LMR Georgette’s PMHNP Certification Exam Latest
2026/2027 Questions And Correct Answers
What do you do if a patient presents with fever while on Clozaril? - correct answer
>>>Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - correct answer >>>Antidepressants, St. John's
Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - correct answer >>>Elevated WBC (over 11,000) and
elevated CPK
S/S of NMS - correct 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? - correct answer
>>>Check for rhabdo with CPK
s/s of serotonin syndrome - correct answer >>>hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - correct answer >>>bromocriptine (Parlodel)-
D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - correct answer >>>cyproheptadine (Periactin)-
5HT-2A receptor antagonist
What is the onset and typical length of NMS? - correct answer >>>Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - correct answer >>>Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - correct answer >>>NMS
has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - correct answer >>>Increased risk of lithium
toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - correct 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? - correct answer
>>>Risk of fatal nephrotoxicity
,What is a fetal side effect of lithium? - correct answer >>>Epstein's anomaly
What lab should you check for athletes on lithium? - correct answer >>>Specific gravity
to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - correct answer >>>Do not give the next dose
and assess for s/s
At what level is lithium toxicity a medical emergency? - correct answer >>>>3
S/S of lithium toxicity - correct answer >>>vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
What does ADPIE stand for? - correct 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? - correct 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? - correct answer
>>>Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? - correct answer >>>Check
renal function
Why check an EKG with lithium? - correct answer >>>Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - correct answer
>>>Synthroid
What do you do if patient is prescribed both depakote and lamictal? - correct answer
>>>Decreased lamictal dose by 50%
Depakote and pregnancy - correct answer >>>Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
- correct answer >>>Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown
urine? - correct answer >>>LFTs
What lab means pregnancy? - correct answer >>>HCG
, Why is Clozaril used? - correct answer >>>Treatment resistant schizophrenia, improves
SI, and improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? -
correct answer >>>Clozaril and Tegretol
What symptoms may mean a Clozaril induced infection? - correct answer >>>Sore
throats, sores in mouth/gums, fever
When should you discontinue Clozaril or Tegretol? - correct answer >>>WBC < 2000 or
ANC <1000
What should you check in Asian patients taking Tegretol? - correct answer >>>For the
HLA-B*1502 allele (higher risk of SJS)
What two epidermal issues can arise from Tegretol or Lamictal? - correct answer
>>>Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe
headache? - correct answer >>>Aspetic meningitis
What three antipsychotics have very low weight gaining effects? - correct answer
>>>Geodon, Abilify, and Latuda
Mini-Cog - correct answer >>>3 word recall and
clock drawing
MMSE scoring - correct answer >>>24-30 severe impairment
18-23 mild impairment
17 and less no impairment
What happens during pruning? - correct answer >>>Brain eliminates extra synapses
during infancy
autism and pruning - correct answer >>>Excess synapses caused by under-pruning
(patient oversensitive to light/sounds and seizures)
schizophrenia and pruning - correct answer >>>Fewer synapses caused by over-
pruning
grey matter vs white matter - correct answer >>>Grey matter- synapses, working area
of brain, dendrites
White matter- myelinated axons
2026/2027 Questions And Correct Answers
What do you do if a patient presents with fever while on Clozaril? - correct answer
>>>Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - correct answer >>>Antidepressants, St. John's
Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - correct answer >>>Elevated WBC (over 11,000) and
elevated CPK
S/S of NMS - correct 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? - correct answer
>>>Check for rhabdo with CPK
s/s of serotonin syndrome - correct answer >>>hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - correct answer >>>bromocriptine (Parlodel)-
D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - correct answer >>>cyproheptadine (Periactin)-
5HT-2A receptor antagonist
What is the onset and typical length of NMS? - correct answer >>>Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - correct answer >>>Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - correct answer >>>NMS
has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - correct answer >>>Increased risk of lithium
toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - correct 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? - correct answer
>>>Risk of fatal nephrotoxicity
,What is a fetal side effect of lithium? - correct answer >>>Epstein's anomaly
What lab should you check for athletes on lithium? - correct answer >>>Specific gravity
to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - correct answer >>>Do not give the next dose
and assess for s/s
At what level is lithium toxicity a medical emergency? - correct answer >>>>3
S/S of lithium toxicity - correct answer >>>vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
What does ADPIE stand for? - correct 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? - correct 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? - correct answer
>>>Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? - correct answer >>>Check
renal function
Why check an EKG with lithium? - correct answer >>>Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - correct answer
>>>Synthroid
What do you do if patient is prescribed both depakote and lamictal? - correct answer
>>>Decreased lamictal dose by 50%
Depakote and pregnancy - correct answer >>>Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
- correct answer >>>Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown
urine? - correct answer >>>LFTs
What lab means pregnancy? - correct answer >>>HCG
, Why is Clozaril used? - correct answer >>>Treatment resistant schizophrenia, improves
SI, and improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? -
correct answer >>>Clozaril and Tegretol
What symptoms may mean a Clozaril induced infection? - correct answer >>>Sore
throats, sores in mouth/gums, fever
When should you discontinue Clozaril or Tegretol? - correct answer >>>WBC < 2000 or
ANC <1000
What should you check in Asian patients taking Tegretol? - correct answer >>>For the
HLA-B*1502 allele (higher risk of SJS)
What two epidermal issues can arise from Tegretol or Lamictal? - correct answer
>>>Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe
headache? - correct answer >>>Aspetic meningitis
What three antipsychotics have very low weight gaining effects? - correct answer
>>>Geodon, Abilify, and Latuda
Mini-Cog - correct answer >>>3 word recall and
clock drawing
MMSE scoring - correct answer >>>24-30 severe impairment
18-23 mild impairment
17 and less no impairment
What happens during pruning? - correct answer >>>Brain eliminates extra synapses
during infancy
autism and pruning - correct answer >>>Excess synapses caused by under-pruning
(patient oversensitive to light/sounds and seizures)
schizophrenia and pruning - correct answer >>>Fewer synapses caused by over-
pruning
grey matter vs white matter - correct answer >>>Grey matter- synapses, working area
of brain, dendrites
White matter- myelinated axons
