GEORGETTES LMR STUDY SET 2023, Exams of Nursing

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GEORGETTES LMR STUDY SET When questions ask for a priority action...think about... - ✔ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: - ✔the umbrella answer What is the most common side effect of olanzapine/zyprexa - ✔metabolic syndrome what is the difference between typical and atypical antipsychotics - ✔Atypical 5HT2A specific 1st psychotic break... two actions to take - ✔UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain - ✔Latuda, Abilify, Geodon Always encourage interprofessional collaboration - ✔between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 - ✔T3, T4 low TSH low, then...t3/t4 - ✔T3, T4 high cold/hot sensitivity with t3/t4 relationship - ✔T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? - ✔Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? - ✔Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat - ✔anxiety and insomnia Rash and fever associated with tegretol, suspect - ✔ What allele is HLAB 1502 associated? - ✔Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol - ✔Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis - ✔unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue GEORGETTES LMR STUDY SET if starting a woman on lithium what test should be done? why? - ✔HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine - ✔SJS labs to checke BEFORE starting on lithium - ✔BUN CRE urine protein What does protein in urine indicate - ✔kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. - ✔lithium best choice med for si in schizophrenia - ✔clozaril best choice med for SI in borderline - ✔lithium What medications will INCREASE Li levels - ✔NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels - ✔dehydration hyponatremia lithium s/e inc N/V, which will effect electrolytes, and dehydration status what type of tremors will you see with lithium toxicity? - ✔course tremors lithium can cause what other comorbidities? - ✔hypothyroidism maculopapular rash leukocytosis twave inversion what is a defining characteristic of NMS vs SS - ✔muscle rigidity Sx's/labs associated with NMS - ✔Inc CPK, WBC, LFT Rhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does - ✔DC the offending agent bromocriptin-D2 agonis GEORGETTES LMR STUDY SET If HARMFUL delusions, notify authority Also notify potential victim how to assess mental abstraction - ✔interpret a proverb assess thought process why? and potential findings - ✔to assess organization of patients thoughts tangential: no rip to a ? circumstantial: gets around to anss after going in circles with unnecessary details MMSE thought content include - ✔SI HI plan Hallucinations delusions MMSE/ Folstein Test assesses? - ✔tool used to assess cognitive status in adults concentration/attention/calculation assessed how? - ✔spell a word backward or serial 7's Registration/ability to learn new material assessed how? - ✔remember 3 words orientation is assessed by - ✔Person place time fund of knowledge assessed how? - ✔Who is the president? Governor? clock drawing assesses? - ✔takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP - ✔haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP - ✔rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway - ✔positive sx of schizophrenia GEORGETTES LMR STUDY SET decreased DA in mesocoritcal pathway - ✔negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway - ✔excess DA in this pathway but it doesn't cause any sx, but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx Tuberoinfundibular pathway - ✔excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia what does high prolactin levels lead to - ✔breast DC amenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia - ✔risperidone Male prolactin female prolactin---normals - ✔male less than 20ng/ml female less than 25ng/ml EPS caused by - ✔DA blockade in the NS pathway acute dystonia - ✔acute sustained contraction of muscles, usually of the head and neck spasms painful treatment of acute dystonia - ✔cogentin/benztropine IM, but may need Oral follow up for several days akathisia - ✔ANXIETY restless cannot sit still pacing rocking 1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? - ✔propranolol/or beta blocker client with asthma on bronchodilators due to increased risk of bronchospasm when given beta blockers 2nd line: cogentin/benztropine GEORGETTES LMR STUDY SET 3rd line: benzos akanesia - ✔difficulty iniating motion treatment for akanesia - ✔cogentin/benztropin Sx of akinesia - ✔DIFFICULTY INITIATING MOVEMENT; PSEUDO PARKINSONIAN SX'S: muscle rigidity shuffling gait mask like facial expression affect may be flat or blunted pill rolling tremors (motor slowing) Tardive dyskinesia (TD)/timeframes - ✔chewing/lip smacking facial dyskinesia Treatment: dec dose of offending agent or switch to a different AP or can switch to clozaril. can have onset between