NEED TO KNOW Flashcards
Metoprolol (Lopressor) should not be used with (3)
Paroxetine, Fluoxetine, or Bupropion due to risk of serious adverse effects like hypotension and bradycardia
What supplements can improve depressive symptoms (4)
B12, B6, Folate, Omega 3 fatty acid
What medications can cause QT prolongation (4)
Ziprasidone
Quetiapine
Haloperidol
Citalopram
What medications are LESS Likely to prolong QT interval (3)
aripriprazole
lurasidone
olanzapine
Least sedating SSRIs (2)
Lexapro (escitalopram)
Fluoxetine
Safest SSRIs for patients with heart issues
sertraline
escitalopram
Symptoms of serotonin discontinuation syndrome (6)
muscle soreness
achiness
n&v
fatigue
lethargy
agitation
Effective tx for serotonin discontinuation syndrome
resume taking the antidepressant at the previously prescribed dose
Mood stabilizer with least weight gain
Lamictal
Migraine medications
Triptans and sumatriptan (imitrex)
What conditions present likely with homicidal ideation
Antisocial personality d/o very common
why do studies online show more efficacy for antidepressants with adults versus children
because studies contain more adults not children
Medications that can cause mania (4)
steroids like prednisone and dexamethason
Disulfiram (antabuse)
Isoniazid (INH)
Antidepressants for bipolar
Medications that can cause depression (9)
steroids **
liothyronine
beta blockers
interferon
Isotretinoin
retroviral drugs
antineoplastic drugs
benzodiazepines
progesterone
Paradoxical effects
prescribe patient with anxiety and agitation with Geodon, but instead of it helping the anxiety- it makes it worse- so patient is experiencing the opposite effect
Risk factors for osteoporosis 5
smoking, drinking caffeine, lack of calcium i diet, and vitamin D, lack of weight-bearing exercise
if pt has RA what is a common test
erythrocyte sedimentation rate
if pt is positive for RA what happens to teh erythrocyte sedimentation rate
increased
the infant is producing a shrill cry (high pitch) can be due to
can be due to increased intracranial pressure
postmenopausal women have low sex drive can be due to
hormonal decrease in testosterone, progesterone, and estrogen, and reduced pelvic blood flow
what hormonal therapy can help menopausal depression
estrogen and progesterone
what kind of diet helps with depression
low fat diets
who is more prone to alcohol related liver damage
women because they have lower levels of alcohol dehydrogenase, which is the enzyme that metabolizes alcohol
Macrocytic normachromic anemia you want to check
b12 and folic acid levels because b12 deficiency can lead to symptoms
major cause of microcytic anemia is
iron deficiency
what happens with low levels of iron
less oxygen gets to the cells keeping them from properly functioning and often leads to fatigue, weakness and anxiety
protects patients against unlawful hospitalization- esp mental illness, if they were hospitalized for no just reason they can use this to leave AMA
habeas corpus
in order to provide evidenced based care we need access to
current journal articles
you wanted the patient to review timeline but they couldn’t remember within a specific time frame what can you do
ask more specific questions or ask questions that link memorable events
if you wanted to educate patient about a medication you must first assess what
patients knowledge of the medication and their beliefs around it
disseminated encephalomyelitis symptoms
nervous system disorder- headache, confusion, ataxia, asymmetrical body movements
if patient has disseminated encephalomyelitis may need
neuroexam
if you are trying to implement a policy that will affect nurse practitioners nationwide you want to
create an online forum so questions and concerns can be addressed there
if you want to implement new policy but your coworkers are against the new policy what can you do
prove how the new policy can improve quality of patient care
PICOT QUESTIONS stands for
Population problem patient
intervention issues interest
comparison
outcome
time
starting investigation for nursing what should you do
start with PICOT question
evidence from a systemic review or meta analysis of all relevant randomized controlled trials or evidence-based clinical practice guidelines based on a systematic review of RCTs or three or more RCTs of good quality that have similar results
level 1
evidence obtained from at least one well designed RCT
level 2
how to ensure continuous improvement of quality of care in an outpatient clinic
