LMR GEORGETTE’S PMHNP CERTIFICATION Exam
NEWEST 2025 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+||BRAND NEW VERSION!!
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
What does ADPIE stand for? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER- Scrape
nail and send for testing
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
NEWEST 2025 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY
GRADED A+||BRAND NEW VERSION!!
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
What does ADPIE stand for? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER- Scrape
nail and send for testing
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
