PMHNP-BC ANCC EXAM PREP 2026 |
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER STUDY GUIDE &
PRACTICE EXAM WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED
DETAILED ANSWERS|FREQUENTLY
TESTED QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS
Signs of NMS (Neuroleptic Malignant Syndrome)
Initial Symptoms: altered sensorium, hyperreflexia, fever
Then signs of autonomic instability: extreme muscle rigidity, hypotension, tachycardia, diaphoresis,
tachypnea, hyperthermia, coma, death.
Check for increased WBCs (leukocytosis)/LFTs/CPK
Signs of Lithium toxicity
Confusion, diplopia, nausea/diarrhea, ataxia, lethargy, fatigue, clumsiness, weakness, muscle cramping,
severe tremor, blurred vision, nystagmus, increased DTRs, altered mental status, cardiac dysrhythmias
Signs of Serotonin Snydrome
agitation, restlessness, rapid heart rate, blood pressure elevation, headache, sweating, shivering, goose
bumps, myoclonic jerking and loss of coordination, confusion, fevers, unconsciousness, seizures
Medications that can increase lithium level
NSAIDs, ACE Inhibitors (-prils), ARBs (-sartans), tetracyclines, metronidazole
Medications that can decrease lithium level
potassium-sparing diuretics, thiazide diuretics, theophylline
Clozaril - monitoring considerations
Monitor ANC (absolute neutrophil count); pt needs an ANC of at least 1500 to start clozaril therapy;
watch for Benign Ethnic Neutropenia (BED); Monitor ANC weekly x6 months, every 2 weeks x6 months,
then monthly if ANC is at least 1500.
1|Page
,Substances that can cause a false + drug test for PCP & methadone
Niquil, OTC cough meds
Substances that can cause a false + drug test for heroin & morphine
rifampin, fluoroquniolones
Substances that can cause a false + drug test for cocaine
NSAIDs, amoxicillin, most antibiotics
Substances that can cause a false + drug test for amphetamines
Prozac, Wellbutrin, Trazodone, Nefazodone, Sudafed, OTC decongestants.
Schizophrenia Prevalence:
Non-twin siblings of a schizophrenic parent
Dizygotic twins of a schizophrenic parent
Monozygotic twins of a schizophrenic parent
8%
12%
47%
Birth defects caused by benzodiazepines
Cleft palate, floppy baby syndrome
Birth defects caused by carbamazepine
Neural tube defects
Birth defects caused by depakote
Neural tube defects (spina bifida), cleft palate, atrial-septal defects, long-term developmental deficits
CYP450 Inhibitors
bupropion, clomipramine, cimetidine, clarithromycin, fluoroquinolone, grapefruit, ketoconazole,
nefazodone, SSRIs
CYP450 Inducers
carbamazepine, nicotine, hypericum (St. John's wort), phenytoin, phenobarbital
Normal lab value for AST (aspartate aminotransferase)
5-40
Normal lab value for ALT (alanine aminotransferase)
5-35
Normal lab value for Alkaline Phosphatase
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, 44-147; male be increased in gallbladder disease & with bone injury /rapid bone growth
Creatine Kinase (normal range)
<240. Measures muscle injury (heart, brain, and skeletal). Increased in MI (CK-MO), myositis, NMS
BUN (normal range)
10-20.
Creatinine
0.4-0.8 or less than 1.5
Normal GFR
>90 mL/min. If a patient is on psychotropics, as long as their GRF is >60, no dose adjustments need to be
made.
What is the best measure of kidney function?
GFR (glomerular filtration rate)
Normal Plate Count
140,000-340,000
Normal hemoglobin value for males and females
Males: 13.5-18
Females: 12.5-14
Normal MCV (mean corpuscular volume) value
78-100
Normal TSH Range
0.4-4
Normal Free T4 range
10-27
Substances that can cause a false + drug test for codeine
poppy seeds
Substances that can cause a false + drug test for benzodiazepines
Zoloft
Gamma glutamyl transpeptidase (GGT) normal range
10-38
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PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER STUDY GUIDE &
PRACTICE EXAM WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED
DETAILED ANSWERS|FREQUENTLY
TESTED QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS
Signs of NMS (Neuroleptic Malignant Syndrome)
Initial Symptoms: altered sensorium, hyperreflexia, fever
Then signs of autonomic instability: extreme muscle rigidity, hypotension, tachycardia, diaphoresis,
tachypnea, hyperthermia, coma, death.
