Georgette's Review With 100% Passing
Rate
Test taking strategies - read carefully and use info provided by examiner to answer question
- narrow down options to 2 possible right answers
- partially correct answers are not the correct answers
- when 2 answer choices are the opposite of one another, one is usually the correct answer
(hypoglycemia vs hyperglycemia)
- the right answer might use the same word as the test question
- we do not do medical evals, correct answer would be to refer in this case
- when many response choices are remarkably similar, they are usually wrong
Order of importance - questions that use adjectives like priority and initial action test abilify to
prioritize
- most important is airway, breathing, and circulation
- second is maslow's heirarchy of needs (physical needs, food, water, warmth, rest, safety,
security)
- then the nursing process (assessment before intervention).
Assessment collecting data to support the problem towards a resolution. SAFETY BEFORE
ASSESSMENT
Tics If tics are noted, stimulants are contraindicated
Safety Safety for the patient and other is usually the right answer. Safety first.
Abuse If a patient is a victim of violence or abuse, assure them of their personal safety first and
foremost
Before discharging Make sure patient is safe and can cope affectively
Safety/no harm contract most likely incorrect answer
When does behavioral management and support start once the patient is admitted (not after
discharge)
Where to interview an patient? In a private office with door open or partially open. NOT in
their room or in the day room. Safety >>> privacy
Client comes in with parents and is reporting abuse. What should the PMHNP do? Interview the
child separately from the parents and then the parents separately from child.
Then report to CPS
Child comes into a follow up without parents. This child is holding and playing with a toy in a
sexual way. What to do? Immediately contact CPS (suspicion alone is enough to report to
CPS)
How to build therapeutic rapport with adolescents Letting them know everything will be
confidential except harm to themselves or others.
Try to see them without parents present as well.
,Confidential verse nonconfidential Patient is attracted to the same gender- confidential
Patient is in a consensual relationship with another person of their same age- confidential
Suicidal- non confidential
Delegating verse collaborating in a question Delegating will likely be incorrect but collaborating
is good
Example- PMHNP notices a lot of women commiting suicide during post partum care because
they're discharged without a risk assessment. The PMHNP should use interpersonal collaboration
by collaborating with OB docs to do an assessment before discharge. PMHNP identified a gap in
care.
Always choose an answer where we are actively involved.
A patient is being discharged and the rehab facility is requesting lab results. What should the
PMHNP do? PMHNP should obtain informed consent and fax labs over (because this is the
most actively involved answer)
14yo boy comes to office and says he is "feeling weird/funny" because he inhaled acetone. What
should the PMHNP do? Urine drugs screen. This is correct because the PMHNP should
chose to do what is in their scope of practice. He does not necessarily need to be referred out.
Before referring out, ask yourself is there an answer than can be done within my scope of
practice
Culture related question (one that specifies ethnicity of ancestry) First thing to note is
culturally expected response to stressor (their response does not always mean they have a mental
illness)
Cultural syndrome Brief supportive therapy
Example, if someone lost their job or house they might just need brief supportive therapy. They
might not need meds.
Example, if a person is experiencing pain or somatic complaints, interpret their symptoms based
on cultural context
Cultural formulation interviews Clarify meaning of illness or predicament, contextualize
their situation in their local world, empower the patient
Psychoeducation to a client with specific culture should be based on cultural context
When serving a multicultural poputlation it is important to provide multicultural teaching by
using ethnospecific assessment parameters. Respect is very important
Example native americans might believe that substance use or mental illness is an imbalance
between an individuals relationship with the world
Healing sticks Native americans believe that healing sticks have healing powers.
