LMR
Someone
reports
they
are
raped.
Priority
action?
-
ANSWER-Assess
safety.
Safety
before
assessment
and
intervention
Priority
when
discharging
a
patient
from
inpatient?
-
ANSWER-Safety
Child
comes
into
the
office
and
reports
abuse
in
the
presence
of
parents.
Next
action?
-
ANSWER-Interview
child
separately
from
parents
and
then
call
CPS.
Child
comes
into
the
office
without
his/her
parents
and
is
playing
with
a
toy
in
a
sexual
way.
You
suspect
sexual
abuse.
Next
action?
-
ANSWER-Immediately
call
CPS.
Suspicion
is
enough
reason
to
call.
Don't
call
parents
first.
Teen
wants
you
to
keep
something
secret
and
not
tell
parents
(not
related
to
harm),
parents
insist
you
tell
them.
What
do
you
do?
-
ANSWER-Don't
tell
them.
Child/teen
as
the
right
to
CONFIDENTIALITY
(not
privacy).
You
identify
a
gap
in
care
that
many
people
who
commit
suicide
postpartum
did
not
receive
a
risk
assessment
by
the
OBGYN.
What
do
you
do?
-
ANSWER-COLLABORATE
with
OBGYN
to
close
gap.
Patient
is
discharging
to
a
rehab
facility.
Had
labs
done
while
at
your
clinic.
Steps
to
sending
labs
to
rehab
facility?
-
ANSWER-Need
informed
consent
and
then
you
can
fax
the
labs
over
to
the
rehab
facility.
14
yo
comes
to
office
feeling
"funny"
because
they
inhaled
acetone.
What
is
within
your
scope
of
practice
that
you
could
do
before
referring
this
patient?
-
ANSWER-Urine
drug
screen
Pt
has
a
panic
attack
after
you
make
eye
contact
with
them.
This
response
was
related
to
a
cultural
syndrome.
Treatment
for
cultural
syndrome?
-
ANSWER-Brief
supportive
therapy. How
should
you
respond
to
a
patient
who
complains
of
somatic
pain
when
PCP
couldn't
find
any
medical
causes?
-
ANSWER-VALIDATE
their
symptoms
based
on
cultural
experience
Key
components
of
cultural
interviews:
-
ANSWER-Clarify
meaning
of
illness
Contextualize
their
situation
in
their
local
world
Empower
the
patient
Educating
someone
with
schizophrenia
should
include
what
key
component?
-
ANSWER-Cultural
competence.
Educate
based
on
cultural
contexts
of
schizophrenia.
2
key
factors
when
educating
a
diverse
population
-
ANSWER-MULTICULTURAL
EDUCATION
and
ETHNOSPECIFIC
ASSESSMENT
PARAMETERS
(aka
will
use
different
parameters
for
every
household
in
a
diverse
population)
Which
care
attribute
should
you
employ?:
.
Native
Americans
believe
mental
illnesses
of
substance
use
can
be
caused
by
an
imbalance
between
an
individual's
relationship
with
the
world.
-
ANSWER-RESPECT
their
interpretation
Ethnic
group
with
highest
rate
of
suicide
-
ANSWER-Native
americans
Native
Americans
believe
in
the
healing
stick
which
has
healing
powers.
Working
inpatient,
native
american
comes
in
with
healing
stick
and
insists
on
having
the
healing
stick
with
them.
Nurses
want
to
take
away
the
healing
stick.
What
will
you
do?
-
ANSWER-TEACH
NURSE
about
CULTURAL
COMPETENCY.
If
you
find
yourself
being
confrontational
with
a
culture,
incorrect
answer.
Patient
wants
you
to
release
their
info
to
a
traditional
healer.
What
do
you
need
to
do
to
make
this
happen?
-
ANSWER-Get
informed
consent
before
releasing
information.
TSH
normal
level
-
ANSWER-0.5-5.0
Mu/L
Hyperthyroidism
TSH,
T3,
and
T4
levels
-
ANSWER-TSH
low,
T3
and
4
high Symptoms
of
hyperthyroidism
-
ANSWER-Heat
intolerance,
agitation,
anxiety,
irritability,
tachycardia,
mood
swings,
weight
loss
Hypothyroidism
TSH,
T3,
and
T4
levels
-
ANSWER-TSH
high,
T3
and
4
low
Symptoms
of
hypothyroidism
-
ANSWER-cold
intolerance,
lethargy,
weight
gain,
decreased
libido
Which
would
you
check
first,
TSH
or
T3/T4?
-
ANSWER-TSH
first,
if
abnormal,
can
do
individual
T3
and
4
Divalproex
Sodium
(Depakote)
birth
defect?
-
ANSWER-Spina
bifida
(neural
tube
defect)
Divalproex
Sodium
(Depakote)
BB
warning
-
ANSWER-Hepatotoxicity
S/S
of
hepatotoxicity
when
taking
Divalproex
Sodium
(Depakote)
What
to
do
if
hepatotoxic?
-
ANSWER-RUQ
abdominal
pain,
reddish
brown
urine,
yellowing
of
skin
and
whites
of
eye,
fatigue
DC
Depakote
and
do
LFT
checking
AST
and
ALT
Normal
AST
and
ALT
-
ANSWER-AST
5-40
U/land
ALT
5-35
U/land
Therapeutic
range
for
depakote?
when
does
toxicity
occur?
S/S
of
Toxicity?
What
to
do
when
toxic?
-
ANSWER-50-125
ug/mL
Toxic
when
>150
ug/mL
S/S:disorientation,
lethargy,
resp
depression,
N/V
DC
depakote
and
check
drug
levels,
LFT
and
ammonia
levels Besides
hepatotoxicity,
what
other
organ
system
does
depakote
affect?
S/S?
-
ANSWER-Pancreatitis
(RUQ
abd
pain
that
radiates
to
back,
tender
abd,
fever,
rapid
pulse,
vomiting,
oily
stools)
Side
effect
of
Kava
-
ANSWER-liver
damage
If
taking
Kava
and
having
signs
of
hepatotoxicity,
what
should
you
do?
-
ANSWER-tell
them
to
STOP
taking
Kava
Major
med
interactions
with
kava?
Why?
-
ANSWER-BENZOS,
Alprazolam
(Xanax):
extreme
drowsiness
Also
other
CNS
depressants
SJS
symptoms
-
ANSWER-Rash,
body
aches,
FEVER,
peeling
skin,
facial/tongue
swelling
Atypical
antipsychotics
that
cause
least
weight
gain?
-
ANSWER-Ziprasidone,
aripirazole,
lurasidone
Least
sedating
atypical?
-
ANSWER-Abilify
Routine
labs
when
on
an
atypical
that
causes
weight
gain
-
ANSWER-BMI,
hip
to
waist
ratio,
glucose,
lipid
panel
Atypical
induced
weight
gain
management
-
ANSWER-Nonpharm
first:
EXERCISE
and
nutrition
counseling.
if
necessary,
switch
to
atypical
with
less
weight
gain
Started
pt
on
seroquel.
They
don't
exercise
and
gain
a
lot
of
weight.
They
develop
metabolic
syndrome.
Next
action
as
the
PMHNP?
-
ANSWER-ENCOURAGE
EXERCISE.
If
exercise
doesn't
work,
can
prescribe
a
different
med
with
less
weight
gain.
