Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
,Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
When many answers are remarkably similar, they are usually -
wrong
Interprofessional collaboration is encouraged. - Collaborate is usually right.
Delegate is usually wrong.
ADPIER - Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - Normal 0.6-1.2
Lithium toxicity occurs at levels - > 1.5
Signs of Lithium toxicity - severe nausea, diarrhea, vomiting, confusion, drowsiness,
muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - MANIA
Lithium has evidence shown to - reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - Ebstein anomaly
(congenital heart defect)
dehydration and hyponatremia cause lithium levels to - rise
Baseline labs before initiation of lithium - 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 - 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 - staying hydrated
avoiding NSAIDS
,Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
compliance
Depakote normal level - 50-125
Depakote toxicity level - greater than 150
Teratogenic effects of Depakote - spina bifida
Adverse effects of depakote - 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 - disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity - DC med
check level
LFT
ammonia
MAOI + tyramine causes - hypertensive crisis
Symptoms of hypertensive crisis - elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - floppy baby, cleft palate
Teratogenic effects of tegratol - neural tube defect
, Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
teratogenic effects of lithium - ebstein anomaly (heart defect) (avoid, especially 1st
trimester)
teratogenic effects of depakote -neural tube defects/spina bifida
Adverse reaction to Lamictal - Steven Johnson's Syndrome
Signs of SJS - 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 - sedation or weight gain
Carbamazepine (tegretol) black box warning - agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash,
SOA)
Carbamazepine and asians - Screen for HLAB-1502 allele before initiating, due to
high incidence of SJS if positive for allele.
Child-bearing aged women - 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 - agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - ANC
DC clozarli if ANC - less than 1000
DC clozaril if WBC - 2000-3000, risk of agranulocytosis
When on clozaril monitor for - signs and symptoms of infection: sudden fever, chills,
sore throat, weakness
Clozaril only known antipsychotic to - decrease risk of suicide in patients with
schizophrenia.
COMPLETE SOLUTIONS
,Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
When many answers are remarkably similar, they are usually -
wrong
Interprofessional collaboration is encouraged. - Collaborate is usually right.
Delegate is usually wrong.
ADPIER - Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - Normal 0.6-1.2
Lithium toxicity occurs at levels - > 1.5
Signs of Lithium toxicity - severe nausea, diarrhea, vomiting, confusion, drowsiness,
muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - MANIA
Lithium has evidence shown to - reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - Ebstein anomaly
(congenital heart defect)
dehydration and hyponatremia cause lithium levels to - rise
Baseline labs before initiation of lithium - 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 - 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 - staying hydrated
avoiding NSAIDS
,Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
compliance
Depakote normal level - 50-125
Depakote toxicity level - greater than 150
Teratogenic effects of Depakote - spina bifida
Adverse effects of depakote - 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 - disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity - DC med
check level
LFT
ammonia
MAOI + tyramine causes - hypertensive crisis
Symptoms of hypertensive crisis - elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - floppy baby, cleft palate
Teratogenic effects of tegratol - neural tube defect
, Georgette Review. PMHNP- 388 QUESTIONS- WITH
COMPLETE SOLUTIONS
teratogenic effects of lithium - ebstein anomaly (heart defect) (avoid, especially 1st
trimester)
teratogenic effects of depakote -neural tube defects/spina bifida
Adverse reaction to Lamictal - Steven Johnson's Syndrome
Signs of SJS - 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 - sedation or weight gain
Carbamazepine (tegretol) black box warning - agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash,
SOA)
Carbamazepine and asians - Screen for HLAB-1502 allele before initiating, due to
high incidence of SJS if positive for allele.
Child-bearing aged women - 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 - agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - ANC
DC clozarli if ANC - less than 1000
DC clozaril if WBC - 2000-3000, risk of agranulocytosis
When on clozaril monitor for - signs and symptoms of infection: sudden fever, chills,
sore throat, weakness
Clozaril only known antipsychotic to - decrease risk of suicide in patients with
schizophrenia.
