PMHNP certification Exam 2022/2023(Aready GradedA+)
What are assessed in the Thought Content of the MSE - ANSWER: SI/HI, Plan,
Hallucinations
• PNEUMOIC - Old Age Parents Love Grandchildren - ANSWER: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +)
• FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3-6 years old
- ANSWER: • 3-year-old masturbates, play with self, says naughty things
• This is NORMAL for children this age.
What do you do when a patient has an increased prolactin level? - ANSWER: • Stop
prolactin (stop the agent that cause increase prolactin)
• ACUTE STRESS DISORDER - ANSWER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP
to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
What would you do if a 5-year-old tells you his brother sodomized him? - ANSWER: •
Tell mom don't leave him alone with patient and call CPS implement crisis
If a child is playing with doll in a sexual way, what do you do first? - ANSWER: • You
SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO
BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you
have to have something (assessment data) to report - Assess = FIRST
If a 13-year-old tells you he want to smoke, what would be an appropriate response?
- ANSWER: • Ask him of his plan to stop smoking
If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect? -
ANSWER: • Cranial nerve V-Trigeminal nerve (FIVE)
What cranial nerve is responsible for Bells Palsy? - ANSWER: 7 = Facial Paralysis
What cranial nerves do you assess for corneal sensation - ANSWER: Nerves 5 & 7
What cranial nerves do you assess for papillary reaction to light and
accommodation? - ANSWER: Nerves 3,4,& 6
What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular
movements? - ANSWER: Nerves 3, 4, & 6
,What cranial nerves do you assess for corneal light reflex? - ANSWER: 3, 4, & 6
Cranial Nerve 1 - ANSWER: Olfactory (smell)
Cranial Nerve 2 - ANSWER: Optic - vision
Cranial Nerve 3 - ANSWER: Oculomotor (eye movement): The occulomotor nerve is
responsible for motor enervation of upper eyelid muscle, extraocular muscle and
pupillary muscle.
Cranial Nerve 4 - ANSWER: Trochlear (eye movement): The trochlear nerve controls
an extraocular muscle.
Cranial Nerve 5 - ANSWER: Trigeminal: The trigeminal nerve is responsible for
sensory enervation of the face and motor enervation to muscles of mastication
(chewing).
Cranial Nerve 6 - ANSWER: Abducens (motor): The abducent nerve enervates a
muscle, which moves the eyeball.
Cranial Nerve 7 - ANSWER: Facial nerve: The facial nerve enervates the muscles of
the face (facial expression).
Cranial Nerve 8 - ANSWER: Vestibulocochlear (hearing and balance): The
vestibulocochlear nerve is responsible for the sense of hearing and balance (body
position sense).
Cranial Nerve 9 - ANSWER: Glossopharyngeal: The glossopharyngeal nerve enervates
muscles involved in swallowing and taste. Lesions of the ninth nerve result in
difficulty swallowing and disturbance of taste.
Cranial Nerve 10 - ANSWER: vagus nerve: The vagus nerve enervates the gut
(gastrointestinal tract), heart and larynx.
Cranial Nerve 11 - ANSWER: accessory: The accessory nerve enervates the
sternocleidomastoid muscles and the trapezius muscles.
Cranial Nerve 12 - ANSWER: Hypoglossal (tongue movement): The hypoglossal nerve
enervates the muscles of the tongue.
