PMHNP Boards - Georgette's
When many answers are remarkably similar, they are usually
Correct
answers
wrong
When two answers are opposites, usually... Correct answers one of those
two is the
correct
answer
When looking at questions about intraprofessional communication:
don't . Correct answers collaborate, dont
delegate
If asked to differentiate #1 from #2; think what is unique about .
Correct
answers
#1
If a question and an answer use the same words or synonyms, then that
answer is
usually . Correct answers
correct
If an answer has absolutes (only, always) it is usually . Correct
answers
wron
g
Levels of prioritization to use when answering questions: three levels.
Correct answers
1. Airway, breathing, circulation
2. Maslowes - physiological needs (food, water, warmth, rest), safey and
security
Lithium levels
3. Nursing - Normal
process: and Toxicity
Assessment, Correctplan,
diagnosis, answers Normal evaluate,
intervention,
0.6-1.2
Toxicity >
refer out last
1.5
Lithium toxicity occurs at levels Correct
answers > 1.5
Signs of Lithium toxicity Correct answers severe nausea, diarrhea, vomiting,
confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors,
unsteady gait
Lithium is gold standard for Correct answers
MANIA
Lithium has evidence shown to (2) Correct answers 1. reduce
suicidal
2. ideation
Neuroprotective tx of choice for
bipolar
What does lithium cause in neonate, especially 1st trimester Correct
answers Ebstein
anomaly (congenital heart
defect)
dehydration and hyponatremia cause lithium levels to Correct
answers rise
,Baseline labs before initiation of lithium Correct
answers TSH
creatinine (0.6-
1.2)
BUN (10-
20)
HCG (all psychotropics females
12-51)
EKG
50+
Side Effects of Lithium and lithium toxicity Correct answers SIde
Effects:
hypothyroidism, coarse hand tremors with toxicity, diarrhea,
leukocytosis
Toxicity: N/V, confusion, convulsions, drawsiness, blurred vision, slurred
speech, mm
weakness, heart palpitations, course hand tremors, and unsteadiness
when walking
(STOP and check
levels)
Why are elderly more sensitive to lithium (5) Correct answers Decreased
intercellular
water, protein binding, mm mass, and
metabolism
Increased body
fat
MAOI + tyramine causes Correct answers hypertensive crisis - life
threatening and
emergenc
y
Symptoms of hypertensive crisis Correct answers
elevatedexplosive
sudden BP occipital
headache
facial
flushing
palpitatio
ns
pupillary
dilation
diaphoresi
s
feve
r
Hypertensive crisis occurs with MAOI + Correct answers
MEPERIDINE
STIMULANTS
TCAs
asthma
meds
antipsychoti
cs
Treatment for hypertensive crisis Correct answers DC
offending agent
Administer
PHENTOLAMINE
teratogenic effects of depakote Correct answers neural tube
defects/spina bifida
Severe side effect of mood stabilizers Correct answers Steven
Johnson's
Syndrom
e
Signs of Stevens johnson syndrome (SJS) Correct answers FEVER --
high yield
facial
swelling
tongue
swelling
burning papule
rashe
skin
sloughing
,prodromal
headache
painful mucus
membranes
Side effects of valproic acid/divalproex sodium Correct answers
hepatotoxicity and
pancreatit
is
Carbamazepine (tegretol) black box warning Correct answers
agranulocytosis
(decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOB)
Carbamazepine and asians Correct answers FDA REQUIRED ccreen for
HLAB-1502
allele before initiating, due to high incidence of SJS if positive
for allele
Child-bearing aged women (Tegretol) Correct answers check for
pregnancy
starting moodbefore
stabilizer
start on folic acid to support neural tube development during the first
month
womanthat a
is pregnant (0.4-0.5 mg
daily)
Clozaril/clozapine can cause Correct answers agranulocytosis and
neutropenia
For monitoring neutropenia in Clozaril, monitor what lab Correct answers
ANC
in only (not with
conjunction
WBCs)
DC clozaril if ANC Correct answers less than 1000, risk of
neuropenia
Normal 2500-
6000
DC clozaril if WBC Correct answers 2000-3000, risk of
agranulocytosis
Normal: 4500-
11000
Frequency of clozaril labs Correct answers First six months -
Next six months - every two
weekly
weeks
Then monthly if ANC
normal
When on clozaril monitor for Correct answers signs and symptoms of
infection:
fever, sudden
chills, sore throat,
weakness
Your patient with bipolar disorder is admitted to a medical hospital.
