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

What should you not do when advocating for a patient? - ANSWER Judge or confront What class of medication is contraindicated with tics? - ANSWER Stimulants What should you provide for prior to assessing abuse victims? - ANSWER A safe environment What are your actions if a child reports abuse? - ANSWER First interview separately from parents then report to CPS What should you do if a child plays with toys in a way that you suspect abuse? - ANSWER Report to CPS In what setting as an inpatient provider should you interview a patient? - ANSWER Use a private room with the door partially open How should you begin your interview with adolescents? - ANSWER By building rapport with them by ensuring confidentiality absent exceptions Should you interview adolescents with or without parents? - ANSWER Without What if an adolescent tells you they are homosexual and they don't want their parents to know? - ANSWER This is confidential The patient is being discharged and would like their labs faxed to the rehab facility. What is your initial action? - ANSWER Get informed consent/ROI What do you do if a medical evaluation is needed? - ANSWER Refer out - this is out of scope What do you do if a patient is takes something and is feeling really funny/unwell in your office? - ANSWER Collect UDS and then refer out Is it considered a mental illness if it is an expected response culturally? What do you offer as treatment? - ANSWER No; brief supportive therapy - not medication A mother states her child is experiencing a cultural illness. What is your initial action? - ANSWER Respect the mother's cultural understanding of illness prior to assessment Native Americans view mental illness and SUDs as? - ANSWER An imbalance between the individual and the world What ethnic group has the highest rate of suicidality in the US? - ANSWER Native Americans If a patient believes they need a healing stick in their room, but the staff nurses removed it from them - what should you do? - ANSWER Teach cultural sensitivity and make accommodations for patient to have healing stick available such as 1:1 Psychoeducation should be based on? - ANSWER Cultural context How do you promote health in a location with multiple ethnicities and education levels? - ANSWER Multiple cultural education and ethnospecific assessment parameters What if a patient wants a traditional healer? - ANSWER Allow this - remember ROI/informed consent Normal TSH? - ANSWER 0.5-5.0 TSH 0.5 = ? - ANSWER Hyperthyroidism TSH 5.0 = ? - ANSWER Hypothyroidism Relationship between TSH & T3/T4? - ANSWER Inverse Hyperthyroidism can present as? - ANSWER Mania Hypothyroidism can present as? - ANSWER Depression Normal depakote level? - ANSWER 50-125 Toxic depakote level? - ANSWER 150+ Birth defect caused by depakote? - ANSWER Spina Bifida S/S of depakote toxicity? - ANSWER Disorientation, lethargy, decreased respiratory rate, and N/V What to do if there is depakote toxicity? - ANSWER D/C depakote and check VPA level, LFTs, and ammonia S/S of hepatotoxicity? - ANSWER RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs Normal AST? - ANSWER 5-40 Normal ALT? - ANSWER 5-35 Kava kava can cause? - ANSWER Liver damage and heavy sedation Kava kava is c/i with? - ANSWER Benzos or sedatives Mood stabilizer most associated with SJS? - ANSWER Lamictal Mood stabilizer with least weight gain? - ANSWER Lamictal SGAs with least weight gain? - ANSWER ziprasidone, abilify, and latuda Least sedating SGA? - ANSWER Abilify Routine labs with SGAs? - ANSWER BMI, hip to waist ratio, glucose, A1C, and lipid panel Management of metabolic syndrome with SGAs? - ANSWER 1. Nonpharm = exercise or nutritional counseling 2. Pharm = switch to other SGA with lower chance of metabolic syndrome Carbamazepine can cause? - ANSWER Agranulocytosis and aplastic anemia What should you screen for prior to starting Asians on carbamazepine and why? - ANSWER HLAB1502 Allele; risk of SJS When should you d/c carbamazepine if agranulocytosis is suspected? - ANSWER If ANC is 1000 with or without s/s of infection Lithium range? - ANSWER 0.6 - 1.2 What to do if lithium is 1.3 or 1.4? - ANSWER Monitor What to do if lithium is 1.5+? - ANSWER D/C Benefits of lithium? - ANSWER Gold standard for mania, neuroprotective, and antisuicidal effects