a few weeks and 2 years post starting of medication Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? - ✔TD what medication can worsen TD? - ✔benztropine/cogentin Inducers - ✔cause low serum levels inhibitors - ✔cause high serum levles reglan and compazine can both cause - ✔TD Smoking and dosing of meds - ✔smoking is a strong inducer. therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase. Always assess for smoking/cessation of. Antibiotics/macroglides are INHIBITORS and greatly effect what medication - ✔tegratol what meds can cause mania - ✔disulfram steroids isoniazide antidepressants what meds can cause depression - ✔steroids beta blockers interferon GEORGETTES LMR STUDY SET theft arson INTENSE AGE 6-17 When 18; think of Antisocial personality disorder Treatment for CD - ✔Medication and therapy to target symptoms of mood and aggression Alpha agonist aka alpha 2 adrenergic receptor blockers (clonidin, guanfacine) Family therapy acute stress disorder - ✔An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last LESS THAN 1 MONTH Over 1 month is PTSD PTSD cluster of sx - ✔Increased arousal Reexperiencing the event avoidance nightmares nightmare trmt in ptsd - ✔prazosin/minipress PTSD treatment - ✔EMDR SSRI CBT phases of EMDR - ✔see purple book Panic attack vs disorder - ✔panic attack: acute/seldom disorder: chronic leads to feelings of impending doom propanolol Tourette dx criteria - ✔2 motor tic 1 vocal tic for ONE year (even if ? says 6 months) its still most likely the correct answer NT in tourette - ✔DA-da dysfunction is major NT in tourette NE S GEORGETTES LMR STUDY SET tics can be caused by what type of medication - ✔stimulant how do you treat a kid with tics for adhd - ✔non stimulant guanfacine and clonidine are good choice for adhd in kid with tics - ✔TRUE Meds for tourettes - ✔FDA approved haldol abilify pimozide guanfacine clonidine esp if kid is having impulse control problems are tics in kids normal - ✔yes normal. normally by teen years they disappear. no treatment unless meeting dsm criteria for tourettes. tourettes needs trmt. 2 motor 1 vocal brain region affected in adhd - ✔frontal cortex basal ganglia- dorsolateral PFC--executive function, attention, cognitive processes (problem solving, working memory) reticular activating OCD NT's - ✔S NE Pandas - ✔causes OCD from strep infection treat with SSRI prozac in kids, in adults use sertraline. adults can also get TCA like clomipramine DMDD (disruptive mood dysregulation disorder) - ✔in kids, mood d/o 6-17yo kid has bipolar disorder but is not 18 yet moody for no reason irritible for no reason tantrums for no reason Mad/Sad for no reason IED (intermittent explosive disorder) - ✔reacts grossly out of proportion to the situation GEORGETTES LMR STUDY SET violent aggressive HAVE REMORSE, feel bad about it all later irritibility, depression, labile mood...utilize a________ - ✔mood questionnaire nightmares in children can be genetic or psychological - ✔assess the family tree/hx for this GAD (Generalized Anxiety Disorder) - ✔AT LEAST SIX MONTHS If less it is ASD Autism Spectrum Disorder NTs - ✔Gaba glutamate SE impaired communication poor cognition broken mirror theory of autism- what two things do you have to have to diagnose adhd - ✔a teacher and a parent evaluation Do stimulants increase DA? - ✔Yes, so don't give a vmat 2 and a stimulant together. wipes one another out P450 Inducer meds - ✔carbamazepine rifampin alcohol phenytoin griseofulvin phenobarbital sulfonylureas P450 inhibitor - ✔Valproate ketoconazole isoniazid sulfonomides choramphenical amiodarone erythromycin quinidine grapefruit juice GEORGETTES LMR STUDY SET pseudo dementia - ✔cognitive screening present with: agitation irritability what disorder does a provider hear a lot of "I don't know answers" - ✔pseudo dementia aphasia is associated with which region of the brain - ✔prefrontal cortex visual hallucinations are associated with which type of dementia - ✔lewy body frontotemoporal dementia - ✔frontal lobe picks disease personality changes behavioral language (slurred) Signs of lead abuse - ✔developmental delay learning difficulties irritability loss of appetite weight loss sluggishness fatigue abd pain vomiting constipation hearing loss seizures pica TEST LEAD LEVELS Components of the COW Scale - ✔Pulse sweating restlessness pupil size bone aches running nose tearing GI upset yawning tremors anxiety/irritability goosebumps GEORGETTES LMR STUDY SET anterior cingulate is responsible for what - ✔cognitive functions decision making emotions impulse control NE is produced in the locus ceruleus and the ... - ✔medullary reticular formation SE is produced in the_________? And is involved in ______? - ✔raphe nuclei of the brainstem/sleep DA is produce in the substantia nigra and ______? - ✔the ventral tegmental area VTA and nucleus accumbens Acetylcholine is synthesized by the basal nucleus of _____? - ✔Meynert