LMR GEORGETTE’S PMHNP CERTIFICATION EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE 249 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
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 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
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
EXAM COMPLETE 249 QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
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 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
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
