1
Georgette’s LMR – Revised for 2025
PART I
Test Taking Strategies
1. Read the entire question carefully before answering and identify what the question is seeking.
Do not skim over the words or read them too quickly. Pay attention to key words in the question.
2. 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. Read all the answer choices.
a. Narrow down options to two possible right questions.
b. Partially correct answers are NOT the correct answer.
c. When two answer choices are the opposite of one another, one is usually the correct
answer.
d. The correct answer may have the same word or a synonym as the test question
e. Choose client-focused answers
f. When many responses are remarkably similar in meaning, they are usually wrong
g. Be wary of absolutes – all, only, always, every, must, never, none, everything,
nothing -> usually wrong
4. Questions that use adjectives like PRIORITY, INITIAL ACTION are testing your
ability to prioritize. – There are multiple questions regarding priority
a. Airway, Breathing, Circulation
b. Maslow’s Hierarchy of Needs – basic physiologic needs (food, water, warmth, rest)
>>> self-actualization (highest)
c. Nursing Process: Assessment before Intervention – Assessment is collecting
data to support the problem towards a resolution.
5. Safety of the patient and others is usually the right answer
6. Critical Thinking is important
7. Interprofessional collaboration is encouraged
a. Looking for Collaboration – usually correct answer
b. Delegation – Not correct
c. Before you refer out ask yourself if there is something that you can do within
your scope of practice such as order a UDS
8. Culture is important to be included in all your nursing care
a. Cultural Expected Response to a stressor
i. Understand the context / meaning (cultural syndrome)
1. Use brief supportive therapy
ii. Contextualize their situation culturally
iii. Empower the patient
iv. Ethnicity, Ancestry, immigrant = Culturally sensitive = PRIORITY
1. Perform Cultural Assessment
a. Clarify meaning of illness – Validate symptoms with
cultural context = cultural syndrome = brief supportive therapy =
job/house loss
b. Psychoeducation should have cultural context
b. Culture = Respect
, 2
i. Examples Cultural Syndromes – clusters of symptoms and attributions that tend to
occur among individuals in specific cultural groups, communities, or contexts. They are
recognized locally as coherent patterns of experience. Ask the patient the meaning of the
symptoms to them and offer brief supportive therapy.
1. Native Americans believe illness = imbalance between individual and the
world. Native Americans = Highest suicide rate + attempts
Traditional Healers (even when patient requests them verbally - Require a
ROI)
2. Latino – Susto (“fright”) – illness is believed to result from a shocking,
unpleasant, or frightening experience that is believed to cause the soul to leave the
body. Symptoms often include appetite disturbances, inadequate or excessive
sleep, troubled sleep or dreams, sadness, lack of motivation, and feelings of low
self-worth or dirtiness. Somatic symptoms include muscle aches and pains,
headache, stomach ache, and diarrhea.
3. Puerto Rican syndrome –
a. Ataque de nervios = attack of nerves: uncontrollable shouting, attacks of
crying, trembling, heat in the chest rising into the head, and verbal or
physical aggression.
b. Mal de ojo = evil eye: fatigue, headache, weight loss, exhaustion, and
malaise
c. Empacho = blocked intestine
d. Mollera caida = sunken fontanel
3. Chinese medicine – “Wind-cold” illness = a pattern of symptoms associated
with invasion of the body by external pathogenic factors, particularly wind and
cold.
a. These pathogenic factors can disrupt the body’s balance and flow of Qi
(vital energy) and blood, leading to various health problems.
b. Manifests as symptoms such as chills, aversion to cold, body aches,
nasal congestion, headache, and possibly a mild fever.
c. It is often distinguished from “wind-heat” illness, which presents with
similar symptoms but is characterized by a fever and more pronounced
heat signs such as sweating and thirst.
