LMR GEORGETTE’S PMHNP CERTIFICATION QUESTIONS
WITH COMPLETE SOLUTIONS GUARANTEED PASS BRAND
NEW 2025
What labs are indicative of NMS? -ANSWER ->Elevated
WBC (over 11,000) and elevated CPK
S/S of NMS -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? -ANSWER ->Check for rhabdo with
CPKWhat does ADPIE stand for?
-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? -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? -ANSWER ->Scrape nail and send for testing
What do you do if a patient on lithium has dark brown
urine? -ANSWER ->Check renal function
What do you do if a patient presents with fever while on
Clozaril? -ANSWER ->Check ANC level to assess for
agranulocytosis
What can cause serotonin syndrome? -ANSWER -
>Antidepressants, St. John's Wort, Same-E, Kava Kava,
and Tryptophan
s/s of serotonin syndrome -ANSWER ->hyperreflexia,
muscle spasms, myoclonus (involuntary muscle jerk),
fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? -ANSWER -
>bromocriptine (Parlodel)- D2 agonist dantrolene-
muscle relaxer
What medication to give during SS? -ANSWER -
>cyproheptadine (Periactin)- 5HT-2A receptor antagonist
,What is the onset and typical length of NMS? -ANSWER -
>Slow onset (1-2 weeks after changing or starting
therapy) and resolves within 9-14 days
What is the onset of SS? -ANSWER ->Within 24 hours of
starting/changing medication and resolves within a few
days
How do you distinguish between NMS and acute
dystonia? -ANSWER ->NMS has a slower onset while
acute dystonia occurs within hours
What happens with lithium and NSAIDs? -ANSWER -
>Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? -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? -ANSWER ->Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? -ANSWER -
>Epstein's anomaly
, What lab should you check for athletes on lithium? -
ANSWER ->Specific gravity to assess for dehydration
(dehydration is >1.015)
What do you do if the lithium level is 1.3? -ANSWER ->Do
not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? -
ANSWER ->>3
S/S of lithium toxicity -ANSWER ->vomiting, diarrhea,
slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Why check an EKG with lithium? -ANSWER ->Inverted T-
waves
What medication should treat hypothyroidism caused by
lithium use? -ANSWER ->Synthroid
What do you do if patient is prescribed both depakote
and lamictal? -ANSWER ->Decreased lamictal dose by
50%
Depakote and pregnancy -ANSWER ->Spina bifida
WITH COMPLETE SOLUTIONS GUARANTEED PASS BRAND
NEW 2025
What labs are indicative of NMS? -ANSWER ->Elevated
WBC (over 11,000) and elevated CPK
S/S of NMS -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? -ANSWER ->Check for rhabdo with
CPKWhat does ADPIE stand for?
-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? -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? -ANSWER ->Scrape nail and send for testing
What do you do if a patient on lithium has dark brown
urine? -ANSWER ->Check renal function
What do you do if a patient presents with fever while on
Clozaril? -ANSWER ->Check ANC level to assess for
agranulocytosis
What can cause serotonin syndrome? -ANSWER -
>Antidepressants, St. John's Wort, Same-E, Kava Kava,
and Tryptophan
s/s of serotonin syndrome -ANSWER ->hyperreflexia,
muscle spasms, myoclonus (involuntary muscle jerk),
fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? -ANSWER -
>bromocriptine (Parlodel)- D2 agonist dantrolene-
muscle relaxer
What medication to give during SS? -ANSWER -
>cyproheptadine (Periactin)- 5HT-2A receptor antagonist
,What is the onset and typical length of NMS? -ANSWER -
>Slow onset (1-2 weeks after changing or starting
therapy) and resolves within 9-14 days
What is the onset of SS? -ANSWER ->Within 24 hours of
starting/changing medication and resolves within a few
days
How do you distinguish between NMS and acute
dystonia? -ANSWER ->NMS has a slower onset while
acute dystonia occurs within hours
What happens with lithium and NSAIDs? -ANSWER -
>Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? -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? -ANSWER ->Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? -ANSWER -
>Epstein's anomaly
, What lab should you check for athletes on lithium? -
ANSWER ->Specific gravity to assess for dehydration
(dehydration is >1.015)
What do you do if the lithium level is 1.3? -ANSWER ->Do
not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? -
ANSWER ->>3
S/S of lithium toxicity -ANSWER ->vomiting, diarrhea,
slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Why check an EKG with lithium? -ANSWER ->Inverted T-
waves
What medication should treat hypothyroidism caused by
lithium use? -ANSWER ->Synthroid
What do you do if patient is prescribed both depakote
and lamictal? -ANSWER ->Decreased lamictal dose by
50%
Depakote and pregnancy -ANSWER ->Spina bifida
