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PMHNP Boards > LMR Part 1 > Flashcards

LMR Part 1 Flashcards

1
Q

What medications can exacerbate TICs?

A

Stimulants

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2
Q

If TICs are developed with stimulants what should you do?

A

If tics developed when placed on stimulants, you must D/C and place on non-stimulants.

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3
Q

What are top three things to prioritize?

A
  1. ABCs
  2. Maslow’s Hierarchy (food, warmth, rest).
  3. Nursing process (assessment before intervention)
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4
Q

Safety for the patients or others is usually the right answer.

A

Just read

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5
Q

What to do if the patient is a victim of abuse or rape?

A

Reassure their personal safety, make sure the patient can be safe and can cope.

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6
Q

For victims of abuse or rape, what is priority before reporting or assessment?

A

Safety before reporting/assessment

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7
Q

If you are working inpatient and a patient is about to discharge, what do you have to make sure?

A

Make sure that the patient can be safe and cope effectively

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8
Q

For board purposes, what do you know about safety/no harm contracts?

A

On the boards, it will most likely be incorrect.

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9
Q

When is behavioral management/support started?

A

This starts immediately after a patient is admitted

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10
Q

If you are working inpatient, were should you interview the patient?

A

Do not interview patient in their room (not safe), do not interview in day room due to confidentiality issues.
Interview in private area/office with the door open/cracked.

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11
Q

What do you do if a child comes in appointment without parents and you notice the child is holding/playing with a toy in a sexual manner?

A

You suspect sexual abuse and immediately report to DCS.

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12
Q

What do you do if a child comes to an appointment with their parents and the child reports abuse?

A

Interview the child separately from parents, then report to DCS.

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13
Q

How do you build a therapeutic rapport with adolescents?

A

For adolescent assessment, you let them know that information can be confidential unless they are DTS/DTO.

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14
Q

For adolescent assessment, should you interview parent in room?

A

Separating patient from parent may create an ethical dilemma because the parent may feel they have the right to know everything, but you are advocating for adolescent patient.

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15
Q

On the boards, if answers have collaborate it is most likely:

A

The correct answer

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16
Q

On the boards, if the answers have delegating it is most likely:

A

The incorrect answer

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17
Q

If a woman attempts SI during postpartum depression, it’s because their OB doctors didn’t do a risk assessment before discharged. What is the most appropriate way to close this Gap in care?

A

Collaborate with OB doctor to do risk assessment to close gap in care.

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18
Q

If you work in an inpatient hospital and the patient is discharging to a rehab facility what do you have to do if they request labs while you were taking care of them?

A

Get informed consent and fax labs over.

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19
Q

When is it appropriate to refer a patient out?

A

Refer out is the last option. Try to do something within your scope first and then refer out if there is nothing you can do.

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20
Q

A 15-year-old patient tells you that they feel funny or weird because they inhaled acetone, what do they have and what should you order?

A

Acetone has ETOH so order a UDS.

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21
Q

What does it mean if a patient has a cultural expected response to a stressor?

A

This does not mean they have a mental illness. Have them make cultural context/meaning of their symptoms.

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22
Q

What to offer for cultural syndrome?

A

offer them brief supportive therapy

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23
Q

What to offer for patients that lost their job or house?

A

offer them brief supportive therapy

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24
Q

How do you validate patient symptoms within their cultural context?

A

Validate patient symptoms within a cultural context, such as:
a. somatic complaints of pain
b. validate pain
c. understand cultural context.

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25
Q

In a cultural formulation interview (cultural assessment), what should you clarify, and what should you contextualize?

A

a. Clarify the meaning of illness
b. Contextualize their situation in their local world while empowering them.

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26
Q

What does psychoeducation from someone from a specific culture mean? Just read

A

Info based on cultural context.

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27
Q

What kind of assessment should you use to educate a diverse population?

A

Multicultural education: Use ethnospecific assessment parameters.

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28
Q

Culture = respect important, respect what they believe is causing illness for example: Just read

A

Native American believe imbalance between individuals relationship with the world causes mental illness and SUD

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29
Q

Which ethnic group has the highest rate in US with SI and SA?

A

Native Americans are the ethnic group with the highest rate of SI/SA in the US.

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30
Q

What do Native Americans believe in regarding mental health?

A

The believe in the healing stick

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31
Q

What to teach staff about healing sticks?

A

Teach staff members if inpatient about healing stick through cultural competency, make accommodations for cultural significance.

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32
Q

Can you release info t a traditional healer?

A

Only release if you have clearance or informed consent.

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33
Q

What do you do if a patient does not understand English?

A

Make accommodations for an interpreter. Culturally sensitive.

