PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
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. COWS scale components: · Opioid W/D
Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea
(running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (goose-
flesh skin), insomnia
3. What does COWS stand for?: Clinical Opiate Withdrawal Scale
4. What does CIWA stand for?: Clinical Institute Withdrawal Assessment
5. What does CIWA assess for?: --used to determine likelihood of ETOH withdrawal or DTs
--usually occur within the first 24-72 hours after cessation
o used to determine when to administer medications for ETOH withdrawal
6. What does CIWA NOT test for?: Alcohol Use Disorder
7. What are the CIWA scale components?: · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile
disturbances, auditory disturbances, visual disturbances, H/A, orientation
Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)-4 (disoriented)
Score:
<10: Very mild Start PRN meds at score of 8
>10 to 15: Mild scheduled + PRN meds
>16 to 20: Moderate
>21: Severe Diazepam, Librium, Ativan
8. 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 confidential. Parents may be upset but
remember you are advocating for the child.
9. Which Ethnic group has the highest rate of suicide?: Native Americans
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
10. 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 antago-
nism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
11. 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
12. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
13. When presented with a question about typical vs atypical antipsychotic the
answer is usually to start of a: atypical
14. 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
15. When a patient is hesitant to participate in treatment you should encour-
age?: Bring a support person like a husband
16. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
17. When T4 and T3 are high and TSH is low what is the diagnosis: HYPERTHYROIDISM,
TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE
18. Key symptoms of Heat Intolerance: Hyperthyroidism
19. When T4 and T3 are Low and TSH is high what is the diagnosis: (HYPOTHYROIDISM)
TSH secretion increased: TSH HIGH à COLD INTERANCE
20. Key symptoms of Cold Intolerance: Hypothyroidism
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
21. Hyperthyroid can mimic: Mania
22. Hypothyroid can mimic: Depression
23. A patient on depakote complains of RUQ pain and has reddish/brown urine-
: Hepatoxicity
-Check LFTs
24. Signs of Depakote toxicity: Disorientation, confusion, lethargy
25. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
26. What herbal supplement can cause hepatoxicity?: Kava Kava
27. When taking Kava Kava in combinations with other medications you should
caution about: Risk of Hepatoxicity and Sedation
28. TCAs carry a risk of: Hepatotoxicity
29. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin
pain
30. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
31. What nationality is most suseptible of getting steven johnson?: Asians
32. When treating asians with tegretol screen for?: HLAB-1502 Allele
33. What two medications cause agranulocytosis?: Clozaril & Tegretol
34. Agranulocytosis when to discontinue medication: Less than 1000
35. When monitoring for agranulocytosis in patients look for s/s of what?: Infection
-Fever, sore throat, fatigue, chills
36. Before starting any mood stabilizer in a female of childbearing age be sure
to check?: HCG
37. Which two medications may decrease the risk of suicide?: clozaril and lithium
38. Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN
THIAZIDES-hydrochlorithiazide
ACE INHIBITORS-lisinopril
39. Ace inhibitors are treatment of choice for?: Heart Failure
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
40. Certain medications are known to increase lithium level, but HOW?: by reducing
renal clearance
41. When educating a patient about lithium teach them about: Hyponatremia
Dehydration-hot days, exercise
42. Normal Lithium Level: 0.6-1.2 per Quie
43. Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium level
44. Lithium level of 1.4: Monitor for toxicity
45. 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 impairment)
4+ protein in urine=MONITOR FOR TOXICITY
46. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
47. Lithium side effects: "LITHIUM GI"
L-Leukocytosis
I-inverted t-waves
T-tremors of the hand (fine)/teratogenic Ebstein's
H-hypothroidism
IU-Increased Urination
M-maculopapular rash
GI- GI upset (nausea, vomiting, anorexia)
48. Signs of lithium toxicity: confusion, ataxia, severe GI upset, palpitation, coarse hand tremor, slurred
speech, metallic taste in mouth
49. NMS is caused by: "think 'Antipsychotics'"; usually Atypicals
50. NMS: "NMS is like S&M"
o First Sx:
-You get a lil crazy (altered LOC)
-you get hot (hyperpyrexia)
and stiff (extreme muscle rigidity)
o Then:
-You get sweaty (diaphoresis)
Study online at https://quizlet.com/_bpfu9u
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. COWS scale components: · Opioid W/D
Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea
(running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (goose-
flesh skin), insomnia
3. What does COWS stand for?: Clinical Opiate Withdrawal Scale
4. What does CIWA stand for?: Clinical Institute Withdrawal Assessment
5. What does CIWA assess for?: --used to determine likelihood of ETOH withdrawal or DTs
--usually occur within the first 24-72 hours after cessation
o used to determine when to administer medications for ETOH withdrawal
6. What does CIWA NOT test for?: Alcohol Use Disorder
7. What are the CIWA scale components?: · N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile
disturbances, auditory disturbances, visual disturbances, H/A, orientation
Each component is scored from 0(none)-7(severe) except orientation wh/ is (0 (AA0x4)-4 (disoriented)
Score:
<10: Very mild Start PRN meds at score of 8
>10 to 15: Mild scheduled + PRN meds
>16 to 20: Moderate
>21: Severe Diazepam, Librium, Ativan
8. 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 confidential. Parents may be upset but
remember you are advocating for the child.
