Exam (elaborations)
GEORGETTE - S LMR QUESTIONS AND ANSWERS
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GEORGETTE - S LMR QUESTIONS AND ANSWERS
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GEORGETTE ' S LMR QUESTIONS AND ANSWERSWhat should you not do when advocating for a patient? - Answers- Judge or confront
What class of medication is contraindicated with tics? - Answers- Stimulants
What should you provide for prior to assessing abuse victims? - Answers- A safe
environment
What are your actions if a child reports abuse? - Answers- First interview separately
from parents then report to CPS
What should you do if a child plays with toys in a way that you suspect abuse? -
Answers- Report to CPS
What do you do if a medical evaluation is needed? - Answers- Refer out - this is out of
scope
What do you do if a patient is takes something and is feeling really funny/unwell in your
office? - Answers- Collect UDS and then refer out
Is it considered a mental illness if it is an expected response culturally? What do you
offer as treatment? - Answers- No; brief supportive therapy - not medication
A mother states her child is experiencing a cultural illness. What is your initial action? -
Answers- Respect the mother's cultural understanding of illness prior to assessment
Native Americans view mental illness and SUDs as? - Answers- An imbalance between
the individual and the world
What ethnic group has the highest rate of suicidality in the US? - Answers- Native
Americans
If a patient believes they need a healing stick in their room, but the staff nurses removed
it from them - what should you do? - Answers- Teach cultural sensitivity and make
accommodations for patient to have healing stick available such as 1:1
Psychoeducation should be based on? - Answers- Cultural context
How do you promote health in a location with multiple ethnicities and education levels? -
Answers- Multiple cultural education and ethnospecific assessment parameters
In what setting as an inpatient provider should you interview a patient? - Answers- Use
a private room with the door partially open
,How should you begin your interview with adolescents? - Answers- By building rapport
with them by ensuring confidentiality absent exceptions
Should you interview adolescents with or without parents? - Answers- Without
What if an adolescent tells you they are homosexual and they don't want their parents to
know? - Answers- This is confidential
The patient is being discharged and would like their labs faxed to the rehab facility.
What is your initial action? - Answers- Get informed consent/ROI
What if a patient wants a traditional healer? - Answers- Allow this - remember
ROI/informed consent
Normal TSH? - Answers- 0.5-5.0
TSH < 0.5 = ? - Answers- Hyperthyroidism
TSH > 5.0 = ? - Answers- Hypothyroidism
Relationship between TSH & T3/T4? - Answers- Inverse
Hyperthyroidism can present as? - Answers- Mania
Hypothyroidism can present as? - Answers- Depression
Normal depakote level? - Answers- 50-125
Toxic depakote level? - Answers- 150+
Birth defect caused by depakote? - Answers- Spina Bifida
S/S of depakote toxicity? - Answers- Disorientation, lethargy, decreased respiratory
rate, and N/V
What to do if there is depakote toxicity? - Answers- D/C depakote and check VPA level,
LFTs, and ammonia
S/S of hepatotoxicity? - Answers- RUQ pain, reddish brown urine, jaundice, fatigue,
and elevated LFTs
Normal AST? - Answers- 5-40
Normal ALT? - Answers- 5-35
Kava kava can cause? - Answers- Liver damage and heavy sedation
, Kava kava is c/i with? - Answers- Benzos or sedatives
Mood stabilizer most associated with SJS? - Answers- Lamictal
Mood stabilizer with least weight gain? - Answers- Lamictal
SGAs with least weight gain? - Answers- ziprasidone, abilify, and latuda
Least sedating SGA? - Answers- Abilify
Routine labs with SGAs? - Answers- BMI, hip to waist ratio, glucose, A1C, and lipid
panel
Management of metabolic syndrome with SGAs? - Answers- 1. Nonpharm = exercise
or nutritional counseling
2. Pharm = switch to other SGA with lower chance of metabolic syndrome
Carbamazepine can cause? - Answers- Agranulocytosis and aplastic anemia
What should you screen for prior to starting Asians on carbamazepine and why? -
Answers- HLAB1502 Allele; risk of SJS
When should you d/c carbamazepine if agranulocytosis is suspected? - Answers- If
ANC is < 1000 with or without s/s of infection
Lithium range? - Answers- 0.6 - 1.2
What to do if lithium is 1.3 or 1.4? - Answers- Monitor
What to do if lithium is 1.5+? - Answers- D/C
Benefits of lithium? - Answers- Gold standard for mania, neuroprotective, and
antisuicidal effects
S/S of lithium toxicity? - Answers- Severe N/V, polydipsia, polyuria, leukocytosis,
palpitations, coarse tremor
What to do if lithium toxicity is suspected? - Answers- D/C and check serum levels prior
to checking VS
Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are
these drugs? - Answers- NSAIDs, ace inhibitors for heart failure (-pril), and thiazides
(HCTZ)
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