LMR GEORGETTE REVIEW PMHNP
ACTUAL TEST PAPER 2026 QUESTIONS
WITH SOLUTIONS 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%
ACTUAL TEST PAPER 2026 QUESTIONS
WITH SOLUTIONS 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%
