GEORGETTE REVIEW EXAM QUESTIONS
WITH CORRECT ANSWERS
When many answers are remarkably similar, they are usually
_____________ - ANS✔✔wrong
Interprofessional collaboration is encouraged. - ANS✔✔Collaborate is
usually right.
Delegate is usually wrong.
ADPIER - ANS✔✔Assessment, diagnosis, Plan, intervention, evaluate,
refer out last.
Lithium - ANS✔✔Normal 0.6-1.2
Lithium toxicity occurs at levels - ANS✔✔> 1.5
Signs of Lithium toxicity - ANS✔✔severe nausea, diarrhea, vomiting,
confusion, drowsiness, muscle weakness, heart palpitation, coarse hand
tremors, unsteady gait
Lithium is gold standard for - ANS✔✔MANIA
Lithium has evidence shown to - ANS✔✔reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester -
ANS✔✔Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to - ANS✔✔rise
Baseline labs before initiation of lithium - ANS✔✔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 - ANS✔✔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 - ANS✔✔staying hydrated
avoiding NSAIDS
compliance
Depakote normal level - ANS✔✔50-125
Depakote toxicity level - ANS✔✔greater than 150
Teratogenic effects of Depakote - ANS✔✔spina bifida
Adverse effects of depakote - ANS✔✔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 - ANS✔✔disorientation, lethargy, respiratory
depression, nausea/vomiting
Intervention for depakote toxicity - ANS✔✔DC med
check level
LFT
ammonia
MAOI + tyramine causes - ANS✔✔hypertensive crisis
Symptoms of hypertensive crisis - ANS✔✔elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - ANS✔✔MEPERIDINE
STIMULANTS
decongestants
,TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - ANS✔✔DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - ANS✔✔floppy baby, cleft palate
Teratogenic effects of tegratol - ANS✔✔neural tube defect
teratogenic effects of lithium - ANS✔✔ebstein anomaly (heart defect)
(avoid, especially 1st trimester)
teratogenic effects of depakote - ANS✔✔neural tube defects/spina bifida
Adverse reaction to Lamictal - ANS✔✔Steven Johnson's Syndrome
Signs of SJS - ANS✔✔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 - ANS✔✔sedation or weight gain
Carbamazepine (tegretol) black box warning - ANS✔✔agranulocytosis
(decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians - ANS✔✔Screen for HLAB-1502 allele before
initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women - ANS✔✔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 - ANS✔✔agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - ANS✔✔ANC
DC clozarli if ANC - ANS✔✔less than 1000
, DC clozaril if WBC - ANS✔✔2000-3000, risk of agranulocytosis
When on clozaril monitor for - ANS✔✔signs and symptoms of infection:
sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to - ANS✔✔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 - ANS✔✔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 - ANS✔✔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 5,000
D. ANC less than 2000 - ANS✔✔Answer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the
following medical problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate - ANS✔✔A. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in
the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal - ANS✔✔A. Carbamazepine
WITH CORRECT ANSWERS
When many answers are remarkably similar, they are usually
_____________ - ANS✔✔wrong
Interprofessional collaboration is encouraged. - ANS✔✔Collaborate is
usually right.
Delegate is usually wrong.
ADPIER - ANS✔✔Assessment, diagnosis, Plan, intervention, evaluate,
refer out last.
Lithium - ANS✔✔Normal 0.6-1.2
Lithium toxicity occurs at levels - ANS✔✔> 1.5
Signs of Lithium toxicity - ANS✔✔severe nausea, diarrhea, vomiting,
confusion, drowsiness, muscle weakness, heart palpitation, coarse hand
tremors, unsteady gait
Lithium is gold standard for - ANS✔✔MANIA
Lithium has evidence shown to - ANS✔✔reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester -
ANS✔✔Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to - ANS✔✔rise
Baseline labs before initiation of lithium - ANS✔✔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 - ANS✔✔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 - ANS✔✔staying hydrated
avoiding NSAIDS
compliance
Depakote normal level - ANS✔✔50-125
Depakote toxicity level - ANS✔✔greater than 150
Teratogenic effects of Depakote - ANS✔✔spina bifida
Adverse effects of depakote - ANS✔✔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 - ANS✔✔disorientation, lethargy, respiratory
depression, nausea/vomiting
Intervention for depakote toxicity - ANS✔✔DC med
check level
LFT
ammonia
MAOI + tyramine causes - ANS✔✔hypertensive crisis
Symptoms of hypertensive crisis - ANS✔✔elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - ANS✔✔MEPERIDINE
STIMULANTS
decongestants
,TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - ANS✔✔DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - ANS✔✔floppy baby, cleft palate
Teratogenic effects of tegratol - ANS✔✔neural tube defect
teratogenic effects of lithium - ANS✔✔ebstein anomaly (heart defect)
(avoid, especially 1st trimester)
teratogenic effects of depakote - ANS✔✔neural tube defects/spina bifida
Adverse reaction to Lamictal - ANS✔✔Steven Johnson's Syndrome
Signs of SJS - ANS✔✔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 - ANS✔✔sedation or weight gain
Carbamazepine (tegretol) black box warning - ANS✔✔agranulocytosis
(decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin
rash, SOA)
Carbamazepine and asians - ANS✔✔Screen for HLAB-1502 allele before
initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women - ANS✔✔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 - ANS✔✔agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - ANS✔✔ANC
DC clozarli if ANC - ANS✔✔less than 1000
, DC clozaril if WBC - ANS✔✔2000-3000, risk of agranulocytosis
When on clozaril monitor for - ANS✔✔signs and symptoms of infection:
sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to - ANS✔✔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 - ANS✔✔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 - ANS✔✔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 5,000
D. ANC less than 2000 - ANS✔✔Answer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the
following medical problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate - ANS✔✔A. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in
the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal - ANS✔✔A. Carbamazepine