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34
Q

Symptoms of HYPOthyroidism mimic symptoms of what?

A

symptoms of depression

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35
Q

Symptoms of HYPERthyroidism mimic symptoms of what?

A

symptoms of mania

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36
Q

What happens when T4/T3 are high? What are the main symptoms?

A

TSH secretion decreases
Symptoms include
a. Heat intolerance
b. agitation
c. anxiety
d. irritability
e. tachycardia,
f. mood swings
h. weight loss

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37
Q

What happens when T4/T3 are Low? What are the main symptoms?

A

TSH secretion increase.
Symptoms include:
a. cold intolerance
b. lethargy
c. weight gain
d. Decreased libido

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38
Q

What labs to check first if T4/T3 are low?

A

Check TSH first

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39
Q

What can Depakote cause in pregnant women?

A

Can cause Spina bifida (neural tube defect)

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40
Q

What is a black box warning for Depakote?

A

Hepatotoxicity (Liver)

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41
Q

If a patient is taking Depakote, what are the main signs of hepatotoxicity (5 symptoms to look out for)?

A
  1. Abd pain in RUQ of abdomen
  2. Reddish brown urine
  3. Yellow skin/white of the eye
  4. Fatigue
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42
Q

What is the intervention for a patient taking Depakote at risk for toxicity?

A

D/C offending agent and do LFT lab test. Also check AST/ALT.

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43
Q

What are the main signs of valproic acid toxicity (4 symptoms to look out for)?

A
  1. Disorientation
  2. Lethargy
  3. Respiratory Depression
  4. N/V
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44
Q

What is the intervention for a patient with valproic acid toxicity?

A

DC med, check valproic acid, LFTs, and ammonia levels.

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45
Q

Depakote can cause pancreatitis: What are the main symptoms for pancreatitis?

A
  1. RUQ abd pain
  2. Abd pain that radiates to back.
  3. tenderness whe touching abd
  4. fever
  5. rapid pulse
  6. N/V
  7. oily stools
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46
Q

What is Kava?

A

Herbal supplement for anxiety, stress, and insomnia.

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47
Q

What is the main side effect and what is the priority? (For depakote?)

A

Liver damage and priority is do LFT test

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48
Q

What medications interacts with Kava and what does it do?

A

Alprazolam (Xanax)
both makes you drowsy so avoid taking together

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49
Q

What can sedative medications do when they interact with KAVA?

A

Sedative (CNS depressants) and Kava are both sedating. Don’t take together due to increased sleepiness.

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50
Q

Sedative medications include: just read

A

a. Clonazepam (Klonipine)
b. lorazepam (Ativan)
c. phenobarbital (Donnatal)
d. zolpidem (Ambien)

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51
Q

What is the main component for Steven Johnsons syndrome?

A

Severe rash- Black box warning.
Other symptoms include fever, body aches, red rash, peeling skin, and facial/tongue swelling.

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52
Q

Lamictal (mood stabilizer) causes weight gain: True or false?

A

False: This medication causes the least weight gain

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53
Q

Which antipsychotics cause the least weight gain? (ZAL)

A
  1. Ziprasidone
  2. aripiprazole
  3. lurasidone
54
Q

Which antipsychotic is the least sedating?

A

aripiprazole

55
Q

Patients on antipsychotics can cause weight gain. Routine labs and check ups include?

A
  1. Checking BMI
  2. hip-to-waist ratio
  3. Labs = lipid panel and glucose
56
Q

Management of Antipsychotic-induced weight gain:
Non-pharm strategies

A

Exercise and nutritional counseling

57
Q

Management of Antipsychotic-induced weight gain:
Pharm strategies

A

Pharmacological therapies consist of switching to another antipsychotic which has less potential to gain weight.

58
Q

Carbamazepine (Tegretol)- AAA issues. What is AAA?

A

Agranulocytosis, aplastic anemia, and Asians

59
Q

What is the main black box warning symptoms for Tegretol?

A

Agranulocytosis (decrease WBCs) and aplastic anemia

60
Q

Other symptoms for Tegretol (just read)

A

(pallor, fatigue, headache, fever, nosebleeds, bleeding gums, skin rash, SOB)

61
Q

For Asian patients that have Steven Johnson syndrome, what should you screen before initiating?

A

Screen for HLAB-1502 allele before initiating.

62
Q

This is highly associated with the outcome of carbamazepine induced Steven Johnson syndrome.

A

HLAB-B 1502

63
Q

Carbamazepine/Clozaril can cause agranulocytosis: What do you look for when it comes to signs of infection?

