Georgette Review PMHNP.
1. When many answers are remarkably similar, they are usually
_____________: wrong
2. Interprofessional collaboration is encouraged.: Collaborate is usually right.
Delegate is usually wrong.
3. ADPIER: Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
4. Lithium: Normal 0.6-1.2
5. Lithium toxicity occurs at levels: > 1.5
6. Signs of Lithium toxicity: severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors,
unsteady gait
7. Lithium is gold standard for: MANIA
8. Lithium has evidence shown to: reduce suicidal ideation
9. What does lithium cause in neonate, especially 1st trimester: Ebstein
anomaly (congenital heart defect)
10. dehydration and hyponatremia cause lithium levels to: rise 11. 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)
12. 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
13. Pt education for lithimum: staying hydrated avoiding NSAIDS
compliance
14. Depakote normal level: 50-125
15. Depakote toxicity level: greater than 150
16. Teratogenic effects of Depakote: spina bifida 17. 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
, Georgette Review PMHNP.
.
18. Signs of Depakote toxicity: disorientation, lethargy, respiratory depression,
nausea/vomiting
19 Intervention for depakote toxicity: DC med
check level
LFT
ammonia
20. MAOI + tyramine causes: hypertensive crisis
21. Symptoms of hypertensive crisis: elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
22. Hypertensive crisis occurs with MAOI +: MEPERIDINE STIMULANTS
decongestants
TCAs
atypicals St.
John's wart L-
tryptophan
asthma meds
23. Treatment for hypertensive crisis: DC offending agent
Administer PHENTOLAMINE
24. Teratogenic effects of benzos: floppy baby, cleft palate
25. Teratogenic effects of tegratol: neural tube defect
26. teratogenic effects of lithium: ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
27. teratogenic effects of depakote: neural tube defects/spina bifida
28. Adverse reaction to Lamictal: Steven Johnson's Syndrome 29. Signs of
SJS: FEVER --high yield sore throat facial swelling tongue swelling red rash
skin sloughing body aches prodromal headache malaise
arthralgia
painful mucus membranes
30 Lamotrigine is least likely to cause: sedation or weight gain
, Georgette Review PMHNP.
.
31. Carbamazepine (tegretol) black box warning: agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash,
SOA)
32. Carbamazepine and asians: Screen for HLAB-1502 allele before initiating,
due to high incidence of SJS if positive for allele.
33. Child-bearing aged women: 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
34. Clozaril/clozapine can cause: agranulocytosis and neutropenia
35. For monitoring neutropenia in Clozaril, monitor: ANC
36. DC clozarli if ANC: less than 1000
37. DC clozaril if WBC: 2000-3000, risk of agranulocytosis
38. When on clozaril monitor for: signs and symptoms of infection: sudden
fever, chills, sore throat, weakness
39. Clozaril only known antipsychotic to: decrease risk of suicide in patients
with schizophrenia.
40. 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: Answer: Lithium can invert the t waves.
41. 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: Answer: Methylphenidate
42. You are treating a client with schizophrenia who takes clozapine. What
lab values will indicate the client needs to discontinue treatment?
, Georgette Review PMHNP.
.
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: Answer: ANC less than 1000
43 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: A. Spina bifida
44. Which mood stabilizer is associated with potential life-threatening rash in
the Asian population? A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal: A. Carbamazepine
45. Bulimia, weight is ___________: within the normal range.
46. Pharm treatment for bulimia: Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
47. Signs of anorexia nervosa: low BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
48. Pharm treatment for anorexia: there is none therapy
49. Which of the following physical exam findings would help the PMHNP
differentiate anorexia nervosa from bulimia nervosa?
A. Russell sign
B. Low BMI
C. Erosion of dental enamel
D. Hypertrophy of salivary glands: Low BMI
50. If a patient is depression, low energy, fatigued, you would prescribe:
Wellbutrin
51. Wellbutrin is contraindicated in patients with: seizure disorder or
conditions that increase risk of seizures such as eating disorder.
