GEORGETTE REVIEW PMHNP WITH CORRECT QUESTIONS AND ANSWERS

GEORGETTE REVIEW PMHNP WITH
CORRECT QUESTIONS AND
ANSWERS
When6many6answers6are6remarkably6similar,6they6are6usually6_____________6-
6answer-wrong

Interprofessional6collaboration6is6encouraged.6-6answer-
Collaborate6is6usually6right.6
Delegate6is6usually6wrong.

ADPIER6-6answer-
Assessment,6diagnosis,6Plan,6intervention,6evaluate,6refer6out6last.

Lithium6-6answer-Normal60.6-1.2

Lithium6toxicity6occurs6at6levels6-6answer->61.5

Signs6of6Lithium6toxicity6-6answer-
severe6nausea,6diarrhea,6vomiting,6confusion,6drowsiness,6muscle6weakness,6heart
6palpitation,6coarse6hand6tremors,6unsteady6gait

Lithium6is6gold6standard6for6-6answer-MANIA

Lithium6has6evidence6shown6to6-6answer-reduce6suicidal6ideation

What6does6lithium6cause6in6neonate,6especially61st6trimester6-6answer-
Ebstein6anomaly6(congenital6heart6defect)

dehydration6and6hyponatremia6cause6lithium6levels6to6-6answer-rise

Baseline6labs6before6initiation6of6lithium6-6answer-TSH
creatinine6(0.6-1.2)
BUN6(10-20)
HCG6(all6psychotropics6females612-51)
EKG650+
Urinalysis6(check6for6proteins,64+6may6indicate6kidney6disease)

Side6Effects6of6Lithium6-6answer-hypothyroidism
coase6hand6tremors6with6toxicity
maculopapular6rash
diarrhea,6vomiting,6cramps--signs6of6toxicity.6Monitor6closely.6

,anorexia
t6wave6inversions
leukocytosis

Pt6education6for6lithimum6-6answer-staying6hydrated
avoiding6NSAIDS
compliance

Depakote6normal6level6-6answer-50-125

Depakote6toxicity6level6-6answer-greater6than6150

Teratogenic6effects6of6Depakote6-6answer-spina6bifida

Adverse6effects6of6depakote6-6answer-alopecia
hepatotoxicity6(RUQ6pain6or6brown/red6urine--order6LFTs)6AST65-40,6ALT65-
35,6yellowing6of6skin6or6eyes,6fatigue

Signs6of6Depakote6toxicity6-6answer-
disorientation,6lethargy,6respiratory6depression,6nausea/vomiting

Intervention6for6depakote6toxicity6-6answer-DC6med
check6level
LFT
ammonia

MAOI6+6tyramine6causes6-6answer-hypertensive6crisis

Symptoms6of6hypertensive6crisis6-6answer-elevated6BP
sudden6explosive6like6headache
facial6flushing
palpitations
pupillary6dilation
diaphoresis
fever

Hypertensive6crisis6occurs6with6MAOI6+6-6answer-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St.6John's6wart
L-tryptophan
asthma6meds

Treatment6for6hypertensive6crisis6-6answer-DC6offending6agent

,Administer6PHENTOLAMINE

Teratogenic6effects6of6benzos6-6answer-floppy6baby,6cleft6palate

Teratogenic6effects6of6tegratol6-6answer-neural6tube6defect

teratogenic6effects6of6lithium6-6answer-
ebstein6anomaly6(heart6defect)6(avoid,6especially61st6trimester)

teratogenic6effects6of6depakote6-6answer-neural6tube6defects/spina6bifida

Adverse6reaction6to6Lamictal6-6answer-Steven6Johnson's6Syndrome

Signs6of6SJS6-6answer-FEVER6--high6yield
sore6throat
facial6swelling
tongue6swelling
red6rash
skin6sloughing
body6aches
prodromal6headache
malaise
arthralgia
painful6mucus6membranes

Lamotrigine6is6least6likely6to6cause6-6answer-sedation6or6weight6gain

Carbamazepine6(tegretol)6black6box6warning6-6answer-
agranulocytosis6(decrease6WBCs)
aplastic6anemia6(pallor,6fatigue,6HA,6fever,6nosebleeds,6bleeding6gums,6skin6rash,
6SOA)

Carbamazepine6and6asians6-6answer-Screen6for6HLAB-
15026allele6before6initiating,6due6to6high6incidence6of6SJS6if6positive6for6allele.

Child-bearing6aged6women6-6answer-
check6for6pregnancy6before6starting6mood6stabilizer
start6on6folic6acid6to6support6neural6tube6development6during6the6first6month6that
6a6woman6is6pregnant

Clozaril/clozapine6can6cause6-6answer-agranulocytosis6and6neutropenia

For6monitoring6neutropenia6in6Clozaril,6monitor6-6answer-ANC

DC6clozarli6if6ANC6-6answer-less6than61000

, DC6clozaril6if6WBC6-6answer-2000-3000,6risk6of6agranulocytosis

When6on6clozaril6monitor6for6-6answer-
signs6and6symptoms6of6infection:6sudden6fever,6chills,6sore6throat,6weakness

Clozaril6only6known6antipsychotic6to6-6answer-
decrease6risk6of6suicide6in6patients6with6schizophrenia.

Your6patient6with6bipolar6disorder6is6admitted6to6a6medical6hospital.6The6internist
6contacts6your6office6and6asks6whether6the6lithium6you6prescribed6him6is6effectin
g6his6ECG.6How6do6you6respond?
A.6Lithium6can6prolong6the6QT6interval
B.6Lithium6has6no6effect6on6his6ECG
C.6Lithium6can6invert6the6t6waves
D.6Lithium6can6shorten6the6PR6interval6-6answer-
Answer:6Lithium6can6invert6the6t6waves.

Mary6is6a645-year-
old6African6American6female6who6has6been6treated6on6Isocarboxazid6(Marplan)6fo
r6over666years.6Mary6is6going6in6for6a6surgical6procedure.6Which6medication6is6s
trictly6contraindicated6with6Isocarboxazid?
A.6Morphine
B.6NSAIDS
C.6Methylphenidate
D.6Acetaminophen6-6answer-Answer:6Methylphenidate

You6are6treating6a6client6with6schizophrenia6who6takes6clozapine.6What6lab6value
s6will6indicate6the6client6needs6to6discontinue6treatment?
A.6WBC6less6than618006and6ANC6less6than61200
B.6ANC6less6than61,000
C.6WBC6less6than65,000
D.6ANC6less6than620006-6answer-Answer:6ANC6less6than61000

If6given6during6pregnancy,6socium6valproate6can6cause6which6of6the6following6me
dical6problems6in6the6baby?
A.6SJS
B.6Ebstein's6anomaly
C.6Spina6bifida
D.6Cleft6palate6-6answer-A.6Spina6bifida

Which6mood6stabilizer6is6associated6with6potential6life-
threatening6rash6in6the6Asian6population?
A.6Carbamazepine6(tegretol)
B.6Depakote
C.6Lithium
D.6Lamictal6-6answer-A.6Carbamazepine