LMR - Georgette's Review PMHNP Questions Bank | 526 Question and answers | GUARANTEED PASS

What drugs should be avoided with Kava Kava?

Alprazolam

CNS depressants (e.g., phenobarbital, zolpidem)

What is the normal range for TSH?

0.5 - 5.0 mu/L

What are lab values in Hyperthyroidism

Decreased TSH

Increased T4 and T3

What are labs in Hypothyroidism?

Increased TSH

Decreased T4 and T3

What are 5 primary symptoms of Hyperthyroidism?

Heat intolerance

Agitation, Anxiety, Irritability

Tachycardia

Mood swings

Weight loss

What are 4 primary symptoms of Hypothyroidism?

Cold intolerance

Lethargy

Weight gain

Decreased libido

Hypothyroidism mimics symptoms of what psychiatric disorder?

Depression

Hyperthyroidism mimics symptoms of what psychiatric disorder?

Mania

Valproic acid produces what teratogenic effect?

Spina bifida (neural tube defect)

What is the primary organ where valproic acid is toxic?

Liver (hepatoxicity)

What are 4 signs of hepatoxicity?

Abdominal pain in the URQ

Reddish-brown urine

Yellowing of the skin and sclera

Fatigue

What is the therapeutic range for valproic acid?

50-125 mcg/ml

What is a toxic level of valproic acid?

>150 mcg/ml

What are 4 signs of valproic acid toxicity?

Disorientation

Lethargy

Respiratory depression

Nausea/vomiting

A pt on Depakote C/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do?

Hepatotoxicity; hold med, draw LFT's (priority), DVP level

With suspected toxicity with valproic acid, what steps/labs should be drawn?

D/C drug

Check drug level

Obtain LFTs

Obtain ammonia level

A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d/c'd?

Accutane (used for acne; Causes birth Defects!!!)

What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava?

Kava Kava

liver damage

What are 5 symptoms of Stephen's Johnson Syndrome?

Fever -Key sx to suspect SJS; high yield (HY)

burning of mouth/eyes -HY

Body aches

Severe red rash

Peeling skin

Facial and tongue swelling

Which mood stabilizer causes the least weight gain?

Lamotrigine (Lamictal)

Which 3 SGAs cause the least weight gain?

Lurasidone (Latuda)

Aripiprazole (Abilify)

Ziprasidone (Geodon)

Which SGA is the least sedating?

Aripiprazole (Abilify)

Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add?

Aripiprazole (least sedating)

What are 2 hallmark symptoms of delirium?

Acute onset

disturbance of LOC

impaired cognition

inattention

How are agitation and psychotic symptoms treated in delirium?

Low dose Haldol (QTc check first)

16 y/o C/O feeling funny after inhaling Acetone (nail polish remover). What is your action?

Do UDS; chances are they may be abusing other substances

What 4 drugs can cause mania?

"SAID"

Steroids

Antidepressants (in BPD)

Isoniazid (INH)

Disulfiram (Antabuse)

What 6 drugs can induce depression?

"SIP BARB"

Steroids

Interferon,

Progesterone

Beta blockers

Accutane, (Isotretinoin)

Retroviral drugs, Antineoplastic drugs

Benzodiazepines

Steroids can induce what 3 psychiatric states?

Mania

Depression

Psychosis

REMEMBER SAFETY FIRST; pt s/p assault, 1st thing you do is_____.

What is the best environment to interview this pt in?

reassure safety, provide environment of safety

private area with door open/partially open

What is the therapeutic range for lithium?

0.6-1.2 mEq/L

Many postpartum women have SI after delivery, yet they don't have psych evals before leaving the hospital, what could a possible solution be?

collaborating care between psych and OBGYN to provide the best care for that pt

If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does/does not] apply?

Does not, ie pt will need to sign consent for labs/ chart to be sent

When discharging from inpatient you want [to fax/print off-give to pt.] labs for the outpatient provider before pt discharge?

fax; so the new provider has them for follow-up appointment

Before referring a pt out or discharging them, it is good to ask yourself what question?

is there something that I could do for this patient first?

What 3 things are MUST KNOWS about Lithium?

has neuroprotective effect for bipolar disorder

the gold standard for treating manic episodes

the mood stabilizer w/ anti-suicidal effects

What mood stabilizer has anti-suicidal effects?

Lithium

What 5 labs should be drawn with lithium?

Thyroid panel (TSH)

Serum creatinine

BUN

Urinalysis

HCG

What is a normal SerumCr range?

0.6-1.2 mg/dL

What is the normal range for BUN?

10-20 mg/dL

When should you suspect kidney disease with a urinalysis?

4+ protein; if pt on Lithium-->monitor closely toxicity

What are 7 side effects of lithium?

Hypothyroidism

Fine hand tremors

Maculopapular rash

GI upset (N/V/D, cramps, anorexia)

Polyuria, polydipsia, diabetes insipidus

T-wave inversions

Leucocytosis

What are 7 signs of lithium toxicity?

Severe nausea, vomiting, diarrhea

Confusion

Drowsiness

Muscle weakness

Heart palpitations

Coarse hand tremor

Unsteadiness while standing or walking

Bold =must knows

Which 3 drugs can increase lithium levels by decreasing renal clearance?

NSAIDs (ibuprofen, indomethacin)

Thiazides

ACE-I

What is a toxic level of lithium?

1.5 mEq/L or higher

At what level do you monitor lithium closely

(but not discontinue)?

1.3 -1.4 mEq/L or higher

With suspected lithium toxicity, what do you do first?

