PMHNP Certification Exam:PMHNP:PMHNP Certification Exam Study
Guide:PMHNP Exam: LMR Georgette’s PMHNP Certification
Exam:Georgettes LMR
What does ADPIE stand for? - 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? -
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%
Depakote and pregnancy - ANSWER:Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
ANSWER:Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
ANSWER:LFTs
What lab means pregnancy? - ANSWER:HCG
Why is Clozaril used? - ANSWER:Treatment resistant schizophrenia, improves SI, and improves negative
symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? - ANSWER:Clozaril
and Tegretol
What symptoms may mean a Clozaril induced infection? - ANSWER:Sore throats, sores in mouth/gums,
fever
When should you discontinue Clozaril or Tegretol? - ANSWER:WBC < 2000 or ANC <1000
What should you check in Asian patients taking Tegretol? - ANSWER:For the HLA-B*1502 allele (higher
risk of SJS)
Guide:PMHNP Exam: LMR Georgette’s PMHNP Certification
Exam:Georgettes LMR
What does ADPIE stand for? - 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? -
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%
Depakote and pregnancy - ANSWER:Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
ANSWER:Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
ANSWER:LFTs
What lab means pregnancy? - ANSWER:HCG
Why is Clozaril used? - ANSWER:Treatment resistant schizophrenia, improves SI, and improves negative
symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? - ANSWER:Clozaril
and Tegretol
What symptoms may mean a Clozaril induced infection? - ANSWER:Sore throats, sores in mouth/gums,
fever
When should you discontinue Clozaril or Tegretol? - ANSWER:WBC < 2000 or ANC <1000
What should you check in Asian patients taking Tegretol? - ANSWER:For the HLA-B*1502 allele (higher
risk of SJS)
