MODULE 1 & 2 QUESTIONS AND
ANSWERS GRADED A+
r
Carbamazepine r(Tegretol) r(PB rpg. r181-182 r(on rthe rtable)) r- rÞ rBlack rbox rwarning rfor rcarbamaze1. Test
Taking Strategies - Read the entire question carefully before answering and identifying what the question
is seeking. Do not skim over the words or read them too quickly.
Þ When reading the question pay attention to keywords.
2. Test Taking Strategies - Do not read into the question. Only use the information provided by the
examiner to answer the question without making any assumptions or adding more information in the
question.
3. Test Taking Strategies - Read all the answer choices.
Þ Narrow down options to 2 possible right answers.
Þ Partially correct answers are not the correct answer.
Þ When two answer choices are the opposite of one another, one is usually the correct answer.
Þ The right answer option might have the same word(s) as the test question; it can be the same word or
synonym of the word.
Þ Choose client-focused answers.
· Best Answer/Choice: Answers that acknowledge a patient's feelings and makes the patient feel heard.
Þ When many response choices are remarkably similar in meaning, they usually are wrong.
Þ Be wary of absolutes: all, only, always, every, must, never, none, everything, nothing, etc. usually
wrong.
4. Test Taking Strategies - Questions that use adjectives like "priority," "Initial action," test your ability to
prioritize.
Þ Airway, Breathing, and Circulation,
Þ Maslow's Hierarchy of Needs (physiological needs (food, water, warmth, rest), safety, and security,
etc.).
Þ Nursing Process (Assessment before intervention). Assessment is collecting data to support the
problem towards a resolution.
5. Test Taking Strategies - Safety for the patient and others is usually the right answer.
6. Test Taking Strategies - Culture is important to be included in all nursing care.
,7. Test Taking Strategies - Critical thinking is important.
8. Test Taking Strategies - Interprofessional collaboration is encouraged.
Refer Out
Lithium (0.6-1.2 mEq/L) (PB pg. 180) - Lithium toxicity can occur when this level reaches 1.5 mEq/L or
higher.
What is the normal value of lithium? - 0.6-1.2 mEq/L
What medication is the gold standard when treating manic episodes? - Lithium
Which medication for the treatment of Bipolar 1 has evidence of anti-suicidal effects? - Lithium
Which medication is neuroprotective treatment of choice for bipolar? - Lithium
Baseline labs to get before initiation of lithium to ensure safety and efficacy (PB pg. 180) - · Thyroid panel
(TSH)
· Serum creatine (0.6-1.2 mg/dl)
· Blood urea nitrogen (BUN) (10-20 mg/dl)
· Pregnancy test (human chorionic gonadotropin (HCG)
· ECG for clients older than age 50
Side effects of Lithium (PB pg. 181)
Endocrine - Hypothyroidism
Weight gain
Side effects of Lithium (PB pg. 181)
Central nervous system - Fine hand tremors
Fatigue
Mental cloudiness
Headaches
Coarse hand tremors occur with toxicity
Nystagmus
Side effects of Lithium (PB pg. 181)
Dermatological - Maculopapular rash
Pruritis
,Acne
Side effects of Lithium (PB pg. 181)
Gastrointestinal - GI upset
Diarrhea
Vomiting
Cramps
Anorexia
Side effects of Lithium (PB pg. 181)
Renal - Diabetes insipidus: Polyuria, Polydipsia
Edema
Microscopic tubular changes
Side effects of Lithium (PB pg. 181)
Cardiac - T-wave inversions
Dysrhythmia
Side effects of Lithium (PB pg. 181)
Hematologic - Leukocytosis (Increases WBCs)
Signs of Lithium toxicity - Severe nausea, vomiting, and diarrhea, confusion, convulsions, drowsiness,
blurred vision, slurred speech, muscle weakness, heart palpitations, coarse hand tremors, and
unsteadiness while standing or walking (ataxia).
What is the intervention of lithium toxicity? - DC Li and check serum Li levels
Hypertensive crisis (PB pg. 157) - Hypertensive crisis occurs when MAOIs are taken in conjunction with
foods containing tyramine, a dietary precursor to norepinephrine.
