LMR Georgette’s PMHNP
Certification Exam V2 Questions
and Answers 100% Correct Graded
A
1. What does ADPIE stand for? -
ANSWER: Assessment
Diagnosis
Planning
Implementation
Evaluation
2. 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
3. What do you do if a patient comes in with fungus on their toenail? -
ANSWER Scrape nail and send for testing
4. What do you do if a patient on lithium has dark brown urine? - ANSWER
Check renal function
5. What do you do if a patient presents with fever while on Clozaril? -
ANSWER Check ANC level to assess for agranulocytosis
,6. What can cause serotonin syndrome? - ANSWER Antidepressants, St.
John's Wort, Same-E, Kava Kava, and Tryptophan
7. What labs are indicative of NMS? - ANSWER Elevated WBC (over
11,000) and elevated CPK
8. S/S of NMS - ANSWER muscle rigidity, hyperthermia, tachycardia,
abnormal bp, sweating, altered mental status, cherry colored urine
9. What should you do if a patient presents with cherry colored urine? -
ANSWER Check for rhabdo with CPK
10.s/s of serotonin syndrome - ANSWER hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and
shivers
11.What two medications to give with NMS? - ANSWER bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
12.What medication to give during SS? - ANSWER cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
13.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
14.What is the onset of SS? - ANSWER Within 24 hours of starting/changing
medication and resolves within a few days
,15.How do you distinguish between NMS and acute dystonia? - ANSWER
NMS has a slower onset while acute dystonia occurs within hours
16.What happens with lithium and NSAIDs? - ANSWER Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
17.What happens with lithium and ACE inhibitors? - ANSWER Increased risk
of lithium toxicity related to the increased urination from the ACE inhibitors
18.Why should a patient on lithium avoid calcium channel blockers? -
ANSWER Risk of fatal nephrotoxicity
19.What is a fetal side effect of lithium? - ANSWER Epstein's anomaly
20.What lab should you check for athletes on lithium? - ANSWER Specific
gravity to assess for dehydration (dehydration is >1.015)
21.What do you do if the lithium level is 1.3? - ANSWER Do not give the next
dose and assess for s/s
22.At what level is lithium toxicity a medical emergency? - ANSWER >3
23.S/S of lithium toxicity - ANSWER vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
24.Why check an EKG with lithium? - ANSWER Inverted T-waves
, 25.What medication should treat hypothyroidism caused by lithium use? -
ANSWER Synthroid
26.What do you do if patient is prescribed both depakote and lamictal? -
ANSWER Decreased lamictal dose by 50%
27.Depakote and pregnancy - ANSWER Spina bifida
28.What emergency may be occuring if patient on depakote reports upper
abdominal pain? - ANSWER Pancreatitis
29.What lab should you check if patient has right upper quadrant pain and dark
brown urine? - ANSWER LFTs
30.What lab means pregnancy? - ANSWER HCG
31.Why is Clozaril used? - ANSWER Treatment resistant schizophrenia,
improves SI, and improves negative symptoms of schizophrenia
32.What two medications have the highest risk of agranulocytosis and aplastic
anemia? - ANSWER Clozaril and Tegretol
33.What symptoms may mean a Clozaril induced infection? - ANSWER Sore
throats, sores in mouth/gums, fever
34.When should you discontinue Clozaril or Tegretol? - ANSWER WBC <
2000 or ANC <1000
Certification Exam V2 Questions
and Answers 100% Correct Graded
A
1. What does ADPIE stand for? -
ANSWER: Assessment
Diagnosis
Planning
Implementation
Evaluation
2. 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
3. What do you do if a patient comes in with fungus on their toenail? -
ANSWER Scrape nail and send for testing
4. What do you do if a patient on lithium has dark brown urine? - ANSWER
Check renal function
5. What do you do if a patient presents with fever while on Clozaril? -
ANSWER Check ANC level to assess for agranulocytosis
,6. What can cause serotonin syndrome? - ANSWER Antidepressants, St.
John's Wort, Same-E, Kava Kava, and Tryptophan
7. What labs are indicative of NMS? - ANSWER Elevated WBC (over
11,000) and elevated CPK
8. S/S of NMS - ANSWER muscle rigidity, hyperthermia, tachycardia,
abnormal bp, sweating, altered mental status, cherry colored urine
9. What should you do if a patient presents with cherry colored urine? -
ANSWER Check for rhabdo with CPK
10.s/s of serotonin syndrome - ANSWER hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and
shivers
11.What two medications to give with NMS? - ANSWER bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
12.What medication to give during SS? - ANSWER cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
13.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
14.What is the onset of SS? - ANSWER Within 24 hours of starting/changing
medication and resolves within a few days
,15.How do you distinguish between NMS and acute dystonia? - ANSWER
NMS has a slower onset while acute dystonia occurs within hours
16.What happens with lithium and NSAIDs? - ANSWER Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
17.What happens with lithium and ACE inhibitors? - ANSWER Increased risk
of lithium toxicity related to the increased urination from the ACE inhibitors
18.Why should a patient on lithium avoid calcium channel blockers? -
ANSWER Risk of fatal nephrotoxicity
19.What is a fetal side effect of lithium? - ANSWER Epstein's anomaly
20.What lab should you check for athletes on lithium? - ANSWER Specific
gravity to assess for dehydration (dehydration is >1.015)
21.What do you do if the lithium level is 1.3? - ANSWER Do not give the next
dose and assess for s/s
22.At what level is lithium toxicity a medical emergency? - ANSWER >3
23.S/S of lithium toxicity - ANSWER vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
24.Why check an EKG with lithium? - ANSWER Inverted T-waves
, 25.What medication should treat hypothyroidism caused by lithium use? -
ANSWER Synthroid
26.What do you do if patient is prescribed both depakote and lamictal? -
ANSWER Decreased lamictal dose by 50%
27.Depakote and pregnancy - ANSWER Spina bifida
28.What emergency may be occuring if patient on depakote reports upper
abdominal pain? - ANSWER Pancreatitis
29.What lab should you check if patient has right upper quadrant pain and dark
brown urine? - ANSWER LFTs
30.What lab means pregnancy? - ANSWER HCG
31.Why is Clozaril used? - ANSWER Treatment resistant schizophrenia,
improves SI, and improves negative symptoms of schizophrenia
32.What two medications have the highest risk of agranulocytosis and aplastic
anemia? - ANSWER Clozaril and Tegretol
33.What symptoms may mean a Clozaril induced infection? - ANSWER Sore
throats, sores in mouth/gums, fever
34.When should you discontinue Clozaril or Tegretol? - ANSWER WBC <
2000 or ANC <1000