A Native American patient on an inpatient unit has a healing stick and insists on keeping it. The
nurse is trying to take it. What does the PMHNP do? Teach nurse cultural competence
If a cultural question has a judgmental answer it is usually incorrect
A Native American patient wants to send notes to his traditional healer. What to do? Obtain
clearance for informed consent then send the notes
, Susto ("fright") One of the common folk illnesses seen in the latino population. Illnesses
from susto are believed to result from a shocking, unpleasant, or frightenin experience that is
believed to cause the soul to leave the body
Ataque de nervios (puerto rican syndrome) Attack of nerves. Uncontrollable shouting, attacks
of crying, tremling, heat in the chest rising into the head, and verbal or physical aggression
Mal de ojo (evil eye) fatigue, headache, weight loss, exhaustion, and malaise
Empacho (blocked intestine) indigestion (feeling bloated or nauseous)
Mollera caida sunken fontanel
Normal TSH level 0.5- 5.0
Symptoms of hyperthyroidism mimic mania
symptoms of hypothyroidism mimin depression
Hyperthyroidism - T3 and T4 high
- TSH low
- symptoms include heat intolerance, agitation, anxiety, irritability, tachycardia, mood swings,
and weight loss
Hypothyroidism - T3 and T4 are low
- TSH high
- cold intolerance, lethargy, weight gain, decreased libido
Patient has a TSH of 0.4. What is this? Hyperthyroidism
Patient has a TSH of 7.0. What is this? Hypothyroidism
Divalproex sodium (Depakote) - Anticonvulsant
- can cause spina bifida (neural tube defect). do NOT prescribe to a pregnant patient
- BBW for hepatotoxicity (liver toxicity)
A patient taking Depakote presents with signs of hepatotoxicity (abdominal pain in RUQ,
reddish brown urine, yellowing of the skin and whites of eyes, fatigue). What to do?
Discontinue offending agent and do a liver function test (LFT).
Check AST (range is 50-125) and ALT (range is 5-35)
Therapeutic range for Depakote 50-125 mcg/mL
Toxicity from Depakote happens when levels are greater than 150
Signs of valproic acid toxicity - disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for valproic acid toxicity Discontinue the offending agent and check valproic
acid levels, LFTs, and ammonia levels
Depakote can cause pancreatitis (upper abdominal pain, abdominal pain that radiates to back,
tenderness when touching the abdomen, fever, rapid pulse, nausea, vomiting, oily stools)
Kava Kava herbal supplement for anxiety/stress
side effects include liver damage
monitor for: liver toxicity
Liver toxicity signs abdominal pain in RUQ, reddish urine, yellowing of the skin, fatigue
Major interaction with Kava Kava Benzos/sedatives!!! Safety issue, can cause major
drowsiness
- ex klonpin, ativan, phenobarbital (donnatal), ambien, etc
Lamictal Major SE- steven johnsons syndrome
Steven Johnson Syndrome (SJS) fever, cough, muscular aches and pains, headache, and
lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters,
often starting on the face, in the mouth, or on the lips, neck, and extremities
Rate
Test taking strategies - read carefully and use info provided by examiner to answer question
- narrow down options to 2 possible right answers
- partially correct answers are not the correct answers
- when 2 answer choices are the opposite of one another, one is usually the correct answer
(hypoglycemia vs hyperglycemia)
- the right answer might use the same word as the test question
- we do not do medical evals, correct answer would be to refer in this case
- when many response choices are remarkably similar, they are usually wrong
Order of importance - questions that use adjectives like priority and initial action test abilify to
prioritize
- most important is airway, breathing, and circulation
- second is maslow's heirarchy of needs (physical needs, food, water, warmth, rest, safety,
security)
- then the nursing process (assessment before intervention).
Assessment collecting data to support the problem towards a resolution. SAFETY BEFORE
ASSESSMENT
Tics If tics are noted, stimulants are contraindicated
Safety Safety for the patient and other is usually the right answer. Safety first.
Abuse If a patient is a victim of violence or abuse, assure them of their personal safety first and
foremost
Before discharging Make sure patient is safe and can cope affectively
Safety/no harm contract most likely incorrect answer
When does behavioral management and support start once the patient is admitted (not after
discharge)
Where to interview an patient? In a private office with door open or partially open. NOT in
their room or in the day room. Safety >>> privacy
Client comes in with parents and is reporting abuse. What should the PMHNP do? Interview the
child separately from the parents and then the parents separately from child.
Then report to CPS
Child comes into a follow up without parents. This child is holding and playing with a toy in a
sexual way. What to do? Immediately contact CPS (suspicion alone is enough to report to
CPS)
How to build therapeutic rapport with adolescents Letting them know everything will be
confidential except harm to themselves or others.
Try to see them without parents present as well.
,Confidential verse nonconfidential Patient is attracted to the same gender- confidential
Patient is in a consensual relationship with another person of their same age- confidential
Suicidal- non confidential
Delegating verse collaborating in a question Delegating will likely be incorrect but collaborating
is good
Example- PMHNP notices a lot of women commiting suicide during post partum care because
they're discharged without a risk assessment. The PMHNP should use interpersonal collaboration
by collaborating with OB docs to do an assessment before discharge. PMHNP identified a gap in
care.
Always choose an answer where we are actively involved.
