LMR GEORGETTE’S PMHNP CERTIFICATION EXAM
(LATEST 2026/2027) QUESTIONS AND 100% CORRECT
ANSWERS (GRADED A+)
What does ADPIE stand for?
- 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?
- 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?
- ANSWER: Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
- ANSWER: Check renal function
What do you do if a patient presents with fever while on Clozaril?
- ANSWER: Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
- ANSWER: Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
- ANSWER: Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
- 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?
- ANSWER: Check for rhabdo with CPK
,s/s of serotonin syndrome
- ANSWER: hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
What two medications to give with NMS?
- ANSWER: bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS?
- ANSWER: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
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
What is the onset of SS?
- ANSWER: Within 24 hours of starting/changing medication and resolves within a few
days
How do you distinguish between NMS and acute dystonia?
- ANSWER: NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs?
- ANSWER: Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors?
- 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?
- ANSWER: Risk of fatal nephrotoxicity
What is a fetal side effect of lithium?
- ANSWER: Epstein's anomaly
What lab should you check for athletes on lithium?
- ANSWER: Specific gravity to assess for dehydration (dehydration is >1.015)
, What do you do if the lithium level is 1.3?
- ANSWER: Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
- ANSWER: >3
S/S of lithium toxicity
- ANSWER: vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Why check an EKG with lithium?
- ANSWER: Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
- ANSWER: Synthroid
What do you do if patient is prescribed both depakote and lamictal?
- ANSWER: Decreased lamictal dose by 50%
Depakote and pregnancy
- ANSWER: Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
- ANSWER: Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine?
- ANSWER: LFTs
What lab means pregnancy?
- ANSWER: HCG
Why is Clozaril used?
- ANSWER: Treatment resistant schizophrenia, improves SI, and improves negative
symptoms of schizophrenia
(LATEST 2026/2027) QUESTIONS AND 100% CORRECT
ANSWERS (GRADED A+)
What does ADPIE stand for?
- 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?
- 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?
- ANSWER: Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
- ANSWER: Check renal function
What do you do if a patient presents with fever while on Clozaril?
- ANSWER: Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
- ANSWER: Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
- ANSWER: Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
- 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?
- ANSWER: Check for rhabdo with CPK
,s/s of serotonin syndrome
- ANSWER: hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
What two medications to give with NMS?
- ANSWER: bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS?
- ANSWER: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
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
What is the onset of SS?
- ANSWER: Within 24 hours of starting/changing medication and resolves within a few
days
How do you distinguish between NMS and acute dystonia?
- ANSWER: NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs?
- ANSWER: Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors?
- 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?
- ANSWER: Risk of fatal nephrotoxicity
What is a fetal side effect of lithium?
- ANSWER: Epstein's anomaly
What lab should you check for athletes on lithium?
- ANSWER: Specific gravity to assess for dehydration (dehydration is >1.015)
, What do you do if the lithium level is 1.3?
- ANSWER: Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
- ANSWER: >3
S/S of lithium toxicity
- ANSWER: vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Why check an EKG with lithium?
- ANSWER: Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
- ANSWER: Synthroid
What do you do if patient is prescribed both depakote and lamictal?
- ANSWER: Decreased lamictal dose by 50%
Depakote and pregnancy
- ANSWER: Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
- ANSWER: Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine?
- ANSWER: LFTs
What lab means pregnancy?
- ANSWER: HCG
Why is Clozaril used?
- ANSWER: Treatment resistant schizophrenia, improves SI, and improves negative
symptoms of schizophrenia
