Georgette Review PMHNP: Questions With Expert
Solutions
When many answers are remarkably similar, they are usually _____________
Correct Answer - wrong
Interprofessional collaboration is encouraged. Correct Answer -
Collaborate is usually right.
Delegate is usually wrong.
ADPIER Correct Answer - Assessment, diagnosis, Plan, intervention,
evaluate, refer out last.
Lithium Correct Answer - Normal 0.6-1.2
Lithium toxicity occurs at levels Correct Answer - > 1.5
Signs of Lithium toxicity Correct Answer - severe nausea, diarrhea,
vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse
hand tremors, unsteady gait
Lithium is gold standard for Correct Answer - MANIA
Lithium has evidence shown to Correct Answer - reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester Correct
Answer - Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to Correct Answer -
rise
Baseline labs before initiation of lithium Correct Answer - 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 Correct Answer - 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 Correct Answer - staying hydrated
avoiding NSAIDS
compliance
Depakote normal level Correct Answer - 50-125
Depakote toxicity level Correct Answer - greater than 150
Teratogenic effects of Depakote Correct Answer - spina bifida
Adverse effects of depakote Correct Answer - 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 Correct Answer - disorientation, lethargy,
respiratory depression, nausea/vomiting
Intervention for depakote toxicity Correct Answer - DC med
check level
LFT
ammonia
MAOI + tyramine causes Correct Answer - hypertensive crisis
Symptoms of hypertensive crisis Correct Answer - elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
,Hypertensive crisis occurs with MAOI + Correct Answer - MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis Correct Answer - DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos Correct Answer - floppy baby, cleft palate
Teratogenic effects of tegratol Correct Answer - neural tube defect
teratogenic effects of lithium Correct Answer - ebstein anomaly (heart
defect) (avoid, especially 1st trimester)
teratogenic effects of depakote Correct Answer - neural tube defects/spina
bifida
Adverse reaction to Lamictal Correct Answer - Steven Johnson's Syndrome
Signs of SJS Correct Answer - 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 Correct Answer - sedation or weight
gain
, Carbamazepine (tegretol) black box warning Correct Answer -
agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians Correct Answer - Screen for HLAB-1502 allele
before initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women Correct Answer - 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 Correct Answer - agranulocytosis and
neutropenia
For monitoring neutropenia in Clozaril, monitor Correct Answer - ANC
DC clozarli if ANC Correct Answer - less than 1000
DC clozaril if WBC Correct Answer - 2000-3000, risk of agranulocytosis
When on clozaril monitor for Correct Answer - signs and symptoms of
infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to Correct Answer - decrease risk of
suicide in patients with schizophrenia.
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 his ECG. How do 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 Answer - Answer: Lithium
can invert the t waves.
Solutions
When many answers are remarkably similar, they are usually _____________
Correct Answer - wrong
Interprofessional collaboration is encouraged. Correct Answer -
Collaborate is usually right.
Delegate is usually wrong.
ADPIER Correct Answer - Assessment, diagnosis, Plan, intervention,
evaluate, refer out last.
Lithium Correct Answer - Normal 0.6-1.2
Lithium toxicity occurs at levels Correct Answer - > 1.5
Signs of Lithium toxicity Correct Answer - severe nausea, diarrhea,
vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse
hand tremors, unsteady gait
Lithium is gold standard for Correct Answer - MANIA
Lithium has evidence shown to Correct Answer - reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester Correct
Answer - Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to Correct Answer -
rise
Baseline labs before initiation of lithium Correct Answer - 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 Correct Answer - 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 Correct Answer - staying hydrated
avoiding NSAIDS
compliance
Depakote normal level Correct Answer - 50-125
Depakote toxicity level Correct Answer - greater than 150
Teratogenic effects of Depakote Correct Answer - spina bifida
Adverse effects of depakote Correct Answer - 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 Correct Answer - disorientation, lethargy,
respiratory depression, nausea/vomiting
Intervention for depakote toxicity Correct Answer - DC med
check level
LFT
ammonia
MAOI + tyramine causes Correct Answer - hypertensive crisis
Symptoms of hypertensive crisis Correct Answer - elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
,Hypertensive crisis occurs with MAOI + Correct Answer - MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis Correct Answer - DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos Correct Answer - floppy baby, cleft palate
Teratogenic effects of tegratol Correct Answer - neural tube defect
teratogenic effects of lithium Correct Answer - ebstein anomaly (heart
defect) (avoid, especially 1st trimester)
teratogenic effects of depakote Correct Answer - neural tube defects/spina
bifida
Adverse reaction to Lamictal Correct Answer - Steven Johnson's Syndrome
Signs of SJS Correct Answer - 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 Correct Answer - sedation or weight
gain
, Carbamazepine (tegretol) black box warning Correct Answer -
agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians Correct Answer - Screen for HLAB-1502 allele
before initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women Correct Answer - 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 Correct Answer - agranulocytosis and
neutropenia
For monitoring neutropenia in Clozaril, monitor Correct Answer - ANC
DC clozarli if ANC Correct Answer - less than 1000
DC clozaril if WBC Correct Answer - 2000-3000, risk of agranulocytosis
When on clozaril monitor for Correct Answer - signs and symptoms of
infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to Correct Answer - decrease risk of
suicide in patients with schizophrenia.
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 his ECG. How do 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 Answer - Answer: Lithium
can invert the t waves.
