PMNHP Psychiatric-Mental Health Nurse
Practitioner 2024-2025 NUR
663 Psychiatric Nursing Last Minute Review
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, NUR 663 Psychiatric Nursing Last Minute Review LMR PMHNP
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Lurasidone (Latuda): atypical antipsychotic
Lithium Normal levels: 0.6-1.2 mEq/l,
Lithium toxic level: 1.5 mEq/l (D/C lithium and check levels)
Benefits of lithium: Evidence of anti suicidal effect, Neuroprotective
(protects nerve cells from damage)
Lithium Baseline labs before initiation: Thyroid panel, Serum creatinine
(0.6-1.2), Blood urea nitrogen (BUN)(10-20), Pregnancy test, UA for
protein, ECG for clients older than age 50
Lithium Clinically significant side effects: impaired thyroid functioning, fine
hand tremors (can see it, not fine), maculopapular rash, GI symptoms,
T-wave inversion, leukocytosis, polyuria, polydipsia
Gold standard treatment for manic episodes: lithium
Lithium Signs of toxicity: severe GI, confusion, drowsiness, weakness,
palpita- tions, coarse hand tremor
What can increase serum levels of lithium: Kidney disease or drugs that
reduce renal clearance can increase serum concentration: NSAIDS,
thiazides, ACE inhibitors
Dehydration and hyponatremia can increase?: lithium levels
Causes Ebstein anomaly (cardiac defect) not recommended in first trimester
lithium
Hypertensive Crisis: occurs when MAOIs are taken in conjunction with
foods containing tyramine, a dietary precursor to norepinephrine.
Meds that cause hypertensive crisis: Meperidine, Decongestants, TCAs,
Atypical antipsychotics, St. John's wort, L-tryptophan, Stimulants and
, NUR 663 Psychiatric Nursing Last Minute Review LMR PMHNP
Exam Review Questions with Correct Answers
other sympa- thomimetics, Asthma medications
Symptoms of hypertensive crisis: Sudden, explosive-like headache
usually in occipital region , Elevated blood pressure, Facial flushing
Palpitations, Pupillary dilation. Diaphoresis, Fever (think about wha
happens with hypertension)
Treatment of hypertensive crisis: Discontinue the MAOI, Give
phentolamine (binds with norepinephrine receptor sites, blocks
norepinephrine).
Floppy baby syndrome, cleft palate caused by,: Benzodiazepines
Neural tube defects caused by: Carbamazepine (Tegretol):
Neural tube defects specifically spina bifida and atrial septal defect and clef
palate and possible long-term developmental deficits caused by: Dival
proex sodium (Depakote)
Signs/symptoms of SJS: • Fever
facial swelling
tongue swelling
macules, papules, and "burning," confluent erythematous rash
skin sloughing
Carbamazepine BBW: Agranulocytosis - decreased WBC o
Monitor for signs of infection (fever, chills, ST, weakness) with what meds-
, NUR 663 Psychiatric Nursing Last Minute Review LMR PMHNP
Exam Review Questions with Correct Answers
: Clozaril/Tegretol
D/C Clozaril/Tegretol if: ANC < 1,000 whether signs of infection or not
Aplastic anemia signs and symptoms: pallor, fatigue, H/A, fever,
nosebleeds, bleeding gums, skin rash, SOB
• SJS is a higher risk in what group of people=: asian higher risk- screen
with HLA-B 1502 allele
Folic Acid dose: : 0.4-0.8mg daily important for neural tube during first
month,
Clozapine DC criteria: d/c if ANC levels < 1,000 not 500
Bulimia presentation=: Weight usually within normal range (different from
anorexia), Erosion of dental enamel, Russell's sign (calluses on hands),
Hypertrophy of salivary glands, Rectal prolapse
Bulimia TX: Fluoxetine is FDA-approved for bulimia nervosa, SSRIs and
tricyclic antidepressants (TCAs) effective in reducing the frequency of
binging and purging
Anorexia Nervosa S/S: Low body mass index, Amenorrhea, Emaciation,
Brady- cardia, Hypotension, Electrocardiogram (ECG) changes
(Inversion of T-waves, ST segment depression, Prolonged QT interval),
Hypertrophy of the salivary glands, Russell's sign
Anorexia TX: CBT (if medically stable, if not then send to hospital)
Bupropion uses: NDRI used with depression with low energy/fatigue
Bupropion do not use: Contraindicated with bulimia or seizures, increased
risk for sz
SNRI is goof for: depression with chronic neuropathic pain
Enzyme inducers: can decrease the serum level of other drugs (tobacco