Georgette Review ANCC Review Manual PMHNP Exam
When many answers are remarkably similar, they are usually _____________
Wrong
Interprofessional collaboration is encouraged.
Collaborate is usually right.
Delegate is usually wrong.
ADPIER
Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium
Normal 0.6-1.2
Lithium toxicity occurs at levels
> 1.5
Signs of Lithium toxicity
severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart
palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for
MANIA
,Lithium has evidence shown to
reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester
Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to
rise
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)
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
Pt education for lithimum
staying hydrated
avoiding NSAIDS
compliance
,Depakote normal level
50-125
Depakote toxicity level
greater than 150
Teratogenic effects of Depakote
spina bifida
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
Signs of Depakote toxicity
disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity
DC med
check level
LFT
ammonia
MAOI + tyramine causes
hypertensive crisis
Symptoms of hypertensive crisis
, elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI +
MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis
DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos
floppy baby, cleft palate
Teratogenic effects of tegratol
neural tube defect
teratogenic effects of lithium
ebstein anomaly (heart defect) (avoid, especially 1st trimester)
When many answers are remarkably similar, they are usually _____________
Wrong
Interprofessional collaboration is encouraged.
Collaborate is usually right.
Delegate is usually wrong.
ADPIER
Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium
Normal 0.6-1.2
Lithium toxicity occurs at levels
> 1.5
Signs of Lithium toxicity
severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart
palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for
MANIA
,Lithium has evidence shown to
reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester
Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to
rise
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)
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
Pt education for lithimum
staying hydrated
avoiding NSAIDS
compliance
,Depakote normal level
50-125
Depakote toxicity level
greater than 150
Teratogenic effects of Depakote
spina bifida
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
Signs of Depakote toxicity
disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity
DC med
check level
LFT
ammonia
MAOI + tyramine causes
hypertensive crisis
Symptoms of hypertensive crisis
, elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI +
MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis
DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos
floppy baby, cleft palate
Teratogenic effects of tegratol
neural tube defect
teratogenic effects of lithium
ebstein anomaly (heart defect) (avoid, especially 1st trimester)
