PMHNP Certification Exam
Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression)
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression)
Count the risk factors
When interview teenagers (16 y/o) that arrive with their parents what should you
do?
interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is
confidential. Parents may be upset but remember you are advocating for the child.
Which Ethnic group has the highest rate of suicide?
Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which of the
following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism
C. Increased Lipids
D. Metabolic Syndrome
D. Metabolic Syndrome (UMBRELLA ANSWER)
,Which antipsychotics have the least weight gain?
Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome
consider switching to one of the medications above. Or if the patient is overly
sedated try switching to ABILIFY
Which mood stabilizer have the least weight gain?
Lamictal
-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the answer
is usually to start of a
atypical
A client presents with complains of changes in appetite, feeling fatigued, problems
with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of
the brain that is responsible for the normal regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus
Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage?
Bring a support person like a husband
Thyroid-Stimulating hormone normal level
-0.5-5.0 Mu/L
,When T4 and T3 are high and TSH is low what is the diagnosis
-HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms
HEAT INTOLERANCE
Key symptoms of Heat Intolerance
-Hyperthyroidism
Key symptoms of Cold Intolerance
-Hypothyroidism
Hyperthyroid can mimic
-Mania
Hypothyroid can mimic
-Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine
Hepatoxicity
-Check LFTs
Signs of Depakote toxicity
-Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do?
Check
-LFT
-Ammonia
-Depakote Level
What herbal supplement can cause hepatoxicity?
Kava Kava
, When taking Kava Kava in combinations with other medications you should
caution about
Risk of Hepatoxicity and Sedation
TCAs carry a risk of
Hepatotoxicity
Signs of Stevens-Johnson Syndrome
-fever, mouth pain, swelling, burning eyes, blisters, skin pain
two psychotropics known to cause steven johnson syndrome
lamictal and tegretol
What nationality is most suseptible of getting steven Johnson?
Asians
When treating asians with tegretal screen for?
HLAB-1502 Allele
What two medications cause agranulocytosis?
Clozaril & Tegretal
Agranulocytosis when to discontinue medication
Less than 1000
When monitoring for agranulocytosis in patients look for s/s of what?
Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age be sure to
check?
-HCG
Which two medications may decrease the risk of suicide?
clozaril and lithium
Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression)
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression)
Count the risk factors
When interview teenagers (16 y/o) that arrive with their parents what should you
do?
interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is
confidential. Parents may be upset but remember you are advocating for the child.
Which Ethnic group has the highest rate of suicide?
Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which of the
following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism
C. Increased Lipids
D. Metabolic Syndrome
D. Metabolic Syndrome (UMBRELLA ANSWER)
,Which antipsychotics have the least weight gain?
Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome
consider switching to one of the medications above. Or if the patient is overly
sedated try switching to ABILIFY
Which mood stabilizer have the least weight gain?
Lamictal
-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the answer
is usually to start of a
atypical
A client presents with complains of changes in appetite, feeling fatigued, problems
with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of
the brain that is responsible for the normal regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus
Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage?
Bring a support person like a husband
Thyroid-Stimulating hormone normal level
-0.5-5.0 Mu/L
,When T4 and T3 are high and TSH is low what is the diagnosis
-HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms
HEAT INTOLERANCE
Key symptoms of Heat Intolerance
-Hyperthyroidism
Key symptoms of Cold Intolerance
-Hypothyroidism
Hyperthyroid can mimic
-Mania
Hypothyroid can mimic
-Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine
Hepatoxicity
-Check LFTs
Signs of Depakote toxicity
-Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do?
Check
-LFT
-Ammonia
-Depakote Level
What herbal supplement can cause hepatoxicity?
Kava Kava
, When taking Kava Kava in combinations with other medications you should
caution about
Risk of Hepatoxicity and Sedation
TCAs carry a risk of
Hepatotoxicity
Signs of Stevens-Johnson Syndrome
-fever, mouth pain, swelling, burning eyes, blisters, skin pain
two psychotropics known to cause steven johnson syndrome
lamictal and tegretol
What nationality is most suseptible of getting steven Johnson?
Asians
When treating asians with tegretal screen for?
HLAB-1502 Allele
What two medications cause agranulocytosis?
Clozaril & Tegretal
Agranulocytosis when to discontinue medication
Less than 1000
When monitoring for agranulocytosis in patients look for s/s of what?
Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age be sure to
check?
-HCG
Which two medications may decrease the risk of suicide?
clozaril and lithium
