Georgette Review PMHNP | Exam Review 2024
57. If your patient is a smoker you will need doses of their med- ication.: higher
58. Inhibitors: inhibit metabolism and therefore increase levels of the drug.
59. SICKFACES.com for Inhibitors:
1. When many answers are remarkably similar, they are usually
: wrong
2. Interprofessional collaboration is encouraged.: Collaborate is usually right. Delegate is
usually wrong.
3. ADPIER: Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
4. Lithium: Normal 0.6-1.2
5. Lithium toxicity occurs at levels: > 1.5
6. Signs of Lithium toxicity: severe nausea, diarrhea, vomiting, confusion, drowsi- ness, muscle
weakness, heart palpitation, coarse hand tremors, unsteady gait
7. Lithium is gold standard for: MANIA
8. Lithium has evidence shown to: reduce suicidal ideation
9. What does lithium cause in neonate, especially 1st trimester: Ebstein anom- aly (congenital
heart defect)
10.dehydration and hyponatremia cause lithium levels to: rise
11.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)
12.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
13.Pt education for lithimum: staying hydrated avoiding
NSAIDS
compliance
14.Depakote normal level: 50-125
15.Depakote toxicity level: greater than 150
16.Teratogenic effects of Depakote: spina bifida
17.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
18.Signs of Depakote toxicity: disorientation, lethargy, respiratory depression,
nausea/vomiting
, Georgette Review PMHNP | Exam Review 2024
19.Intervention for depakote toxicity: DC med check level
LFT
ammonia
20.MAOI + tyramine causes: hypertensive crisis
21.Symptoms of hypertensive crisis: elevated BP sudden
explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis fever
22.Hypertensive crisis occurs with MAOI +: MEPERIDINE STIMULANTS
decongestants
TCAs
atypicals
St. John's wart L-
tryptophan
asthma meds
23.Treatment for hypertensive crisis: DC offending agent Administer
PHENTOLAMINE
24.Teratogenic effects of benzos: floppy baby, cleft palate
25.Teratogenic effects of tegratol: neural tube defect
26.teratogenic effects of lithium: ebstein anomaly (heart defect) (avoid, especial- ly 1st
trimester)
27.teratogenic effects of depakote: neural tube defects/spina bifida
28.Adverse reaction to Lamictal: Steven Johnson's Syndrome
29.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
, Georgette Review PMHNP | Exam Review 2024
30.Lamotrigine is least likely to cause: sedation or weight gain
31.Carbamazepine (tegretol) black box warning: agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
32.Carbamazepine and asians: Screen for HLAB-1502 allele before initiating, due to high
incidence of SJS if positive for allele.
33.Child-bearing aged women: check for pregnancy before starting mood stabi- lizer
start on folic acid to support neural tube development during the first month that a woman is
pregnant
34.Clozaril/clozapine can cause: agranulocytosis and neutropenia
35.For monitoring neutropenia in Clozaril, monitor: ANC
36.DC clozarli if ANC: less than 1000
37.DC clozaril if WBC: 2000-3000, risk of agranulocytosis
38.When on clozaril monitor for: signs and symptoms of infection: sudden fever, chills, sore
throat, weakness
39.Clozaril only known antipsychotic to: decrease risk of suicide in patients with schizophrenia.
40. 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.
41. 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
42. 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
, Georgette Review PMHNP | Exam Review 2024
D. ANC less than 2000: Answer: ANC less than 1000
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