GEORGETTE REVIEW. PMHNP- 388 QUESTIONS-
WITH COMPLETE & VERIFIED SOLUTIONS
When many answers are remarkably similar, they are usually _____________ Correct
Answer wrong
Interprofessional collaboration is encouraged. Correct Answer Collaborate is usually
right.
Delegate is usually wrong.
ADPIER Correct Answer Assessment, diagnosis, Plan, intervention, evaluate, refer out
last.
Lithium Correct Answer Normal 0.6-1.2
Lithium toxicity occurs at levels Correct Answer > 1.5
Signs of Lithium toxicity Correct Answer severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for Correct Answer MANIA
Lithium has evidence shown to Correct Answer reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester Correct Answer Ebstein
anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to Correct Answer rise
Baseline labs before initiation of lithium Correct Answer 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 Correct Answer 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 Correct Answer staying hydrated
,avoiding NSAIDS
compliance
Depakote normal level Correct Answer 50-125
Depakote toxicity level Correct Answer greater than 150
Teratogenic effects of Depakote Correct Answer spina bifida
Adverse effects of depakote Correct Answer 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 Correct Answer disorientation, lethargy, respiratory
depression, nausea/vomiting
Intervention for depakote toxicity Correct Answer DC med
check level
LFT
ammonia
MAOI + tyramine causes Correct Answer hypertensive crisis
Symptoms of hypertensive crisis Correct Answer elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + Correct Answer MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis Correct Answer DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos Correct Answer floppy baby, cleft palate
Teratogenic effects of tegratol Correct Answer neural tube defect
,teratogenic effects of lithium Correct Answer ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
teratogenic effects of depakote Correct Answer neural tube defects/spina bifida
Adverse reaction to Lamictal Correct Answer Steven Johnson's Syndrome
Signs of SJS Correct Answer 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 Correct Answer sedation or weight gain
Carbamazepine (tegretol) black box warning Correct Answer agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians Correct Answer Screen for HLAB-1502 allele before
initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women Correct Answer 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 Correct Answer agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor Correct Answer ANC
DC clozarli if ANC Correct Answer less than 1000
DC clozaril if WBC Correct Answer 2000-3000, risk of agranulocytosis
When on clozaril monitor for Correct Answer signs and symptoms of infection: sudden
fever, chills, sore throat, weakness
, Clozaril only known antipsychotic to Correct Answer 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?
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 Correct Answer Answer: Lithium can invert the t
waves.
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 Correct Answer Answer: Methylphenidate
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
D. ANC less than 2000 Correct Answer Answer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the following medical
problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate Correct Answer A. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in the Asian
population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal Correct Answer A. Carbamazepine
Bulimia, weight is ___________ Correct Answer within the normal range.
Pharm treatment for bulimia Correct Answer Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
WITH COMPLETE & VERIFIED SOLUTIONS
When many answers are remarkably similar, they are usually _____________ Correct
Answer wrong
Interprofessional collaboration is encouraged. Correct Answer Collaborate is usually
right.
Delegate is usually wrong.
ADPIER Correct Answer Assessment, diagnosis, Plan, intervention, evaluate, refer out
last.
Lithium Correct Answer Normal 0.6-1.2
Lithium toxicity occurs at levels Correct Answer > 1.5
Signs of Lithium toxicity Correct Answer severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for Correct Answer MANIA
Lithium has evidence shown to Correct Answer reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester Correct Answer Ebstein
anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to Correct Answer rise
Baseline labs before initiation of lithium Correct Answer 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 Correct Answer 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 Correct Answer staying hydrated
,avoiding NSAIDS
compliance
Depakote normal level Correct Answer 50-125
Depakote toxicity level Correct Answer greater than 150
Teratogenic effects of Depakote Correct Answer spina bifida
Adverse effects of depakote Correct Answer 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 Correct Answer disorientation, lethargy, respiratory
depression, nausea/vomiting
Intervention for depakote toxicity Correct Answer DC med
check level
LFT
ammonia
MAOI + tyramine causes Correct Answer hypertensive crisis
Symptoms of hypertensive crisis Correct Answer elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI + Correct Answer MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis Correct Answer DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos Correct Answer floppy baby, cleft palate
Teratogenic effects of tegratol Correct Answer neural tube defect
,teratogenic effects of lithium Correct Answer ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
teratogenic effects of depakote Correct Answer neural tube defects/spina bifida
Adverse reaction to Lamictal Correct Answer Steven Johnson's Syndrome
Signs of SJS Correct Answer 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 Correct Answer sedation or weight gain
Carbamazepine (tegretol) black box warning Correct Answer agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians Correct Answer Screen for HLAB-1502 allele before
initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women Correct Answer 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 Correct Answer agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor Correct Answer ANC
DC clozarli if ANC Correct Answer less than 1000
DC clozaril if WBC Correct Answer 2000-3000, risk of agranulocytosis
When on clozaril monitor for Correct Answer signs and symptoms of infection: sudden
fever, chills, sore throat, weakness
, Clozaril only known antipsychotic to Correct Answer 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?
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 Correct Answer Answer: Lithium can invert the t
waves.
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 Correct Answer Answer: Methylphenidate
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
D. ANC less than 2000 Correct Answer Answer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the following medical
problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate Correct Answer A. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in the Asian
population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal Correct Answer A. Carbamazepine
Bulimia, weight is ___________ Correct Answer within the normal range.
Pharm treatment for bulimia Correct Answer Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