D/C Li and draw Lithium level (not VS)

What is the appropriate action if lithium level is 1.5 mEq/L?

D/C lithium

Check lithium level

What 2 conditions can increase lithium levels?

If this pt is going on a hike, what would you recommend ?

Dehydration

Hyponatremia

Take extra water to avoid dehydration

What birth defect can lithium cause?

Ebstein anomaly (congenital heart defect)

When working with adolescents, parents often feel they have a right to know what is going on with their child, but the teen has a right to confidentiality. This can create an

Ethical dilemma

When building a therapeutic alliance w/ adolescents, it is important to stress

confidentiality;

what they say remains confidential unless they are wanting to harm self/ someone else,

[or they are in a relationship with someone much older (like 14 y/o seeing a 30 y/o)]

if an adolescent C/O abuse, even if they make the claim in the presence of the parents, what should you do?

interview the teen w/o the parents; call CPS

What 3 neurotransmitters are associated with ADHD?

DA, NE, 5HT aka serotonin -->(DNS)

The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder?

ADHD

Inattentive Type ADHD demonstrates abnormalities in which part of the brain?

Prefrontal cortex

What should be done before placing a patient on stimulants for ADHD (priority)?

Cardiac history

Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is

GAD

if ADHD and tic both present, what is contraindicated?

Stimulants

if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean?

the medication has been cleared from the body

What are the lower age limits for stimulants for ADHD?

AMPH = 3yrs MPH = 6yrs

When considering Clonidine or Guanfacine for a pt, the PMHNP knows?

Clonidine is more sedating than Guanfacine;

Guanfacine lasts longer than Clonidine

What does thought process assess?

thoughts and ideas

A normal thought process is described as

Logical

Linear

Coherent

Goal-oriented

Moving from thought to thought and never getting to the point is called

Tangentiality ("goes on tangent")

Providing unnecessary detail but eventually getting to the point is called

Circumstantiality ("goes in circles")

Themes that occupy a patient's thoughts and perceptual disturbances is called

Thought content

Thought content includes 3 items

Suicidal ideation

Homicidal ideation

Hallucinations/Delusions

Asking a patient to count backward from 100 by seven (serial 7s), or anything going backwards measures what?

Concentration

Attention

Asking the year, season, date, month, and location measures

Orientation

Asking a patient to repeat "bed, red, ball" measures

Registration (ability to learn new material)

Asking a patient to repeat objects 5 minutes later measures

Recall (memory)

Asking the patient who is the president of the US or governor of state is measuring

Fund of Knowledge

What is a simple test that can be administered in a minute or two to measure possible dementia?

Clock Drawing Test

Impairments in the clock drawing test (CDT) can be associated with damage to

Right parietal lobe (right hemisphere)

Hyperactivity of dopamine in the mesolimbic pathway to the dorsolateral prefrontal cortex (DLPFC) modulates

positive psychotic symptoms

The safest drug switch strategy is to have a "washout period" of _______ half-lives between cessation of old med and the introduction of the new med.

5 1/2

Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms?

Negative symptoms: affect, anhedonia, asociality, alogia, apathy, avolition,

Depressive symptoms

The nigrostriatal pathway modulates

motor movements

Dopamine has what type of relationship with acetycholine

Inverse

Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects?

Acute dystonia: stiff neck, muscle spasms neck/back, painful

Parkinsonism syndromes

Akathisia

Tardive dyskinesia

Blocking DA in the tuberoinfundibular pathway leads to

Increased prolactin

What are 5 symptoms of hyperprolactinemia?

Amenorrhea

Galactorrhea

Sexual dysfunction

Gynecomastia

Osteoporosis (Long-term)

What antipsychotic has the greatest effect on prolactin?

Risperidone

What is the black box warning for carbamazepine?

Agranulocytosis and

SJS in Asians (+) for HLA-B*1502 allele

What are 8 symptoms of aplastic anemia?

Pallor

Fatigue

Headache

Fever

Nosebleeds

Bleeding gums

Skin rash

SOB

In which ethnic group must you screen for the HLA-B*1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary?

Asians

risk for SJS in Asians (+) for HLA-B*1502 allele

Which 2 drugs have the highest likelihood of causing agranulocytosis?

Clozaril

Carbamazepine

A sudden fever, chills, a sore throat, and weakness are symptoms of

Agranulocytosis

At what ANC should clozapine be stopped (even if asymptomatic)?

<1000

What is neutropenia?

<2000 PMNs or WBC <2000

What is agranulocytosis?

<500 ANC

What does DIGFAST stand for?

Distractibility

Indiscretion

Grandiosity

FOI

Activity increased

Sleep decreased

Talkativeness

What neurological symptoms might one see in Conversion Disorder?

Blindness

Mutism

Paralysis

Paresthesia (glove stocking syndrome)

Seizures

When do symptoms typically begin with Conversion Disorder?

After a stressful experience (suddenly)

What are 5 stressful events in a child's life that can cause adjustment disorder?

Family move

Parent divorce/separation

Loss of pet

Birth of sibling

Sudden or chronic illness

A child with an Adjustment Disorder with disturbances of conduct may have what symptoms?

Not going to school, destroying property, driving recklessly, or fighting

What are some key sx of Oppositional Defiant Disorder (ODD)?

NOT aggressive (key difference vs CD)

loses temper easily

annoys others

angry/resentful

argues with authority

easily annoyed

blames others

spiteful

refuses to comply with rules/requests from authority figures

What is the mainstay treatment of Oppositional Defiant Disorder (ODD)?

Therapy, individual and family

What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)?

Child and parent problem-solving skills training, boundary setting