9. Behavior Management and Support – STARTS upon or immediately after admission
a. Private office with partially opened door
10. Adolescent Confidentiality (advocating for confidentiality)
a. Provides them a safe place to address things such as
i. Consensual Relationship
ii. Attraction to same gender
11. Self-Esteem Building
a. Promotes Resilience in children
b. Use Open-ended Questions
c. If they cannot construct narrative you can use yes/no questions
12, Joint Appointments
a. If only one shows, then Reschedule
, 3
13. 5 y/o sodomized by 16 y/o brother
a. Do not leave 5 y/o with 16 y/o
b. Contact CPS
c. Arrange for Crisis Counseling
PART II
Apoptosis – neuronal loss or cell death/cell extinction/cell shrinkage/cell disintegration
Thyroid Disorder
1. Normal TSH – 0.5–5.0 Mu/L
a. Hypothyroid mimics symptoms of Depression
b. Hyperthyroid mimics symptoms of Mania
2. When T3 & T4 = High (Hyperthyroid) = TSH secretions DECREASE
a. Symptoms: (SPEED UP)
i. Heat Intolerance
ii. Agitation
iii. Irritability
iv. Tachycardia
v. Mood Swings
vi. Weight Loss
3. When T4 & T3 are low (Hypothyroid) = TSH secretions INCREASE
a. Symptoms: (SLOW DOWN)
i. Cold Intolerance
ii. Lethargy
iii. Weight Gain
iv. Decreased Libido
Divalproex sodium (Depakote)
1. Can cause Spina Bifida (neural tube defect)
2. RISK of Hepatotoxicity – liver toxicity (BBW)
a. Signs of Hepatotoxicity
i. Abdominal pain in Upper right portion of Abdomen
ii. Reddish Brown Urine
iii. Yellowing of the Skin and whites of the eyes
iv. Fatigue
b. INTERVENTION:
i. Discontinue offending agent
ii. Perform Liver Function Test (LFT)
1. AST: 5 to 40 U/L; ALT: 5 to 35 U/L
3. Therapeutic Range for Depakote/Valproic Acid
a. 50-125 µg/mL (therapeutic range)
b. Toxicity occurs when levels are greater than 150 µg/mL
i. Signs of Depakote Toxicity:
1. Disorientation
2. Lethargy
, 4
3. Respiratory Depression
4. Nausea/Vomiting
ii. INTERVENTION:
1. Discontinue Depakote
2. Check Valproic acid levels
3. Check LFT
4. Check Ammonia Levels
4. Depakote can cause Pancreatitis (BBW)
1. Upper abdominal pain that radiates to your back
2. tenderness when touching the abdomen
3. fever
4. rapid pulse
5. nausea/vomiting
6. oily stools
KAVA (piper methysticum)
1. Herbal Supplement used for Anxiety, Stress, and Insomnia
2. Side Effects:
a. Can cause Liver Damage
3. Major Interactions:
a. Do not use in combination with:
i. Alcohol – may increase risk of liver toxicity and other adverse effects
ii. Medications Metabolized by the Liver, such as benzodiazepines
1. Kava can cause drowsiness. Benzo med, such as Alprazolam,
can cause drowsiness.
2. Combined can lead to excessive drowsiness and impairment.
NOTE:
1. Metoprolol (Lopressor) should not be used concomitantly with Paroxetine,
Fluoxetine, or Bupropion due to the risk of serious adverse effects like hypotension
and bradycardia.
2. Vitamin B12, B6, Folate, Omega 3 Fatty Acid – can improve depressive symptoms
3. Ziprasidone (Geodon), Quetiapine (Seroquel), and Haloperidol (Haldol) can
cause QT prolongation as Citalopram (Celexa).
4. Aripiprazole (Abilify), Lurasidone (Latuda), Olanzapine (Zyprexa) – less likely to
prolong QT interval
5. Least sedating SSRI – Escitalopram (Lexapro) and Fluoxetine (Prozac)
6. Safest SSRI for patients with heart issues = Sertraline (Zoloft) and Escitalopram
(Lexapro)
7. The most effective treatment for Serotonin Discontinuation Syndrome (Sx. muscle
soreness, achiness, N/V, fatigue, lethargy, agitation) is to resume taking the
antidepressant at the previously prescribed dose. Symptoms usually go away within
24 hours of restarting the medication.
8. Lab test for a new patient diagnosed with mental illness:
a. Comprehensive Metabolic Panel (CMP) – evaluates kidney and liver function,
electrolyte levels, and blood glucose.