Hypertensive crisis is life-threatening and cannot be reversed unless... - more MAO is produced by the
body.
Hypertensive crisis and death also can occur when MAOIs are taken in conjunction with what certain
medications: - Þ Meperidine
Þ Stimulants and other sympathomimetics
Þ Decongestants
Þ Tricyclic antidepressants (TCAs)
Þ Atypical antipsychotics
, Þ St. John's wort
Þ L-tryptophan
Þ Asthma medication
Symptoms of Hypertensive Crisis (PB pg. 157) - · Elevated blood pressure
· Sudden, explosive-like headache, usually occipital region
· Facial flushing
· Palpitations
· Pupillary dilation
· Diaphoresis
· Fever
Symptoms of Hypertensive Crisis (PB pg. 157)
Treatment - · DC the offending agent (MAOI)
· Administer phentolamine
· Stabilize fever
Teratogenic risks of common psychiatric medications (PB pg. 118, last paragraph) - · Benzodiazepines:
Floppy baby syndrome, cleft palate.
· Carbamazepine (Tegretol): Neural tube defect.
· Lithium (Eskalith): Epstein anomaly (congenital heart defect).
· Divalproex sodium (Depakote): Neural tube defects, specifically spina bifida.
What is the pregnancy risk for benzodiazepines? - Floppy baby syndrome, cleft palate.
What is the pregnancy risk for Carbamazepine (Tegretol)? - Neural tube defect.
What is the pregnancy risk for Lithium (Eskalith)? - Epstein anomaly (congenital heart defect).
What is the pregnancy risk for Divalproex sodium (Depakote)? - Neural tube defects, specifically spina
bifida.
Side effects of mood stabilizers (PB pg. 181, 8th bullet point after the table) - Lamictal
What is the black box warning of mood stabilizers? - Stevens Johnson syndrome (severe rash).
Signs and symptoms of Steven Johnson Syndrome include: (PB pg. 184) - · Fever
· Sore throat
· Facial swelling
ANSWERS GRADED A+
r
Carbamazepine r(Tegretol) r(PB rpg. r181-182 r(on rthe rtable)) r- rÞ rBlack rbox rwarning rfor rcarbamaze1. Test
Taking Strategies - Read the entire question carefully before answering and identifying what the question
is seeking. Do not skim over the words or read them too quickly.
Þ When reading the question pay attention to keywords.
2. Test Taking Strategies - Do not read into the question. Only use the information provided by the
examiner to answer the question without making any assumptions or adding more information in the
question.
3. Test Taking Strategies - Read all the answer choices.
Þ Narrow down options to 2 possible right answers.
Þ Partially correct answers are not the correct answer.
Þ When two answer choices are the opposite of one another, one is usually the correct answer.
Þ The right answer option might have the same word(s) as the test question; it can be the same word or
synonym of the word.
Þ Choose client-focused answers.
· Best Answer/Choice: Answers that acknowledge a patient's feelings and makes the patient feel heard.
Þ When many response choices are remarkably similar in meaning, they usually are wrong.
Þ Be wary of absolutes: all, only, always, every, must, never, none, everything, nothing, etc. usually
wrong.
4. Test Taking Strategies - Questions that use adjectives like "priority," "Initial action," test your ability to
prioritize.
Þ Airway, Breathing, and Circulation,
Þ Maslow's Hierarchy of Needs (physiological needs (food, water, warmth, rest), safety, and security,
etc.).
Þ Nursing Process (Assessment before intervention). Assessment is collecting data to support the
problem towards a resolution.
5. Test Taking Strategies - Safety for the patient and others is usually the right answer.
6. Test Taking Strategies - Culture is important to be included in all nursing care.
,7. Test Taking Strategies - Critical thinking is important.
8. Test Taking Strategies - Interprofessional collaboration is encouraged.
Refer Out
Lithium (0.6-1.2 mEq/L) (PB pg. 180) - Lithium toxicity can occur when this level reaches 1.5 mEq/L or
higher.
