Georgette Review PMHNP. TEST GUIDE
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
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
