Georgette's LMR | Georgette's Last Minute Review | with complete solution | Rated A+ | Updated

Georgette's LMR | Georgette's Last Minute Revie w | with complete solution | Rated A+ | Updated What should you not do when advocating for a patient? Judge or confront What class of medication is contraindicated with tics? Stimulants What should you provide for prior to assessing abuse victims? A safe environment What are your actions if a child reports abuse? First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you su spect abuse? Report to CPS In what setting as an inpatient provider should you interview a patient? Use a private room with the door partially open How should you begin your interview with adolescents? By building rapport with them by ensuring confidenti ality absent exceptions Should you interview adolescents with or without parents? Without What if an adolescent tells you they are homosexual and they don't want their parents to know? This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? Get informed consent/ROI What do you do if a medical evaluation is needed? Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/un well in your office? 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? No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? 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? Teach cultural sensitivity and mak e accommodations for patient to have healing stick available such as 1:1 Psychoeducation should be based on? Cultural context How do you promote health in a location with multiple ethnicities and education levels? Multiple cultural education and ethnospe cific assessment parameters What if a patient wants a traditional healer? Allow this - remember ROI/informed consent Normal TSH? 0.5-5.0 TSH < 0.5 = ? Hyperthyroidism TSH > 5.0 = ? Hypothyroidism Relationship between TSH & T3/T4? Inverse Hyperthyroid ism can present as? Mania Hypothyroidism can present as? Depression Normal depakote level? 50-125 Toxic depakote level? 150+ Birth defect caused by depakote? Spina Bifida S/S of depakote toxicity? Disorien tation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? D/C depakote and check VPA level, LFTs, and ammonia S/S of hepatotoxicity? RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? 5-40 Normal ALT? 5-35 Kava kava can cause? Liver damage and heavy sedation Kava kava is c/i with? Benzos or sedatives Mood stabilizer most associated with SJS? Lamictal Mood stabilizer with least weight gain? Lamictal SGAs with least weight gain? zipra sidone, abilify, and latuda Least sedating SGA? Abilify Routine labs with SGAs? BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? 1. Nonpharm = exercise or nutritional counseling 2. Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? HLAB1502 Allele; risk of SJS When should yo u d/c carbamazepine if agranulocytosis is suspected? If ANC is < 1000 with or without s/s of infection Lithium range? 0.6 - 1.2 What to do if lithium is 1.3 or 1.4? Monitor What to do if lithium is 1.5+? D/C Benefits of lithium? Gold standard for mania , neuroprotective, and antisuicidal effects S/S of lithium toxicity? Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor What to do if lithium toxicity is suspected? 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? NSAIDs, ace inhibitors for heart failure ( -pril), and thiazides (HCTZ) What demonstrates understanding of education on lithium? Taking extra water with patient when they go hiking NMS s/s? Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased WBCs, and increased LFTs