What is the best action for a 16 y/o with conduct disorder that refuses tx? -
ANSWER: • Send to psych specialist for acting out kids - Referrals - Have to see if you
are going to refer the same patient to the same provider - Cannot refer the patient
to another provider that is the same as you (ie psych) - you must refer to a
neurologist or another specialist or PCP
,What is a priority consideration for a 16-year-old that shows up with mother for first
therapy? - ANSWER: • Confidentiality (ex. mom sits in lobby)
What is important to know about ACE inhibitors (Meds for Heart failure/HTN) -
ANSWER: • This medication can cause increased lithium levels to toxic levels - must
collaborate with PCP to determine whether to change ACE or change Lithium - Can't
use both
What medication INCREASES Lithium serum level up to double - ANSWER: Ibuprofen
Why is Lithium used? - ANSWER: • First-line neuro-protective for bipolar
• Lab Values concerning for patient on Lithium: - ANSWER: • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• + Pregnancy Test
• Lithium (Eskalith/Lithobid) Toxicity - ANSWER: • Normal Range of LITHIUM LEVEL -
0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
Common side effects of Lithium (Eskalith/Lithobid) - ANSWER: Nausea, fine-hand
tremors (start monitoring for toxicity), increased urination and thirst
What pregnancy category is Lithium (Eskalith/Lithobid) - ANSWER: CATEGORY D:
AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect
What increases risk of lithium (Eskalith/Lithobid) toxicity? - ANSWER: NSAID,
dehydration and Thiazides
What co-morbid risk in increased with Lithium (Eskalith/Lithobid)? - ANSWER: • Risk
of Hypothyroidism
What do symptoms of hypothyroidism (decreased T4 & increased TSH) mimic? -
ANSWER: Unipolar mood disorders:
- confusion
- decreased libido
- impotence
- decreased apetite
- memory loss
- lethargy
- constipation
, - headaches
- slow or clumsy movements
- syncope
- weight gain
- fluid retention
- muscle aches and stiffness
- slowed reflexes
- somatic discomfort including aching and joint stiffness
- slowed speech and thinking
- sensory disturbances including hearing
- cerebellar ataxia (may present with symptoms of an inability to coordinate balance,
gait, extremity and eye movements)
- loss of amplitude in ECG
What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic? -
ANSWER: Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias
What does ADPIE stand for? - ANSWER: • Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
Recommend CBT for - ANSWER: Depression & Anxiety (keep a daily log)
pg 209 and every PB pages for each dx - ANSWER: all thing for each disorder
What medication is best for an aggressive patient? - ANSWER: IM Geodon
Medications to improve anxiety... - ANSWER: act directly or indirectly on GABA
system
What are assessed in the Thought Content of the MSE - ANSWER: SI/HI, Plan,
Hallucinations
• PNEUMOIC - Old Age Parents Love Grandchildren - ANSWER: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +)
• FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3-6 years old
- ANSWER: • 3-year-old masturbates, play with self, says naughty things
• This is NORMAL for children this age.
What do you do when a patient has an increased prolactin level? - ANSWER: • Stop
prolactin (stop the agent that cause increase prolactin)
• ACUTE STRESS DISORDER - ANSWER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP
to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
What would you do if a 5-year-old tells you his brother sodomized him? - ANSWER: •
Tell mom don't leave him alone with patient and call CPS implement crisis
If a child is playing with doll in a sexual way, what do you do first? - ANSWER: • You
SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO
BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you
have to have something (assessment data) to report - Assess = FIRST
If a 13-year-old tells you he want to smoke, what would be an appropriate response?
- ANSWER: • Ask him of his plan to stop smoking
If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect? -
ANSWER: • Cranial nerve V-Trigeminal nerve (FIVE)
What cranial nerve is responsible for Bells Palsy? - ANSWER: 7 = Facial Paralysis
What cranial nerves do you assess for corneal sensation - ANSWER: Nerves 5 & 7
What cranial nerves do you assess for papillary reaction to light and
accommodation? - ANSWER: Nerves 3,4,& 6
What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular
movements? - ANSWER: Nerves 3, 4, & 6
,What cranial nerves do you assess for corneal light reflex? - ANSWER: 3, 4, & 6
Cranial Nerve 1 - ANSWER: Olfactory (smell)
Cranial Nerve 2 - ANSWER: Optic - vision
Cranial Nerve 3 - ANSWER: Oculomotor (eye movement): The occulomotor nerve is
responsible for motor enervation of upper eyelid muscle, extraocular muscle and
pupillary muscle.
Cranial Nerve 4 - ANSWER: Trochlear (eye movement): The trochlear nerve controls
an extraocular muscle.
