LMR GEORGETTE’S PMHNP
CERTIFICATION EXAM LATEST 2025-
2025 QUESTIONS AND CORRECT
ANSWERS(VERIFIED ANSWERS)
,What do you do if a patient on lithium has dark brown urine? - ANSWERCheck renal
function
What do you do if a patient presents with fever while on Clozaril? - ANSWERCheck
ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - ANSWERAntidepressants, St. John's Wort,
Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - ANSWERElevated WBC (over 11,000) and elevated
CPK
S/S of NMS - ANSWERmuscle rigidity, hyperthermia, tachycardia, abnormal bp,
sweating, altered mental status, cherry colored urine
What should you do if a patient presents with cherry colored urine? - ANSWERCheck
for rhabdo with CPK
s/s of serotonin syndrome - ANSWERhyperreflexia, muscle spasms, myoclonus
(involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - ANSWERbromocriptine (Parlodel)- D2
agonist dantrolene- muscle relaxer
What medication to give during SS? - ANSWERcyproheptadine (Periactin)- 5HT-2A
receptor antagonist
What is the onset and typical length of NMS? - ANSWERSlow onset (1-2 weeks after
changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - ANSWERWithin 24 hours of starting/changing medication
and resolves within a few days
How do you distinguish between NMS and acute dystonia? - ANSWERNMS has a
slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - ANSWERIncreased risk of lithium toxicity
(gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - ANSWERIncreased risk of lithium
toxicity related to the increased urination from the ACE inhibitors
, Why should a patient on lithium avoid calcium channel blockers? - ANSWERRisk of
fatal nephrotoxicity
What is a fetal side effect of lithium? - ANSWEREpstein's anomaly
What lab should you check for athletes on lithium? - ANSWERSpecific gravity to assess
for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - ANSWERDo 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 - ANSWERvomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - ANSWERInverted T-waves
What medication should treat hypothyroidism caused by lithium use? -
ANSWERSynthroid
What do you do if patient is prescribed both depakote and lamictal? -
ANSWERDecreased lamictal dose by 50%
Depakote and pregnancy - ANSWERSpina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
- ANSWERPancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown
urine? - ANSWERLFTs
What lab means pregnancy? - ANSWERHCG
Why is Clozaril used? - ANSWERTreatment resistant schizophrenia, improves SI, and
improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? -
ANSWERClozaril and Tegretol
What symptoms may mean a Clozaril induced infection? - ANSWERSore throats, sores
in mouth/gums, fever
When should you discontinue Clozaril or Tegretol? - ANSWERWBC < 2000 or ANC
<1000
CERTIFICATION EXAM LATEST 2025-
2025 QUESTIONS AND CORRECT
ANSWERS(VERIFIED ANSWERS)
,What do you do if a patient on lithium has dark brown urine? - ANSWERCheck renal
function
What do you do if a patient presents with fever while on Clozaril? - ANSWERCheck
ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - ANSWERAntidepressants, St. John's Wort,
Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - ANSWERElevated WBC (over 11,000) and elevated
CPK
S/S of NMS - ANSWERmuscle rigidity, hyperthermia, tachycardia, abnormal bp,
sweating, altered mental status, cherry colored urine
What should you do if a patient presents with cherry colored urine? - ANSWERCheck
for rhabdo with CPK
s/s of serotonin syndrome - ANSWERhyperreflexia, muscle spasms, myoclonus
(involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - ANSWERbromocriptine (Parlodel)- D2
agonist dantrolene- muscle relaxer
What medication to give during SS? - ANSWERcyproheptadine (Periactin)- 5HT-2A
receptor antagonist
What is the onset and typical length of NMS? - ANSWERSlow onset (1-2 weeks after
changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - ANSWERWithin 24 hours of starting/changing medication
and resolves within a few days
How do you distinguish between NMS and acute dystonia? - ANSWERNMS has a
slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - ANSWERIncreased risk of lithium toxicity
(gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - ANSWERIncreased risk of lithium
toxicity related to the increased urination from the ACE inhibitors
, Why should a patient on lithium avoid calcium channel blockers? - ANSWERRisk of
fatal nephrotoxicity
What is a fetal side effect of lithium? - ANSWEREpstein's anomaly
What lab should you check for athletes on lithium? - ANSWERSpecific gravity to assess
for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - ANSWERDo 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 - ANSWERvomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - ANSWERInverted T-waves
What medication should treat hypothyroidism caused by lithium use? -
ANSWERSynthroid
What do you do if patient is prescribed both depakote and lamictal? -
ANSWERDecreased lamictal dose by 50%
Depakote and pregnancy - ANSWERSpina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
- ANSWERPancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown
urine? - ANSWERLFTs
What lab means pregnancy? - ANSWERHCG
Why is Clozaril used? - ANSWERTreatment resistant schizophrenia, improves SI, and
improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia? -
ANSWERClozaril and Tegretol
What symptoms may mean a Clozaril induced infection? - ANSWERSore throats, sores
in mouth/gums, fever
When should you discontinue Clozaril or Tegretol? - ANSWERWBC < 2000 or ANC
<1000
