LMR Georgette’s PMHNP Certification Exam Latest 2025 Questions And Correct Answers (Verified Answers)

LMR Georgette’s PMHNP Certification Exam Latest 2025 Questions And Correct Answers (Verified Answers) What do you do if a patient on lithium has dark brown urine? Check renal function What do you do if a patient presents with fever while on Clozaril? Check ANC level to assess for agranulocytosis What can cause serotonin syndrome? Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan What labs are indicative of NMS? Elevated WBC (over 11,000) and elevated CPK S/S of NMS 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? Check for rhabdo with CPK s/s of serotonin syndrome hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers What two medications to give with NMS? bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer What medication to give during SS? cyproheptadine (Periactin)- 5HT-2A receptor antagonist What is the onset and typical length of NMS? Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14 days What is the onset of SS? Within 24 hours of starting/changing medication and resolves within a few days How do you distinguish between NMS and acute dystonia? NMS has a slower onset while acute dystonia occurs within hours What happens with lithium and NSAIDs? Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.) What happens with lithium and ACE inhibitors? Increased risk of lithium toxicity related to the increased urination from the ACE inhibitors Why should a patient on lithium avoid calcium channel blockers? Risk of fatal nephrotoxicity What is a fetal side effect of lithium? Epstein's anomaly What lab should you check for athletes on lithium? Specific gravity to assess for dehydration (dehydration is 1.015) What do you do if the lithium level is 1.3? Do not give the next dose and assess for s/s At what level is lithium toxicity a medical emergency? 3 S/S of lithium toxicity vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle weakness/twitching Why check an EKG with lithium? Inverted T-waves What medication should treat hypothyroidism caused by lithium use? Synthroid What do you do if patient is prescribed both depakote and lamictal? Decreased lamictal dose by 50% Depakote and pregnancy Spina bifida What emergency may be occuring if patient on depakote reports upper abdominal pain? Pancreatitis What lab should you check if patient has right upper quadrant pain and dark brown urine? LFTs What lab means pregnancy? HCG Why is Clozaril used? Treatment resistant schizophrenia, improves SI, and improves negative symptoms of schizophrenia What two medications have the highest risk of agranulocytosis and aplastic anemia? Clozaril and Tegretol What symptoms may mean a Clozaril induced infection? Sore throats, sores in mouth/gums, fever When should you discontinue Clozaril or Tegretol? WBC 2000 or ANC 1000 What should you check in Asian patients taking Tegretol? For the HLA-B*1502 allele (higher risk of SJS) What two epidermal issues can arise from Tegretol or Lamictal? Toxic epidermal necrosis and SJS What may be the issue if a patient on Lamictal presents with a fever and severe headache? Aspetic meningitis What three antipsychotics have very low weight gaining effects? Geodon, Abilify, and Latuda Mini-Cog 3 word recall and clock drawing MMSE scoring 24-30 severe impairment 18-23 mild impairment 17 and less no impairment What happens during pruning? Brain eliminates extra synapses during infancy autism and pruning Excess synapses caused by under-pruning (patient oversensitive to light/sounds and seizures) schizophrenia and pruning Fewer synapses caused by over-pruning grey matter vs white matter Grey matter- synapses, working area of brain, dendrites White matter- myelinated axons axons and dendrites axon away from cell and dendrites to neuron's cell body CNS is made up of brain and spinal cord PNS consists of cranial nerves and spinal nerves- responsible for voluntary movement somatic nervous system the division of the peripheral nervous system that controls the body's skeletal muscles autonomic nervous system the part of the peripheral nervous system that controls the glands and the muscles of the internal organs parasympathetic nervous system the division of the autonomic nervous system that calms the body, conserving its energy sympathetic nervous system