PMHNP Certification Exam: Questions With Complete
Solutions
Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression) Correct Answer - D. 68 y/o single white male with depression
*5 risk factors (age, male, white, depression)
Count the risk factors
COWS scale components Correct Answer - · Opioid W/D
Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid
intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation
(eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability,
Piloerection (gooseflesh skin), insomnia
What does COWS stand for? Correct Answer - Clinical Opiate Withdrawal
Scale
What does CIWA stand for? Correct Answer - Clinical Institute Withdrawal
Assessment
What does CIWA assess for? Correct Answer - --used to determine
likelihood of ETOH withdrawal or DTs
--usually occur within the first 24-72 hours after cessation
o used to determine when to administer medications for ETOH withdrawal
What does CIWA NOT test for? Correct Answer - Alcohol Use Disorder
What are the CIWA scale components? Correct Answer - · N/V, tremor,
paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory
disturbances, visual disturbances, H/A, orientation
Each component is scored from 0(none)-7(severe) except orientation wh/ is
(0 (AA0x4)-4 (disoriented)
,Score:
<10: Very mild Start PRN meds at score of 8
>10 to 15: Mild scheduled + PRN meds
>16 to 20: Moderate
>21: Severe Diazepam, Librium, Ativan
When interview teenagers (16 y/o) that arrive with their parents what should
you do? Correct Answer - interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is
confidential. Parents may be upset but remember you are advocating for the
child.
Which Ethnic group has the highest rate of suicide? Correct Answer -
Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which
of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor
antagonism
C. Increased Lipids
D. Metabolic Syndrome Correct Answer - D. Metabolic Syndrome
(UMBRELLA ANSWER)
Which antipsychotics have the least weight gain? Correct Answer - Latuda,
Abilify, (also least sedating), Geodon-if patient has metabolic syndrome
consider switching to one of the medications above. Or if the patient is overly
sedated try switching to ABILIFY
Which mood stabilizer have the least weight gain? Correct Answer -
Lamictal
-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the
answer is usually to start of a Correct Answer - atypical
A client presents with complains of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the
,neuroanatomical area of the brain that is responsible for the normal
regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus Correct Answer - Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage?
Correct Answer - Bring a support person like a husband
Thyroid-Stimulating hormone normal level Correct Answer - 0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis Correct
Answer - HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key
symptoms HEAT INTOLERANCE
Key symptoms of Heat Intolerance Correct Answer - Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis Correct
Answer - (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD
INTERANCE
Key symptoms of Cold Intolerance Correct Answer - Hypothyroidism
Hyperthyroid can mimic Correct Answer - Mania
Hypothyroid can mimic Correct Answer - Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine
Correct Answer - Hepatoxicity
-Check LFTs
Signs of Depakote toxicity Correct Answer - Disorientation, confusion,
lethargy
You suspect depakote toxicity what do you do? Correct Answer - Check
-LFT
-Ammonia
, -Depakote Level
What herbal supplement can cause hepatoxicity? Correct Answer - Kava
Kava
When taking Kava Kava in combinations with other medications you should
caution about Correct Answer - Risk of Hepatoxicity and Sedation
TCAs carry a risk of Correct Answer - Hepatotoxicity
Signs of Stevens-Johnson Syndrome Correct Answer - -fever, mouth pain,
swelling, burning eyes, blisters, skin pain
two psychotropics known to cause steven johnson syndrome Correct
Answer - lamictal and tegretol
What nationality is most suseptible of getting steven johnson? Correct
Answer - Asians
When treating asians with tegretol screen for? Correct Answer - HLAB-
1502 Allele
What two medications cause agranulocytosis? Correct Answer - Clozaril &
Tegretol
Agranulocytosis when to discontinue medication Correct Answer - Less
than 1000
When monitoring for agranulocytosis in patients look for s/s of what?
