Georgette Review Exams With Question And Answers

When many answers are remarkably similar, they are usually _____________ - correct answerswrong Interprofessional collaboration is encouraged. - correct answersCollaborate is usually right. Delegate is usually wrong. ADPIER - correct answersAssessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - correct answersNormal 0.6-1.2 Lithium toxicity occurs at levels - correct answers 1.5 Signs of Lithium toxicity - correct answerssevere nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - correct answersMANIA Lithium has evidence shown to - correct answersreduce suicidal ideation What does lithium cause in neonate, especially 1st trimester - correct answersEbstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - correct answersrise Baseline labs before initiation of lithium - correct answersTSH creatinine (0.6-1.2) BUN (10-20) HCG (all psychotropics females 12-51) EKG 50+ Urinalysis (check for proteins, 4+ may indicate kidney disease) Side Effects of Lithium - correct answershypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - correct answersstaying hydrated avoiding NSAIDS compliance Depakote normal level - correct answers50-125 Depakote toxicity level - correct answersgreater than 150 Teratogenic effects of Depakote - correct answersspina bifida Adverse effects of depakote - correct answersalopecia hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue Signs of Depakote toxicity - correct answersdisorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity - correct answersDC med check level LFT ammonia MAOI + tyramine causes - correct answershypertensive crisis Symptoms of hypertensive crisis - correct answerselevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + - correct answersMEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds Treatment for hypertensive crisis - correct answersDC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos - correct answersfloppy baby, cleft palate Teratogenic effects of tegratol - correct answersneural tube defect teratogenic effects of lithium - correct answersebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote - correct answersneural tube defects/spina bifida Adverse reaction to Lamictal - correct answersSteven Johnson's Syndrome Signs of SJS - correct answersFEVER --high yield sore throat facial swelling tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause - correct answerssedation or weight gain Carbamazepine (tegretol) black box warning - correct answersagranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians - correct answersScreen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women - correct answerscheck for pregnancy before starting mood stabilizer start on folic acid to support neural tube development during the first month that a woman is pregnant Clozaril/clozapine can cause - correct answersagranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor - correct answersANC DC clozarli if ANC - correct answersless than 1000 DC clozaril if WBC - correct answers, risk of agranulocytosis When on clozaril monitor for - correct answerssigns and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to - correct answersdecrease risk of suicide in patients with schizophrenia. Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond? A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval - correct answersAnswer: Lithium can invert the t waves. Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDS C. Methylphenidate D. Acetaminophen - correct answersAnswer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1,000 C. WBC less than 5,000 D. ANC less than 2000 - correct answersAnswer: ANC less than 1000 If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate - correct answersA. Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal - correct answersA. Carbamazepine Bulimia, weight is ___________ - correct answerswithin the normal range. Pharm treatment for bulimia - correct answersFluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa - correct answerslow BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - correct answersthere is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands - correct answersLow BMI If a patient is depression, low energy, fatigued, you would prescribe - correct answersWellbutrin Wellbutrin is contraindicated in patients with - correct answersseizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) - correct answersbupropion CLozaril is metabolized by - correct answerscytochrome P450 enzyme CYP1A2 INducers - correct answersinduce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - correct answersdecrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage - correct answersBarbituates St. Johns Wart Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need ___________doses of their medication. - correct answershigher Inhibitors - correct answersinhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors - correct answersSodium valproate Isoniazid Cimetidine Ketoconazole Alcohol Chloramphenicol Erythromycin Sulfonamine Cipro Omeprazole Metronidazole Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine a. 2D6 b. 1A2 c. 2C19 d. 2C9 - correct answers1A2 (want A 2 cigarette break) When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration - correct answersDecreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium D. Decreased renal clearance of lithium - correct answersA. decreased renal clearance of lithium Where is norepinephrine produced - correct answerslocus coeruleus and medullary reticular formation Norepinephrine is associated with - correct answersmood disorders Serotonin is made where in the brain - correct answersraphe nuclei of the brainsteam Serotonin is associated with - correct answerssleep and mood disorder Dopamine is made in - correct answerssubstantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with - correct answersaddiction and psychosis Acetylcholine is made - correct answersbasal nucleus of Meynert Most abundant inhibitory neurotransmitter in the brain - correct answersGABA I don't have enough GABA, my anxiety is high Med used to increase GABA - correct answersbenzos Fred flinstone needs a Zanny, Gabba dabba do. Most excitatory neutransmitter - correct answersglutamate Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus - correct answersincreases symptoms of anxiety. Autism - correct answersdeficits in social communication and social interaction across multiple settings Parents of kids with autism may report - correct answersNo response when called by name Little or no eye contact Children with autism often like to line up, stack, or organize objects and toys. Screenings for autism - correct answersADOS M-CHAT ASQ Pharm management for autism - correct answersantipsychotics are effective for symptoms such as tantrums, aggressive behaviors, self-injurious behaviors Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons? A. raphe nuclei B. Nucleus acumbuns C. Locus coeruleus D. Amygdala - correct answersraphe nuclei Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality - correct answersfrontal lobe memory, understanding, language - correct answerstemporal lobe Both hemispheres of the brain are connected by the - correct answerscorpus callosum Area of sensorimotor information exchange between two hemispheres - correct answerscorpus callosum When there is disturbances in clock drawing test, which hemisphere is compromised - correct answersright hemisphere/right parietal lobe Area for expressive speech - correct answersfrontal lobe Broca's Area Problems in the frontal lobe can lead to - correct answerspersonality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension - correct answersTemporal lobe Wernicke's area Problems in the temporal lobe can lead to - correct answersauditory hallucinations, aphasia, and amnesia Occipital lobe - correct answersprimary visual area problems in the occipital lobe can lead to - correct answersVisual field deficits, blindness and visual hallucinations. primary sensory area of the brain - correct answersparietal lobe problems in the parietal lobe can lead to - correct answersSensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) Cerebellum is responsible for - correct answersgross motor skills fine motor skills balance A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the A. frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe - correct answersfrontal lobe Impairments in the clock drawing test can be associated with - correct answersdamage to the right parietal lobe What part of the brain is responsible for regulating emotions? A. Wernicke's area B. Occipital lobe C. Hippocampus D. Parietal lobe - correct answersHippocampus Limbic system responsible for - correct answersemotions and memory Hypothalamus - correct answersappetite, hunger, water balance, circadian rhythms, libido, hormonal regulation thalamus - correct answerssensory relay for smell emotions, memory, and regulated affective behaviors amygdala - correct answersregulated emotion mediates mood emotional memories/meanings, fear, anxiety, stress emotion, aggression substantia nigra - correct answersmotor movements amygdala= - correct answersemotional memory