9. Which Ethnic group has the highest rate of suicide?: Native Americans
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
10. 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 antago-
nism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
11. 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
12. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
13. When presented with a question about typical vs atypical antipsychotic the
answer is usually to start of a: atypical
14. 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
15. When a patient is hesitant to participate in treatment you should encour-
age?: Bring a support person like a husband
16. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
17. When T4 and T3 are high and TSH is low what is the diagnosis: HYPERTHYROIDISM,
TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLERANCE
18. Key symptoms of Heat Intolerance: Hyperthyroidism
19. When T4 and T3 are Low and TSH is high what is the diagnosis: (HYPOTHYROIDISM)
TSH secretion increased: TSH HIGH à COLD INTERANCE
20. Key symptoms of Cold Intolerance: Hypothyroidism
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
21. Hyperthyroid can mimic: Mania
22. Hypothyroid can mimic: Depression
23. A patient on depakote complains of RUQ pain and has reddish/brown urine-
: Hepatoxicity
-Check LFTs
24. Signs of Depakote toxicity: Disorientation, confusion, lethargy
25. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
26. What herbal supplement can cause hepatoxicity?: Kava Kava
27. When taking Kava Kava in combinations with other medications you should
caution about: Risk of Hepatoxicity and Sedation
28. TCAs carry a risk of: Hepatotoxicity
29. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters, skin
pain
30. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
31. What nationality is most suseptible of getting steven johnson?: Asians
32. When treating asians with tegretol screen for?: HLAB-1502 Allele
33. What two medications cause agranulocytosis?: Clozaril & Tegretol
34. Agranulocytosis when to discontinue medication: Less than 1000
35. When monitoring for agranulocytosis in patients look for s/s of what?: Infection
-Fever, sore throat, fatigue, chills
36. Before starting any mood stabilizer in a female of childbearing age be sure
to check?: HCG
37. Which two medications may decrease the risk of suicide?: clozaril and lithium
38. Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN
THIAZIDES-hydrochlorithiazide
ACE INHIBITORS-lisinopril
39. Ace inhibitors are treatment of choice for?: Heart Failure
, PMHNP certification Exam 22
Study online at https://quizlet.com/_bpfu9u
40. Certain medications are known to increase lithium level, but HOW?: by reducing
renal clearance
41. When educating a patient about lithium teach them about: Hyponatremia
Dehydration-hot days, exercise
42. Normal Lithium Level: 0.6-1.2 per Quie
43. Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium level
44. Lithium level of 1.4: Monitor for toxicity
45. 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 impairment)
4+ protein in urine=MONITOR FOR TOXICITY
46. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
47. Lithium side effects: "LITHIUM GI"
L-Leukocytosis
I-inverted t-waves
T-tremors of the hand (fine)/teratogenic Ebstein's
H-hypothroidism
IU-Increased Urination
M-maculopapular rash
GI- GI upset (nausea, vomiting, anorexia)
48. Signs of lithium toxicity: confusion, ataxia, severe GI upset, palpitation, coarse hand tremor, slurred
speech, metallic taste in mouth
49. NMS is caused by: "think 'Antipsychotics'"; usually Atypicals
50. NMS: "NMS is like S&M"
o First Sx:
-You get a lil crazy (altered LOC)
-you get hot (hyperpyrexia)
and stiff (extreme muscle rigidity)
o Then:
-You get sweaty (diaphoresis)
