PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
1
PMHNP CERTIFICATION FINAL EXAM
STUDY GUIDE. GRADED A+. WITH
QUESTIONS AND 100% VERIFIED
ANSWERS. LATEST UPDATE
1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression): D. 68 y/o single white male with depression *5 risk factors (age, male,
white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents what
should you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confiden-
tial. Parents may be upset but remember you are advocating for the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with olanzapine.
Which of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an-
tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least
sedating), Geodon-if patient has metabolic syndrome consider switching to one of
the medications above. Or if the patient is overly sedated try switching to ABILIFY
6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
,PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
7. When presented with a question about typical vs atypical antipsychotic
the answer is usually to start of a: atypical
2
8. A client presents with complains of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the neu-
roanatomical area of the brain that is responsible for the normal regulation
of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
3
9. When a patient is hesitant to participate in treatment you should encour-
age?: Bring a support person like a husband
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. When T4 and T3 are high and TSH is low what is the diagnosis: HY-
PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT
INTOLERANCE
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY-
POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has reddish/brown
urine: Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
,PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
21. When taking Kava Kava in combinations with other medications you
should caution about: Risk of Hepatoxicity and Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning
eyes, blisters, skin pain
24. two psychotropics known to cause steven johnson syndrome: lamictal
and tegretol
25. What nationality is most suseptible of getting steven johnson?: Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
28. Agranulocytosis when to discontinue medication: Less than 1000
4
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing age be
sure to check?: HCG
31. Which two medications may decrease the risk of suicide?: clozaril and
lithium
32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but HOW?: by
reducing renal clearance
35. When educating a patient about lithium teach them about: Hyponatremia
Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
37. Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium level
38. Lithium level of 1.4: Monitor for toxicity
39. Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check
for presence of protein in the urine (4+ protein is concerning for renal impair-
ment)à4+ protein in urine=MONITOR FOR TOXICITY
40. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for
,PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
41. Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t-wave
inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)
-Some of these are also signs of toxicity
42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation, tremor
43. NMS: muscle rigidity, mutism (because of muscle rigidity), increased CPK
(caused by muscle contraction and muscle destruction), increase WBC, increased
WBC, myoglobinuria (also from muscle destruction)
44. Cherry colored urine in a patient that exercises a lot: test for myoglobinuria
may be a sign of rhabdo
5
45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in-
hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta-
bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
46. Treatment for NMS: Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs muscle
relaxer
47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI,
TCA, MOAI)
-Cyproheptadine
48. Triptans: Used for MIGRAINES
-These meds increase serotonin
example SUMATRIPTAN
49. patient taking Prozac and started on sumatriptan: -call PCP to ask them
to switch the migraine med if patient already on SUMATRIPTAN do not start
antidepressant without talking to PCP
50. How long do you wait when switching between an SSRI to an MAOI?: 2
weeks
51. How long do you wait when switching between Prozac and MAOI?: 5-6
weeks wash out period
52. What is the first line treatment for depression and why?: SSRI-First line
1
PMHNP CERTIFICATION FINAL EXAM
STUDY GUIDE. GRADED A+. WITH
QUESTIONS AND 100% VERIFIED
ANSWERS. LATEST UPDATE
1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression): D. 68 y/o single white male with depression *5 risk factors (age, male,
white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents what
should you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confiden-
tial. Parents may be upset but remember you are advocating for the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with olanzapine.
Which of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an-
tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least
sedating), Geodon-if patient has metabolic syndrome consider switching to one of
the medications above. Or if the patient is overly sedated try switching to ABILIFY
6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
,PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
7. When presented with a question about typical vs atypical antipsychotic
the answer is usually to start of a: atypical
2
8. A client presents with complains of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the neu-
roanatomical area of the brain that is responsible for the normal regulation
of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
3
9. When a patient is hesitant to participate in treatment you should encour-
age?: Bring a support person like a husband
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. When T4 and T3 are high and TSH is low what is the diagnosis: HY-
PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT
INTOLERANCE
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY-
POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has reddish/brown
urine: Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
,PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
21. When taking Kava Kava in combinations with other medications you
should caution about: Risk of Hepatoxicity and Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning
eyes, blisters, skin pain
24. two psychotropics known to cause steven johnson syndrome: lamictal
and tegretol
25. What nationality is most suseptible of getting steven johnson?: Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
28. Agranulocytosis when to discontinue medication: Less than 1000
4
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing age be
sure to check?: HCG
31. Which two medications may decrease the risk of suicide?: clozaril and
lithium
32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but HOW?: by
reducing renal clearance
35. When educating a patient about lithium teach them about: Hyponatremia
Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
37. Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium level
38. Lithium level of 1.4: Monitor for toxicity
39. Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check
for presence of protein in the urine (4+ protein is concerning for renal impair-
ment)à4+ protein in urine=MONITOR FOR TOXICITY
40. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for
,PMHNP CERTIFICATION FINAL EXAM STUDY GUIDE
renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
41. Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t-wave
inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)
-Some of these are also signs of toxicity
42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation, tremor
43. NMS: muscle rigidity, mutism (because of muscle rigidity), increased CPK
(caused by muscle contraction and muscle destruction), increase WBC, increased
WBC, myoglobinuria (also from muscle destruction)
44. Cherry colored urine in a patient that exercises a lot: test for myoglobinuria
may be a sign of rhabdo
5
45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in-
hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta-
bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
46. Treatment for NMS: Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs muscle
relaxer
47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI,
TCA, MOAI)
-Cyproheptadine
48. Triptans: Used for MIGRAINES
-These meds increase serotonin
example SUMATRIPTAN
49. patient taking Prozac and started on sumatriptan: -call PCP to ask them
to switch the migraine med if patient already on SUMATRIPTAN do not start
antidepressant without talking to PCP
50. How long do you wait when switching between an SSRI to an MAOI?: 2
weeks
51. How long do you wait when switching between Prozac and MAOI?: 5-6
weeks wash out period
52. What is the first line treatment for depression and why?: SSRI-First line
