Georgette's LMR; Georgette's PMHNP Certification Exam
Review (2022 – 2023) V2
What should you not do when advocating for a patient? Ans- Judge or confront
What class of medication is contraindicated with tics? Ans- Stimulants
What should you provide for prior to assessing abuse victims? Ans- A safe environment
What are your actions if a child reports abuse?
Ans- First interview separately from parents then report to CPS
What should you do if a child plays with toys in a way that you suspect abuse? Ans- Report to CPS
In what setting as an inpatient provider should you interview a patient?
Ans- Use a private room with the door partially open
How should you begin your interview with adolescents?
{{Ans- By building rapport with them by ensuring confidentiality absent exceptions
Should you interview adolescents with or without parents? Ans- Without
What if an adolescent tells you they are homosexual and they don't want their parents to know?
Ans- This is confidential
The patient is being discharged and would like their labs faxed to the rehab facility. What is your
initialaction? {{Ans- Get informed consent/ROI
What do you do if a medical evaluation is needed? Ans- Refer out - this is out of scope
What do you do if a patient is takes something and is feeling really funny/unwell in your office?
Ans- Collect UDS and then refer out
Is it considered a mental illness if it is an expected response culturally? What do you offer as
treatment?
Ans- No; brief supportive therapy - not medication
A mother states her child is experiencing a cultural illness. What is your initial action?
Ans- Respect the mother's cultural understanding of illness prior to assessment
Native Americans view mental illness and SUDs as?
Ans- An imbalance between the individual and the world
,What ethnic group has the highest rate of suicidality in the US?
Ans- Native Americans
If a patient believes they need a healing stick in their room, but the staff nurses removed it from
them -what should you do?
Ans- Teach cultural sensitivity and make accommodations for patient to have healing stick available
such as 1:1
Psychoeducation should be based on? Ans- Cultural context
How do you promote health in a location with multiple ethnicities and education levels?
Ans- Multiple cultural education and ethnospecific assessment parameters
What if a patient wants a traditional healer? Ans- Allow this - remember ROI/informed consent
Normal TSH? Ans- 0.5-5.0
TSH < 0.5 = ? Ans- Hyperthyroidism
TSH > 5.0 = ? Ans- Hypothyroidism
Relationship between TSH & T3/T4? Ans- Inverse
Hyperthyroidism can present as? Ans- Mania
Hypothyroidism can present as? Ans- Depression
Normal depakote level? Ans- 50-125
Toxic depakote level? Ans- 150+
Birth defect caused by depakote? Ans- Spina Bifida
S/S of depakote toxicity? Ans- Disorientation, lethargy, decreased respiratory rate, and N/V
What to do if there is depakote toxicity? Ans- D/C depakote and check VPA level, LFTs, and ammonia
S/S of hepatotoxicity? Ans- RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs
Normal AST? Ans- 5-40
Normal ALT? Ans- 5-35
, Kava kava can cause? Ans- Liver damage and heavy sedation
Kava kava is c/i with? Ans- Benzos or sedatives
Mood stabilizer most associated with SJS? Ans- Lamictal
Mood stabilizer with least weight gain? Ans- Lamictal
SGAs with least weight gain? Ans- ziprasidone, abilify, and latuda
Least sedating SGA? Ans- Abilify
Routine labs with SGAs? Ans- BMI, hip to waist ratio, glucose, A1C, and lipid panel
Management of metabolic syndrome with SGAs?
Ans- 1. Nonpharm = exercise or nutritional counseling
2. Pharm = switch to other SGA with lower chance of metabolic syndrome
Carbamazepine can cause? Ans- Agranulocytosis and aplastic anemia
What should you screen for prior to starting Asians on carbamazepine and why?
Ans- HLAB1502 Allele; risk of SJS
When should you d/c carbamazepine if agranulocytosis is suspected?
Ans- If ANC is < 1000 with or without s/s of infection
Lithium range? Ans- 0.6 - 1.2
What to do if lithium is 1.3 or 1.4? Ans- Monitor
What to do if lithium is 1.5+?{Ans- D/C
Benefits of lithium? Ans- Gold standard for mania, neuroprotective, and antisuicidal effects
S/S of lithium toxicity Ans- Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor
What to do if lithium toxicity is suspected? Ans- D/C and check serum levels prior to checking VS
Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs?
Ans- NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ)
Review (2022 – 2023) V2
What should you not do when advocating for a patient? Ans- Judge or confront
What class of medication is contraindicated with tics? Ans- Stimulants
What should you provide for prior to assessing abuse victims? Ans- A safe environment
What are your actions if a child reports abuse?
