LMR GEORGETTE PMHNP EVALUATION EXAM QUESTIONS
AND ANSWERS RATED A+
✔✔Signs of SJS - ✔✔FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
arthralgia
painful mucus membranes
✔✔Lamotrigine is least likely to cause - ✔✔sedation or weight gain
✔✔Carbamazepine (tegretol) black box warning - ✔✔agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
✔✔Carbamazepine and asians - ✔✔Screen for HLAB-1502 allele before initiating, due
to high incidence of SJS if positive for allele.
✔✔Child-bearing aged women - ✔✔check for pregnancy before starting mood stabilizer
start on folic acid to support neural tube development during the first month that a
woman is pregnant
✔✔Clozaril/clozapine can cause - ✔✔agranulocytosis and neutropenia
✔✔For monitoring neutropenia in Clozaril, monitor - ✔✔ANC
✔✔DC clozarli if ANC - ✔✔less than 1000
✔✔DC clozaril if WBC - ✔✔2000-3000, risk of agranulocytosis
✔✔When on clozaril monitor for - ✔✔signs and symptoms of infection: sudden fever,
chills, sore throat, weakness
✔✔Clozaril only known antipsychotic to - ✔✔decrease risk of suicide in patients with
schizophrenia.
✔✔Your patient with bipolar disorder is admitted to a medical hospital. The internist
contacts your office and asks whether the lithium you prescribed him is effecting his
ECG. How do you respond?
,A. Lithium can prolong the QT interval
B. Lithium has no effect on his ECG
C. Lithium can invert the t waves
D. Lithium can shorten the PR interval - ✔✔Answer: Lithium can invert the t waves.
✔✔Mary is a 45-year-old African American female who has been treated on
Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure.
Which medication is strictly contraindicated with Isocarboxazid?
A. Morphine
B. NSAIDS
C. Methylphenidate
D. Acetaminophen - ✔✔Answer: Methylphenidate
✔✔You are treating a client with schizophrenia who takes clozapine. What lab values
will indicate the client needs to discontinue treatment?
A. WBC less than 1800 and ANC less than 1200
B. ANC less than 1,000
C. WBC less than 5,000
D. ANC less than 2000 - ✔✔Answer: ANC less than 1000
✔✔If given during pregnancy, socium valproate can cause which of the following
medical problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate - ✔✔A. Spina bifida
✔✔Which mood stabilizer is associated with potential life-threatening rash in the Asian
population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal - ✔✔A. Carbamazepine
✔✔Bulimia, weight is ___________ - ✔✔within the normal range.
✔✔Pharm treatment for bulimia - ✔✔Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
✔✔Signs of anorexia nervosa - ✔✔low BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
,✔✔Pharm treatment for anorexia - ✔✔there is none
therapy
✔✔Which of the following physical exam findings would help the PMHNP differentiate
anorexia nervosa from bulimia nervosa?
A. Russell sign
B. Low BMI
C. Erosion of dental enamel
D. Hypertrophy of salivary glands - ✔✔Low BMI
✔✔If a patient is depression, low energy, fatigued, you would prescribe - ✔✔Wellbutrin
✔✔Wellbutrin is contraindicated in patients with - ✔✔seizure disorder or conditions that
increase risk of seizures such as eating disorder.
✔✔Which of the following medications has a unique mechanism that is both a
norepinephrine and dopamine reuptake inhibitor?
A. Bupropion (Wellbutrin)
B. Sertraline (Zoloft)
C. Clomipramine (Anafranil)
D. Duloxetine (Cymbalta) - ✔✔bupropion
✔✔CLozaril is metabolized by - ✔✔cytochrome P450 enzyme CYP1A2
✔✔INducers - ✔✔induce metabolism and therefore decrease serum levels of other
drugs that are substrates
✔✔Smoking will do what to drug levels - ✔✔decrease therapeutic levels of the drug
✔✔Bull Shit CRAP GPS Induces my rage - ✔✔Barbituates
St. Johns Wart
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulphonylureas
✔✔If your patient is a smoker you will need ___________doses of their medication. -
✔✔higher
✔✔Inhibitors - ✔✔inhibit metabolism and therefore increase levels of the drug.
, ✔✔SICKFACES.com for Inhibitors - ✔✔Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Alcohol
Chloramphenicol
Erythromycin
Sulfonamine
Cipro
Omeprazole
Metronidazole
✔✔Which cytochrome enzyme is implicated as a tobacco inducer when an individual is
treated with clozapine
a. 2D6
b. 1A2
c. 2C19
d. 2C9 - ✔✔1A2
(want A 2 cigarette break)
✔✔When treating older adults, you should keep in mind that they are more sensitive to
issues of drug toxicity because of which of the following reasons?
A. Decreased body fat
B. Increased liver capacity
C. Decreased protein binding
D. Increased muscle concentration - ✔✔Decreased protein binding
✔✔For 12 years, a 65 year old patient with bipolar affective disorder has been treated
with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the
patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's
serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has
induced:
A. hypokalemia
B. hyponatremia
C. Increased renal clearance of lithium
D. Decreased renal clearance of lithium - ✔✔A. decreased renal clearance of lithium
✔✔Where is norepinephrine produced - ✔✔locus coeruleus and medullary reticular
formation
✔✔Norepinephrine is associated with - ✔✔mood disorders
✔✔Serotonin is made where in the brain - ✔✔raphe nuclei of the brainsteam
✔✔Serotonin is associated with - ✔✔sleep and mood disorder
AND ANSWERS RATED A+
✔✔Signs of SJS - ✔✔FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
arthralgia
painful mucus membranes
✔✔Lamotrigine is least likely to cause - ✔✔sedation or weight gain
✔✔Carbamazepine (tegretol) black box warning - ✔✔agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
✔✔Carbamazepine and asians - ✔✔Screen for HLAB-1502 allele before initiating, due
to high incidence of SJS if positive for allele.