1. When many answers are remarkably similar, they are usually
_____________: wrong
2. Interprofessional collaboration is encouraged.: Collaborate is usually right.
Delegate is usually wrong.
3. ADPIER: Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
4. Lithium: Normal 0.6-1.2
5. Lithium toxicity occurs at levels: > 1.5
6. Signs of Lithium toxicity: severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitation, coarse hand tremors,
unsteady gait
7. Lithium is gold standard for: MANIA
8. Lithium has evidence shown to: reduce suicidal ideation
9. What does lithium cause in neonate, especially 1st trimester: Ebstein
anomaly (congenital heart defect)
10. dehydration and hyponatremia cause lithium levels to: rise 11. 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)
12. 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
13. Pt education for lithimum: staying hydrated avoiding NSAIDS
compliance
14. Depakote normal level: 50-125
15. Depakote toxicity level: greater than 150
16. Teratogenic effects of Depakote: spina bifida 17. 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
, Georgette Review PMHNP.
.
18. Signs of Depakote toxicity: disorientation, lethargy, respiratory depression,
nausea/vomiting
19 Intervention for depakote toxicity: DC med
check level
LFT
ammonia
20. MAOI + tyramine causes: hypertensive crisis
21. Symptoms of hypertensive crisis: elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
22. Hypertensive crisis occurs with MAOI +: MEPERIDINE STIMULANTS
decongestants
TCAs
atypicals St.
John's wart L-
tryptophan
asthma meds
23. Treatment for hypertensive crisis: DC offending agent
Administer PHENTOLAMINE
24. Teratogenic effects of benzos: floppy baby, cleft palate
25. Teratogenic effects of tegratol: neural tube defect
26. teratogenic effects of lithium: ebstein anomaly (heart defect) (avoid,
especially 1st trimester)
27. teratogenic effects of depakote: neural tube defects/spina bifida
28. Adverse reaction to Lamictal: Steven Johnson's Syndrome 29. Signs of
SJS: FEVER --high yield sore throat facial swelling tongue swelling red rash
skin sloughing body aches prodromal headache malaise
arthralgia
painful mucus membranes
30 Lamotrigine is least likely to cause: sedation or weight gain
, Georgette Review PMHNP.
.
31. Carbamazepine (tegretol) black box warning: agranulocytosis (decrease
WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash,
SOA)
32. Carbamazepine and asians: Screen for HLAB-1502 allele before initiating,
due to high incidence of SJS if positive for allele.
33. Child-bearing aged women: 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
34. Clozaril/clozapine can cause: agranulocytosis and neutropenia
35. For monitoring neutropenia in Clozaril, monitor: ANC
36. DC clozarli if ANC: less than 1000
37. DC clozaril if WBC: 2000-3000, risk of agranulocytosis
38. When on clozaril monitor for: signs and symptoms of infection: sudden
fever, chills, sore throat, weakness
39. Clozaril only known antipsychotic to: decrease risk of suicide in patients
with schizophrenia.
40. 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: Answer: Lithium can invert the t waves.
41. 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: Answer: Methylphenidate
42. You are treating a client with schizophrenia who takes clozapine. What
lab values will indicate the client needs to discontinue treatment?
, Georgette Review PMHNP.
.
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: Answer: ANC less than 1000
43 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: A. Spina bifida
44. Which mood stabilizer is associated with potential life-threatening rash in
the Asian population? A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal: A. Carbamazepine
45. Bulimia, weight is ___________: within the normal range.
46. Pharm treatment for bulimia: Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
47. Signs of anorexia nervosa: low BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
48. Pharm treatment for anorexia: there is none therapy
49. Which of the following physical exam findings would help the PMHNP
differentiate anorexia nervosa from bulimia nervosa?
A. Russell sign
B. Low BMI
C. Erosion of dental enamel
D. Hypertrophy of salivary glands: Low BMI
50. If a patient is depression, low energy, fatigued, you would prescribe:
Wellbutrin
51. Wellbutrin is contraindicated in patients with: seizure disorder or
conditions that increase risk of seizures such as eating disorder.
