolar depression 20% Bipolar depression 40% Dementia: 100% Factors of non-adherence of the SMI populationAss
Assessment for Dementia tools ✔ Mini-mental state examination Brief Interview for Mental Status Montreal Cognive Assessment Alzheimer's disease stage ✔ Stage 1: forgetfulness Stage 2: confusion, personality changes Stage 3: disconnect, wandering Stage 4: End stage, unable to eat, walk, talk (safety a concern) In the psycho-social assessment for dementia/AD patients what is the important facet of the assessment ✔ Safety Cultural competency ✔ Beware of jewelry and dress: may have meaning Acknowledge the inclusion of elders and non-family members who are important to the client If refusing services: need to determine if there is competent and literate Beaware of eye contact: non-direct eye contact may be a form of respect The importance of the therapeutic communication: key element ✔ listening focus on feelings Never ask "why", tell me more Be direct and kind, no euphemisms, piercing of the truth but with sensitivity, not "passed on" The components of the Healthcare directive ✔ Type of advance directive that may include a living will/and not specification regarding durable power of attorney in one or two separate documents Components of crisis intervention ✔ ensure saftety and boundaries establish trust and rapport in communication: acknowledge feelings, show empathy HIPPA title I ✔ protects health insurance coverage for workers and their families when they lose their jobs. Coverage under COBRA for 18 months
HIPPA title 2 ✔ establishment of safe electronic transactions protect PHI Covered identities: covers most providers and big data The privacy rule: Patient rights ✔ They have right to see their chart Have a right to make changes in their chart May receive notice if the information is shared Can receive a report who/what information with Can file a complaint if their rights are not being followed Examples of those not required to follow HIPAA ✔ Life insurers Employers Workers compensation carriers schools and school districts state agencies like child protective service agencies law enforcement agencies municipal offices Confidentiality vs. Duty to Warn ✔ The duty to warn supersedes the right to confidentiality if a patient's condition may endanger others The duty to protect a patient from harming him/herself supersedes the right to confidentiality Reportable diagnoses DHHS ✔ Gonorrhea Chlamydia Syphilis HIV TB Animal bites (Animal control) Suspected or actual child or elder abuse (call social services) Domestic violence is not legally reportable Overarching goals of Healthy People 2020 ✔ Increase the quality and years of healthy life Eliminate health disparities among Americans Medicare Part A
Definition of "incident to" billing ✔ When billing a physician's service, a practice may be reimbursed 100% of the physician fee schedule integral part of the physician's professional service commonly rendered and provided in the office Physician establishes care, NP follows up Physician is in the office at the time and immediately available "incident to" billing is not allowed in a hospital setting An assistant to the NP can be reimbursed such as EKG Which reimbursement form differs from state to state ✔ Medicaid Purpose of case management ✔ Mobilize, monitor, and control resources that a patient uses during a course of an illness while balancing quality and cost Quality Assurance, Improvement, continuous process improvement ✔ improve care continuously monitoring structure, process, and outcome standards Root cause analysis defintion ✔ a tool to identify prevention stategies to ensure safety the process is build a cutlure of safety and move beyond the culture of blame Need to identify the changes and be impartial as possible Sentinel Events ✔ Unexpected occurrences involving death or serious physical or psychological injury or risk signal need for immediate investipation sentinel events and medical error are not the same, not all sentinel events occur because of an error and not errors result in a sentinel event need to conduct a root cause analysis NP scope of practice is defined by ✔ the State Nurse Practice Act
guidelines varies from state to state NP standards of Professional Nursing Practice ✔ American Nurses Association: defines standards of professional nursing practrice NP prescriptive authority ✔ state practice act dictates the prescriptive authority and dictate the level of prescriptive authority allowed NP credentialing ✔ The LACE consensus model: Licensure Accreditation Certification Education establish minimal levels of acceptable performance It ensure the safe healthcare of qualified individuals Mandates accountability Medical futility defintion and what two types ✔ Refers to interventions that are unlikely to produce any significant benefit for the patient quantitative futility: where the likelihood that an intervention will benefit the patient is extremely poor qualitative futility: where the quality of benefit an intervention will produce is extremely poor What are the components of informed consent ✔ Competence: implies to the ability to understand, reason, differentiate good and bad, and communicate Informed consent: received adequate instruction or information regarding aspects of care Includes all risks and benefits of the procedure Right to refuse care: Types of mental health consultation ✔ Client centered consultation: develop plan to deal with client Consultee-centered case consultation: remediate work-related difficulty brought up by consultee Program-centered administrative consultation: developing a program
Experimental study definition: ✔ manipulates the variables control group exists typically a randomized control group Non-experimental study: two types ✔ descriptive research ex post facto Cross sectional study definition ✔ a survey examines a relationship of a population in a point of time Cohort study definition ✔ study a group of people over time Experimental study ✔ randomization and control group, Quasi experiment study definition ✔ lacks randomization or control group or both Qualitative study definition ✔ open ended inquiry, field studies, participant observation Confidence interval definition ✔ an estimated rnage that predicts the probability of including a specific parameter, small confidence interval implies a very precise range of values Standard deviation defintion ✔ indicates the average amount of deviation of values from the mean. the data aggregates in a specific range Level of significance definition ✔ p value: the probability level of which the results of statistcal analyses are judged to indicate a statistically significant difference between groups Null hypothesis definition ✔ There is no difference if the intervention is effective Rejecting the null hypothesis ✔ that is a coorelation between the outcomes and the intervention
Correlation coefficient definition ✔ a measre of the interdependce of two random variables that ranges in value from - to 1 -1 indicates that there is an inverse relationship 0 indicates an absence of correlation 1 indicates a perfect positive correlation T test definition ✔ statistical test to evaluate the differences in means between two groups Reliability definition ✔ the consistency of measurement or the degree to which an instrument measures the same way over time with the same objects,. Reliability is tested in two ways ✔ Test./Retest: Internal consistency: cronbach's alpha, closer the number is to 1, the higher the reliability of the instrument The major different between test/retest and internal consistency is ✔ estimates of reliability that test/retest involves two administrations of the measurement instrument, whereas the internal consistency method involves only one Validity ✔ the degree to which a study measures what it is intended to measure Internal validity ✔ treatment with an independent variable led to outcome (dependent variable) External validity ✔ the generalizability of the results Cultural considerations: African Americans ✔ religious rituals are valued, the minister Save the medications when not feeling better Elements of Crisis ✔ Disorganization occurs Emergency methods of problem solving continue to be ineffective Requires a new solution Situational Crisis definition ✔ arises from external events can happen from
