GEORGETTE REVIEW PMHNP WITH
CORRECT QUESTIONS AND
ANSWERS
When many answers are remarkably similar, they are usually _____________ - answer-
wrong
Interprofessional collaboration is encouraged. - answer-Collaborate is usually right.
Delegate is usually wrong.
ADPIER - answer-Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - answer-Normal 0.6-1.2
Lithium toxicity occurs at levels - answer-> 1.5
Signs of Lithium toxicity - answer-severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - answer-MANIA
Lithium has evidence shown to - answer-reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - answer-Ebstein anomaly
(congenital heart defect)
dehydration and hyponatremia cause lithium levels to - answer-rise
Baseline labs before initiation of lithium - answer-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 - answer-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 - answer-staying hydrated
avoiding NSAIDS
compliance
Depakote normal level - answer-50-125
Depakote toxicity level - answer-greater than 150
Teratogenic effects of Depakote - answer-spina bifida
Adverse effects of depakote - answer-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 - answer-disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity - answer-DC med
check level
LFT
ammonia
MAOI + tyramine causes - answer-hypertensive crisis
Symptoms of hypertensive crisis - answer-elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - answer-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - answer-DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - answer-floppy baby, cleft palate
,Teratogenic effects of tegratol - answer-neural tube defect
teratogenic effects of lithium - answer-ebstein anomaly (heart defect) (avoid, especially
1st trimester)
teratogenic effects of depakote - answer-neural tube defects/spina bifida
Adverse reaction to Lamictal - answer-Steven Johnson's Syndrome
Signs of SJS - answer-FEVER --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 - answer-sedation or weight gain
Carbamazepine (tegretol) black box warning - answer-agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians - answer-Screen for HLAB-1502 allele before initiating, due
to high incidence of SJS if positive for allele.
Child-bearing aged women - answer-check 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 - answer-agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - answer-ANC
DC clozarli if ANC - answer-less than 1000
DC clozaril if WBC - answer-2000-3000, risk of agranulocytosis
When on clozaril monitor for - answer-signs and symptoms of infection: sudden fever,
chills, sore throat, weakness
, Clozaril only known antipsychotic to - answer-decrease 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 - answer-Answer: 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 - answer-Answer: 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 - answer-Answer: 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 - answer-A. 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 - answer-A. Carbamazepine
Bulimia, weight is ___________ - answer-within the normal range.
Pharm treatment for bulimia - answer-Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
CORRECT QUESTIONS AND
ANSWERS
When many answers are remarkably similar, they are usually _____________ - answer-
wrong
Interprofessional collaboration is encouraged. - answer-Collaborate is usually right.
Delegate is usually wrong.
ADPIER - answer-Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - answer-Normal 0.6-1.2
Lithium toxicity occurs at levels - answer-> 1.5
Signs of Lithium toxicity - answer-severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - answer-MANIA
Lithium has evidence shown to - answer-reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - answer-Ebstein anomaly
(congenital heart defect)
dehydration and hyponatremia cause lithium levels to - answer-rise
Baseline labs before initiation of lithium - answer-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 - answer-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 - answer-staying hydrated
avoiding NSAIDS
compliance
Depakote normal level - answer-50-125
Depakote toxicity level - answer-greater than 150
Teratogenic effects of Depakote - answer-spina bifida
Adverse effects of depakote - answer-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 - answer-disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity - answer-DC med
check level
LFT
ammonia
MAOI + tyramine causes - answer-hypertensive crisis
Symptoms of hypertensive crisis - answer-elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - answer-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - answer-DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - answer-floppy baby, cleft palate
,Teratogenic effects of tegratol - answer-neural tube defect
teratogenic effects of lithium - answer-ebstein anomaly (heart defect) (avoid, especially
1st trimester)
teratogenic effects of depakote - answer-neural tube defects/spina bifida
Adverse reaction to Lamictal - answer-Steven Johnson's Syndrome
Signs of SJS - answer-FEVER --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 - answer-sedation or weight gain
Carbamazepine (tegretol) black box warning - answer-agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians - answer-Screen for HLAB-1502 allele before initiating, due
to high incidence of SJS if positive for allele.
Child-bearing aged women - answer-check 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 - answer-agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - answer-ANC
DC clozarli if ANC - answer-less than 1000
DC clozaril if WBC - answer-2000-3000, risk of agranulocytosis
When on clozaril monitor for - answer-signs and symptoms of infection: sudden fever,
chills, sore throat, weakness
, Clozaril only known antipsychotic to - answer-decrease 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 - answer-Answer: 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 - answer-Answer: 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 - answer-Answer: 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 - answer-A. 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 - answer-A. Carbamazepine
Bulimia, weight is ___________ - answer-within the normal range.
Pharm treatment for bulimia - answer-Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