Georgette’s LMR – Revised for 2025
PART I
Test Taking Strategies
1. Read the entire question carefully before answering and identify what the question is seeking.
Do not skim over the words or read them too quickly. Pay attention to key words in the question.
2. 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. Read all the answer choices.
a. Narrow down options to two possible right questions.
b. Partially correct answers are NOT the correct answer.
c. When two answer choices are the opposite of one another, one is usually the correct
answer.
d. The correct answer may have the same word or a synonym as the test question
e. Choose client-focused answers
f. When many responses are remarkably similar in meaning, they are usually wrong
g. Be wary of absolutes – all, only, always, every, must, never, none, everything,
nothing -> usually wrong
4. Questions that use adjectives like PRIORITY, INITIAL ACTION are testing your
ability to prioritize. – There are multiple questions regarding priority
a. Airway, Breathing, Circulation
b. Maslow’s Hierarchy of Needs – basic physiologic needs (food, water, warmth, rest)
>>> self-actualization (highest)
c. Nursing Process: Assessment before Intervention – Assessment is collecting
data to support the problem towards a resolution.
5. Safety of the patient and others is usually the right answer
6. Critical Thinking is important
7. Interprofessional collaboration is encouraged
a. Looking for Collaboration – usually correct answer
b. Delegation – Not correct
c. Before you refer out ask yourself if there is something that you can do within
your scope of practice such as order a UDS
8. Culture is important to be included in all your nursing care
a. Cultural Expected Response to a stressor
i. Understand the context / meaning (cultural syndrome)
1. Use brief supportive therapy
ii. Contextualize their situation culturally
iii. Empower the patient
iv. Ethnicity, Ancestry, immigrant = Culturally sensitive = PRIORITY
1. Perform Cultural Assessment
a. Clarify meaning of illness – Validate symptoms with
cultural context = cultural syndrome = brief supportive therapy =
job/house loss
b. Psychoeducation should have cultural context
b. Culture = Respect
, 2
i. Examples Cultural Syndromes – clusters of symptoms and attributions that tend to
occur among individuals in specific cultural groups, communities, or contexts. They are
recognized locally as coherent patterns of experience. Ask the patient the meaning of the
symptoms to them and offer brief supportive therapy.
1. Native Americans believe illness = imbalance between individual and the
world. Native Americans = Highest suicide rate + attempts
Traditional Healers (even when patient requests them verbally - Require a
ROI)
2. Latino – Susto (“fright”) – illness is believed to result from a shocking,
unpleasant, or frightening experience that is believed to cause the soul to leave the
body. Symptoms often include appetite disturbances, inadequate or excessive
sleep, troubled sleep or dreams, sadness, lack of motivation, and feelings of low
self-worth or dirtiness. Somatic symptoms include muscle aches and pains,
headache, stomach ache, and diarrhea.
3. Puerto Rican syndrome –
a. Ataque de nervios = attack of nerves: uncontrollable shouting, attacks of
crying, trembling, heat in the chest rising into the head, and verbal or
physical aggression.
b. Mal de ojo = evil eye: fatigue, headache, weight loss, exhaustion, and
malaise
c. Empacho = blocked intestine
d. Mollera caida = sunken fontanel
3. Chinese medicine – “Wind-cold” illness = a pattern of symptoms associated
with invasion of the body by external pathogenic factors, particularly wind and
cold.
a. These pathogenic factors can disrupt the body’s balance and flow of Qi
(vital energy) and blood, leading to various health problems.
b. Manifests as symptoms such as chills, aversion to cold, body aches,
nasal congestion, headache, and possibly a mild fever.
c. It is often distinguished from “wind-heat” illness, which presents with
similar symptoms but is characterized by a fever and more pronounced
heat signs such as sweating and thirst.
