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Question 1: A 34 year old male patient with a 4 year history of Bipolar disorder has been stable on Lithium 300mg TID (three times daily) for the last six months. He comes in for a lithium level blood draw and tells you he has been working in construction and trying to get in better shape by running for 30 minutes 5 times a week. You are concerned he may be dehydrated. Which of the following laboratory values confirms the NP's suspicion of dehydration?

 

  1. Hematocrit 43%

  2. Glomerular Filtration Rate (GFR) >60 mL/min

  3. Creatinine 1.0mg/dl

  4. Specific Gravity 1.045

 

Reference: Brunner & Suddarth's Textbook of Medical Surgical Nursing. (2014). 13th edition. Authors: Hinkle and Cheever.Psych Notes, Clinical Pocket Guide. (2012). F.A.Davis Company. (3rd edition). Author: Pedersen

Question 2: On 6/17/2015, A.R. comes into the clinic for an initial evaluation for anxiety. You note during the physical exam he has diaphoresis, tachycardia and BP 167/98. He states he has not been feeling well and is “anxious”. He also states he needs something “new” for his anxiety because it is “so bad because I have a lot of stress”. You as his provider decide to pull an INSPECT report, which is Indiana’s prescription monitoring program. The report states that another provider gave him Xanax 1 mg tabs #60 on 6/7/2015 with directions to take q 8 PRN, with no refills. When A. R. is confronted about the report and how he is out so soon, he states he has been out of the Xanax for 2 days and then continues to insist he was given only 10 tabs and the report is an error. Your next step in his treatment would be:

  1. Go ahead and give him 1 week of Xanax because he is stressed out.

  2. Do not give him any meds and discharge him for lying.

  3. Educate him on the signs and symptoms of detoxification and that he may be very ill and needs to be evaluated at the nearest ED and that you will call an ambulance for him.

  4. Give him Klonopin 1 mg TID for 1 month with no refills.

 

Reference: Pocket Handbook of Clinical Psychiatry 5th edition, Sadock and Sadock, pg. 129

Psychiatric-Mental Health NP Question Bank

Over 1700 Psychiatric-Mental Health NP questions, specifically targeting the ANCC Mental Health examination. Questions include detailed explanations, but also many questions include charts and other relevant tables. The questions often serve as mini-lectures.

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BoardVitals is the best resource I have seen for the Mental Health / Psych NP exam. The questions are hard and the explanations are thorough. I've recommended this to many others and wish you the best of luck at your company!” - Meghan Farrell, PMHNP-BC