ANCC PMHNP BOARDS WITH 280 QUESTIONS
AND CORRECT ANSWQERS RATD A+
2026/2027[NEWEST UPDATES
What do we remember about Lithium & Clozaril?
Lithium is to Bipolar as Clozaril is to Schizophrenia.
both are great at decreasing thoughts of SH/SI.
Which classes of medications can increase lithium levels?
-Thiazides (like HCTZ)
-NSAIDS (Indocin, Ibuprofen)
-ACE Inhibitors for cardiac failure such as Lisinopril
How do these classes of medications increase lithium levels?
These meds (thiazides, NSAIDS, ACE inhibitors) INCREASE lithium levels by
DECREASING renal clearance.
Renal clearance: ability of kidneys to clear solutes from plasma.
these meds inhibit that ability to clear solutes, leading to buildup of lithium.
Neuroleptic Malignant Syndrome (NMS)
potentially fatal reaction to antipsychotics blocking dopamine reception in brain.
s/s:
-fever
-altered LOC
-diaphoresis
,-unstable VS
-extreme MUSCLE RIGIDITY that can lead to MUTISM
-muscle contraction/destruction leads to elevated CPK lvls and myoglobinuria
Serotonin Syndrome
-potentially fatal reaction to SSRI or SNRI causing serotonin overdose in CNS.
s/s:
-fever
-altered LOC
-diaphoresis
-unstable VS
-HYPERREFLEXIA
-MYOCLONIC JERKS
-increased WBC
You have a patient that works out a lot complaining of cherry-red urine. What
could it be?
-This could indicate myoglobinuria d/t muscle breakdown caused by excessive
working out.
Neuroleptic Malignant Syndrome (NMS) Treatment
-STOP offending drug
2 meds:
-Dantrolene (muscle relaxant) or
-Bromocriptine (Dopamine [D2] Agonist) to reverse dopamine shortage.
Serotonin Syndrome (SS) Treatment
-STOP offending drug
,-admin Cyproheptadine, an antihistamine/serotonin antagonist that competes for
serotonin at 5HT1A and 5HT2A serotonin receptors, stopping excessive
serotonin from binding.
How long must you wait before switching a patient from an SSRI to a MAOI to
decrease serotonin syndrome risk?
-wait 2 WEEKS UNLESS it's Prozac.
due to Prozac's long half-life, you must wait 5-6 WEEKS to avoid serotonin
syndrome.
Triptans
-meds like Sumatriptan, Zoltriptan etc
-these are Migraine medications that stop headaches by increasing serotonin. They
can also cause Serotonin Syndrome when paired with other meds like SSRI/SNRI's
ASK PATIENTS A FULL MED HX
Selective Serotonin Reuptake Inhibitors (SSRIs)
-1st line MDD treatment d/t low risk of injury from overdose (especially when
taken intentionally).
-these can also be given to depressed cancer patients
Which class of medications can cause cardiac dysrhythmias?
Tricyclic Antidepressants (TCAs)
Why are SSRIs more safe to give to depressed cancer patients?
Less risk of drug-to-drug interactions
Which type of antidepressant would be prescribed for the depressed patient with
low energy and fatigue?
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) such as Wellbutrin.
Test-Taking Strategies
, -choose client-focused answrs
-DON'T CHANGE YOUR ANSWER
-too many similar answers are probably wrong
-SAFETY is the answer
-choose choices getting NP involved. not passing responsibilities off
Random Q: what do you have to remember about confidentiality when
interviewing teenagers?
Teenagers have the right to privacy, you don't have to interview them w their
parents.
What might you add for a patient experiencing sexual side effects on their SSRI?
Wellbutrin
What are some contraindications for Wellbutrin?
-hx of eating disorders
-hx of seizures (Wellbutrin decreases the seizure threshold, which leads to
increased seizure risk)
What's the black box warning for antidepressants?
These medications can increase suicidal ideations, especially in children,
adolescents and young adults
Why do we screen for ETOH use in depressed patients?
Because alcohol can increase depression
Which class of antidepressants would you prescribe for a patient with neuropathic
pain?
SNRIs like Duloxetine (Cymbalta) because this class helps with depression AND
neuropathy by boosting serotonin/NE in brain/spinal cord which help soothe
overactive pain signals in damaged nerves.
