GEORGETTE REVIEW PMHNP WITH ALL
NEEDED TO PASS
When fmany fanswers fare fremarkably fsimilar, fthey fare fusually f_____________ f-
fcorrect fanswers f-wrong
Interprofessional fcollaboration fis fencouraged. f- fcorrect fanswers f-Collaborate fis
fusually fright. f
Delegate fis fusually fwrong.
ADPIER f- fcorrect fanswers f-Assessment, fdiagnosis, fPlan, fintervention, fevaluate,
frefer fout flast.
Lithium f- fcorrect fanswers f-Normal f0.6-1.2
Lithium ftoxicity foccurs fat flevels f- fcorrect fanswers f-> f1.5
Signs fof fLithium ftoxicity f- fcorrect fanswers f-severe fnausea, fdiarrhea, fvomiting,
fconfusion, fdrowsiness, fmuscle fweakness, fheart fpalpitation, fcoarse fhand ftremors,
funsteady fgait
,Lithium fis fgold fstandard ffor f- fcorrect fanswers f-MANIA
Lithium fhas fevidence fshown fto f- fcorrect fanswers f-reduce fsuicidal fideation
What fdoes flithium fcause fin fneonate, fespecially f1st ftrimester f- fcorrect fanswers f-
Ebstein fanomaly f(congenital fheart fdefect)
dehydration fand fhyponatremia fcause flithium flevels fto f- fcorrect fanswers f-rise
Baseline flabs fbefore finitiation fof flithium f- fcorrect fanswers f-TSH
creatinine f(0.6-1.2)
BUN f(10-20)
HCG f(all fpsychotropics ffemales f12-51)
EKG f50+
Urinalysis f(check ffor fproteins, f4+ fmay findicate fkidney fdisease)
Side fEffects fof fLithium f- fcorrect fanswers f-hypothyroidism
coase fhand ftremors fwith ftoxicity
maculopapular frash
diarrhea, fvomiting, fcramps--signs fof ftoxicity. fMonitor fclosely. f
anorexia
t fwave finversions
leukocytosis
Pt feducation ffor flithimum f- fcorrect fanswers f-staying fhydrated
avoiding fNSAIDS
compliance
Depakote fnormal flevel f- fcorrect fanswers f-50-125
Depakote ftoxicity flevel f- fcorrect fanswers f-greater fthan f150
Teratogenic feffects fof fDepakote f- fcorrect fanswers f-spina fbifida
Adverse feffects fof fdepakote f- fcorrect fanswers f-alopecia
hepatotoxicity f(RUQ fpain for fbrown/red furine--order fLFTs) fAST f5-40, fALT f5-35,
fyellowing fof fskin for feyes, ffatigue
Signs fof fDepakote ftoxicity f- fcorrect fanswers f-disorientation, flethargy, frespiratory
fdepression, fnausea/vomiting
Intervention ffor fdepakote ftoxicity f- fcorrect fanswers f-DC fmed
check flevel
LFT
ammonia
,MAOI f+ ftyramine fcauses f- fcorrect fanswers f-hypertensive fcrisis
Symptoms fof fhypertensive fcrisis f- fcorrect fanswers f-elevated fBP
sudden fexplosive flike fheadache
facial fflushing
palpitations
pupillary fdilation
diaphoresis
fever
Hypertensive fcrisis foccurs fwith fMAOI f+ f- fcorrect fanswers f-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. fJohn's fwart
L-tryptophan
asthma fmeds
Treatment ffor fhypertensive fcrisis f- fcorrect fanswers f-DC foffending fagent
Administer fPHENTOLAMINE
Teratogenic feffects fof fbenzos f- fcorrect fanswers f-floppy fbaby, fcleft fpalate
Teratogenic feffects fof ftegratol f- fcorrect fanswers f-neural ftube fdefect
teratogenic feffects fof flithium f- fcorrect fanswers f-ebstein fanomaly f(heart fdefect)
f(avoid, fespecially f1st ftrimester)
teratogenic feffects fof fdepakote f- fcorrect fanswers f-neural ftube fdefects/spina fbifida
Adverse freaction fto fLamictal f- fcorrect fanswers f-Steven fJohnson's fSyndrome
Signs fof fSJS f- fcorrect fanswers f-FEVER f--high fyield
sore fthroat
facial fswelling
tongue fswelling
red frash
skin fsloughing
body faches
prodromal fheadache
malaise
arthralgia
painful fmucus fmembranes
, Lamotrigine fis fleast flikely fto fcause f- fcorrect fanswers f-sedation for fweight fgain
Carbamazepine f(tegretol) fblack fbox fwarning f- fcorrect fanswers f-agranulocytosis
f(decrease fWBCs)
aplastic fanemia f(pallor, ffatigue, fHA, ffever, fnosebleeds, fbleeding fgums, fskin frash,
fSOA)
Carbamazepine fand fasians f- fcorrect fanswers f-Screen ffor fHLAB-1502 fallele fbefore
finitiating, fdue fto fhigh fincidence fof fSJS fif fpositive ffor fallele.