The internist
contacts your office and asks whether the lithium you prescribed him is
effecting
ECG. Howhisdo you
respond?
A. Lithium can prolong the QT
interval
B. Lithium has no effect on his
ECG
C. Lithium can invert the t
waves
D. Lithium can shorten the PR interval Correct answers Answer: Lithium can
invert the t
waves
.
, Mary is a 45-year-old African American female who has been treated on
Isocarboxazid
(Marplan) for over 6 years. Mary is going in for a surgical procedure. Which
medication
is strictly contraindicated with
Isocarboxazid?
A.
Morphine
B.
NSAIDS
C.
Methylphenidate
D. Acetaminophen Correct answers Answer:
Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab
values will
indicate the client needs to discontinue
treatment?
A. WBC less than 1800 and ANC less than
1200
B. ANC less than
1,000
C. WBC less than
D. ANC less than 2000 Correct answers Answer: ANC less
5,000
than 1000
If given during pregnancy, socium valproate can cause which of the
following
problems medical
in the
baby?
A. SJS
B. Ebstein's
anomaly
C. Spina
bifida
D. Cleft palate Correct answers A. Spina
bifida
Which mood stabilizer is associated with potential life-threatening rash
in the Asian
population
?
A. Carbamazepine
(tegretol)
B.
C.
Depakote
Lithium
D. Lamictal Correct answers A.
Carbamazepine
Signs of bulimia Correct answers weight within the
normal range
erosion od dental
enamal
russell's
sign
hypertrophy of salivary
glands
rectal
prolapse
Pharm treatment for bulimia Correct answers
SSRIs and TCAs effective in reducing frequency of binging and
Fluoxetine
purging
Signs of anorexia nervosa Correct answers
low BMI
Amennorrhe
a
Emaciatio
n
Bradycardu
a
Hypotensio
n
EKG changes - inverted T waves, ST segment dperession,
Prolonged QT)
Pharm treatment for anorexia Correct answers there
is none
When many answers are remarkably similar, they are usually
Correct
answers
wrong
When two answers are opposites, usually... Correct answers one of those
two is the
correct
answer
When looking at questions about intraprofessional communication:
don't . Correct answers collaborate, dont
delegate
If asked to differentiate #1 from #2; think what is unique about .
Correct
answers
#1
If a question and an answer use the same words or synonyms, then that
answer is
usually . Correct answers
correct
If an answer has absolutes (only, always) it is usually . Correct
answers
wron
g
Levels of prioritization to use when answering questions: three levels.
Correct answers
1. Airway, breathing, circulation
2. Maslowes - physiological needs (food, water, warmth, rest), safey and
security
Lithium levels
3. Nursing - Normal
process: and Toxicity
Assessment, Correctplan,
diagnosis, answers Normal evaluate,
intervention,
0.6-1.2
Toxicity >
refer out last
1.5
Lithium toxicity occurs at levels Correct
answers > 1.5
Signs of Lithium toxicity Correct answers severe nausea, diarrhea, vomiting,
confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors,
unsteady gait
Lithium is gold standard for Correct answers
MANIA
Lithium has evidence shown to (2) Correct answers 1. reduce
suicidal
2. ideation
Neuroprotective tx of choice for
bipolar
What does lithium cause in neonate, especially 1st trimester Correct
answers Ebstein
anomaly (congenital heart
defect)
dehydration and hyponatremia cause lithium levels to Correct
answers rise
,Baseline labs before initiation of lithium Correct
answers TSH
creatinine (0.6-
1.2)
BUN (10-
20)
HCG (all psychotropics females
12-51)
EKG
50+
Side Effects of Lithium and lithium toxicity Correct answers SIde
Effects:
hypothyroidism, coarse hand tremors with toxicity, diarrhea,
leukocytosis
Toxicity: N/V, confusion, convulsions, drawsiness, blurred vision, slurred
speech, mm
weakness, heart palpitations, course hand tremors, and unsteadiness
when walking
(STOP and check
levels)
Why are elderly more sensitive to lithium (5) Correct answers Decreased
intercellular
water, protein binding, mm mass, and
