PMHNP ACTUAL EXAM - - A. 30y/o married AA female with previous SI att...

PMHNP ACTUAL EXAM -

ANSWERS GRADED A+

Which patient is at highest risk for SI

• 30y/o married AA female with previous SI attempt *1 risk factor
• 35 y/o single Asian male with previous SI attempt *3 risk factors
• 38 y/o single AA male who is a manager of a bank *2 risk factors
• 68 y/o single white male with depression *5 risk factors (age, male, white,

depression)answer== D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)

Count the risk factors When interview teenagers (16 y/o) that arrive with their parents what should you do?answer== interview them separately from parents.-This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child.

Which Ethnic group has the highest rate of suicide?answer== Native Americans

Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine?

• Increased waist circumference
• EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism
• Increased Lipids
• Metabolic Syndromeanswer== D. Metabolic Syndrome (UMBRELLA ANSWER)

Which antipsychotics have the least weight gain?answer== Latuda, Abilify, (also least

Which mood stabilizer have the least weight gain?answer== Lamictal -But remember all mood stabilizers cause some weight gain

When presented with a question about typical vs atypical antipsychotic the answer is usually to start of aanswer== atypical

A client presents with complains of changes in appetite, feeling fatigued, problems with sleep- rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?

• Thalamus
• Hypothalamus

sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY

• Limbic System

2

• Hippocampusanswer== Hypothalamus

A, B, & D are all part of the limbic system so you can rule that out

When a patient is hesitant to participate in treatment you should encourage? answer==Bring a support person like a husband

Thyroid-Stimulating hormone normal level answer== 0.5-5.0 Mu/L

When T4 and T3 are high and TSH is low what is the diagnosis answer== HYPERTHYROIDISM,

TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE

Key symptoms of Heat Intolerance answer== Hyperthyroidism

When T4 and T3 are Low and TSH is high what is the diagnosis answer== (HYPOTHYROIDISM)

TSH secretion increased: TSH HIGH à COLD INTERANCE

Key symptoms of Cold Intolerance answer== Hypothyroidism

Hyperthyroid can mimic answer== Mania

Hypothyroid can mimic answer== Depression

A patient on depakote complains of RUQ pain and has reddish/brown urine answer== Hepatoxicity -Check LFTs Signs of Depakote toxicity answer== Disorientation, confusion, lethargy You suspect depakote toxicity what do you do? answer== Check -LFT -Ammonia -Depakote Level

What herbal supplement can cause hepatoxicity? answer== Kava Kava

When taking Kava Kava in combinations with other medications you should caution about answer== Risk of Hepatoxicity and Sedation

TCAs carry a risk of answer== Hepatotoxicity

Signs of Stevens-Johnson Syndrome answer== -fever, mouth pain, swelling, burningeyes, blisters, skin pain

two psychotropics known to cause steven johnson syndrome answer== lamictal andtegretol 3

4

What nationality is most suseptible of getting steven johnson? answer== Asians When treating asians with tegretal screen for? answer== HLAB-1502 Allele

What two medications cause agranulocytosis? answer== Clozaril & Tegretal

Agranulocytosis when to discontinue medication answer== Less than 1000

When monitoring for agranulocytosis in patients look for s/s of what? answer== Infection -Fever, sore throat, fatigue, chills

Before starting any mood stabilizer in a female of childbearing age be sure to check?answer== HCG

Which two medications may decrease the risk of suicide? answer== clozaril and lithium

Medications that increase lithium level answer== NSAID-ibuprofen, INDOCINTHIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril

Ace inhibitors are treatment of choice for? answer== Heart Failure

Certain medications are known to increase lithium level, but HOW? answer== byreducing renal clearance

When educating a patient about lithium teach them about answer== HyponatremiaDehydration-hot days, exercise

Normal Lithium Level answer== 0.6-1.2

Lithium Toxicity answer== 1.5 or aboveDiscontinue and re-order lithium level

Lithium level of 1.4 answer== Monitor for toxicity

Labs before starting lithium answer== TSH, BUN, CREATININE, HCG, U/A to check forpresence of protein in the urine (4+ protein is concerning for renal impairment)à4+ protein in urine=MONITOR FOR TOXICITY

4+ protein in the urine of a patient on lithium answer== 4+ protein is concerning for renalimpairment 4+ protein in urine=MONITOR FOR TOXICITY

Lithium side effects answer== hypothyroid, leukocytosis, maculopapular rash, t- waveinversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)