A

Sudden fever
Chills
Sore throat
Weakness

64
Q

Carbamazepine/Clozaril can cause agranulocytosis: True or false- Repeat/recheck labs whether they show symptoms or not

A

True

65
Q

Neuroprotective treatment of choice for Bipolar disorder: What does that mean?

A

Protecting nerve cells from damage

66
Q

What is the gold standard treatment for Lithium?

A

The gold standard for lithium is treating manic episodes

67
Q

Lithium: Evidence of anti-suicidal effects: True or False

A

True

68
Q

What medication is the only known antipsychotic medication that has been shown to reduce the risk of suicide in patients diagnosed with schizophrenia?

A

Clozaril

69
Q

What bloodwork to check before placing a patient on Lithium?

A

TSH, serum creatine, and BUN.
Urine- UA and HCG

70
Q

UA: What may indicate kidney disease?

A

large amounts of proteinuria (4+)

71
Q

HCG: For females of childbearing age of what?

A

12-51 years old

72
Q

Common side effects of Lithium: Just read

A

hypothyroidsim, hadn tremors, maculopapular rash, Gi upset (N/V, diarrhea, cramps, and anorexia), polyuria, polydipsia, Diabetes Insipidus, T-wave inversions, leukocytosis (increased WBC)

73
Q

What congenital heart defect can lithium cause?

A

Epstein anomaly

74
Q

What are the main symptoms of lithium toxicity? (9 symptoms)

A

Severe N/V
diarrhea
Confusion
Drowsiness
Muscle weakness
Heart palpitation
course hand tremors
Ataxia (unsteadiness)

75
Q

Intervention for Lithium Toxicity?

A

DC Lithium and check serum Lithium levels

76
Q

How does Kidney disease or drugs effect Lithium levels?

A

Kidney Disease or Drugs that reduce renal clearance, may increase serum concentrations to drugs that are excreted by the kidneys such as Lithium.

77
Q

What are common medications that reduce renal clearance?

A
  1. NSAIDs (Ibu)
  2. Thiazides
  3. ACE inhibitors (lisinopril)
78
Q

What can dehydration and hyponatremia do to Lithium levels?

A

These both can increase lithium levels.

79
Q

What is Neuroleptic Malignant Syndrome caused by?

A

Antipsychotics

80
Q

The three main symptoms of NMS?

A

Muscle rigidity
Mutism
Heat/High temp

81
Q

Other symptoms of NMS include (4 of them)

A

ALOC- confusion
Tachycardia
Diaphoresis

82
Q

What labs are elevated in NMS?

A

Elevated, CPK, WBCs, and LFTs?

83
Q

What is myoglobinuria?

A

The result of muscle breakdown aka rhabdo

84
Q

Treatment for NMS?

A

DC offending agent and give both bromocriptine (Parlodel) and Dantrolene

85
Q

What is Bromocriptine (Parlodel)?

A

Dopamine (D2) agonist

86
Q

What is Dantrolene?

A

Muscle relaxant for muscle rigidity

87
Q

What is Serotonin Syndrome caused by?

A

Caused by antidepressants

88
Q

Symptoms to look out for with Serotonin Syndrome?

A

Hyperreflexia and Myoclonic jerks

89
Q

How do you treat Serotonin Syndrome?

A

DC offending agent and offer Cyproheptadine

90
Q

What can worsen Serotonin Syndrome?

A

SSRI/SNRI
TCA
MAOI

91
Q

When switching from SSRIs to MAOIs, how long to wait?

A

Wait 2 weeks

92
Q

When switching from Prozac to MAOI, how long to wait?

A

Wait 5-6 weeks

93
Q

When switching from MAOI to Prozac how long to wait?

A

Wait 2 weeks

94
Q

Note: a washout period of 5 half-lives between cessation of previous drug and the introduction of a new drug is the safest switching strategy from the point of view of drug interaction (degenerate)

A

Just read

95
Q

Some migraine medications can cause increase serotonin levels which can result in Serotonin Syndrome: True/False

A

True

96
Q

What type of migraine medications can cause SS?

A

Sumatriptan (Imitrex)

97
Q

If a patient is on a Triptan medication, what is an alternative antidepressant?

A

NDRI

98
Q

On the board exam, if you see the word “regenerate” is it: Correct or Incorrect?

A

Incorrect

99
Q

What type of medications is used as the first line treatment for depression and why?

A

SSRI because it is SAFER in intentional OVERDOSE compared to other classes.

100
Q

Depression + Cancer = What medication to give and why?

A

Give SSRI- Citalopram/Escitalopram because of fewer drug to drug interactions

101
Q

Depression with chronic neuropathic pain/fibromyalgia = What medication to give and why?

A

SNRI because it is safer. TCA is another alternative

102
Q

What meds have alpha 2 delta ligand?

