LMR Georgette’s PMHNP Certification QUESTIONS AND CORRECT VERIFIED ANSWERS
LATEST 2025
What do you do if a patient on lithium has dark brown urine? -CORRECT ANSWER-Check
renal function
What do you do if a patient presents with fever while on Clozaril? -CORRECT ANSWER-Check
ANC level to assess for agranulocytosis
What can cause serotonin syndrome? -CORRECT ANSWER-Antidepressants, St. John's Wort,
Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? -CORRECT ANSWER-Elevated WBC (over 11,000) and
elevated CPK
S/S of NMS -CORRECT 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? -CORRECT ANSWER-
Check for rhabdo with CPK
s/s of serotonin syndrome -CORRECT ANSWER-hyperreflexia, muscle spasms, myoclonus
(involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? -CORRECT ANSWER-bromocriptine (Parlodel)- D2
agonist dantrolene- muscle relaxer
,What medication to give during SS? -CORRECT ANSWER-cyproheptadine (Periactin)- 5HT-2A
receptor antagonist
What is the onset and typical length of NMS? -CORRECT ANSWER-Slow onset (1-2 weeks
after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? -CORRECT ANSWER-Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? -CORRECT ANSWER-NMS has a
slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? -CORRECT ANSWER-Increased risk of lithium
toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? -CORRECT 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? -CORRECT ANSWER-Risk of
fatal nephrotoxicity
What is a fetal side effect of lithium? -CORRECT ANSWER-Epstein's anomaly
What lab should you check for athletes on lithium? -CORRECT ANSWER-Specific gravity to
assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? -CORRECT ANSWER-Do not give the next dose and
assess for s/s
At what level is lithium toxicity a medical emergency? -CORRECT ANSWER->3
, S/S of lithium toxicity -CORRECT ANSWER-vomiting, diarrhea, slurred speech, hand tremor,
dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? -CORRECT ANSWER-Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? -CORRECT ANSWER-
Synthroid
What do you do if patient is prescribed both depakote and lamictal? -CORRECT ANSWER-
Decreased lamictal dose by 50%
Depakote and pregnancy -CORRECT ANSWER-Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
CORRECT ANSWER-Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
CORRECT ANSWER-LFTs
What lab means pregnancy? -CORRECT ANSWER-HCG
Why is Clozaril used? -CORRECT ANSWER-Treatment resistant schizophrenia, improves SI,
and improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? -
CORRECT ANSWER-Clozaril and Tegretol
What symptoms may mean a Clozaril induced infection? -CORRECT ANSWER-Sore throats,
sores in mouth/gums, fever
LATEST 2025
What do you do if a patient on lithium has dark brown urine? -CORRECT ANSWER-Check
renal function
What do you do if a patient presents with fever while on Clozaril? -CORRECT ANSWER-Check
ANC level to assess for agranulocytosis
What can cause serotonin syndrome? -CORRECT ANSWER-Antidepressants, St. John's Wort,
Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? -CORRECT ANSWER-Elevated WBC (over 11,000) and
elevated CPK
S/S of NMS -CORRECT 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? -CORRECT ANSWER-
Check for rhabdo with CPK
s/s of serotonin syndrome -CORRECT ANSWER-hyperreflexia, muscle spasms, myoclonus
(involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? -CORRECT ANSWER-bromocriptine (Parlodel)- D2
agonist dantrolene- muscle relaxer
,What medication to give during SS? -CORRECT ANSWER-cyproheptadine (Periactin)- 5HT-2A
receptor antagonist
What is the onset and typical length of NMS? -CORRECT ANSWER-Slow onset (1-2 weeks
after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? -CORRECT ANSWER-Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? -CORRECT ANSWER-NMS has a
slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? -CORRECT ANSWER-Increased risk of lithium
toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? -CORRECT 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? -CORRECT ANSWER-Risk of
fatal nephrotoxicity
What is a fetal side effect of lithium? -CORRECT ANSWER-Epstein's anomaly
What lab should you check for athletes on lithium? -CORRECT ANSWER-Specific gravity to
assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? -CORRECT ANSWER-Do not give the next dose and
assess for s/s
At what level is lithium toxicity a medical emergency? -CORRECT ANSWER->3
, S/S of lithium toxicity -CORRECT ANSWER-vomiting, diarrhea, slurred speech, hand tremor,
dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? -CORRECT ANSWER-Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? -CORRECT ANSWER-
Synthroid
What do you do if patient is prescribed both depakote and lamictal? -CORRECT ANSWER-
Decreased lamictal dose by 50%
Depakote and pregnancy -CORRECT ANSWER-Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
CORRECT ANSWER-Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
CORRECT ANSWER-LFTs
What lab means pregnancy? -CORRECT ANSWER-HCG
Why is Clozaril used? -CORRECT ANSWER-Treatment resistant schizophrenia, improves SI,
and improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? -
CORRECT ANSWER-Clozaril and Tegretol
What symptoms may mean a Clozaril induced infection? -CORRECT ANSWER-Sore throats,
sores in mouth/gums, fever
