PMHNP Board Review - 1
Which of the following patients is at a higher risk of suicide?
a. A 30-year-old married African-American female with a previous suicide attempt.
b. A 35-year-old single Asian male with a previous suicide attempt.
c. A 38-year-old single African male who is a manager of a bank.
d. A 68-year-old single Caucasian male with depression D. A 68-year-old single Caucasian
male with depression
A 72-year-old female is brought in by her husband with increasing forgetfulness, insomnia,
decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is
being treated with lisinopril. The exam is normal, and the mini-mental status exam provides a
score of 24 but she declines to answer some questions and needs to be urged to participate in the
assessment. What is the most likely diagnosis?
a. Alzheimer's disease (2 months is too short)
b. Vascular dementia
c. Depression
d. Delirium C. Depression
A new female patient has recently been diagnosed with bipolar disorder. The PMHNP and the
patient agreed to start Lithium. The PMHNP reviews the benefits and risks of taking lithium with
the patient, and the PMHNP sends the order to the pharmacy. Which of the following patient
rights was violated in this case?
a. Beneficence
b. Informed consent
c. Non-maleficence
d. Confidentiality D. Confidentiality
1. In treating a 47-year-old male patient with a history of asthma who presents with sudden onset
symptoms of tachycardia, elevated blood pressure, sweating, shaking, agitation, and anxiety, the
PMHNP prescribes:
a. 0.5 mg of Xanax IV
b. 2 mg of lorazepam IM
c. 10 mg of propranolol IM
d. 50 mg of hydroxyzine IM D. 50mg of Hydroxyzine IM
1. A 46-year-old hx bipolar comes for a regular follow-up appointment w/ PMHNP and presents
w/complains of severe vomiting, diarrhea, muscle weakness, blurred vision, and ataxia. The
patient is currently taking 900 mg of lithium daily. The psychiatric nurse practitioner identifies
these symptoms as signs of lithium toxicity. What is the priority action of the PMHNP?
,a. Maintains education regimen and monitors the symptoms
b. Tells the pt to stop taking the lithium and orders a serum lithium level
c. Orders an electrocardiogram
d. Take the patient's vital signs b. Tells the pt to stop taking the lithium and orders a serum
lithium level
For 12 years, a 65-year-old pt with bipolar affective disorder has been treated with lithium
Eskalith 900 mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for
hypertension, the patient develops nausea, vomiting ataxia, and muscle weakness. The patient's
serum lithium level is 2.0 mEq/L. The interaction of the lithium and the thiazide diuretic has
induced:
a. Hypokalemia
b. Hyponatremia
c. Increased renal clearance of lithium
d. Reduced renal clearance of lithiumD. Reduced Renal Clearance of Lithium
Mary a 45 yr old African American female has been treated on isocarboxazid (Marplan) for over
6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated
w/isocarboxazid?
a. Morphine
b. NSAIDs
c. Methylphenidate
d. Acetaminophen c. Methylphenidate - (this causes a risk of HTN Crisis)
1. The PMHNP is aware of the following signs to watch out for pts taking clozapine (Clozaril)?
a. Nosebleeds, bleeding gums, and skin rash
b. Mutism, muscle rigidity, and hyperthermia
c. Fever, sore throats, and chills
d. Ataxia, confusion, hypothyroidism c. Fever, sore throats, and chills -- due to leukocytopenia
A new Rx of carbamazepine (Tegretol) is given to a pt whose baseline WBC is 5000 and
absolute neutrophil count (ANC) is 4000. Laboratory tests show that the pts WBC count has
decreased to 2500 and ANC has decreased to 750 after 2 weeks of therapy. Similar outcomes are
obtained when the laboratory studies are repeated. The pt does not present w/ s/s of infection.
