LMR GEORGETTE’S PMHNP
CERTIFICATION EXAM 2025
QUESTIONS AND ANSWERS
What do you do if a patient on lithium has dark brown urine? - ANS Check renal function
What do you do if a patient presents with fever while on Clozaril? - ANS Check ANC level to
assess for agranulocytosis
What can cause serotonin syndrome? - ANS Antidepressants, St. John's Wort, Same-E, Kava
Kava, and Tryptophan
What labs are indicative of NMS? - ANS Elevated WBC (over 11,000) and elevated CPK
S/S of NMS - ANS 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? - ANS Check for rhabdo
with CPK
s/s of serotonin syndrome - ANS hyperreflexia, muscle spasms, myoclonus (involuntary
muscle jerk), fever, tachycardia, HTN, shits and shivers
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, What two medications to give with NMS? - ANS bromocriptine (Parlodel)- D2 agonist
dantrolene- muscle relaxer
What medication to give during SS? - ANS cyproheptadine (Periactin)- 5HT-2A receptor
antagonist
What is the onset and typical length of NMS? - ANS Slow onset (1-2 weeks after changing or
starting therapy) and resolves within 9-14 days
What is the onset of SS? - ANS Within 24 hours of starting/changing medication and resolves
within a few days
How do you distinguish between NMS and acute dystonia? - ANS NMS has a slower onset
while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - ANS Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - ANS Increased risk of lithium toxicity
related to the increased urination from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers? - ANS Risk of fatal
nephrotoxicity
What is a fetal side effect of lithium? - ANS Epstein's anomaly
What lab should you check for athletes on lithium? - ANS Specific gravity to assess for
dehydration (dehydration is >1.015)
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, What do you do if the lithium level is 1.3? - ANS Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - ANS >3
S/S of lithium toxicity - ANS vomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - ANS Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - ANS Synthroid
What do you do if patient is prescribed both depakote and lamictal? - ANS Decreased
lamictal dose by 50%
Depakote and pregnancy - ANS Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
ANS Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
ANS LFTs
What lab means pregnancy? - ANS HCG
Why is Clozaril used? - ANS Treatment resistant schizophrenia, improves SI, and improves
negative symptoms of schizophrenia
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@COPYRIGHT FYNDLAY 2025/2026
CERTIFICATION EXAM 2025
QUESTIONS AND ANSWERS
What do you do if a patient on lithium has dark brown urine? - ANS Check renal function
What do you do if a patient presents with fever while on Clozaril? - ANS Check ANC level to
assess for agranulocytosis
What can cause serotonin syndrome? - ANS Antidepressants, St. John's Wort, Same-E, Kava
Kava, and Tryptophan
What labs are indicative of NMS? - ANS Elevated WBC (over 11,000) and elevated CPK
S/S of NMS - ANS 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? - ANS Check for rhabdo
with CPK
s/s of serotonin syndrome - ANS hyperreflexia, muscle spasms, myoclonus (involuntary
muscle jerk), fever, tachycardia, HTN, shits and shivers
1
Page
@COPYRIGHT FYNDLAY 2025/2026
, What two medications to give with NMS? - ANS bromocriptine (Parlodel)- D2 agonist
dantrolene- muscle relaxer
What medication to give during SS? - ANS cyproheptadine (Periactin)- 5HT-2A receptor
antagonist
What is the onset and typical length of NMS? - ANS Slow onset (1-2 weeks after changing or
starting therapy) and resolves within 9-14 days
What is the onset of SS? - ANS Within 24 hours of starting/changing medication and resolves
within a few days
How do you distinguish between NMS and acute dystonia? - ANS NMS has a slower onset
while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - ANS Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - ANS Increased risk of lithium toxicity
related to the increased urination from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers? - ANS Risk of fatal
nephrotoxicity
What is a fetal side effect of lithium? - ANS Epstein's anomaly
What lab should you check for athletes on lithium? - ANS Specific gravity to assess for
dehydration (dehydration is >1.015)
2
Page
@COPYRIGHT FYNDLAY 2025/2026
, What do you do if the lithium level is 1.3? - ANS Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - ANS >3
S/S of lithium toxicity - ANS vomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - ANS Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - ANS Synthroid
What do you do if patient is prescribed both depakote and lamictal? - ANS Decreased
lamictal dose by 50%
Depakote and pregnancy - ANS Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
ANS Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
ANS LFTs
What lab means pregnancy? - ANS HCG
Why is Clozaril used? - ANS Treatment resistant schizophrenia, improves SI, and improves
negative symptoms of schizophrenia
3
Page
@COPYRIGHT FYNDLAY 2025/2026
