LMR Georgette’s PMHNP Certification Exam | Questions
with 100% Verified Answers | Latest Update 2026/2027
Question: What does ADPIE stand for?
Answer: Assessment
Diagnosis
Planning
Implementation
Evaluation
Question: What should you do when a mother reports her child woke up screaming in the
middle of the night?
Answer: Ask her if it's happened before to assess for sleep issue patterns
Question: What do you do if a patient comes in with fungus on their toenail?
Answer: Scrape nail and send for testing
Question: What do you do if a patient on lithium has dark brown urine?
Answer: Check renal function
Question: What do you do if a patient presents with fever while on Clozaril?
Answer: Check ANC level to assess for agranulocytosis
Question: What can cause serotonin syndrome?
Answer: Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
Question: What labs are indicative of NMS?
Answer: Elevated WBC (over 11,000) and elevated CPK
Question: S/S of NMS
Answer: muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental
status,
cherry colored urine
Question: What should you do if a patient presents with cherry colored urine?
Answer: Check for rhabdo with CPK
Question: s/s of serotonin syndrome
Answer: hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia,
HTN, shits and shivers
,Question: What two medications to give with NMS?
Answer: bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
Question: What medication to give during SS?
Answer: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
Question: What is the onset and typical length of NMS?
Answer: Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
days
Question: What is the onset of SS?
Answer: Within 24 hours of starting/changing medication and resolves within a few days
Question: How do you distinguish between NMS and acute dystonia?
Answer: NMS has a slower onset while acute dystonia occurs within hours
Question: What happens with lithium and NSAIDs?
Answer: Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
Question: What happens with lithium and ACE inhibitors?
Answer: Increased risk of lithium toxicity related to the increased urination from the ACE
inhibitors
Question: Why should a patient on lithium avoid calcium channel blockers?
Answer: Risk of fatal nephrotoxicity
Question: What is a fetal side effect of lithium?
Answer: Epstein's anomaly
Question: What lab should you check for athletes on lithium?
Answer: Specific gravity to assess for dehydration (dehydration is >1.015)
Question: What do you do if the lithium level is 1.3?
Answer: Do not give the next dose and assess for s/s
Question: At what level is lithium toxicity a medical emergency?
Answer: >3
, Question: S/S of lithium toxicity
Answer: vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Question: Why check an EKG with lithium?
Answer: Inverted T-waves
Question: What medication should treat hypothyroidism caused by lithium use?
Answer: Synthroid
Question: What do you do if patient is prescribed both depakote and lamictal?
Answer: Decreased lamictal dose by 50%
Question: Depakote and pregnancy
Answer: Spina bifida
Question: What emergency may be occuring if patient on depakote reports upper abdominal
pain?
Answer: Pancreatitis
Question: What lab should you check if patient has right upper quadrant pain and dark brown
urine?
Answer: LFTs
Question: What lab means pregnancy?
Answer: HCG
Question: Why is Clozaril used?
Answer: Treatment resistant schizophrenia, improves SI, and improves negative symptoms of
schizophrenia
Question: What two medications have the highest risk of agranulocytosis and aplastic
anemia?
Answer: Clozaril and Tegretol
Question: What symptoms may mean a Clozaril induced infection?
Answer: Sore throats, sores in mouth/gums, fever
Question: When should you discontinue Clozaril or Tegretol?
Answer: WBC < 2000 or ANC <1000
with 100% Verified Answers | Latest Update 2026/2027
Question: What does ADPIE stand for?
Answer: Assessment
Diagnosis
Planning
Implementation
Evaluation
Question: What should you do when a mother reports her child woke up screaming in the
middle of the night?
Answer: Ask her if it's happened before to assess for sleep issue patterns
Question: What do you do if a patient comes in with fungus on their toenail?
Answer: Scrape nail and send for testing
Question: What do you do if a patient on lithium has dark brown urine?
Answer: Check renal function
Question: What do you do if a patient presents with fever while on Clozaril?
Answer: Check ANC level to assess for agranulocytosis
Question: What can cause serotonin syndrome?
Answer: Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
Question: What labs are indicative of NMS?
Answer: Elevated WBC (over 11,000) and elevated CPK
Question: S/S of NMS
Answer: muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental
status,
cherry colored urine
Question: What should you do if a patient presents with cherry colored urine?
Answer: Check for rhabdo with CPK
Question: s/s of serotonin syndrome
Answer: hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia,
HTN, shits and shivers
,Question: What two medications to give with NMS?
Answer: bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
Question: What medication to give during SS?
Answer: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
Question: What is the onset and typical length of NMS?
Answer: Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
days
Question: What is the onset of SS?
Answer: Within 24 hours of starting/changing medication and resolves within a few days
Question: How do you distinguish between NMS and acute dystonia?
Answer: NMS has a slower onset while acute dystonia occurs within hours
Question: What happens with lithium and NSAIDs?
Answer: Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
Question: What happens with lithium and ACE inhibitors?
Answer: Increased risk of lithium toxicity related to the increased urination from the ACE
inhibitors
Question: Why should a patient on lithium avoid calcium channel blockers?
Answer: Risk of fatal nephrotoxicity
Question: What is a fetal side effect of lithium?
Answer: Epstein's anomaly
Question: What lab should you check for athletes on lithium?
Answer: Specific gravity to assess for dehydration (dehydration is >1.015)
Question: What do you do if the lithium level is 1.3?
Answer: Do not give the next dose and assess for s/s
Question: At what level is lithium toxicity a medical emergency?
Answer: >3
, Question: S/S of lithium toxicity
Answer: vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Question: Why check an EKG with lithium?
Answer: Inverted T-waves
Question: What medication should treat hypothyroidism caused by lithium use?
Answer: Synthroid
Question: What do you do if patient is prescribed both depakote and lamictal?
Answer: Decreased lamictal dose by 50%
Question: Depakote and pregnancy
Answer: Spina bifida
Question: What emergency may be occuring if patient on depakote reports upper abdominal
pain?
Answer: Pancreatitis
Question: What lab should you check if patient has right upper quadrant pain and dark brown
urine?
Answer: LFTs
Question: What lab means pregnancy?
Answer: HCG
Question: Why is Clozaril used?
Answer: Treatment resistant schizophrenia, improves SI, and improves negative symptoms of
schizophrenia
Question: What two medications have the highest risk of agranulocytosis and aplastic
anemia?
Answer: Clozaril and Tegretol
Question: What symptoms may mean a Clozaril induced infection?
Answer: Sore throats, sores in mouth/gums, fever
Question: When should you discontinue Clozaril or Tegretol?
Answer: WBC < 2000 or ANC <1000