Ans- First interview separately from parents then report to CPS
What should you do if a child plays with toys in a way that you suspect abuse? Ans- Report to CPS
In what setting as an inpatient provider should you interview a patient?
Ans- Use a private room with the door partially open
How should you begin your interview with adolescents?
{{Ans- By building rapport with them by ensuring confidentiality absent exceptions
Should you interview adolescents with or without parents? Ans- Without
What if an adolescent tells you they are homosexual and they don't want their parents to know?
Ans- This is confidential
The patient is being discharged and would like their labs faxed to the rehab facility. What is your
initialaction? {{Ans- Get informed consent/ROI
What do you do if a medical evaluation is needed? Ans- Refer out - this is out of scope
What do you do if a patient is takes something and is feeling really funny/unwell in your office?
Ans- Collect UDS and then refer out
Is it considered a mental illness if it is an expected response culturally? What do you offer as
treatment?
Ans- No; brief supportive therapy - not medication
A mother states her child is experiencing a cultural illness. What is your initial action?
Ans- Respect the mother's cultural understanding of illness prior to assessment
Native Americans view mental illness and SUDs as?
Ans- An imbalance between the individual and the world
,What ethnic group has the highest rate of suicidality in the US?
Ans- Native Americans
If a patient believes they need a healing stick in their room, but the staff nurses removed it from
them -what should you do?
Ans- Teach cultural sensitivity and make accommodations for patient to have healing stick available
such as 1:1
Psychoeducation should be based on? Ans- Cultural context
How do you promote health in a location with multiple ethnicities and education levels?
Ans- Multiple cultural education and ethnospecific assessment parameters
What if a patient wants a traditional healer? Ans- Allow this - remember ROI/informed consent
Normal TSH? Ans- 0.5-5.0
TSH < 0.5 = ? Ans- Hyperthyroidism
TSH > 5.0 = ? Ans- Hypothyroidism
Relationship between TSH & T3/T4? Ans- Inverse
Hyperthyroidism can present as? Ans- Mania
Hypothyroidism can present as? Ans- Depression
Normal depakote level? Ans- 50-125
Toxic depakote level? Ans- 150+
Birth defect caused by depakote? Ans- Spina Bifida
S/S of depakote toxicity? Ans- Disorientation, lethargy, decreased respiratory rate, and N/V
What to do if there is depakote toxicity? Ans- D/C depakote and check VPA level, LFTs, and ammonia
S/S of hepatotoxicity? Ans- RUQ pain, reddish brown urine, jaundice, fatigue, and elevated LFTs
Normal AST? Ans- 5-40
Normal ALT? Ans- 5-35
, Kava kava can cause? Ans- Liver damage and heavy sedation
Kava kava is c/i with? Ans- Benzos or sedatives
Mood stabilizer most associated with SJS? Ans- Lamictal
Mood stabilizer with least weight gain? Ans- Lamictal
SGAs with least weight gain? Ans- ziprasidone, abilify, and latuda
Least sedating SGA? Ans- Abilify
Routine labs with SGAs? Ans- BMI, hip to waist ratio, glucose, A1C, and lipid panel
Management of metabolic syndrome with SGAs?
Ans- 1. Nonpharm = exercise or nutritional counseling
2. Pharm = switch to other SGA with lower chance of metabolic syndrome
Carbamazepine can cause? Ans- Agranulocytosis and aplastic anemia
What should you screen for prior to starting Asians on carbamazepine and why?
Ans- HLAB1502 Allele; risk of SJS
When should you d/c carbamazepine if agranulocytosis is suspected?
Ans- If ANC is < 1000 with or without s/s of infection
Lithium range? Ans- 0.6 - 1.2
What to do if lithium is 1.3 or 1.4? Ans- Monitor
What to do if lithium is 1.5+?{Ans- D/C
Benefits of lithium? Ans- Gold standard for mania, neuroprotective, and antisuicidal effects
S/S of lithium toxicity Ans- Severe N/V, polydipsia, polyuria, leukocytosis, palpitations, coarse tremor
What to do if lithium toxicity is suspected? Ans- D/C and check serum levels prior to checking VS
Kidney disease and drugs that reduce renal clearance can raise lithium levels. What are these drugs?
Ans- NSAIDs, ace inhibitors for heart failure (-pril), and thiazides (HCTZ)
