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GEORGETTE REVIEW EXAM QUESTIONS & ANSWERS, ANCC REVIEW MANUAL PMHNP
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GEORGETTE REVIEW EXAM QUESTIONS & ANSWERS, ANCC REVIEW MANUAL PMHNP
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GEORGETTE REVIEW EXAM QUESTIONS &ANSWERS, ANCC REVIEW MANUAL PMHNP
When many answers are remarkably similar, they are usually _____________ -
Answers- wrong
Interprofessional collaboration is encouraged. - Answers- Collaborate is usually right.
Delegate is usually wrong.
ADPIER - Answers- Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - Answers- Normal 0.6-1.2
Lithium toxicity occurs at levels - Answers- > 1.5
Signs of Lithium toxicity - Answers- severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - Answers- MANIA
Lithium has evidence shown to - Answers- reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - Answers- Ebstein
anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to - Answers- rise
Baseline labs before initiation of lithium - Answers- 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 - Answers- 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 - Answers- staying hydrated
avoiding NSAIDS
compliance
,Depakote normal level - Answers- 50-125
Depakote toxicity level - Answers- greater than 150
Teratogenic effects of Depakote - Answers- spina bifida
Adverse effects of depakote - Answers- 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 - Answers- disorientation, lethargy, respiratory depression,
nausea/vomiting
Intervention for depakote toxicity - Answers- DC med
check level
LFT
ammonia
MAOI + tyramine causes - Answers- hypertensive crisis
Symptoms of hypertensive crisis - Answers- elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + - Answers- MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis - Answers- DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos - Answers- floppy baby, cleft palate
Teratogenic effects of tegratol - Answers- neural tube defect
,teratogenic effects of lithium - Answers- ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
teratogenic effects of depakote - Answers- neural tube defects/spina bifida
Adverse reaction to Lamictal - Answers- Steven Johnson's Syndrome
Signs of SJS - Answers- 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 - Answers- sedation or weight gain
Carbamazepine (tegretol) black box warning - Answers- agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians - Answers- Screen for HLAB-1502 allele before initiating,
due to high incidence of SJS if positive for allele.
Child-bearing aged women - Answers- 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 - Answers- agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - Answers- ANC
DC clozarli if ANC - Answers- less than 1000
DC clozaril if WBC - Answers- 2000-3000, risk of agranulocytosis
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? - Answers- Answer: Methylphenidate
, You are treating a client with schizophrenia who takes clozapine. What lab values will
indicate the client needs to discontinue treatment? - Answers- Answer: ANC less than
1000
If given during pregnancy, sodium valproate can cause which of the following medical
problems in the baby? - Answers- Spina bifida
When on clozaril monitor for - Answers- signs and symptoms of infection: sudden fever,
chills, sore throat, weakness
Clozaril only known antipsychotic to - Answers- 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? - Answers- Answer: Lithium can invert the t waves.
Which mood stabilizer is associated with potential life-threatening rash in the Asian
population? - Answers- Carbamazepine
Bulimia, weight is ___________ - Answers- within the normal range.
Pharm treatment for bulimia - Answers- Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
Signs of anorexia nervosa - Answers- low BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
Pharm treatment for anorexia - Answers- there is none
therapy
Which of the following physical exam findings would help the PMHNP differentiate
anorexia nervosa from bulimia nervosa? - Answers- Low BMI
If a patient is depression, low energy, fatigued, you would prescribe - Answers-
Wellbutrin
Wellbutrin is contraindicated in patients with - Answers- seizure disorder or conditions
that increase risk of seizures such as eating disorder.
Which of the following medications has a unique mechanism that is both a
norepinephrine and dopamine reuptake inhibitor? - Answers- bupropion
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