9. Behavior Management and Support – STARTS upon or immediately after admission
a. Private office with partially opened door
10. Adolescent Confidentiality (advocating for confidentiality)
a. Provides them a safe place to address things such as
i. Consensual Relationship
ii. Attraction to same gender
11. Self-Esteem Building
a. Promotes Resilience in children
b. Use Open-ended Questions
c. If they cannot construct narrative you can use yes/no questions
12, Joint Appointments
a. If only one shows, then Reschedule
, 3
13. 5 y/o sodomized by 16 y/o brother
a. Do not leave 5 y/o with 16 y/o
b. Contact CPS
c. Arrange for Crisis Counseling
PART II
Apoptosis – neuronal loss or cell death/cell extinction/cell shrinkage/cell disintegration
Thyroid Disorder
1. Normal TSH – 0.5–5.0 Mu/L
a. Hypothyroid mimics symptoms of Depression
b. Hyperthyroid mimics symptoms of Mania
2. When T3 & T4 = High (Hyperthyroid) = TSH secretions DECREASE
a. Symptoms: (SPEED UP)
i. Heat Intolerance
ii. Agitation
iii. Irritability
iv. Tachycardia
v. Mood Swings
vi. Weight Loss
3. When T4 & T3 are low (Hypothyroid) = TSH secretions INCREASE
a. Symptoms: (SLOW DOWN)
i. Cold Intolerance
ii. Lethargy
iii. Weight Gain
iv. Decreased Libido
Divalproex sodium (Depakote)
1. Can cause Spina Bifida (neural tube defect)
2. RISK of Hepatotoxicity – liver toxicity (BBW)
a. Signs of Hepatotoxicity
i. Abdominal pain in Upper right portion of Abdomen
ii. Reddish Brown Urine
iii. Yellowing of the Skin and whites of the eyes
iv. Fatigue
b. INTERVENTION:
i. Discontinue offending agent
ii. Perform Liver Function Test (LFT)
1. AST: 5 to 40 U/L; ALT: 5 to 35 U/L
3. Therapeutic Range for Depakote/Valproic Acid
a. 50-125 µg/mL (therapeutic range)
b. Toxicity occurs when levels are greater than 150 µg/mL
i. Signs of Depakote Toxicity:
1. Disorientation
2. Lethargy
, 4
3. Respiratory Depression
4. Nausea/Vomiting
ii. INTERVENTION:
1. Discontinue Depakote
2. Check Valproic acid levels
3. Check LFT
4. Check Ammonia Levels
4. Depakote can cause Pancreatitis (BBW)
1. Upper abdominal pain that radiates to your back
2. tenderness when touching the abdomen
3. fever
4. rapid pulse
5. nausea/vomiting
6. oily stools
KAVA (piper methysticum)
1. Herbal Supplement used for Anxiety, Stress, and Insomnia
2. Side Effects:
a. Can cause Liver Damage
3. Major Interactions:
a. Do not use in combination with:
i. Alcohol – may increase risk of liver toxicity and other adverse effects
ii. Medications Metabolized by the Liver, such as benzodiazepines
1. Kava can cause drowsiness. Benzo med, such as Alprazolam,
can cause drowsiness.
2. Combined can lead to excessive drowsiness and impairment.
NOTE:
1. Metoprolol (Lopressor) should not be used concomitantly with Paroxetine,
Fluoxetine, or Bupropion due to the risk of serious adverse effects like hypotension
and bradycardia.
2. Vitamin B12, B6, Folate, Omega 3 Fatty Acid – can improve depressive symptoms
3. Ziprasidone (Geodon), Quetiapine (Seroquel), and Haloperidol (Haldol) can
cause QT prolongation as Citalopram (Celexa).
4. Aripiprazole (Abilify), Lurasidone (Latuda), Olanzapine (Zyprexa) – less likely to
prolong QT interval
5. Least sedating SSRI – Escitalopram (Lexapro) and Fluoxetine (Prozac)
6. Safest SSRI for patients with heart issues = Sertraline (Zoloft) and Escitalopram
(Lexapro)
7. The most effective treatment for Serotonin Discontinuation Syndrome (Sx. muscle
soreness, achiness, N/V, fatigue, lethargy, agitation) is to resume taking the
antidepressant at the previously prescribed dose. Symptoms usually go away within
24 hours of restarting the medication.
8. Lab test for a new patient diagnosed with mental illness:
a. Comprehensive Metabolic Panel (CMP) – evaluates kidney and liver function,
electrolyte levels, and blood glucose.
