Georgette Review PMHNP Questions and answers

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