NT in mood disorders - ✔SE and NE risk factors for osteoporosis - ✔smoking caffeine lack of exercise diet low in cal and vit D What is the hippocampus responsible for? - ✔ST to LT memory emotions stress learning Amygdala - ✔fear anger anxiety aggression stress cerebellum - ✔balance anterior cingulate - ✔cognitive functions decision making empathy impulse control emotions decision making frontal lobe issues - ✔social skills tumor here can cause behavioral problems GEORGETTES LMR STUDY SET If you are caring for an infant that is dying and the parents are present, what action should you take - ✔give the infant to the parents to hold and grieve their loss osteoporosis can be prevented by a diet rich in what? and other ways to prevent - ✔ calcium and vitamin d weight bearing exercises not using tobacco Cognitive theory basics - ✔trying to replace automatic negative beliefs/irrational thoughts with positive / functional thoughts Humanistic therapy basics - ✔Person centered self actualization self directed growth Behavioral therapy - ✔problem solving techniques role playing skills training relaxation SKILLS SKILLS interpersonal therapy (IPT) - ✔interpersonal distress with lots of people and in several settings. also used in marital conflict for a 12-16 weeks. Think relationship distress with this Family systems therapy - ✔triangles triangulation self differentiation genograms structural family therapy - ✔hierarchies keyword structural mapping genograms strategic family therapy - ✔problem focused/symptom focused paradoxical strategies or a straight forward directive Reframe patients belief system solution focused family therapy - ✔miracle question miracle solution exception based finding questions GEORGETTES LMR STUDY SET what is habeus corpus - ✔legal, not medical concept, that protects patients from unlawful hospitalization substance induced psychosis has a very high rate of ? - ✔HI. even more than ASPD. disseminated encephalomyelitis - ✔nervous system is affected asymmetrical body movements do a neuro exam patient has a mood disorder. started depakote and been stable. BMI 25 now 30. eating alot of sweets and juices. recommendations? A. switch med b. dec depakote c. ask them to exercise - ✔ how can you help your client remember something by anchoring their memory. how do you do thta? - ✔ask a specific question that will provide an anchor to a timeline, like a wedding, bday, new job, etc. ask what they know about medications before rxing - ✔assesses their knowledge of meds polypharmacy can lead to adverse side effects - ✔assess medication hx iatrogenic - ✔an iatrogenic illness is an illness that is caused by a medication or physician. tardive dys: caused by a med rx'd by a doc post online forms to give responses to influence - ✔policy making advocacy autoimmune diseases can lead to increased....? - ✔cytokine levels Desmopressin (DDAVP) - ✔for nighttime bed wetting reduces urine production esp at noc guanfacine and clonidine is disliked by some patients due to? - ✔have low tolerability due to lowers BP cannot look up patietns information on Social media - ✔violates trust treatment for nighttime wetting under 12yo? - ✔nonpharm GEORGETTES LMR STUDY SET setting alarms bladder training if addicts are still blamining others they are not ready for....? - ✔discharge. If still blaming others they are not ready. Need to take responsibility for their actions. non compliant with medication? - ✔intervention based on why they are not compliant assess data before changing anything if patient comes to your with concerns make sure you - ✔validate their concerns to promote communication come to office or discuss by phone documentation for off label use? do this.... - ✔document why. and document support for off label use. MSL or trials risk factors for sleep apnea - ✔excessive weight obesity diabetes smoking HTN narrowed airways what is macrocytic anemia - ✔vit B12 deficiency MMSE high score means? - ✔Good! low score is severe cognitive deficit if depression is "severe" assess for - ✔SI MMSE scale - ✔25-30 is normal 21-24 mild 10-20 moderate 0-9 severe SLUM scale - ✔27-30 Normal 21-26 Mild 0-20 dementia HAM D - ✔0-7 Normal 8-13 mild 14-18 moderate 19-22 severe GEORGETTES LMR STUDY SET 23 plus very severe PHQ 9 - ✔0-4 normal 5-9 mild 10-14 moderate 15-19 moderate to severe 20-27 severe Beck - ✔0-9 normal 10-18 mild 19-29 moderate 30-63 severe HAM A - ✔under 17 mild 18-24 moderate 25 plus severe GAD - ✔0-4 normal 5-9 mild 10-14 moderate 15-21 severe COWs - ✔0-4 none 5-12 mild 13-24 moderate 25-35 mod to severe 35 plus severe CIWA - ✔0-9 none 10-15 mild 16-20 moderate 21 plus severe cows criteria - ✔mod: treatment at 13 and above for scheduled. consider buprenorphine or Suboxone. methadone consider safety concerns and under supervision pulse sweating restlessness pupil size-dilated bone aches runny nose tearing gi upset yawning tremors anxi/irritable