LMR GEORGETTE'S PMHNP
CERTIFICATION EXAM 2024
1.What should you do when a mother reports her child woke up screaming in the middle
of the night?
Ask her if it's happened before to assess for sleep issue patterns
2.What do you do if a patient comes in with fungus on their toenail?
Scrape nail and send for testing
3.What do you do if a patient on lithium has dark brown urine?
, Check renal function
4.What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
5.What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
6.What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
7.S/S of NMS
muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental
status, cherry colored urine
8.What should you do if a patient presents with cherry colored urine?
Check for rhabdo with CPK
9.s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
10. What two medications to give with NMS?
, bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
11. What medication to give during SS?
cyproheptadine (Periactin)- 5HT-2A receptor antagonist
12. What is the onset and typical length of NMS?
Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
days
13. What is the onset of SS?
Within 24 hours of starting/changing medication and resolves within a few days
14. How do you distinguish between NMS and acute dystonia?
NMS has a slower onset while acute dystonia occurs within hours
15. What happens with lithium and NSAIDs?
Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
16. What happens with lithium and ACE inhibitors?: Increased risk of lithium toxicity
related to the increased urination from the ACE inhibitors
17. Why should a patient on lithium avoid calcium channel blockers?: Risk of fatal
nephrotoxicity
18 What is a fetal side effect of lithium?: Epstein's anomaly
, 19. What lab should you check for athletes on lithium?: Specific gravity to assess for
dehydration (dehydration is >1.015)
20. What do you do if the lithium level is 1.3?: Do not give the next dose and assess for
s/s
21. At what level is lithium toxicity a medical emergency?: >3
22. S/S of lithium toxicity: vomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
23. Why check an EKG with lithium?: Inverted T-waves
24. What medication should treat hypothyroidism caused by lithium use?: Synthroid
25. What do you do if patient is prescribed both depakote and lamictal?: Decreased
lamictal dose by 50%
26. Depakote and pregnancy: Spina bifida
27. What emergency may be occuring if patient on depakote reports upper abdominal
pain?: Pancreatitis
28. What lab should you check if patient has right upper quadrant pain and dark brown
urine?: LFTs
29. What lab means pregnancy?: HCG
30. Why is Clozaril used?: Treatment resistant schizophrenia, improves SI, and improves
negative symptoms of schizophrenia
31. What two medications have the highest risk of agranulocytosis and aplastic
anemia?: Clozaril and Tegretol
32. What symptoms may mean a Clozaril induced infection?: Sore throats, sores in
mouth/gums, fever
CERTIFICATION EXAM 2024
1.What should you do when a mother reports her child woke up screaming in the middle
of the night?
Ask her if it's happened before to assess for sleep issue patterns
2.What do you do if a patient comes in with fungus on their toenail?
Scrape nail and send for testing
3.What do you do if a patient on lithium has dark brown urine?
, Check renal function
4.What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
5.What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
6.What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
7.S/S of NMS
muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental
status, cherry colored urine
8.What should you do if a patient presents with cherry colored urine?
Check for rhabdo with CPK
9.s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
10. What two medications to give with NMS?
, bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
11. What medication to give during SS?
cyproheptadine (Periactin)- 5HT-2A receptor antagonist
12. What is the onset and typical length of NMS?
Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
days
13. What is the onset of SS?
Within 24 hours of starting/changing medication and resolves within a few days
14. How do you distinguish between NMS and acute dystonia?
NMS has a slower onset while acute dystonia occurs within hours
15. What happens with lithium and NSAIDs?
Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
16. What happens with lithium and ACE inhibitors?: Increased risk of lithium toxicity
related to the increased urination from the ACE inhibitors
17. Why should a patient on lithium avoid calcium channel blockers?: Risk of fatal
nephrotoxicity
18 What is a fetal side effect of lithium?: Epstein's anomaly
, 19. What lab should you check for athletes on lithium?: Specific gravity to assess for
dehydration (dehydration is >1.015)
20. What do you do if the lithium level is 1.3?: Do not give the next dose and assess for
s/s
21. At what level is lithium toxicity a medical emergency?: >3
22. S/S of lithium toxicity: vomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
23. Why check an EKG with lithium?: Inverted T-waves
24. What medication should treat hypothyroidism caused by lithium use?: Synthroid
25. What do you do if patient is prescribed both depakote and lamictal?: Decreased
lamictal dose by 50%
26. Depakote and pregnancy: Spina bifida
27. What emergency may be occuring if patient on depakote reports upper abdominal
pain?: Pancreatitis
28. What lab should you check if patient has right upper quadrant pain and dark brown
urine?: LFTs
29. What lab means pregnancy?: HCG
30. Why is Clozaril used?: Treatment resistant schizophrenia, improves SI, and improves
negative symptoms of schizophrenia
31. What two medications have the highest risk of agranulocytosis and aplastic
anemia?: Clozaril and Tegretol
32. What symptoms may mean a Clozaril induced infection?: Sore throats, sores in
mouth/gums, fever