Check for increased WBCs (leukocytosis)/LFTs/CPK
Signs of Lithium toxicity
Confusion, diplopia, nausea/diarrhea, ataxia, lethargy, fatigue, clumsiness, weakness, muscle cramping,
severe tremor, blurred vision, nystagmus, increased DTRs, altered mental status, cardiac dysrhythmias
Signs of Serotonin Snydrome
agitation, restlessness, rapid heart rate, blood pressure elevation, headache, sweating, shivering, goose
bumps, myoclonic jerking and loss of coordination, confusion, fevers, unconsciousness, seizures
Medications that can increase lithium level
NSAIDs, ACE Inhibitors (-prils), ARBs (-sartans), tetracyclines, metronidazole
Medications that can decrease lithium level
potassium-sparing diuretics, thiazide diuretics, theophylline
Clozaril - monitoring considerations
Monitor ANC (absolute neutrophil count); pt needs an ANC of at least 1500 to start clozaril therapy;
watch for Benign Ethnic Neutropenia (BED); Monitor ANC weekly x6 months, every 2 weeks x6 months,
then monthly if ANC is at least 1500.
1|Page
,Substances that can cause a false + drug test for PCP & methadone
Niquil, OTC cough meds
Substances that can cause a false + drug test for heroin & morphine
rifampin, fluoroquniolones
Substances that can cause a false + drug test for cocaine
NSAIDs, amoxicillin, most antibiotics
Substances that can cause a false + drug test for amphetamines
Prozac, Wellbutrin, Trazodone, Nefazodone, Sudafed, OTC decongestants.
Schizophrenia Prevalence:
Non-twin siblings of a schizophrenic parent
Dizygotic twins of a schizophrenic parent
Monozygotic twins of a schizophrenic parent
8%
12%
47%
Birth defects caused by benzodiazepines
Cleft palate, floppy baby syndrome
Birth defects caused by carbamazepine
Neural tube defects
Birth defects caused by depakote
Neural tube defects (spina bifida), cleft palate, atrial-septal defects, long-term developmental deficits
CYP450 Inhibitors
bupropion, clomipramine, cimetidine, clarithromycin, fluoroquinolone, grapefruit, ketoconazole,
nefazodone, SSRIs
CYP450 Inducers
carbamazepine, nicotine, hypericum (St. John's wort), phenytoin, phenobarbital
Normal lab value for AST (aspartate aminotransferase)
5-40
Normal lab value for ALT (alanine aminotransferase)
5-35
Normal lab value for Alkaline Phosphatase
2|Page
, 44-147; male be increased in gallbladder disease & with bone injury /rapid bone growth
Creatine Kinase (normal range)
<240. Measures muscle injury (heart, brain, and skeletal). Increased in MI (CK-MO), myositis, NMS
BUN (normal range)
10-20.
Creatinine
0.4-0.8 or less than 1.5
Normal GFR
>90 mL/min. If a patient is on psychotropics, as long as their GRF is >60, no dose adjustments need to be
made.
What is the best measure of kidney function?
GFR (glomerular filtration rate)
Normal Plate Count
140,000-340,000
Normal hemoglobin value for males and females
Males: 13.5-18
Females: 12.5-14
Normal MCV (mean corpuscular volume) value
78-100
Normal TSH Range
0.4-4
Normal Free T4 range
10-27
Substances that can cause a false + drug test for codeine
poppy seeds
Substances that can cause a false + drug test for benzodiazepines
Zoloft
Gamma glutamyl transpeptidase (GGT) normal range
10-38
3|Page