A patient is being discharged and the rehab facility is requesting lab results. What should the
PMHNP do? PMHNP should obtain informed consent and fax labs over (because this is the
most actively involved answer)
14yo boy comes to office and says he is "feeling weird/funny" because he inhaled acetone. What
should the PMHNP do? Urine drugs screen. This is correct because the PMHNP should
chose to do what is in their scope of practice. He does not necessarily need to be referred out.
Before referring out, ask yourself is there an answer than can be done within my scope of
practice
Culture related question (one that specifies ethnicity of ancestry) First thing to note is
culturally expected response to stressor (their response does not always mean they have a mental
illness)
Cultural syndrome Brief supportive therapy
Example, if someone lost their job or house they might just need brief supportive therapy. They
might not need meds.
Example, if a person is experiencing pain or somatic complaints, interpret their symptoms based
on cultural context
Cultural formulation interviews Clarify meaning of illness or predicament, contextualize
their situation in their local world, empower the patient
Psychoeducation to a client with specific culture should be based on cultural context
When serving a multicultural poputlation it is important to provide multicultural teaching by
using ethnospecific assessment parameters. Respect is very important
Example native americans might believe that substance use or mental illness is an imbalance
between an individuals relationship with the world
Healing sticks Native americans believe that healing sticks have healing powers.
A Native American patient on an inpatient unit has a healing stick and insists on keeping it. The
nurse is trying to take it. What does the PMHNP do? Teach nurse cultural competence
If a cultural question has a judgmental answer it is usually incorrect
A Native American patient wants to send notes to his traditional healer. What to do? Obtain
clearance for informed consent then send the notes
, Susto ("fright") One of the common folk illnesses seen in the latino population. Illnesses
from susto are believed to result from a shocking, unpleasant, or frightenin experience that is
believed to cause the soul to leave the body
Ataque de nervios (puerto rican syndrome) Attack of nerves. Uncontrollable shouting, attacks
of crying, tremling, heat in the chest rising into the head, and verbal or physical aggression
Mal de ojo (evil eye) fatigue, headache, weight loss, exhaustion, and malaise
Empacho (blocked intestine) indigestion (feeling bloated or nauseous)
Mollera caida sunken fontanel
Normal TSH level 0.5- 5.0
Symptoms of hyperthyroidism mimic mania
symptoms of hypothyroidism mimin depression
Hyperthyroidism - T3 and T4 high
- TSH low
- symptoms include heat intolerance, agitation, anxiety, irritability, tachycardia, mood swings,
and weight loss
Hypothyroidism - T3 and T4 are low
- TSH high
- cold intolerance, lethargy, weight gain, decreased libido
Patient has a TSH of 0.4. What is this? Hyperthyroidism
Patient has a TSH of 7.0. What is this? Hypothyroidism
Divalproex sodium (Depakote) - Anticonvulsant
- can cause spina bifida (neural tube defect). do NOT prescribe to a pregnant patient
- BBW for hepatotoxicity (liver toxicity)
A patient taking Depakote presents with signs of hepatotoxicity (abdominal pain in RUQ,
reddish brown urine, yellowing of the skin and whites of eyes, fatigue). What to do?
Discontinue offending agent and do a liver function test (LFT).
Check AST (range is 50-125) and ALT (range is 5-35)
Therapeutic range for Depakote 50-125 mcg/mL
Toxicity from Depakote happens when levels are greater than 150
Signs of valproic acid toxicity - disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for valproic acid toxicity Discontinue the offending agent and check valproic
acid levels, LFTs, and ammonia levels
Depakote can cause pancreatitis (upper abdominal pain, abdominal pain that radiates to back,
tenderness when touching the abdomen, fever, rapid pulse, nausea, vomiting, oily stools)
Kava Kava herbal supplement for anxiety/stress
side effects include liver damage
monitor for: liver toxicity
Liver toxicity signs abdominal pain in RUQ, reddish urine, yellowing of the skin, fatigue
Major interaction with Kava Kava Benzos/sedatives!!! Safety issue, can cause major
drowsiness
- ex klonpin, ativan, phenobarbital (donnatal), ambien, etc
Lamictal Major SE- steven johnsons syndrome
Steven Johnson Syndrome (SJS) fever, cough, muscular aches and pains, headache, and
lesions of the skin, mucous membranes, and eyes; the lesions appear as red wheals or blisters,
often starting on the face, in the mouth, or on the lips, neck, and extremities