Child-bearing faged fwomen f- fcorrect fanswers f-check ffor fpregnancy fbefore fstarting
fmood fstabilizer
start fon ffolic facid fto fsupport fneural ftube fdevelopment fduring fthe ffirst fmonth fthat
fa fwoman fis fpregnant
Clozaril/clozapine fcan fcause f- fcorrect fanswers f-agranulocytosis fand fneutropenia
For fmonitoring fneutropenia fin fClozaril, fmonitor f- fcorrect fanswers f-ANC
DC fclozarli fif fANC f- fcorrect fanswers f-less fthan f1000
DC fclozaril fif fWBC f- fcorrect fanswers f-2000-3000, frisk fof fagranulocytosis
When fon fclozaril fmonitor ffor f- fcorrect fanswers f-signs fand fsymptoms fof finfection:
fsudden ffever, fchills, fsore fthroat, fweakness
Clozaril fonly fknown fantipsychotic fto f- fcorrect fanswers f-decrease frisk fof fsuicide fin
fpatients fwith fschizophrenia.
Your fpatient fwith fbipolar fdisorder fis fadmitted fto fa fmedical fhospital. fThe finternist
fcontacts fyour foffice fand fasks fwhether fthe flithium fyou fprescribed fhim fis feffecting
fhis fECG. fHow fdo fyou frespond?
A. fLithium fcan fprolong fthe fQT finterval
B. fLithium fhas fno feffect fon fhis fECG
C. fLithium fcan finvert fthe ft fwaves
D. fLithium fcan fshorten fthe fPR finterval f- fcorrect fanswers f-Answer: fLithium fcan
finvert fthe ft fwaves.
Mary fis fa f45-year-old fAfrican fAmerican ffemale fwho fhas fbeen ftreated fon
fIsocarboxazid f(Marplan) ffor fover f6 fyears. fMary fis fgoing fin ffor fa fsurgical
fprocedure. fWhich fmedication fis fstrictly fcontraindicated fwith fIsocarboxazid?
A. fMorphine
B. fNSAIDS
C. fMethylphenidate
D. fAcetaminophen f- fcorrect fanswers f-Answer: fMethylphenidate
NEEDED TO PASS
When fmany fanswers fare fremarkably fsimilar, fthey fare fusually f_____________ f-
fcorrect fanswers f-wrong
Interprofessional fcollaboration fis fencouraged. f- fcorrect fanswers f-Collaborate fis
fusually fright. f
Delegate fis fusually fwrong.
ADPIER f- fcorrect fanswers f-Assessment, fdiagnosis, fPlan, fintervention, fevaluate,
frefer fout flast.
Lithium f- fcorrect fanswers f-Normal f0.6-1.2
Lithium ftoxicity foccurs fat flevels f- fcorrect fanswers f-> f1.5
Signs fof fLithium ftoxicity f- fcorrect fanswers f-severe fnausea, fdiarrhea, fvomiting,
fconfusion, fdrowsiness, fmuscle fweakness, fheart fpalpitation, fcoarse fhand ftremors,
funsteady fgait
,Lithium fis fgold fstandard ffor f- fcorrect fanswers f-MANIA
Lithium fhas fevidence fshown fto f- fcorrect fanswers f-reduce fsuicidal fideation
What fdoes flithium fcause fin fneonate, fespecially f1st ftrimester f- fcorrect fanswers f-
Ebstein fanomaly f(congenital fheart fdefect)
dehydration fand fhyponatremia fcause flithium flevels fto f- fcorrect fanswers f-rise
Baseline flabs fbefore finitiation fof flithium f- fcorrect fanswers f-TSH
creatinine f(0.6-1.2)
BUN f(10-20)
HCG f(all fpsychotropics ffemales f12-51)
EKG f50+
Urinalysis f(check ffor fproteins, f4+ fmay findicate fkidney fdisease)
Side fEffects fof fLithium f- fcorrect fanswers f-hypothyroidism
coase fhand ftremors fwith ftoxicity
maculopapular frash
diarrhea, fvomiting, fcramps--signs fof ftoxicity. fMonitor fclosely. f
anorexia
t fwave finversions
leukocytosis
Pt feducation ffor flithimum f- fcorrect fanswers f-staying fhydrated
avoiding fNSAIDS
compliance
Depakote fnormal flevel f- fcorrect fanswers f-50-125
Depakote ftoxicity flevel f- fcorrect fanswers f-greater fthan f150
Teratogenic feffects fof fDepakote f- fcorrect fanswers f-spina fbifida
Adverse feffects fof fdepakote f- fcorrect fanswers f-alopecia
hepatotoxicity f(RUQ fpain for fbrown/red furine--order fLFTs) fAST f5-40, fALT f5-35,
