PMHNP CERTIFICATION EXAM 2024
ACTUAL TEST VERIFIED A+ UPDATED
REVIEW PAPER 2026 QUESTIONS AND
CORRECT ANSWERS GRADED A+
⩥ What should you do when a mother reports her child woke up
screaming in the middle of the night? Answer: Ask her if it's happened
before to assess for sleep issue patterns
⩥ What do you do if a patient comes in with fungus on their toenail?
Answer: Scrape nail and send for testing
⩥ What do you do if a patient on lithium has dark brown urine? Answer:
Check renal function
⩥ What do you do if a patient presents with fever while on Clozaril?
Answer: Check ANC level to assess for agranulocytosis
⩥ What can cause serotonin syndrome? Answer: Antidepressants, St.
John's Wort, Same-E, Kava Kava, and Tryptophan
⩥ What labs are indicative of NMS? Answer: Elevated WBC (over
11,000) and elevated CPK
,⩥ S/S of NMS Answer: muscle rigidity, hyperthermia, tachycardia,
abnormal bp, sweating, altered mental status, cherry colored urine
⩥ What should you do if a patient presents with cherry colored urine?
Answer: Check for rhabdo with CPK
⩥ s/s of serotonin syndrome Answer: hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and
shivers
⩥ What two medications to give with NMS? Answer: bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
⩥ What medication to give during SS? Answer: cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
⩥ What is the onset and typical length of NMS? Answer: Slow onset (1-
2 weeks after changing or starting therapy) and resolves within 9-14
days
⩥ What is the onset of SS? Answer: Within 24 hours of
starting/changing medication and resolves within a few days
,⩥ How do you distinguish between NMS and acute dystonia? Answer:
NMS has a slower onset while acute dystonia occurs within hours
⩥ What happens with lithium and NSAIDs? Answer: Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
⩥ What happens with lithium and ACE inhibitors? Answer: Increased
risk of lithium toxicity related to the increased urination from the ACE
inhibitors
⩥ Why should a patient on lithium avoid calcium channel blockers?
Answer: Risk of fatal nephrotoxicity
⩥ What is a fetal side effect of lithium? Answer: Epstein's anomaly
⩥ What lab should you check for athletes on lithium? Answer: Specific
gravity to assess for dehydration (dehydration is >1.015)
⩥ What do you do if the lithium level is 1.3? Answer: Do not give the
next dose and assess for s/s
⩥ At what level is lithium toxicity a medical emergency? Answer: >3
, ⩥ S/S of lithium toxicity Answer: vomiting, diarrhea, slurred speech,
hand tremor, dry mouth/thirst, muscle weakness/twitching
⩥ Why check an EKG with lithium? Answer: Inverted T-waves
⩥ What medication should treat hypothyroidism caused by lithium use?
Answer: Synthroid
⩥ What do you do if patient is prescribed both depakote and lamictal?
Answer: Decreased lamictal dose by 50%
⩥ Depakote and pregnancy Answer: Spina bifida
⩥ What emergency may be occuring if patient on depakote reports upper
abdominal pain? Answer: Pancreatitis
⩥ What lab should you check if patient has right upper quadrant pain
and dark brown urine? Answer: LFTs
⩥ What lab means pregnancy? Answer: HCG
⩥ Why is Clozaril used? Answer: Treatment resistant schizophrenia,
improves SI, and improves negative symptoms of schizophrenia
ACTUAL TEST VERIFIED A+ UPDATED
REVIEW PAPER 2026 QUESTIONS AND
CORRECT ANSWERS GRADED A+
⩥ What should you do when a mother reports her child woke up
screaming in the middle of the night? Answer: Ask her if it's happened
before to assess for sleep issue patterns
⩥ What do you do if a patient comes in with fungus on their toenail?
Answer: Scrape nail and send for testing
⩥ What do you do if a patient on lithium has dark brown urine? Answer:
Check renal function
⩥ What do you do if a patient presents with fever while on Clozaril?
Answer: Check ANC level to assess for agranulocytosis
⩥ What can cause serotonin syndrome? Answer: Antidepressants, St.
John's Wort, Same-E, Kava Kava, and Tryptophan
⩥ What labs are indicative of NMS? Answer: Elevated WBC (over
11,000) and elevated CPK
,⩥ S/S of NMS Answer: muscle rigidity, hyperthermia, tachycardia,
abnormal bp, sweating, altered mental status, cherry colored urine
⩥ What should you do if a patient presents with cherry colored urine?
Answer: Check for rhabdo with CPK
⩥ s/s of serotonin syndrome Answer: hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and
shivers
⩥ What two medications to give with NMS? Answer: bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
⩥ What medication to give during SS? Answer: cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
⩥ What is the onset and typical length of NMS? Answer: Slow onset (1-
2 weeks after changing or starting therapy) and resolves within 9-14
days
⩥ What is the onset of SS? Answer: Within 24 hours of
starting/changing medication and resolves within a few days
,⩥ How do you distinguish between NMS and acute dystonia? Answer:
NMS has a slower onset while acute dystonia occurs within hours
⩥ What happens with lithium and NSAIDs? Answer: Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
⩥ What happens with lithium and ACE inhibitors? Answer: Increased
risk of lithium toxicity related to the increased urination from the ACE
inhibitors
⩥ Why should a patient on lithium avoid calcium channel blockers?
Answer: Risk of fatal nephrotoxicity
⩥ What is a fetal side effect of lithium? Answer: Epstein's anomaly
⩥ What lab should you check for athletes on lithium? Answer: Specific
gravity to assess for dehydration (dehydration is >1.015)
⩥ What do you do if the lithium level is 1.3? Answer: Do not give the
next dose and assess for s/s
⩥ At what level is lithium toxicity a medical emergency? Answer: >3
, ⩥ S/S of lithium toxicity Answer: vomiting, diarrhea, slurred speech,
hand tremor, dry mouth/thirst, muscle weakness/twitching
⩥ Why check an EKG with lithium? Answer: Inverted T-waves
⩥ What medication should treat hypothyroidism caused by lithium use?
Answer: Synthroid
⩥ What do you do if patient is prescribed both depakote and lamictal?
Answer: Decreased lamictal dose by 50%
⩥ Depakote and pregnancy Answer: Spina bifida
⩥ What emergency may be occuring if patient on depakote reports upper
abdominal pain? Answer: Pancreatitis
⩥ What lab should you check if patient has right upper quadrant pain
and dark brown urine? Answer: LFTs
⩥ What lab means pregnancy? Answer: HCG
⩥ Why is Clozaril used? Answer: Treatment resistant schizophrenia,
improves SI, and improves negative symptoms of schizophrenia
