PMHNP ANCC Exam questions with complete solutions

Nursing Process Assess before intervention. Assessment is collecting data Lithium level 0.6-1.2 lithum toxicity Level of 1.5 or higher What drug has been proven to have evidence of anti-suicidal effects Lithium What drug is gold standard for manic episodes Lithium What drug is neuroprotective treatment of choice for bipolar Lithium Endocrine S/S of lithium toxicity Endocrine = course hand tremors, and hypothyroidism Dermatological S/S of lithium toxicity Maculopapular rash Gastro S/S of lithium toxicity Diarrhea, vomiting, cramps, anorexia Hematologic S/S of lithium toxicity Leukocytosis (increased WBC) What intervention should the PMHNP take if she suspects lithium toxicity D/C and check serum lithium levels What drugs can cause a hypertensive crisis Meperidine Stimulant's and other sympathomimetics Treatment for a hypertensive crisis Administer phentolamine Teratogenic risk of psych meds (HIGH) Epstein anomaly from lithium Spina bifida from Depakote Backbox warming for mood stabilizer Steven Johnson syndrome S/S of Steven Johnson syndrome which can be a S/E of mood stabilizers FEVER Valproic acid can cause? Hepatoxicity and pancreatitis Carbamazepine (Tegretol) can cause Stevens Johnson syndrome in what ethnicity (HIGH) Asian population What should you screen in the Asian population before starting Carbamazepine (Tegretol) (HIGH) HLAB-1502 allele What should you check in females before starting Carbamazepine (Tegretol) HCG pregnancy What supplement should be started in any female of child bearing age Folic acid 0.4-0.8 for neural tube development For Clozaril and Carbamazepine monitor what labs? WBC and ANC D/C if ANC is <1000 D/C id WBC is Signs of agranulocytosis fever, chills, sore throat, weakness Normal BMI range 18.5-24.9 With bulimia nervosa what can you see? Normal BMI and erosion of dental What are the s/s of anorexia nervosa? (HIGH) Low BMI Amenorrhea Emaciation Bradycardia Hypotension What SNRI can help with both pain and depression (HIGH) Duloxetine Clozaril is an an atypical antipsychotic that is metabolized by the? (HIGH) Cytochrome P450 enzyme and CYP1A2 If a patient starts smoking on carbamazepine what should the PMHNP do with the dose? (HIGH) Increase dose Because this drug mixed with tobacco is an enzyme inducer which decreases serum level. If they stop smoking decrease the dose. Nsaids, thiazides, ace inhibitors and kidney disease may reduce renal clearance which in return can? Increase lithium levels by reducing renal clearance Everything decreases in older adults except? Body fat concentration increases dopamine is produced the? substantia nigra which is the part of the brain involved in regulating motor movements Increases level of corticotropin released in the amygdala, hippocampus and lucas coeruleus can increase? Anxiety The cerebellum is responsible for? Cognition and balance Problems within this region of the brain can result in personality changes, emotions and intellectual changes (HIGH) Frontal lobe What part of the brain is involved with expressive speech Broca Temporal lobe is responsible for? Language (wernickes) Receptive speech, auditory hallucination's What can be used to screen for dementia and how long does it take for completion? (HIGH) Clock drawing test. 2 minutes Impairment when doing the clock drawing test can be associated with dementia involved with what regions of the brain? (HIGH) Right parietal lobe or right hemisphere Limbic system is involved with? Emotions and memory Hippocampus within the limbic system regulates? (HIGH) Motivation, stress, emotion and learning Amygdala within the limbic system regulates? (HIGH) Mediating mood, emotional memories, FEAR, ANXIETY, ANGER, emotion and AGGRESSION. Blockage of dopamine can lead to? EPS, dystonia, Parkinson, akathisia Tuberoinfundibular pathway Can lead to increased prolactin, amenorrhea, glactoria (risperdal) and sexual s/e Treatment of oculogyric crisis Stop agent and treat with Cogentin (benzotropine) Akathsia Treatment Treated with a benzodiazepine such as lorazepam or a beta blocker such as propranolol akinesia treatment Cogentin (Benztropine) pseudo-parkinsonism stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, pill-rolling motion of the hand Pseudoparkinsonism treatment Cogentin (benztropine) Tardive dyskinesia treatment Valbenazine Deutetrabenazine What med should not be used to treat tardive dyskinesia due to its ability to worsen symptoms Cogentin Reglan (metoclopramide) (HIGH) Can cause EPS Pharmacodynamics what the drug does to the body Pharmacokinetics The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. Agonist Activates a biological response by closing ion channel Antagonist Does not activate a biological response Meds that can cause depression Steroids, Isotretinon, Beta blockers Example Flonase, prednisone, propranolol meds that can induce mania steroids disulfiram (Antabuse) isoniazid (INH) antidepressants in persons with BP Neuroleptic Malignant Syndrome Life-threatening muscle rigidity, fever, and rhabdomyolysis. Elevated CPK (creation phosphate). elevated WBC, elevated liver function Treatment for neuroleptic malignant syndrome STOP ANITPSYCHOTIC! Dantrolene or bromocriptine, muscle relaxant Serotonin syndrome symptoms hypertension, tachycardia; myoclonic jerking, tremors; nausea, diarrhea, sweating, hyperthermia; agitation, confusion Serotonin syndrome treatment (HIGH) Cyproheptadine SSRI -> MAOI wait how long? (HIGH) 2 weeks except Prozac wait 5-6 weeks because of its long half life MAIO to prozac Wait 2 weeks MSE: thought process (HIGH) thought processes, organization of thought, thought content, perceptions, screen for suicidal thoughts MSE: concentration and attention Ask them to count backwards 100 by 7's MSE: Registration Ask to repeat 3 words MSE: Recall Ask to repeat 3 words 5 minutes later MSE: fund of knowledge President?