Georgette Review PMHNP exam with
100% complete solutions
When many answers are remarkably similar, they are usually _____________ -Correct Answer-wrong
Interprofessional collaboration is encouraged. -Correct Answer-Collaborate is usually right. Delegate is usually wrong.
ADPIER -Correct Answer-Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium -Correct Answer-Normal 0.6-1.2
Lithium toxicity occurs at levels -Correct Answer-> 1.5
Signs of Lithium toxicity -Correct Answer-severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for -Correct Answer-MANIA
Lithium has evidence shown to -Correct Answer-reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester -Correct Answer-Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to -Correct Answer-rise
Baseline labs before initiation of lithium -Correct 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 -Correct 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 -Correct Answer-staying hydrated
avoiding NSAIDS
compliance
Depakote normal level -Correct Answer-50-125
Depakote toxicity level -Correct Answer-greater than 150
Teratogenic effects of Depakote -Correct Answer-spina bifida
Adverse effects of depakote -Correct 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 -Correct Answer-disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity -Correct Answer-DC med check level
LFT
ammonia
MAOI + tyramine causes -Correct Answer-hypertensive crisis
Symptoms of hypertensive crisis -Correct Answer-elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + -Correct Answer-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis -Correct Answer-DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos -Correct Answer-floppy baby, cleft palate
Teratogenic effects of tegratol -Correct Answer-neural tube defect teratogenic effects of lithium -Correct Answer-ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote -Correct Answer-neural tube defects/spina bifida
Adverse reaction to Lamictal -Correct Answer-Steven Johnson's Syndrome
Signs of SJS -Correct 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 -Correct Answer-sedation or weight gain
Carbamazepine (tegretol) black box warning -Correct Answer-agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians -Correct Answer-Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women -Correct Answer-check for pregnancy before starting mood stabilizer
100% complete solutions
When many answers are remarkably similar, they are usually _____________ -Correct Answer-wrong
Interprofessional collaboration is encouraged. -Correct Answer-Collaborate is usually right. Delegate is usually wrong.
ADPIER -Correct Answer-Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium -Correct Answer-Normal 0.6-1.2
Lithium toxicity occurs at levels -Correct Answer-> 1.5
Signs of Lithium toxicity -Correct Answer-severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for -Correct Answer-MANIA
Lithium has evidence shown to -Correct Answer-reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester -Correct Answer-Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to -Correct Answer-rise
Baseline labs before initiation of lithium -Correct 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 -Correct 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 -Correct Answer-staying hydrated
avoiding NSAIDS
compliance
Depakote normal level -Correct Answer-50-125
Depakote toxicity level -Correct Answer-greater than 150
Teratogenic effects of Depakote -Correct Answer-spina bifida
Adverse effects of depakote -Correct 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 -Correct Answer-disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity -Correct Answer-DC med check level
LFT
ammonia
MAOI + tyramine causes -Correct Answer-hypertensive crisis
Symptoms of hypertensive crisis -Correct Answer-elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + -Correct Answer-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis -Correct Answer-DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos -Correct Answer-floppy baby, cleft palate
Teratogenic effects of tegratol -Correct Answer-neural tube defect teratogenic effects of lithium -Correct Answer-ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote -Correct Answer-neural tube defects/spina bifida
Adverse reaction to Lamictal -Correct Answer-Steven Johnson's Syndrome
Signs of SJS -Correct 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 -Correct Answer-sedation or weight gain
Carbamazepine (tegretol) black box warning -Correct Answer-agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians -Correct Answer-Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women -Correct Answer-check for pregnancy before starting mood stabilizer
