LMR GEORGETTE’S PMHNP CERTIFICATION EXAM
|A COMPLETE SOLUTION WITH VERIFIED
QUESTIONS AND ANSWERS |GET IT 100% CORRECT
|GRADED A+
What does ADPIE stand for?
Assessment
Diagnosis
Planning
Implementation
Evaluation
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
What do you do if a patient comes in with fungus on their toenail?
Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
Check renal function
What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
,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?
Check for rhabdo with CPK
s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
What two medications to give with NMS?
bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS?
cyproheptadine (Periactin)- 5HT-2A receptor antagonist
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
What is the onset of SS?
Within 24 hours of starting/changing medication and resolves within a
few days
How do you distinguish between NMS and acute dystonia?
NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs?
Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors?
Increased risk of lithium toxicity related to the increased urination from
the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers?
Risk of fatal nephrotoxicity
, What is a fetal side effect of lithium?
Epstein's anomaly
What lab should you check for athletes on lithium?
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3?
Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
>3
S/S of lithium toxicity
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst,
muscle weakness/twitching
Why check an EKG with lithium?
Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
Synthroid
What do you do if patient is prescribed both depakote and lamictal?
Decreased lamictal dose by 50%
Depakote and pregnancy
Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain?
Pancreatitis
What lab should you check if patient has right upper quadrant pain and
dark brown urine?
LFTs
|A COMPLETE SOLUTION WITH VERIFIED
QUESTIONS AND ANSWERS |GET IT 100% CORRECT
|GRADED A+
What does ADPIE stand for?
Assessment
Diagnosis
Planning
Implementation
Evaluation
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
What do you do if a patient comes in with fungus on their toenail?
Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
Check renal function
What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
,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?
Check for rhabdo with CPK
s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
tachycardia, HTN, shits and shivers
What two medications to give with NMS?
bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS?
cyproheptadine (Periactin)- 5HT-2A receptor antagonist
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
What is the onset of SS?
Within 24 hours of starting/changing medication and resolves within a
few days
How do you distinguish between NMS and acute dystonia?
NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs?
Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors?
Increased risk of lithium toxicity related to the increased urination from
the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers?
Risk of fatal nephrotoxicity
, What is a fetal side effect of lithium?
Epstein's anomaly
What lab should you check for athletes on lithium?
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3?
Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
>3
S/S of lithium toxicity
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst,
muscle weakness/twitching
Why check an EKG with lithium?
Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
Synthroid
What do you do if patient is prescribed both depakote and lamictal?
Decreased lamictal dose by 50%
Depakote and pregnancy
Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain?
Pancreatitis
What lab should you check if patient has right upper quadrant pain and
dark brown urine?
LFTs