✔✔Child-bearing aged women - ✔✔check for pregnancy before starting mood stabilizer
start on folic acid to support neural tube development during the first month that a
woman is pregnant
✔✔Clozaril/clozapine can cause - ✔✔agranulocytosis and neutropenia
✔✔For monitoring neutropenia in Clozaril, monitor - ✔✔ANC
✔✔DC clozarli if ANC - ✔✔less than 1000
✔✔DC clozaril if WBC - ✔✔2000-3000, risk of agranulocytosis
✔✔When on clozaril monitor for - ✔✔signs and symptoms of infection: sudden fever,
chills, sore throat, weakness
✔✔Clozaril only known antipsychotic to - ✔✔decrease risk of suicide in patients with
schizophrenia.
✔✔Your patient with bipolar disorder is admitted to a medical hospital. The internist
contacts your office and asks whether the lithium you prescribed him is effecting his
ECG. How do you respond?
,A. Lithium can prolong the QT interval
B. Lithium has no effect on his ECG
C. Lithium can invert the t waves
D. Lithium can shorten the PR interval - ✔✔Answer: Lithium can invert the t waves.
✔✔Mary is a 45-year-old African American female who has been treated on
Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure.
Which medication is strictly contraindicated with Isocarboxazid?
A. Morphine
B. NSAIDS
C. Methylphenidate
D. Acetaminophen - ✔✔Answer: Methylphenidate
✔✔You are treating a client with schizophrenia who takes clozapine. What lab values
will indicate the client needs to discontinue treatment?
A. WBC less than 1800 and ANC less than 1200
B. ANC less than 1,000
C. WBC less than 5,000
D. ANC less than 2000 - ✔✔Answer: ANC less than 1000
✔✔If given during pregnancy, socium valproate can cause which of the following
medical problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate - ✔✔A. Spina bifida
✔✔Which mood stabilizer is associated with potential life-threatening rash in the Asian
population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal - ✔✔A. Carbamazepine
✔✔Bulimia, weight is ___________ - ✔✔within the normal range.
✔✔Pharm treatment for bulimia - ✔✔Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
✔✔Signs of anorexia nervosa - ✔✔low BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
,✔✔Pharm treatment for anorexia - ✔✔there is none
therapy
✔✔Which of the following physical exam findings would help the PMHNP differentiate
anorexia nervosa from bulimia nervosa?
A. Russell sign
B. Low BMI
C. Erosion of dental enamel
D. Hypertrophy of salivary glands - ✔✔Low BMI
✔✔If a patient is depression, low energy, fatigued, you would prescribe - ✔✔Wellbutrin
✔✔Wellbutrin is contraindicated in patients with - ✔✔seizure disorder or conditions that
increase risk of seizures such as eating disorder.
✔✔Which of the following medications has a unique mechanism that is both a
norepinephrine and dopamine reuptake inhibitor?
A. Bupropion (Wellbutrin)
B. Sertraline (Zoloft)
C. Clomipramine (Anafranil)
D. Duloxetine (Cymbalta) - ✔✔bupropion
✔✔CLozaril is metabolized by - ✔✔cytochrome P450 enzyme CYP1A2
✔✔INducers - ✔✔induce metabolism and therefore decrease serum levels of other
drugs that are substrates
✔✔Smoking will do what to drug levels - ✔✔decrease therapeutic levels of the drug
✔✔Bull Shit CRAP GPS Induces my rage - ✔✔Barbituates
St. Johns Wart
Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulphonylureas
✔✔If your patient is a smoker you will need ___________doses of their medication. -
✔✔higher
✔✔Inhibitors - ✔✔inhibit metabolism and therefore increase levels of the drug.
, ✔✔SICKFACES.com for Inhibitors - ✔✔Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Alcohol
Chloramphenicol
Erythromycin
Sulfonamine
Cipro
Omeprazole
Metronidazole
✔✔Which cytochrome enzyme is implicated as a tobacco inducer when an individual is
treated with clozapine
a. 2D6
b. 1A2
c. 2C19
d. 2C9 - ✔✔1A2
(want A 2 cigarette break)
✔✔When treating older adults, you should keep in mind that they are more sensitive to
issues of drug toxicity because of which of the following reasons?
A. Decreased body fat
B. Increased liver capacity
C. Decreased protein binding
D. Increased muscle concentration - ✔✔Decreased protein binding
✔✔For 12 years, a 65 year old patient with bipolar affective disorder has been treated
with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the
patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's
serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has
induced:
A. hypokalemia
B. hyponatremia
C. Increased renal clearance of lithium
D. Decreased renal clearance of lithium - ✔✔A. decreased renal clearance of lithium
✔✔Where is norepinephrine produced - ✔✔locus coeruleus and medullary reticular
formation
✔✔Norepinephrine is associated with - ✔✔mood disorders
✔✔Serotonin is made where in the brain - ✔✔raphe nuclei of the brainsteam
✔✔Serotonin is associated with - ✔✔sleep and mood disorder