Cranial Nerve 5 - ANSWER: Trigeminal: The trigeminal nerve is responsible for
sensory enervation of the face and motor enervation to muscles of mastication
(chewing).
Cranial Nerve 6 - ANSWER: Abducens (motor): The abducent nerve enervates a
muscle, which moves the eyeball.
Cranial Nerve 7 - ANSWER: Facial nerve: The facial nerve enervates the muscles of
the face (facial expression).
Cranial Nerve 8 - ANSWER: Vestibulocochlear (hearing and balance): The
vestibulocochlear nerve is responsible for the sense of hearing and balance (body
position sense).
Cranial Nerve 9 - ANSWER: Glossopharyngeal: The glossopharyngeal nerve enervates
muscles involved in swallowing and taste. Lesions of the ninth nerve result in
difficulty swallowing and disturbance of taste.
Cranial Nerve 10 - ANSWER: vagus nerve: The vagus nerve enervates the gut
(gastrointestinal tract), heart and larynx.
Cranial Nerve 11 - ANSWER: accessory: The accessory nerve enervates the
sternocleidomastoid muscles and the trapezius muscles.
Cranial Nerve 12 - ANSWER: Hypoglossal (tongue movement): The hypoglossal nerve
enervates the muscles of the tongue.
What is the best action for a 16 y/o with conduct disorder that refuses tx? -
ANSWER: • Send to psych specialist for acting out kids - Referrals - Have to see if you
are going to refer the same patient to the same provider - Cannot refer the patient
to another provider that is the same as you (ie psych) - you must refer to a
neurologist or another specialist or PCP
,What is a priority consideration for a 16-year-old that shows up with mother for first
therapy? - ANSWER: • Confidentiality (ex. mom sits in lobby)
What is important to know about ACE inhibitors (Meds for Heart failure/HTN) -
ANSWER: • This medication can cause increased lithium levels to toxic levels - must
collaborate with PCP to determine whether to change ACE or change Lithium - Can't
use both
What medication INCREASES Lithium serum level up to double - ANSWER: Ibuprofen
Why is Lithium used? - ANSWER: • First-line neuro-protective for bipolar
• Lab Values concerning for patient on Lithium: - ANSWER: • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• + Pregnancy Test
• Lithium (Eskalith/Lithobid) Toxicity - ANSWER: • Normal Range of LITHIUM LEVEL -
0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
Common side effects of Lithium (Eskalith/Lithobid) - ANSWER: Nausea, fine-hand
tremors (start monitoring for toxicity), increased urination and thirst
What pregnancy category is Lithium (Eskalith/Lithobid) - ANSWER: CATEGORY D:
AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect
What increases risk of lithium (Eskalith/Lithobid) toxicity? - ANSWER: NSAID,
dehydration and Thiazides
What co-morbid risk in increased with Lithium (Eskalith/Lithobid)? - ANSWER: • Risk
of Hypothyroidism
What do symptoms of hypothyroidism (decreased T4 & increased TSH) mimic? -
ANSWER: Unipolar mood disorders:
- confusion
- decreased libido
- impotence
- decreased apetite
- memory loss
- lethargy
- constipation
, - headaches
- slow or clumsy movements
- syncope
- weight gain
- fluid retention
- muscle aches and stiffness
- slowed reflexes
- somatic discomfort including aching and joint stiffness
- slowed speech and thinking
- sensory disturbances including hearing
- cerebellar ataxia (may present with symptoms of an inability to coordinate balance,
gait, extremity and eye movements)
- loss of amplitude in ECG
What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic? -
ANSWER: Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias
What does ADPIE stand for? - ANSWER: • Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
Recommend CBT for - ANSWER: Depression & Anxiety (keep a daily log)
pg 209 and every PB pages for each dx - ANSWER: all thing for each disorder
What medication is best for an aggressive patient? - ANSWER: IM Geodon
Medications to improve anxiety... - ANSWER: act directly or indirectly on GABA
system