A

Pregabalin and Gabapentin (for chronic neuropathic pain)

103
Q

If a patient is taking SSRI and has complaints of sexual dysfunction, what other alternative medications can we give?

A

Give NDRI such as Wellbutrin (no sexual side effects)

104
Q

Depression + low energy + fatigue = What medication and why?

A

Wellbutrin because it increases energy levels

105
Q

What are the contraindications for Wellbutrin?

A

Hx of seizures or eating disorders

106
Q

Wellbutrin increases the risk for?

A

This medication decreases the seizure threshold which would increase seizure risk

107
Q

Black box warning for antidepressants= what to assess for?

A

Assess the frequency/severity of SH thoughts

108
Q

Assess alcohol intake in patients that are depressed = use alcohol to self-medicate for depression = cause barrier to treatment

A

Just read

109
Q

Numerous conditions present with HI include?

A

The main one is antisocial personality disorder.
(just read) Others include: schizoaffective, BPD, paranoia, schizophrenia, OCD, brief psychotic disorder, avoidant, schizoid, and delusions

110
Q

When compared to adults, children with depression have a reduced placebo rate: True or False

A

True

111
Q

Schizophrenia Positive symptoms: What are the main symptoms

A

a. Hallucinations
b. Delusions
c. Referential Thinking
d. disorganized behavior
e. Hostility
f. Grandiosity
g. Mania
h. Suspiciousness

112
Q

Schizophrenia Positive symptoms: What is it caused by?

A

Caused by increased dopamine in the mesolimbic pathway

113
Q

Schizophrenia Negative symptoms: Symptoms respond better to Typical antipsychotics. True or False?

A

False
They respond better to atypical antipsychotic medications

114
Q

Schizophrenia Negative symptoms: What does the symptoms represent?

A

They represent a decrease or loss of normal functioning

115
Q

Schizophrenia Negative symptoms: What is it caused by?

A

These symptoms are caused by a decreased dopamine in the mesocortical pathway

116
Q

Schizophrenia negative symptoms: All A’s

A

Affective flattening
Alogia or poverty of speech
Avolitation
Apathy
Abstract thinking
Anhedonia
Attention Deficits

117
Q

Schizophrenia negative symptoms: Onset for men and women

A

a. 18-25 for men
b. 25-35 in women

118
Q

Schizophrenia symptoms: Abnormalities or changes/deficit where (what portion of the brain?) (5 parts of the brain)

A

a. Prefrontal Cortex
b. Amygdala
c. Basal Ganglia
d. Hippocampus
e. Limbic regions

119
Q

Changes in the brain for schizophrenia can cause what?

A

Aggression, impulsivity, and abstract thinking issues.

120
Q

PET SCAN/MRI for schizophrenia:
a. Limbic system: Increase or Decrease?
b. Ventricles: Increase or decrease
c. Cerebral Blood flow: Increase or decrease?

A

Every structure decreases except for Ventricles which are enlarged

121
Q

Can we give stimulants to schizophrenia patients? Why or why not?

A

It potentiates dopamine release, which makes positive symptoms worse.

122
Q

Can we give Alpha 2 adrenergic receptor agonists to schizophrenia patients?

A

This has low tolerability and neuroprotective effects are limited.

123
Q

What is Assertive Community Treatment (ACT)?

A

It’s a rehab post hospitalization for SMI.

124
Q

What do you do if you have a patient with long term history of noncompliance with their medications?

A

Refer to ACT case management. So RN can go to house to administer medications.

125
Q

What level of prevention is social skills training in schizophrenia?

A

Tertiary level of prevention

126
Q

We can refer schizo patient to aerobic exercise program: What does this do?

A

This improves
a. cognitive brain function
b. quality of life
c. long term health.

127
Q

When is a patient a high risk of relapse? What is an example?

A

When the patient is not compliant with medications, multiple failed meds, or multiple inpatient stays.
Ex: Patient is noncompliant with oral Haldol. Switch to IM.

128
Q

Patients stabilized on low daily oral doses (up to 10mg/day)
a. 1st month
b. Maintenance

A

a. 10-15 X daily PO dose
b. 10-15 X daily PO dose

129
Q

Patient that are on High dose, risk of relapse, or tolerant to oral Haldol
a. 1st month
b. Maintenance

A

a. 20 X daily PO dose
b. 10-15 X daily PO dose

130
Q

What is required during initiation and stabilization of Haldol decanoate therapy?

A

Close clinical supervision is required during initiation and stabilization of Haldol decanoate therapy

131
Q

When is Haldol decanoate usually administered?

A

This medication is usually administered monthly or every 4 weeks. It depends on the patient’s response as it may vary and may need an adjustment.

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