PMHNP Georgette Exam Review Questions with complete solutions

When many answers are remarkably similar, they are usually _____________ - wrong Interprofessional collaboration is encouraged. - Collaborate is usually right. Delegate is usually wrong. ADPIER - Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - Normal 0.6-1.2 Lithium toxicity occurs at levels - > 1.5 Signs of Lithium toxicity - severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - MANIA Lithium has evidence shown to - reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester - Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - rise Baseline labs before initiation of lithium - TSH 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 - hypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - staying hydrated avoiding NSAIDS compliance Depakote normal level - 50-125 Depakote toxicity level - greater than 150 Teratogenic effects of Depakote - spina bifida Adverse effects of depakote - alopecia 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 - disorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity - DC med check level LFT ammonia MAOI + tyramine causes - hypertensive crisis Symptoms of hypertensive crisis - elevated BP sudden explosive like headache facial flushing palpitations pupillary dilatio