Antidepressant Psychoeducation
AND CORRECT ANSWQERS RATD A+
2026/2027[NEWEST UPDATES
What do we remember about Lithium & Clozaril?
Lithium is to Bipolar as Clozaril is to Schizophrenia.
both are great at decreasing thoughts of SH/SI.
Which classes of medications can increase lithium levels?
-Thiazides (like HCTZ)
-NSAIDS (Indocin, Ibuprofen)
-ACE Inhibitors for cardiac failure such as Lisinopril
How do these classes of medications increase lithium levels?
These meds (thiazides, NSAIDS, ACE inhibitors) INCREASE lithium levels by
DECREASING renal clearance.
Renal clearance: ability of kidneys to clear solutes from plasma.
these meds inhibit that ability to clear solutes, leading to buildup of lithium.
Neuroleptic Malignant Syndrome (NMS)
potentially fatal reaction to antipsychotics blocking dopamine reception in brain.
s/s:
-fever
-altered LOC
-diaphoresis
,-unstable VS
-extreme MUSCLE RIGIDITY that can lead to MUTISM
-muscle contraction/destruction leads to elevated CPK lvls and myoglobinuria
Serotonin Syndrome
-potentially fatal reaction to SSRI or SNRI causing serotonin overdose in CNS.
s/s:
-fever
-altered LOC
-diaphoresis
-unstable VS
-HYPERREFLEXIA
-MYOCLONIC JERKS
-increased WBC
You have a patient that works out a lot complaining of cherry-red urine. What
could it be?
-This could indicate myoglobinuria d/t muscle breakdown caused by excessive
working out.
Neuroleptic Malignant Syndrome (NMS) Treatment
-STOP offending drug
2 meds:
-Dantrolene (muscle relaxant) or
-Bromocriptine (Dopamine [D2] Agonist) to reverse dopamine shortage.
Serotonin Syndrome (SS) Treatment
-STOP offending drug
,-admin Cyproheptadine, an antihistamine/serotonin antagonist that competes for
serotonin at 5HT1A and 5HT2A serotonin receptors, stopping excessive
serotonin from binding.
How long must you wait before switching a patient from an SSRI to a MAOI to
decrease serotonin syndrome risk?
-wait 2 WEEKS UNLESS it's Prozac.
due to Prozac's long half-life, you must wait 5-6 WEEKS to avoid serotonin
syndrome.
Triptans
-meds like Sumatriptan, Zoltriptan etc
-these are Migraine medications that stop headaches by increasing serotonin. They
can also cause Serotonin Syndrome when paired with other meds like SSRI/SNRI's
ASK PATIENTS A FULL MED HX
Selective Serotonin Reuptake Inhibitors (SSRIs)
-1st line MDD treatment d/t low risk of injury from overdose (especially when
taken intentionally).
-these can also be given to depressed cancer patients
Which class of medications can cause cardiac dysrhythmias?
Tricyclic Antidepressants (TCAs)
Why are SSRIs more safe to give to depressed cancer patients?
Less risk of drug-to-drug interactions
Which type of antidepressant would be prescribed for the depressed patient with
low energy and fatigue?
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) such as Wellbutrin.
Test-Taking Strategies
, -choose client-focused answrs
-DON'T CHANGE YOUR ANSWER
-too many similar answers are probably wrong
-SAFETY is the answer
-choose choices getting NP involved. not passing responsibilities off
Random Q: what do you have to remember about confidentiality when
interviewing teenagers?
Teenagers have the right to privacy, you don't have to interview them w their
parents.
What might you add for a patient experiencing sexual side effects on their SSRI?
Wellbutrin
What are some contraindications for Wellbutrin?
-hx of eating disorders
-hx of seizures (Wellbutrin decreases the seizure threshold, which leads to
increased seizure risk)
What's the black box warning for antidepressants?
These medications can increase suicidal ideations, especially in children,
adolescents and young adults
Why do we screen for ETOH use in depressed patients?
Because alcohol can increase depression
Which class of antidepressants would you prescribe for a patient with neuropathic
pain?
SNRIs like Duloxetine (Cymbalta) because this class helps with depression AND
neuropathy by boosting serotonin/NE in brain/spinal cord which help soothe
overactive pain signals in damaged nerves.
Antidepressant Psychoeducation
