Georgette's LMR 2024 Questions( Graded A+ )And Answers!!!!

What should you not do when advocating for a patient? - ANS Judge or confront What class of medication is contraindicated with tics? - ANS Stimulants What should you provide for prior to assessing abuse victims? - ANS A safe environment What are your actions if a child reports abuse? - ANS First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? - ANS Report to CPS In what setting as an inpatient provider should you interview a patient? - ANS Use a private room with the door partially open How should you begin your interview with adolescents? - ANS By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? - ANS Without What if an adolescent tells you they are homosexual and they don't want their parents to know? - ANS This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? - ANS Get informed consent/ROI What do you do if a medical evaluation is needed? - ANS Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/unwell in your office? - ANS Collect UDS and then refer out Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment? - ANS No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? - ANS Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? - ANS An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? - ANS Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? - ANS Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1:1 Psychoeducation should be based on? - ANS Cultural context How do you promote health in a location with multiple ethnicities and education levels? - ANS Multiple cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? - ANS Allow this - remember ROI/informed consent Normal TSH? - ANS 0.5-5.0 TSH < 0.5 = ? - ANS Hyperthyroidism TSH > 5.0 = ? - ANS Hypothyroidism Relationship between TSH & T3/T4? - ANS Inverse Hyperthyroidism can present as? - ANS Mania Hypothyroidism can present as? - ANS Depression Normal depakote level? - ANS 50-125 Toxic depakote level? - ANS 150+ Birth defect caused by depakote? - ANS Spina Bifida S/S of depakote toxicity? - ANS Disorientation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? - ANS D/C depakote and check VPA level, LFTs, and ammonia S/S of hepatotoxicity? - ANS RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? - ANS 5-40 Normal ALT? - ANS 5-35 Kava kava can cause? - ANS Liver damage and heavy sedation Kava kava is c/i with? - ANS Benzos or sedatives Mood stabilizer most associated with SJS? - ANS Lamictal Mood stabilizer with least weight gain? - ANS Lamictal SGAs with least weight gain? - ANS ziprasidone, abilify, and latuda Least sedating SGA? - ANS Abilify Routine labs with SGAs? - ANS BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? - ANS 1. Nonpharm = exercise or nutritional counseling 2. Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? - ANS Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? - ANS HLAB1502 Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? - ANS If ANC is < 1000 with or without s/s of infection Lithium range? - ANS 0.6 - 1.2 What to do if lithium is 1.3 or 1.4? - ANS Monitor What to do if lithium is 1.5+? - ANS D/C Benefits of lithium? - ANS Gold standard for mania, neuroprotective, and antisuicidal effects S/S of lithium toxicity? - ANS Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor What to do if lithium toxicity is suspected? - ANS D/C and check serum levels prior to checking VS Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs? - ANS NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ) What demonstrates understanding of education on lithium? - ANS Taking extra water with patient when they go hiking NMS s/s? - ANS Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs Treatment of NMS and MOAs? - ANS D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant) Serotonin syndrome s/s? - ANS Hyperreflexia and myoclonic jerks Serotonin syndrome causes? - ANS SSRIs, SNRIs, MAOIs, -triptans (for migraines like sumatriptan/imitrex) Treatment for serotonin syndrome? - ANS D/C med and administer cyproheptad