metabolism
Increased body
fat
MAOI + tyramine causes Correct answers hypertensive crisis - life
threatening and
emergenc
y
Symptoms of hypertensive crisis Correct answers
elevatedexplosive
sudden BP occipital
headache
facial
flushing
palpitatio
ns
pupillary
dilation
diaphoresi
s
feve
r
Hypertensive crisis occurs with MAOI + Correct answers
MEPERIDINE
STIMULANTS
TCAs
asthma
meds
antipsychoti
cs
Treatment for hypertensive crisis Correct answers DC
offending agent
Administer
PHENTOLAMINE
teratogenic effects of depakote Correct answers neural tube
defects/spina bifida
Severe side effect of mood stabilizers Correct answers Steven
Johnson's
Syndrom
e
Signs of Stevens johnson syndrome (SJS) Correct answers FEVER --
high yield
facial
swelling
tongue
swelling
burning papule
rashe
skin
sloughing
,prodromal
headache
painful mucus
membranes
Side effects of valproic acid/divalproex sodium Correct answers
hepatotoxicity and
pancreatit
is
Carbamazepine (tegretol) black box warning Correct answers
agranulocytosis
(decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOB)
Carbamazepine and asians Correct answers FDA REQUIRED ccreen for
HLAB-1502
allele before initiating, due to high incidence of SJS if positive
for allele
Child-bearing aged women (Tegretol) Correct answers check for
pregnancy
starting moodbefore
stabilizer
start on folic acid to support neural tube development during the first
month
womanthat a
is pregnant (0.4-0.5 mg
daily)
Clozaril/clozapine can cause Correct answers agranulocytosis and
neutropenia
For monitoring neutropenia in Clozaril, monitor what lab Correct answers
ANC
in only (not with
conjunction
WBCs)
DC clozaril if ANC Correct answers less than 1000, risk of
neuropenia
Normal 2500-
6000
DC clozaril if WBC Correct answers 2000-3000, risk of
agranulocytosis
Normal: 4500-
11000
Frequency of clozaril labs Correct answers First six months -
Next six months - every two
weekly
weeks
Then monthly if ANC
normal
When on clozaril monitor for Correct answers signs and symptoms of
infection:
fever, sudden
chills, sore throat,
weakness
Your patient with bipolar disorder is admitted to a medical hospital.
The internist
contacts your office and asks whether the lithium you prescribed him is
effecting
ECG. Howhisdo you
respond?
A. Lithium can prolong the QT
interval
B. Lithium has no effect on his
ECG
C. Lithium can invert the t
waves
D. Lithium can shorten the PR interval Correct answers Answer: Lithium can
invert the t
waves
.
, Mary is a 45-year-old African American female who has been treated on
Isocarboxazid
(Marplan) for over 6 years. Mary is going in for a surgical procedure. Which
medication
is strictly contraindicated with
Isocarboxazid?
A.
Morphine
B.
NSAIDS
C.
Methylphenidate
D. Acetaminophen Correct answers Answer:
Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab
values will
indicate the client needs to discontinue
treatment?
A. WBC less than 1800 and ANC less than
1200
B. ANC less than
1,000
C. WBC less than
D. ANC less than 2000 Correct answers Answer: ANC less
5,000
than 1000
If given during pregnancy, socium valproate can cause which of the
following
problems medical
in the
baby?
A. SJS
B. Ebstein's
anomaly
C. Spina
bifida
D. Cleft palate Correct answers A. Spina
bifida
Which mood stabilizer is associated with potential life-threatening rash
in the Asian
population
?
A. Carbamazepine
(tegretol)
B.
C.
Depakote
Lithium
D. Lamictal Correct answers A.
Carbamazepine
Signs of bulimia Correct answers weight within the
normal range
erosion od dental
enamal
russell's
sign
hypertrophy of salivary
glands
rectal
prolapse
Pharm treatment for bulimia Correct answers
SSRIs and TCAs effective in reducing frequency of binging and
Fluoxetine
purging
Signs of anorexia nervosa Correct answers
low BMI
Amennorrhe
a
Emaciatio
n
Bradycardu
a
Hypotensio
n
EKG changes - inverted T waves, ST segment dperession,
Prolonged QT)
Pharm treatment for anorexia Correct answers there
is none
