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Chapter 18 Disorders Revealed by the Cardiac Exam

32 questions in this chapter

Chapter notes
  1. Q1Mr. Cooper is treated for bipolar disorder with lithium carbonate. His last lithium level was 0.7 mEq/L. Which of the following is not a risk factor for developing lithium toxicity?
  2. Q2In a 35-year-old man with bipolar disorder who was recently hospitalized for a manic episode and accesses his company employee assistance program to facilitate his return to work, this is an example of which prevention strategy?
  3. Q3A 56-year-old woman is seen in the emergency department with headache, dizziness, and marked hypertension (BP 205/145 mm Hg) after a German dinner. She is most likely taking which of the following medications?
  4. Q4A 52-year-old male with major depressive disorder presents for medication management. His symptoms have been non-responsive to trials of sertraline and escitalopram. The PMHNP considers initiating nortriptyline. Which of the following is the most appropriate initial diagnostic action before starting this medication?
  5. Q5A 28-year-old female is brought to the emergency department after an intentional overdose of amitriptyline. On presentation, she is lethargic with a blood pressure of 88/54 mmHg, heart rate of 124 beats per minute, and dry mucous membranes. The bedside ECG reveals a QRS duration of 145 milliseconds. Which of the following is the primary mechanism responsible for this cardiac finding?
  6. Q6A 28-year-old female with bipolar I disorder is being evaluated for initiation of lithium therapy. She is currently sexually active and uses barrier contraception inconsistently. Which baseline diagnostic tests must be completed prior to initiating lithium?
  7. Q7A 52-year-old male taking lithium 900 mg daily for bipolar I disorder presents for a routine follow-up. A routine ECG shows benign T-wave inversion without ST-segment changes. The patient is asymptomatic with a normal heart rate and a therapeutic serum lithium level of 0.8 mEq/L. What is the most appropriate PMHNP action?
  8. Q8A 17-year-old female is brought to the clinic by her parents due to severe weight loss, restrictive eating, and amenorrhea for the past 5 months. Physical examination reveals a body mass index of 14.2, dry skin, lanugo, and a resting heart rate of 38 beats per minute. Blood pressure is 82/54 mmHg. An electrocardiogram shows sinus bradycardia with a QTc interval of 468 milliseconds. What is the most appropriate next management step?