What is the next action?
a. Continues the pt on Tegretol and monitors pt for s/s infection
b. Tell the pt to stop taking Tegretol and recheck the ANC and WBC
c. Continues the pt on Tegretol since the WBC is within normal limits
d. Refer the pt to a primary care provider. (if there is something you can do before referring to
another provider then you should do it) B. Tells the pt to stop taking Tegretol and recheck
the ANC and WBC
If given during pregnancy, sodium valproate (Depakote) can cause which if the following
medical problems in the baby?
a. Steven Johnson syndrome
b. Ebstein's anomaly
c. Spina bifida
d. Cleft palate C. Spina Bifida
, 1. Which mood stabilizer is associated with potential life-threatening rash in the Asian
population?
a. Carbamazepine (Tegretol)
b. Depakote
c. Lithium
d. Lamictal A. Carbamazepine (Tegretol)
Which of the following physical exam findings would help the PMHNP differentiate anorexia
nervosa from bulimia nervosa?
a. Russell sign
b. Low body mass index
c. Erosion of dental enamel
d. Hypertrophy of salivary glands B. Low body mass index
Which medication has a unique mechanism being a norepinephrine and dopamine re-uptake
inhibitor?
a. Buproprion (Wellbutrin)
b. Sertraline (Zoloft)
c. Clomipramine (Anafranil)
d. Duloxetine (Cymbalta) A. Buproprion (Wellbutrin)
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is
treated with clozapine?
a. 2D6
b. 1A2
c. 2C19
d. 2C9 B. 1A2
When treating older adults, you should keep in mind they are more sensitive to issues of drug
toxicity for which of the following reasons?
a. Decreased body fat
b. Increased liver capacity
c. Decreased protein binding
d. Increased muscle concentration c. Decreased protein binding
Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a
large majority of serotonin neurons?
a. Raphe nuclei
b. Nucleus accumbens
c. Locus coeruleus
d. Amygdala a. Raphe nuclei
A client who is experiencing difficulties with working memory, planning, prioritizing, insight
into his problems, and impulse control presents for assessment. In planning his care, the PMHNP
should apply his or her knowledge that these symptoms represent problems with the:
a. Frontal lobe
Which of the following patients is at a higher risk of suicide?
a. A 30-year-old married African-American female with a previous suicide attempt.
b. A 35-year-old single Asian male with a previous suicide attempt.
c. A 38-year-old single African male who is a manager of a bank.
d. A 68-year-old single Caucasian male with depression D. A 68-year-old single Caucasian
male with depression
A 72-year-old female is brought in by her husband with increasing forgetfulness, insomnia,
decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is
being treated with lisinopril. The exam is normal, and the mini-mental status exam provides a
score of 24 but she declines to answer some questions and needs to be urged to participate in the
assessment. What is the most likely diagnosis?
a. Alzheimer's disease (2 months is too short)
b. Vascular dementia
c. Depression
d. Delirium C. Depression
A new female patient has recently been diagnosed with bipolar disorder. The PMHNP and the
patient agreed to start Lithium. The PMHNP reviews the benefits and risks of taking lithium with
the patient, and the PMHNP sends the order to the pharmacy. Which of the following patient
rights was violated in this case?
a. Beneficence
b. Informed consent
c. Non-maleficence
d. Confidentiality D. Confidentiality
1. In treating a 47-year-old male patient with a history of asthma who presents with sudden onset
symptoms of tachycardia, elevated blood pressure, sweating, shaking, agitation, and anxiety, the
PMHNP prescribes:
a. 0.5 mg of Xanax IV
b. 2 mg of lorazepam IM
c. 10 mg of propranolol IM
d. 50 mg of hydroxyzine IM D. 50mg of Hydroxyzine IM
1. A 46-year-old hx bipolar comes for a regular follow-up appointment w/ PMHNP and presents
w/complains of severe vomiting, diarrhea, muscle weakness, blurred vision, and ataxia. The
patient is currently taking 900 mg of lithium daily. The psychiatric nurse practitioner identifies
these symptoms as signs of lithium toxicity. What is the priority action of the PMHNP?
