UPDATED Georgette's LMR 100% SOLUTION 2023//2024

There is a medication class that is contraindicated when a patient has tics. What is that class of medication? Stimulants --often used for ADHD What action do you take if a patient reports being a victim of abuse. Safety first! Provide patient with an environment of safety and reassure them of their safety in the clinic/hospital. If you work inpatient, what do you do before discharging a patient who says they have been abused? Make sure the patient will be safe. If you work inpatient, is a safety contract sufficient to determine that you are releasing a patient into a safe home? No. A safety contract is not enough. The NP has to confirm that the patient is going to be safe for themselves or their environment is safe. Inpatient--for safety, where should the NP interview the patient and why? Safety is more important than privacy. In an office with a door open or partially open. The day room would be a breach of confidentiality and a closed door or in their room would give the patient access to harming the NP. If a child comes into the office with their parents and say they have been abused, what action does the NP take? interview the child separately from the parents THEN report to CPS If a child comes into an appointment without their parents and plays with a toy in a sexual way, what action does the NP take? This makes the NP suspect abuse so initial action is to immediately report to CPS. What is the cornerstone of building a therapeutic alliance with adolescents? Confidentiality with the explanation that confidentiality must be broken if they are a danger to self or others Do we interview adolescents with their parents in the room? No because the adolescent may have info that they want kept confidential from their parents. If an adolescent comes in with their parents, do you keep the parents and adolescent together or separate theme? Separate them and speak to adolescent alone because the adolescent has a right to confidentiality. Which ethnic group has the highest incidence of suicide and suicide attempts ? Native American Native Americans believe in their healing stick. If a staff member tries to take it away, what should the NP do? Educate the staff member in cultural competency and sensitivity. If a patient wants a traditional healer to accompany them to an appointment, what does the NP have to do ? Get consent from the patient and allow the traditional healer to attend as well. With permission from the patient, you can include the healer in the care plan as follow up. Which labs should be taken before treating for depression or mania? TSH What is the normal range of TSH? 0.5-5.0 mu/L Symptoms of hypothyroidism mimic which mental illness? Depression Symptoms of hyperthyroidism mimic which mental illness? Mania If TSH is low i.e. 0.4 or lower, what is happening to T4 an T3 and what condition does patient have? T4 and T3 will be high and patient will have hyperthyroidism If TSH is high e.g. 7.0, what is happening to T4 an T3 and what condition does patient have? T4 and T3 will be low and patient will have hypothyroidism. What are the symptoms of hyperthyroidism that can mimic mania? And what are other symptoms? agitation, anxiety, irritability, mood swings, weight loss. Other symptoms are heat intolerance and tachycardia What are symptoms of hypothyroidism that mimic depression? And what are other symptoms? lethargy, weight gain, decreased libido. And, cold intolerance What is the Black Box warning for Depakote? Pancreatitis What are physical side effects/ dangers of Depakote (Divalproex)--for patient or fetus Spina bifida in fetuses Hepatotoxicity If a patient taking depakote has signs of hepatotoxicity what would those signs and symptoms be ? Abdominal pain in upper right quadrant of abdomen Reddish brown urine Yellowing of the skin and whites of eyes