PMHNP certification Exam 22 (Solved 100% Correctly) Updated

PMHNP certification Exam 22 (Solved 100% Correctly) Updated Which patient is at highest risk for SI A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of a bank *2 risk factors D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors COWS scale components · Opioid W/D Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (gooseflesh skin), insomnia What does COWS stand for? Clinical Opiate Withdrawal Scale What does CIWA stand for? Clinical Institute Withdrawal Assessment What does CIWA assess for? --used to determine likelihood of ETOH withdrawal or DTs --usually occur within the first 24-72 hours after cessation o used to determine when to administer medications for ETOH withdrawal What does CIWA NOT test for? Alcohol Use Disorder What are the CIWA scale components? · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, H/A, orientation Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)-4 (disoriented) Score: <10: Very mild Start PRN meds at score of 8 >10 to 15: Mild scheduled + PRN meds >16 to 20: Moderate >21: Severe Diazepam, Librium, Ativan When interview teenagers (16 y/o) that arrive with their parents what should you do? interview them separately from parents. -This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child. Which Ethnic group has the highest rate of suicide? Native Americans Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? A. Increased waist circumference B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism C. Increased Lipids D. Metabolic Syndrome D. Metabolic Syndrome (UMBRELLA ANSWER) Which antipsychotics have the least weight gain? Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY Which mood stabilizer have the least weight gain? Lamictal -But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a atypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus Hypothalamus A, B, & D are all part of the limbic system so you can rule that out When a patient is hesitant to participate in treatment you should encourage? Bring a support person like a husband Thyroid-Stimulating hormone normal level 0.5-5.0 Mu/L When T4 and T3 are high and TSH is low what is the diagnosis HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE Key symptoms of Heat Intolerance Hyperthyroidism When T4 and T3 are Low and TSH is high what is the diagnosis (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE Key symptoms of Cold Intolerance Hypothyroidism Hyperthyroid can mimic Mania Hypothyroid can mimic Depression A patient on depakote complains of RUQ pain and has reddish/brown urine Hepatoxicity -Check LFTs Signs of Depakote toxicity Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? Check -LFT -Ammonia -Depakote Level What herbal supplement can cause hepatoxicity? Kava Kava When taking Kava Kava in combinations with other medications you should caution about Risk of Hepatoxicity and Sedation TCAs carry a risk of Hepatotoxicity Signs of Stevens-Johnson Syndrome -fever, mouth pain, swelling, burning eyes, blisters, skin pain two psychotropics known to cause steven johnson syndrome lamictal and tegretol What nationality is most suseptible of getting steven johnson? Asians When treating asians with tegretol screen for? HLAB-1502 Allele What two medications cause agranulocytosis? Clozaril & Tegretol Agranulocytosis when to discontinue medication Less than 1000 When monitoring for agranulocytosis in patients look for s/s of what? Infection -Fever, sore throat, fatigue, chills Before starting any mood stabilizer in a female of childbearing age be sure to check? HCG Which two medications may decrease the risk of suicide? clozaril and lithium Medications that increase lithium level NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril Ace inhibitors are treatment of choice for? Heart Failure Certain medications are known to increase lithium level, but HOW? by reducing renal clearance When educating a patient about lithium teach them about Hyponatremia Dehydration-hot days, exercise Normal Lithium Level 0.6-1.2 per Quie Lithium Toxicity 1.5 or above Discontinue and re-order lithium level Lithium level of 1.4 Monitor for toxicity Labs before starting lithium TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment) 4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects "LITHIUM GI" L-Leukocytosis I-inverted t-waves T-tremors of the hand (fine)/teratogenic Ebstein's H-hypothroidism IU-Increased Urination M-maculopapular rash GI- GI upset (nausea, vomiting, anorexia) Signs of lithium toxicity confusion, ataxia, severe GI upset, palpitation, coarse hand tremor, slurred speech, metallic taste in mouth NMS is caused by "think 'Antipsychotics'"; usually Atypicals NMS “NMS is like S&M” o First Sx: -You get a lil crazy (altered LOC) -you get hot (hyperpyrexia) and stiff (extreme muscle rigidity) o Then: -You get sweaty (diaphoresis) -Your BP goes up or down, and your pulse and respirations go up (Autonomic instability) -You’re speechless (mutism) & -you start to drool increased CPK (caused by muscle contraction and muscle destruction), increased WBC, myoglobinuria (also from muscle destruction) Cherry colored urine in a patient that exercises a lot test for myoglobinuria may be a sign of rhabdo Serotonin Syndrome is caused by "think 'antidepressants'" anything that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) to excess levels Treatment for NMS