,a. Maintains education regimen and monitors the symptoms
b. Tells the pt to stop taking the lithium and orders a serum lithium level
c. Orders an electrocardiogram
d. Take the patient's vital signs b. Tells the pt to stop taking the lithium and orders a serum
lithium level
For 12 years, a 65-year-old pt with bipolar affective disorder has been treated with lithium
Eskalith 900 mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for
hypertension, the patient develops nausea, vomiting ataxia, and muscle weakness. The patient's
serum lithium level is 2.0 mEq/L. The interaction of the lithium and the thiazide diuretic has
induced:
a. Hypokalemia
b. Hyponatremia
c. Increased renal clearance of lithium
d. Reduced renal clearance of lithiumD. Reduced Renal Clearance of Lithium
Mary a 45 yr old African American female has been treated on isocarboxazid (Marplan) for over
6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated
w/isocarboxazid?
a. Morphine
b. NSAIDs
c. Methylphenidate
d. Acetaminophen c. Methylphenidate - (this causes a risk of HTN Crisis)
1. The PMHNP is aware of the following signs to watch out for pts taking clozapine (Clozaril)?
a. Nosebleeds, bleeding gums, and skin rash
b. Mutism, muscle rigidity, and hyperthermia
c. Fever, sore throats, and chills
d. Ataxia, confusion, hypothyroidism c. Fever, sore throats, and chills -- due to leukocytopenia
A new Rx of carbamazepine (Tegretol) is given to a pt whose baseline WBC is 5000 and
absolute neutrophil count (ANC) is 4000. Laboratory tests show that the pts WBC count has
decreased to 2500 and ANC has decreased to 750 after 2 weeks of therapy. Similar outcomes are
obtained when the laboratory studies are repeated. The pt does not present w/ s/s of infection.
What is the next action?
a. Continues the pt on Tegretol and monitors pt for s/s infection
b. Tell the pt to stop taking Tegretol and recheck the ANC and WBC
c. Continues the pt on Tegretol since the WBC is within normal limits
d. Refer the pt to a primary care provider. (if there is something you can do before referring to
another provider then you should do it) B. Tells the pt to stop taking Tegretol and recheck
the ANC and WBC
If given during pregnancy, sodium valproate (Depakote) can cause which if the following
medical problems in the baby?
a. Steven Johnson syndrome
b. Ebstein's anomaly
c. Spina bifida
d. Cleft palate C. Spina Bifida
, 1. Which mood stabilizer is associated with potential life-threatening rash in the Asian
population?
a. Carbamazepine (Tegretol)
b. Depakote
c. Lithium
d. Lamictal A. Carbamazepine (Tegretol)
Which of the following physical exam findings would help the PMHNP differentiate anorexia
nervosa from bulimia nervosa?
a. Russell sign
b. Low body mass index
c. Erosion of dental enamel
d. Hypertrophy of salivary glands B. Low body mass index
Which medication has a unique mechanism being a norepinephrine and dopamine re-uptake
inhibitor?
a. Buproprion (Wellbutrin)
b. Sertraline (Zoloft)
c. Clomipramine (Anafranil)
d. Duloxetine (Cymbalta) A. Buproprion (Wellbutrin)
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is
treated with clozapine?
a. 2D6
b. 1A2
c. 2C19
d. 2C9 B. 1A2
When treating older adults, you should keep in mind they are more sensitive to issues of drug
toxicity for which of the following reasons?
a. Decreased body fat
b. Increased liver capacity
c. Decreased protein binding
d. Increased muscle concentration c. Decreased protein binding
Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a
large majority of serotonin neurons?
a. Raphe nuclei
b. Nucleus accumbens
c. Locus coeruleus
d. Amygdala a. Raphe nuclei
A client who is experiencing difficulties with working memory, planning, prioritizing, insight
into his problems, and impulse control presents for assessment. In planning his care, the PMHNP
should apply his or her knowledge that these symptoms represent problems with the:
a. Frontal lobe
