LMR Georgette’s PMHNP Certification
Exam Review 2026/2027 | Complete
Practice Question Bank | Detailed Answers
& Rationales
What does ADPIE stand for? - correct answer-Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the
middle of the night? - correct 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? - correct
answer-Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? - correct answer-
Check renal function
,What do you do if a patient presents with fever while on Clozaril? - correct
answer-Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - correct answer-Antidepressants, St. John's
Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - correct answer-Elevated WBC (over 11,000)
and elevated CPK
S/S of NMS - correct 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? - correct
answer-Check for rhabdo with CPK
s/s of serotonin syndrome - correct answer-hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - correct answer-bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - correct answer-cyproheptadine (Periactin)-
5HT-2A receptor antagonist
What is the onset and typical length of NMS? - correct answer-Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
, What is the onset of SS? - correct answer-Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - correct answer-NMS
has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - correct answer-Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - correct 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? - correct
answer-Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? - correct answer-Epstein's anomaly
What lab should you check for athletes on lithium? - correct answer-Specific
gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - correct answer-Do not give the next
dose and assess for s/s
At what level is lithium toxicity a medical emergency? - correct answer->3
S/S of lithium toxicity - correct answer-vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
Exam Review 2026/2027 | Complete
Practice Question Bank | Detailed Answers
& Rationales
What does ADPIE stand for? - correct answer-Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the
middle of the night? - correct 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? - correct
answer-Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? - correct answer-
Check renal function
,What do you do if a patient presents with fever while on Clozaril? - correct
answer-Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - correct answer-Antidepressants, St. John's
Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - correct answer-Elevated WBC (over 11,000)
and elevated CPK
S/S of NMS - correct 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? - correct
answer-Check for rhabdo with CPK
s/s of serotonin syndrome - correct answer-hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - correct answer-bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - correct answer-cyproheptadine (Periactin)-
5HT-2A receptor antagonist
What is the onset and typical length of NMS? - correct answer-Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
, What is the onset of SS? - correct answer-Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - correct answer-NMS
has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - correct answer-Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - correct 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? - correct
answer-Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? - correct answer-Epstein's anomaly
What lab should you check for athletes on lithium? - correct answer-Specific
gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - correct answer-Do not give the next
dose and assess for s/s
At what level is lithium toxicity a medical emergency? - correct answer->3
S/S of lithium toxicity - correct answer-vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
