PMHNP Boards - Georgette's
When many answers are remarkably similar, they are usually _____________ correct answerswrong
When two answers are opposites, usually... correct answersone of those two is the correct answer
When looking at questions about intraprofessional communication: ________ don't _________. correct answerscollaborate, dont delegate
If asked to differentiate #1 from #2; think what is unique about _______. correct answers#1
If a question and an answer use the same words or synonyms, then that answer is usually ______. correct answerscorrect
If an answer has absolutes (only, always) it is usually _________. correct answerswrong
Levels of prioritization to use when answering questions: three levels. correct answers1. Airway, breathing, circulation
2. Maslowes - physiological needs (food, water, warmth, rest), safey and security
3. Nursing process: Assessment, diagnosis, plan, intervention, evaluate, refer out last
Lithium levels - Normal and Toxicity correct answersNormal 0.6-1.2
Toxicity > 1.5
Lithium toxicity occurs at levels correct answers> 1.5
Signs of Lithium toxicity correct answerssevere nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for correct answersMANIA
Lithium has evidence shown to (2) correct answers1. reduce suicidal ideation
2. Neuroprotective tx of choice for bipolar
What does lithium cause in neonate, especially 1st trimester correct answersEbstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to correct answersrise
Baseline labs before initiation of lithium correct answersTSH creatinine (0.6-1.2)
BUN (10-20)
HCG (all psychotropics females 12-51)
EKG 50+
Side Effects of Lithium and lithium toxicity correct answersSIde Effects: hypothyroidism,
coarse hand tremors with toxicity, diarrhea, leukocytosis
Toxicity: N/V, confusion, convulsions, drawsiness, blurred vision, slurred speech, mm weakness, heart palpitations, course hand tremors, and unsteadiness when walking (STOP and check levels)
Why are elderly more sensitive to lithium (5) correct answersDecreased intercellular water, protein binding, mm mass, and metabolism
Increased body fat
MAOI + tyramine causes correct answershypertensive crisis - life threatening and emergency
Symptoms of hypertensive crisis correct answerselevated BP
sudden explosive occipital headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + correct answersMEPERIDINE
STIMULANTS
TCAs
asthma meds
antipsychotics
Treatment for hypertensive crisis correct answersDC offending agent
Administer PHENTOLAMINE
teratogenic effects of depakote correct answersneural tube defects/spina bifida
Severe side effect of mood stabilizers __ __ __ correct answersSteven Johnson's Syndrome
Signs of Stevens johnson syndrome (SJS) correct answersFEVER --high yield
facial swelling
tongue swelling
burning papule rashe
skin sloughing
prodromal headache painful mucus membranes
Side effects of valproic acid/divalproex sodium correct answershepatotoxicity and pancreatitis
Carbamazepine (tegretol) black box warning correct answersagranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOB)
Carbamazepine and asians correct answersFDA REQUIRED ccreen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele
Child-bearing aged women (Tegretol) correct answerscheck for pregnancy before starting mood stabilizer
start on folic acid to support neural tube development during the first month that a woman is pregnant (0.4-0.5 mg daily)
Clozaril/clozapine can cause correct answersagranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor what lab correct answersANC only (not in conjunction with WBCs)
DC clozaril if ANC correct answersless than 1000, risk of neuropenia
Normal 2500-6000
DC clozaril if WBC correct answers2000-3000, risk of agranulocytosis
Normal: 4500-11000
Frequency of clozaril labs correct answersFirst six months - weekly
Next six months - every two weeks
Then monthly if ANC normal
When on clozaril monitor for correct answerssigns and symptoms of infection: sudden fever, chills, sore throat, weakness
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 correct answersAnswer: 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 correct answersAnswer: 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 correct answersAnswer: 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 correct answersA. 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 correct answersA. Carbamazepine
Signs of bulimia correct answersweight within the normal range
erosion od dental enamal
russell's sign
hypertrophy of salivary glands
rectal prolapse
Pharm treatment for bulimia correct answersFluoxetine
SSRIs and TCAs effective in reducing frequency of binging and purging
Signs of anorexia nervosa correct answerslow BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
EKG changes - inverted T waves, ST segment dperession, Prolonged QT)
Pharm treatment for anorexia correct answersthere is none
