(PMHNP IQ
A 43-year-old male is treated for Bipolar 1 on lithium. Which of the following
hematologic changes is associated with lithium?
A) Agranulocytosis
B) Anemia
C) Leukocytosis
D) Leukopenia - C) Leukocytosis
While the mechanism of action is not clear, the use of lithium can raise
white blood cell counts and therefore, CBC should be monitored in patients
treated on lithium.
A new patient comes to you on a medication regimen of: Adderall XR,
Seroquel, Mirtazepine, Diazepam, Zolpidem. In addition if initial dose dose
not help the patient sleep. You confirm the medication regimen with the
patient's past records. You diagnose with PTSD, alcohol use disorder
moderate by history in recovery, depressive disorder, and ADD. You tx the
patient and find that the patient is resistant to changing the past medication
regimen. The pt wants you to rewrite the script so that the medication is
available. In checking with the pharmacy, you find out the pt has potentially
used 60 tablets of Zolpidem (Ambien) in a 20 day period. Your best action
is to:
A) Refill the order for the med as requested. The med has not harmed the
pt so far.
, B) Discontinue the prescription for Zolpidem (Ambien). Talk to the pt about
the overuse of Zolpidem (Ambien) and the danger it poses to his health and
wellbeing.
C) Give the order for the Zolpidem (Ambien). Talk with the pt about the
danger of using too much sleeping medication. Then, discontinue the
medication.
D) Refill the order for the medication. Then, send the pt for the chemical
dependency evaluation. The pt is on too many sedative-type meds and is
harming himself. - B) Discontinue the prescription for Zolpidem. Talk to the
pt about the overuse of Zolpidem and the danger it poses to his health and
wellbeing.
Zolpidem (Ambien) is a hypnotic med for the short-term management of
insomnia. It can be stopped abruptly without significant harm to the patient
other than rebound insomnia. You are protecting your patient by stopping
the dangerous misuse of a hypnotic medication. You must also discuss the
ramifications of the misuse with the pt and attempt to help him by giving
him a rationale for the discontinuation and a healthy plan for managing the
insomnia.
A patient being treated for major depressive disorder and on sertraline
(Zoloft), 150 mg po daily for the past 16 years, presents to the psychiatric
mental health practitioner for an outpatient follow-up visit. During the visit
she states that she has not been feeling well, reporting the flu. She also
states she has not taken her medication in the last five days. Which of the
following symptoms would she be describing if you suspect selective
serotonin reputable inhibitors (SSRIs) discontinuation syndrome?
A) Agitation, nausea, dysphoria, and diequilibrium
B) Agitation, nausea, tremor, and ataxia.