fyellowing fof fskin for feyes, ffatigue
Signs fof fDepakote ftoxicity f- fcorrect fanswers f-disorientation, flethargy, frespiratory
fdepression, fnausea/vomiting
Intervention ffor fdepakote ftoxicity f- fcorrect fanswers f-DC fmed
check flevel
LFT
ammonia
,MAOI f+ ftyramine fcauses f- fcorrect fanswers f-hypertensive fcrisis
Symptoms fof fhypertensive fcrisis f- fcorrect fanswers f-elevated fBP
sudden fexplosive flike fheadache
facial fflushing
palpitations
pupillary fdilation
diaphoresis
fever
Hypertensive fcrisis foccurs fwith fMAOI f+ f- fcorrect fanswers f-MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. fJohn's fwart
L-tryptophan
asthma fmeds
Treatment ffor fhypertensive fcrisis f- fcorrect fanswers f-DC foffending fagent
Administer fPHENTOLAMINE
Teratogenic feffects fof fbenzos f- fcorrect fanswers f-floppy fbaby, fcleft fpalate
Teratogenic feffects fof ftegratol f- fcorrect fanswers f-neural ftube fdefect
teratogenic feffects fof flithium f- fcorrect fanswers f-ebstein fanomaly f(heart fdefect)
f(avoid, fespecially f1st ftrimester)
teratogenic feffects fof fdepakote f- fcorrect fanswers f-neural ftube fdefects/spina fbifida
Adverse freaction fto fLamictal f- fcorrect fanswers f-Steven fJohnson's fSyndrome
Signs fof fSJS f- fcorrect fanswers f-FEVER f--high fyield
sore fthroat
facial fswelling
tongue fswelling
red frash
skin fsloughing
body faches
prodromal fheadache
malaise
arthralgia
painful fmucus fmembranes
, Lamotrigine fis fleast flikely fto fcause f- fcorrect fanswers f-sedation for fweight fgain
Carbamazepine f(tegretol) fblack fbox fwarning f- fcorrect fanswers f-agranulocytosis
f(decrease fWBCs)
aplastic fanemia f(pallor, ffatigue, fHA, ffever, fnosebleeds, fbleeding fgums, fskin frash,
fSOA)
Carbamazepine fand fasians f- fcorrect fanswers f-Screen ffor fHLAB-1502 fallele fbefore
finitiating, fdue fto fhigh fincidence fof fSJS fif fpositive ffor fallele.
Child-bearing faged fwomen f- fcorrect fanswers f-check ffor fpregnancy fbefore fstarting
fmood fstabilizer
start fon ffolic facid fto fsupport fneural ftube fdevelopment fduring fthe ffirst fmonth fthat
fa fwoman fis fpregnant
Clozaril/clozapine fcan fcause f- fcorrect fanswers f-agranulocytosis fand fneutropenia
For fmonitoring fneutropenia fin fClozaril, fmonitor f- fcorrect fanswers f-ANC
DC fclozarli fif fANC f- fcorrect fanswers f-less fthan f1000
DC fclozaril fif fWBC f- fcorrect fanswers f-2000-3000, frisk fof fagranulocytosis
When fon fclozaril fmonitor ffor f- fcorrect fanswers f-signs fand fsymptoms fof finfection:
fsudden ffever, fchills, fsore fthroat, fweakness
Clozaril fonly fknown fantipsychotic fto f- fcorrect fanswers f-decrease frisk fof fsuicide fin
fpatients fwith fschizophrenia.
Your fpatient fwith fbipolar fdisorder fis fadmitted fto fa fmedical fhospital. fThe finternist
fcontacts fyour foffice fand fasks fwhether fthe flithium fyou fprescribed fhim fis feffecting
fhis fECG. fHow fdo fyou frespond?
A. fLithium fcan fprolong fthe fQT finterval
B. fLithium fhas fno feffect fon fhis fECG
C. fLithium fcan finvert fthe ft fwaves
D. fLithium fcan fshorten fthe fPR finterval f- fcorrect fanswers f-Answer: fLithium fcan
finvert fthe ft fwaves.
Mary fis fa f45-year-old fAfrican fAmerican ffemale fwho fhas fbeen ftreated fon
fIsocarboxazid f(Marplan) ffor fover f6 fyears. fMary fis fgoing fin ffor fa fsurgical
fprocedure. fWhich fmedication fis fstrictly fcontraindicated fwith fIsocarboxazid?
A. fMorphine
B. fNSAIDS
C. fMethylphenidate
D. fAcetaminophen f- fcorrect fanswers f-Answer: fMethylphenidate
