LMR Georgette’s PMHNP Certification
Exam Questions With Correct
Answers 2026
What should you do when a mother reports her child woke up screaming in the middle of the
night? - CORRECT ANSWERS -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? - CORRECT ANSWERS -Scrape
nail and send for testing
What do you do if a patient on lithium has dark brown urine? - CORRECT ANSWERS -Check renal
function
What do you do if a patient presents with fever while on Clozaril? - CORRECT ANSWERS -Check
ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - CORRECT ANSWERS -Antidepressants, St. John's Wort,
Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - CORRECT ANSWERS -Elevated WBC (over 11,000) and
elevated CPK
S/S of NMS - CORRECT ANSWERS -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? - CORRECT ANSWERS -
Check for rhabdo with CPK
,s/s of serotonin syndrome - CORRECT ANSWERS -hyperreflexia, muscle spasms, myoclonus
(involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - CORRECT ANSWERS -bromocriptine (Parlodel)- D2
agonist dantrolene- muscle relaxer
What medication to give during SS? - CORRECT ANSWERS -cyproheptadine (Periactin)- 5HT-2A
receptor antagonist
What is the onset and typical length of NMS? - CORRECT ANSWERS -Slow onset (1-2 weeks after
changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - CORRECT ANSWERS -Within 24 hours of starting/changing medication
and resolves within a few days
How do you distinguish between NMS and acute dystonia? - CORRECT ANSWERS -NMS has a
slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - CORRECT ANSWERS -Increased risk of lithium toxicity
(gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - CORRECT ANSWERS -Increased risk of lithium
toxicity related to the increased urination from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers? - CORRECT ANSWERS -Risk of
fatal nephrotoxicity
What is a fetal side effect of lithium? - CORRECT ANSWERS -Epstein's anomaly
, What lab should you check for athletes on lithium? - CORRECT ANSWERS -Specific gravity to
assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - CORRECT ANSWERS -Do not give the next dose and
assess for s/s
At what level is lithium toxicity a medical emergency? - CORRECT ANSWERS ->3
S/S of lithium toxicity - CORRECT ANSWERS -vomiting, diarrhea, slurred speech, hand tremor,
dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - CORRECT ANSWERS -Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - CORRECT ANSWERS -
Synthroid
What do you do if patient is prescribed both depakote and lamictal? - CORRECT ANSWERS -
Decreased lamictal dose by 50%
Depakote and pregnancy - CORRECT ANSWERS -Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
CORRECT ANSWERS -Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
CORRECT ANSWERS -LFTs
What lab means pregnancy? - CORRECT ANSWERS -HCG
Exam Questions With Correct
Answers 2026
What should you do when a mother reports her child woke up screaming in the middle of the
night? - CORRECT ANSWERS -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? - CORRECT ANSWERS -Scrape
nail and send for testing
What do you do if a patient on lithium has dark brown urine? - CORRECT ANSWERS -Check renal
function
What do you do if a patient presents with fever while on Clozaril? - CORRECT ANSWERS -Check
ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - CORRECT ANSWERS -Antidepressants, St. John's Wort,
Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - CORRECT ANSWERS -Elevated WBC (over 11,000) and
elevated CPK
S/S of NMS - CORRECT ANSWERS -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? - CORRECT ANSWERS -
Check for rhabdo with CPK
,s/s of serotonin syndrome - CORRECT ANSWERS -hyperreflexia, muscle spasms, myoclonus
(involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - CORRECT ANSWERS -bromocriptine (Parlodel)- D2
agonist dantrolene- muscle relaxer
What medication to give during SS? - CORRECT ANSWERS -cyproheptadine (Periactin)- 5HT-2A
receptor antagonist
What is the onset and typical length of NMS? - CORRECT ANSWERS -Slow onset (1-2 weeks after
changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - CORRECT ANSWERS -Within 24 hours of starting/changing medication
and resolves within a few days
How do you distinguish between NMS and acute dystonia? - CORRECT ANSWERS -NMS has a
slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - CORRECT ANSWERS -Increased risk of lithium toxicity
(gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - CORRECT ANSWERS -Increased risk of lithium
toxicity related to the increased urination from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers? - CORRECT ANSWERS -Risk of
fatal nephrotoxicity
What is a fetal side effect of lithium? - CORRECT ANSWERS -Epstein's anomaly
, What lab should you check for athletes on lithium? - CORRECT ANSWERS -Specific gravity to
assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - CORRECT ANSWERS -Do not give the next dose and
assess for s/s
At what level is lithium toxicity a medical emergency? - CORRECT ANSWERS ->3
S/S of lithium toxicity - CORRECT ANSWERS -vomiting, diarrhea, slurred speech, hand tremor,
dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - CORRECT ANSWERS -Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - CORRECT ANSWERS -
Synthroid
What do you do if patient is prescribed both depakote and lamictal? - CORRECT ANSWERS -
Decreased lamictal dose by 50%
Depakote and pregnancy - CORRECT ANSWERS -Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
CORRECT ANSWERS -Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
CORRECT ANSWERS -LFTs
What lab means pregnancy? - CORRECT ANSWERS -HCG