develop an instrument to monitor clinical outcomes
how to ensure continuous quality improvement when treating patients with mental illness like depression and anxiety
use a rating scale to determine baseline scores and at regular intervals during treatment
how to monitor clinical progress
standardized rating scales
Diabetic keto acidosis is common complication of type 1 dm symptoms:
kussmaul respirations rapid and deep
fruity-scented breath
excessive thirst and urination
fatigue
confusion
medication for enuresis
desmopressin to reduce urine production
night time bedwetting non pharmacological interventions
set alarm for night time voiding and use moisture alarms
looking up patients info on social media is
violating their trust
patient has been taking a medication and is stable but then FDA releases a black box warning of medication so waht do you do
research benefits and risks of continued use and make decision with patient
off label you want to make sure to provide patient with
FULL DISCLOSURE add evidence supporting of off label use document risks and pros
sleep apnea risk factors
smoking,
excess weight
obesity
diabetes
high BP
narrowed airways
reflective practicing
is a debriefing strategies after an event or cause with the goal of improving practice
pt use to take on pill of clonazepam for two years but now is requesting two pills to achieve the same effect of the one pill
tolerance - decrease effect with continuous use of the SAME dose over time
legal telemed
confidentiality concerns
medical errors
jurisdiction authority over licensure always verify where the patient is (if the client moves to another state in a state not under your license that is illegal)
pt with Substance use disorder in IOP when do you transfer them to less IOP
patient is taking responsibility for their actions and has developed coping skills
med errors what is the first thing you want to do to develop policy
assess common types of med errors and then assess learning needs of staff
MMSE score
0-30
MMSE mild score
21-24 Mild cognitive impairment possibly early to mild alzheimers
MMSE Moderate score
10-20 moderate Alzheimer disease
MMSE normal score
25-30
MMSE severe score
0-9 severe alzheimer
SLUM normal score
27-30
SLUM mild score
21-26
Slum dementia score
0-20
MoCA normal score
26-30
MoCa mild cognitive impairement
18-25
moderate cognitive impairement MoCA
10-17
MoCA less than 10 means
severe cognitive impairment
if someone has Alzheimers they should not be scoring a
20-25 it should be reassessed
PHQ moderate score depression
10-14
HAM D moderate score depression
14-18
MADRS moderate score depression
20-34
Beck moderate depression
19-29
HAM for anxiety moderate range
18-24
GAD moderate
10-14
COWS opioid moderate score
13-24
when to start tx on COWS score
> 7
CIWA ETOH moderate score
16-20
when to start tx on CIWA
8 and above PRNS only
when to start meds for CIWA score
15 and above (valium, Ativan, or librium
what can you give patient scoring a mild on COWS 5-12?
clonidine
when can you give buprenorphine or suboxone on COWS
moderate to severe 13 and above
Suboxone is
buprenorphine and naloxone
methadone can cause
cardiac issues not first choice
clonidine common s/e
drowsiness more than buprenorphine or suboxone
Collecting data can look like? (4)
vital signs, ordering CMP, lab results, and literature search
The assessment process includes: (3)
Identify, survey, and collect data
When does behavioral management and support begin?
AFTER pt is admitted
with cultural questions what should you always do first?
Always respect before assess or intervention with cultural questions
What medication can exacerbate tics? and what would an alternative be especially for an adolescent?
Stimulants exacerbate tics and another alternative is guanfacine
Be wary of absolutes
all, only, always, every, must, never, none, everything, nothing, etc 🡪 usually wrong. The ONLY answer option is USUALLY WRONG.
If a question has 3 interventions and 1 assessment, most likely the answer is the assessment.
Questions that use adjectives like “priority” and “initial action” test your ability to prioritize.
How would you usually prioritize?
-ABC
-Maslow’s hierarchy of needs (physiologic needs (food, water, warmth, rest, safety and security)
-Nursing Process (assessment before intervention) Assessment is collecting data
- Urine drug screen, Vital signs, CMP, literature data etc
What do you do if a patient tells you they are a victim of abuse?