What is the normal value of lithium? - 0.6-1.2 mEq/L
What medication is the gold standard when treating manic episodes? - Lithium
Which medication for the treatment of Bipolar 1 has evidence of anti-suicidal effects? - Lithium
Which medication is neuroprotective treatment of choice for bipolar? - Lithium
Baseline labs to get before initiation of lithium to ensure safety and efficacy (PB pg. 180) - · Thyroid panel
(TSH)
· Serum creatine (0.6-1.2 mg/dl)
· Blood urea nitrogen (BUN) (10-20 mg/dl)
· Pregnancy test (human chorionic gonadotropin (HCG)
· ECG for clients older than age 50
Side effects of Lithium (PB pg. 181)
Endocrine - Hypothyroidism
Weight gain
Side effects of Lithium (PB pg. 181)
Central nervous system - Fine hand tremors
Fatigue
Mental cloudiness
Headaches
Coarse hand tremors occur with toxicity
Nystagmus
Side effects of Lithium (PB pg. 181)
Dermatological - Maculopapular rash
Pruritis
,Acne
Side effects of Lithium (PB pg. 181)
Gastrointestinal - GI upset
Diarrhea
Vomiting
Cramps
Anorexia
Side effects of Lithium (PB pg. 181)
Renal - Diabetes insipidus: Polyuria, Polydipsia
Edema
Microscopic tubular changes
Side effects of Lithium (PB pg. 181)
Cardiac - T-wave inversions
Dysrhythmia
Side effects of Lithium (PB pg. 181)
Hematologic - Leukocytosis (Increases WBCs)
Signs of Lithium toxicity - Severe nausea, vomiting, and diarrhea, confusion, convulsions, drowsiness,
blurred vision, slurred speech, muscle weakness, heart palpitations, coarse hand tremors, and
unsteadiness while standing or walking (ataxia).
What is the intervention of lithium toxicity? - DC Li and check serum Li levels
Hypertensive crisis (PB pg. 157) - Hypertensive crisis occurs when MAOIs are taken in conjunction with
foods containing tyramine, a dietary precursor to norepinephrine.
Hypertensive crisis is life-threatening and cannot be reversed unless... - more MAO is produced by the
body.
Hypertensive crisis and death also can occur when MAOIs are taken in conjunction with what certain
medications: - Þ Meperidine
Þ Stimulants and other sympathomimetics
Þ Decongestants
Þ Tricyclic antidepressants (TCAs)
Þ Atypical antipsychotics
, Þ St. John's wort
Þ L-tryptophan
Þ Asthma medication
Symptoms of Hypertensive Crisis (PB pg. 157) - · Elevated blood pressure
· Sudden, explosive-like headache, usually occipital region
· Facial flushing
· Palpitations
· Pupillary dilation
· Diaphoresis
· Fever
Symptoms of Hypertensive Crisis (PB pg. 157)
Treatment - · DC the offending agent (MAOI)
· Administer phentolamine
· Stabilize fever
Teratogenic risks of common psychiatric medications (PB pg. 118, last paragraph) - · Benzodiazepines:
Floppy baby syndrome, cleft palate.
· Carbamazepine (Tegretol): Neural tube defect.
· Lithium (Eskalith): Epstein anomaly (congenital heart defect).
· Divalproex sodium (Depakote): Neural tube defects, specifically spina bifida.
What is the pregnancy risk for benzodiazepines? - Floppy baby syndrome, cleft palate.
What is the pregnancy risk for Carbamazepine (Tegretol)? - Neural tube defect.
What is the pregnancy risk for Lithium (Eskalith)? - Epstein anomaly (congenital heart defect).
What is the pregnancy risk for Divalproex sodium (Depakote)? - Neural tube defects, specifically spina
bifida.
Side effects of mood stabilizers (PB pg. 181, 8th bullet point after the table) - Lamictal
What is the black box warning of mood stabilizers? - Stevens Johnson syndrome (severe rash).
Signs and symptoms of Steven Johnson Syndrome include: (PB pg. 184) - · Fever
· Sore throat
· Facial swelling
