PMHNP certification Exam 22
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1. Which client is at highest risk for SI
A. 30y/o married AA female with previous SUICIDAL IDEATIONattempt *1 risk
factor
B. 35 y/o single Asian male with previous SUICIDAL IDEATIONattempt *3 risk
factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)
Count the risk factors
2. COWS scale components: · Opioid W/D
Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea
(running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (goose-
flesh skin), insomnia
3. What does COWS stand for?: Clinical Opiate Withdrawal Scale
4. What does CIWA stand for?: Clinical Institute Withdrawal Assessment
5. What does CIWA assess for?: --used to determine likelihood of ETOH withdrawal or DTs
--usually occur within the first 24-72 hours after cessation
o used to determine when to administer medications for ETOH withdrawal
6. What does CIWA NOT test for?: Alcohol Use Disorder
7. What are the CIWA scale components?: · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile
disturbances, auditory disturbances, visual disturbances, H/A, orientation
Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)-4 (disoriented)
Score:
<10: Very mild Start PRN meds at score of 8
>10 to 15: Mild scheduled + PRN meds
>16 to 20: Moderate
>21: Severe Diazepam, Librium, Ativan
8. When interview teenagers (16 y/o) that arrive with their parents what should
you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but
remember you are advocating for the child.
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
9. Which Ethnic group has the highest rate of suicide?: Native Americans
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
10. Example A client is being treated for schizophrenia with olanzapine. Which
of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antago-
nism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
11. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating),
Geodon-if client has metabolic syndrome consider switching to one of the medications above. Or if the client is
overly sedated try switching to ABILIFY
12. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
13. When presented with a question about typical vs atypical antipsychotic the
answer is usually to start of a: atypical
14. A client presents with complains of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the neu-
roanatomical area of the brain that is responsible for the normal regulation of
these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
15. When a client is hesitant to participate in treatment you should encour-
age?: Bring a support person like a husband
16. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
17. When T4 and T3 are high and TSH is low what is the diagnosis: HYPERTHYROIDISM,
TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE
18. Key symptoms of Heat Intolerance: Hyperthyroidism
19. When T4 and T3 are Low and TSH is high what is the diagnosis: (HYPOTHYROIDISM)
TSH secretion increased: TSH HIGH à COLD INTERANCE
20. Key symptoms of Cold Intolerance: Hypothyroidism
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
21. Hyperthyroid can mimic: Mania
22. Hypothyroid can mimic: Depression
23. A client on depakote complains of RUQ pain and has reddish/brown urine-
: Hepatoxicity
-Check LFTs
24. Signs of Depakote toxicity: Disorientation, confusion, lethargy
25. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
26. What herbal supplement can cause hepatoxicity?: Kava Kava
27. When taking Kava Kava in combinations with other medications you should
caution about: Risk of Hepatoxicity and Sedation
28. TCAs carry a risk of: Hepatotoxicity
29. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin
pain
30. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
31. What nationality is most suseptible of getting steven johnson?: Asians
32. When treating asians with tegretol screen for?: HLAB-1502 Allele
33. What two medications cause agranulocytosis?: Clozaril & Tegretol
34. Agranulocytosis when to discontinue medication: Less than 1000
35. When monitoring for agranulocytosis in clients look for s/s of what?: Infection
-Fever, sore throat, fatigue, chills
36. Before starting any mood stabilizer in a female of childbearing age be sure
to check?: HCG
37. Which two medications may decrease the risk of suicide?: clozaril and lithium
38. Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN
THIAZIDES-hydrochlorithiazide
ACE INHIBITORS-lisinopril
39. Ace inhibitors are treatment of choice for?: Heart Failure
Study online at https://quizlet.com/_bpfu9u
1. Which client is at highest risk for SI
A. 30y/o married AA female with previous SUICIDAL IDEATIONattempt *1 risk
factor
B. 35 y/o single Asian male with previous SUICIDAL IDEATIONattempt *3 risk
factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression)
Count the risk factors
2. COWS scale components: · Opioid W/D
Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea
(running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (goose-
flesh skin), insomnia
3. What does COWS stand for?: Clinical Opiate Withdrawal Scale
4. What does CIWA stand for?: Clinical Institute Withdrawal Assessment
5. What does CIWA assess for?: --used to determine likelihood of ETOH withdrawal or DTs
--usually occur within the first 24-72 hours after cessation
o used to determine when to administer medications for ETOH withdrawal
6. What does CIWA NOT test for?: Alcohol Use Disorder
7. What are the CIWA scale components?: · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile
disturbances, auditory disturbances, visual disturbances, H/A, orientation
Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)-4 (disoriented)
Score:
<10: Very mild Start PRN meds at score of 8
>10 to 15: Mild scheduled + PRN meds
>16 to 20: Moderate
>21: Severe Diazepam, Librium, Ativan
8. When interview teenagers (16 y/o) that arrive with their parents what should
you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but
remember you are advocating for the child.
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
9. Which Ethnic group has the highest rate of suicide?: Native Americans
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
10. Example A client is being treated for schizophrenia with olanzapine. Which
of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antago-
nism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
11. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating),
Geodon-if client has metabolic syndrome consider switching to one of the medications above. Or if the client is
overly sedated try switching to ABILIFY
12. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
13. When presented with a question about typical vs atypical antipsychotic the
answer is usually to start of a: atypical
14. A client presents with complains of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the neu-
roanatomical area of the brain that is responsible for the normal regulation of
these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
15. When a client is hesitant to participate in treatment you should encour-
age?: Bring a support person like a husband
16. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
17. When T4 and T3 are high and TSH is low what is the diagnosis: HYPERTHYROIDISM,
TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE
18. Key symptoms of Heat Intolerance: Hyperthyroidism
19. When T4 and T3 are Low and TSH is high what is the diagnosis: (HYPOTHYROIDISM)
TSH secretion increased: TSH HIGH à COLD INTERANCE
20. Key symptoms of Cold Intolerance: Hypothyroidism
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
21. Hyperthyroid can mimic: Mania
22. Hypothyroid can mimic: Depression
23. A client on depakote complains of RUQ pain and has reddish/brown urine-
: Hepatoxicity
-Check LFTs
24. Signs of Depakote toxicity: Disorientation, confusion, lethargy
25. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
26. What herbal supplement can cause hepatoxicity?: Kava Kava
27. When taking Kava Kava in combinations with other medications you should
caution about: Risk of Hepatoxicity and Sedation
28. TCAs carry a risk of: Hepatotoxicity
29. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin
pain
30. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
31. What nationality is most suseptible of getting steven johnson?: Asians
32. When treating asians with tegretol screen for?: HLAB-1502 Allele
33. What two medications cause agranulocytosis?: Clozaril & Tegretol
34. Agranulocytosis when to discontinue medication: Less than 1000
35. When monitoring for agranulocytosis in clients look for s/s of what?: Infection
-Fever, sore throat, fatigue, chills
36. Before starting any mood stabilizer in a female of childbearing age be sure
to check?: HCG
37. Which two medications may decrease the risk of suicide?: clozaril and lithium
38. Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN
THIAZIDES-hydrochlorithiazide
ACE INHIBITORS-lisinopril
39. Ace inhibitors are treatment of choice for?: Heart Failure