1st, reassure them of their safety and provide them with an environment of safety- Do this before assessing them or intervening
A child comes in with the parents and the child tells you they have been sexually abused, what do you do?
You will interview the child separate from the parents FIRST and then report to CPS 2nd
A Child comes in alone and has a toy, based on the play with this toy in a sexual way you suspect sexual abuse what is your next action?
You will contact and report to CPS immediately. Do not start investigating with parents or caregivers
You work as a PMHNP inpatient and want to discharge a patient, what must you confirm first?
You need to ensure patient can stay safe and cope effectively
You work inpatient and you want to interview a patient, what is the best way to interview them?
Do not interview the patient in their room, - this could be an unsafe environment. Do not interview in the day room.
CORRECT-Interview in a private area with the door open/partially open. SAFETY over PRIVACY
How do you build a rapport with teens / adolescents 12-20 years old
Let them know their information is confidential with exceptions to confidentiality such as danger to self or to others. If interviewing a teen, do not interview with parents in the room. Ask the parents to stay in the waiting room.
When a teen tells you they are attracted to the same gender or dating someone of the same age,
Adolescents have a right to _____
No need to tell parents.
- You may tell parents if they are dating someone older or younger but not if they are the same age.
-You are advocating for adolescents and they have the right to CONFIDENTIALITY.
-Parents may feel like they have the right to know everything and this can create an ethical dilemma. However, the teen has a right to confidentiality (not privacy)
Collaboration vs delegation in answering questions:
Interprofessional collaboration is encouraged. If a question had collaborate🡪 this is most likely right
-When answering, choose options you are actively getting involved
-Delegating is usually wrong
-Collaboration with the nurse manager or dietician is usually correct option (Look for KEY WORD collaborate)
Call provider to discuss patient care in interprofessional collaboration.
Example: You notice a lot of women attempt suicide post partum because OB doctor doesn’t do risk assessment before discharge
- Collaborate with OB doctor and recommend the OB doctor does suicide risk assessment before discharging patients
- Discrepancy in care by OB, Collaborate to correct the gap in care
You are discharging a patient to rehab and they request labs. Do you print labs and give to patients? Do you get informed consent and fax labs?
Get informed consent and fax the labs.
- Get actively involved helping patients.
-Printing labs and giving them to patients increases the chance of labs being lost.
Is a medical evaluation within the PMHNP scope?
NO- -Only correct if referring to someone else to do a medical evaluation.
-Is there something I could do within my scope of practice for this patient BEFORE referring out?
-Referring out is usually the last part
For example, a 15-year-old comes into the office and tells you they inhaled acetone and are feeling weird. As an NP, what is your priority action?
-Correct thing is to do a urine drug screen (UDS).
-Patient could be at increased risk of using other substances
-Don’t need to refer out for emergency evaluation yet; Do the UDS and see if they are using other substances.
Cultural Syndrome (something that is normal in that culture)- what is the next action?
-Don’t need to start on psychotropics
-Validate symptoms based on culture
-Offer brief supportive therapy
Cultural question: Somatic complaints of pain “ My pcp hasn’t found any medical reason for this” What do you do?
Validate symptoms based on cultural context.
Interpret the cultural meaning of pain, Ask patient, understand their pain based on cultural significance of pain.
Cultural assessment = cultural formulation interviews: (3)
-Clarify the meaning of illness or predicament
-Contextualize their situation in their local world
-Empower the patient
If you want to provide psychoeducation to patient from a specific culture what do you do? (2)
-Information should be based on developed cultural concepts specific to their culture
-Pt diagnosed w schizophrenia, based information on cultural context 🡪 benefits of meds, psychoeducation
Community Education: with multiple cultures what is your approach?
-Health promotion in the community.; Not everyone who lives in the community is from the same culture -Multicultural community. Ex: Long beach
-Based on the assessment of identifying people in the community who are of different ethnicities 🡪 Provide multicultural education/ teaching. (don’t use the same assessment parameters for every household. Use ETHNO SPECIFIC assessment parameters.