Correct Answer - Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age be sure to
check? Correct Answer - HCG
Which two medications may decrease the risk of suicide? Correct Answer -
clozaril and lithium
Medications that increase lithium level Correct Answer - NSAID-ibuprofen,
Solutions
Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression) Correct Answer - D. 68 y/o single white male with depression
*5 risk factors (age, male, white, depression)
Count the risk factors
COWS scale components Correct Answer - · Opioid W/D
Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid
intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation
(eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability,
Piloerection (gooseflesh skin), insomnia
What does COWS stand for? Correct Answer - Clinical Opiate Withdrawal
Scale
What does CIWA stand for? Correct Answer - Clinical Institute Withdrawal
Assessment
What does CIWA assess for? Correct Answer - --used to determine
likelihood of ETOH withdrawal or DTs
--usually occur within the first 24-72 hours after cessation
o used to determine when to administer medications for ETOH withdrawal
What does CIWA NOT test for? Correct Answer - Alcohol Use Disorder
What are the CIWA scale components? Correct Answer - · N/V, tremor,
paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory
disturbances, visual disturbances, H/A, orientation
Each component is scored from 0(none)-7(severe) except orientation wh/ is
(0 (AA0x4)-4 (disoriented)
,Score:
<10: Very mild Start PRN meds at score of 8
>10 to 15: Mild scheduled + PRN meds
>16 to 20: Moderate
>21: Severe Diazepam, Librium, Ativan
When interview teenagers (16 y/o) that arrive with their parents what should
you do? Correct Answer - interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is
confidential. Parents may be upset but remember you are advocating for the
child.
Which Ethnic group has the highest rate of suicide? Correct Answer -
Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which
of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor
antagonism
C. Increased Lipids
D. Metabolic Syndrome Correct Answer - D. Metabolic Syndrome
(UMBRELLA ANSWER)
Which antipsychotics have the least weight gain? Correct Answer - Latuda,
Abilify, (also least sedating), Geodon-if patient has metabolic syndrome
consider switching to one of the medications above. Or if the patient is overly
sedated try switching to ABILIFY
Which mood stabilizer have the least weight gain? Correct Answer -
Lamictal
-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the
answer is usually to start of a Correct Answer - atypical
A client presents with complains of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the
,neuroanatomical area of the brain that is responsible for the normal
regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus Correct Answer - Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage?
Correct Answer - Bring a support person like a husband
Thyroid-Stimulating hormone normal level Correct Answer - 0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis Correct
Answer - HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key
symptoms HEAT INTOLERANCE
Key symptoms of Heat Intolerance Correct Answer - Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis Correct
Answer - (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD
INTERANCE
Key symptoms of Cold Intolerance Correct Answer - Hypothyroidism
Hyperthyroid can mimic Correct Answer - Mania
Hypothyroid can mimic Correct Answer - Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine
Correct Answer - Hepatoxicity
-Check LFTs
Signs of Depakote toxicity Correct Answer - Disorientation, confusion,
lethargy
You suspect depakote toxicity what do you do? Correct Answer - Check
-LFT
-Ammonia
, -Depakote Level
What herbal supplement can cause hepatoxicity? Correct Answer - Kava
Kava
When taking Kava Kava in combinations with other medications you should
caution about Correct Answer - Risk of Hepatoxicity and Sedation
TCAs carry a risk of Correct Answer - Hepatotoxicity
Signs of Stevens-Johnson Syndrome Correct Answer - -fever, mouth pain,
swelling, burning eyes, blisters, skin pain
two psychotropics known to cause steven johnson syndrome Correct
Answer - lamictal and tegretol
What nationality is most suseptible of getting steven johnson? Correct
Answer - Asians
When treating asians with tegretol screen for? Correct Answer - HLAB-
1502 Allele
What two medications cause agranulocytosis? Correct Answer - Clozaril &
Tegretol
Agranulocytosis when to discontinue medication Correct Answer - Less
than 1000
When monitoring for agranulocytosis in patients look for s/s of what?
Correct Answer - Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age be sure to
check? Correct Answer - HCG
Which two medications may decrease the risk of suicide? Correct Answer -
clozaril and lithium
Medications that increase lithium level Correct Answer - NSAID-ibuprofen,
