LMR Georgette’s PMHNP Certification Exam Latest 2023-2024 Questions A
Correct Answers(Verified Answers)
Study online at https://quizlet.com/_hyvo7o
1. What do you do if a patient on lithium has dark brown urine?: Check renal function
2. What do you do if a patient presents with fever while on Clozaril?: Check ANC leve
to assess for agranulocytosis
3. What can cause serotonin syndrome?: Antidepressants, St. John's Wort, Same-E, Kava Kava, and
Tryptophan
4. What labs are indicative of NMS?: Elevated WBC (over 11,000) and elevated CPK
5. S/S of NMS: muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental status, cherry
colored urine
6. What should you do if a patient presents with cherry colored urine?: Check for
rhabdo with CPK
7. s/s of serotonin syndrome: hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
8. What two medications to give with NMS?: bromocriptine (Parlodel)- D2 agonist dantrolene-
muscle relaxer
9. What medication to give during SS?: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
10. 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
11. What is the onset of SS?: Within 24 hours of starting/changing medication and resolves within a few
days
12. How do you distinguish between NMS and acute dystonia?: NMS has a slower onset
while acute dystonia occurs within hours
13. What happens with lithium and NSAIDs?: Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
14. What happens with lithium and ACE inhibitors?: Increased risk of lithium toxicity related to
the increased urination from the ACE inhibitors
15. Why should a patient on lithium avoid calcium channel blockers?: Risk of fatal
nephrotoxicity
16. What is a fetal side effect of lithium?: Epstein's anomaly
17. What lab should you check for athletes on lithium?: Specific gravity to assess for
dehydration (dehydration is >1.015)
18. What do you do if the lithium level is 1.3?: Do not give the next dose and assess for s/s
, LMR Georgette’s PMHNP Certification Exam Latest 2023-2024 Questions A
Correct Answers(Verified Answers)
Study online at https://quizlet.com/_hyvo7o
19. At what level is lithium toxicity a medical emergency?: >3
20. S/S of lithium toxicity: vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
21. Why check an EKG with lithium?: Inverted T-waves
22. What medication should treat hypothyroidism caused by lithium use?: Synthroid
23. What do you do if patient is prescribed both depakote and lamictal?: Decreased
lamictal dose by 50%
24. Depakote and pregnancy: Spina bifida
25. What emergency may be occuring if patient on depakote reports upper
abdominal pain?: Pancreatitis
26. What lab should you check if patient has right upper quadrant pain and dark
brown urine?: LFTs
27. What lab means pregnancy?: HCG
28. Why is Clozaril used?: Treatment resistant schizophrenia, improves SI, and improves negative symptoms
of schizophrenia
29. What two medications have the highest risk of agranulocytosis and aplastic
anemia?: Clozaril and Tegretol
30. What symptoms may mean a Clozaril induced infection?: Sore throats, sores in
mouth/gums, fever
31. When should you discontinue Clozaril or Tegretol?: WBC < 2000 or ANC <1000
32. What should you check in Asian patients taking Tegretol?: For the HLA-B*1502 allele
(higher risk of SJS)
33. What two epidermal issues can arise from Tegretol or Lamictal?: Toxic epidermal
necrosis and SJS
34. What may be the issue if a patient on Lamictal presents with a fever and
severe headache?: Aspetic meningitis
35. What three antipsychotics have very low weight gaining effects?: Geodon, Abilify,
and Latuda
36. Mini-Cog: 3 word recall and
clock drawing
Correct Answers(Verified Answers)
Study online at https://quizlet.com/_hyvo7o
1. What do you do if a patient on lithium has dark brown urine?: Check renal function
2. What do you do if a patient presents with fever while on Clozaril?: Check ANC leve
to assess for agranulocytosis
3. What can cause serotonin syndrome?: Antidepressants, St. John's Wort, Same-E, Kava Kava, and
Tryptophan
4. What labs are indicative of NMS?: Elevated WBC (over 11,000) and elevated CPK
5. S/S of NMS: muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental status, cherry
colored urine
6. What should you do if a patient presents with cherry colored urine?: Check for
rhabdo with CPK
7. s/s of serotonin syndrome: hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
8. What two medications to give with NMS?: bromocriptine (Parlodel)- D2 agonist dantrolene-
muscle relaxer
9. What medication to give during SS?: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
10. 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
11. What is the onset of SS?: Within 24 hours of starting/changing medication and resolves within a few
days
12. How do you distinguish between NMS and acute dystonia?: NMS has a slower onset
while acute dystonia occurs within hours
13. What happens with lithium and NSAIDs?: Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
14. What happens with lithium and ACE inhibitors?: Increased risk of lithium toxicity related to
the increased urination from the ACE inhibitors
15. Why should a patient on lithium avoid calcium channel blockers?: Risk of fatal
nephrotoxicity
16. What is a fetal side effect of lithium?: Epstein's anomaly
17. What lab should you check for athletes on lithium?: Specific gravity to assess for
dehydration (dehydration is >1.015)
18. What do you do if the lithium level is 1.3?: Do not give the next dose and assess for s/s
, LMR Georgette’s PMHNP Certification Exam Latest 2023-2024 Questions A
Correct Answers(Verified Answers)
Study online at https://quizlet.com/_hyvo7o
19. At what level is lithium toxicity a medical emergency?: >3
20. S/S of lithium toxicity: vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
21. Why check an EKG with lithium?: Inverted T-waves
22. What medication should treat hypothyroidism caused by lithium use?: Synthroid
23. What do you do if patient is prescribed both depakote and lamictal?: Decreased
lamictal dose by 50%
24. Depakote and pregnancy: Spina bifida
25. What emergency may be occuring if patient on depakote reports upper
abdominal pain?: Pancreatitis
26. What lab should you check if patient has right upper quadrant pain and dark
brown urine?: LFTs
27. What lab means pregnancy?: HCG
28. Why is Clozaril used?: Treatment resistant schizophrenia, improves SI, and improves negative symptoms
of schizophrenia
29. What two medications have the highest risk of agranulocytosis and aplastic
anemia?: Clozaril and Tegretol
30. What symptoms may mean a Clozaril induced infection?: Sore throats, sores in
mouth/gums, fever
31. When should you discontinue Clozaril or Tegretol?: WBC < 2000 or ANC <1000
32. What should you check in Asian patients taking Tegretol?: For the HLA-B*1502 allele
(higher risk of SJS)
33. What two epidermal issues can arise from Tegretol or Lamictal?: Toxic epidermal
necrosis and SJS
34. What may be the issue if a patient on Lamictal presents with a fever and
severe headache?: Aspetic meningitis
35. What three antipsychotics have very low weight gaining effects?: Geodon, Abilify,
and Latuda
36. Mini-Cog: 3 word recall and
clock drawing
