LMR GEORGETTE’S PMHNP CERTIFICATION EXAM | QUESTIONS
AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS (100%
CORRECT) | LATEST EXAM UPDATE
What do you do if a patient on lithium has dark brown urine? - CORRECT
ANSWER- Check renal function
What do you do if a patient presents with fever while on Clozaril? -
CORRECT ANSWER- Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - CORRECT ANSWER-
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - CORRECT ANSWER- Elevated WBC
(over 11,000) and elevated CPK
S/S of NMS - CORRECT 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? -
CORRECT ANSWER- Check for rhabdo with CPK
s/s of serotonin syndrome - CORRECT ANSWER- hyperreflexia, muscle
spasms, myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits
and shivers
What two medications to give with NMS? - CORRECT ANSWER-
bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
,What medication to give during SS? - CORRECT ANSWER- cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS? - CORRECT ANSWER- Slow
onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
days
What is the onset of SS? - CORRECT ANSWER- Within 24 hours of
starting/changing medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - CORRECT
ANSWER- NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - CORRECT ANSWER- Increased
risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - CORRECT 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? - CORRECT
ANSWER- Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? - CORRECT ANSWER- Epstein's
anomaly
What lab should you check for athletes on lithium? - CORRECT ANSWER-
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - CORRECT ANSWER- Do not
give the next dose and assess for s/s
,At what level is lithium toxicity a medical emergency? - CORRECT
ANSWER- >3
S/S of lithium toxicity - CORRECT ANSWER- vomiting, diarrhea, slurred
speech, hand tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - CORRECT ANSWER- Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? -
CORRECT ANSWER- Synthroid
What do you do if patient is prescribed both depakote and lamictal? -
CORRECT ANSWER- Decreased lamictal dose by 50%
Depakote and pregnancy - CORRECT ANSWER- Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain? - CORRECT ANSWER- Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark
brown urine? - CORRECT ANSWER- LFTs
What lab means pregnancy? - CORRECT ANSWER- HCG
Why is Clozaril used? - CORRECT ANSWER- Treatment resistant
schizophrenia, improves SI, and improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic
anemia? - CORRECT ANSWER- Clozaril and Tegretol
, What symptoms may mean a Clozaril induced infection? - CORRECT
ANSWER- Sore throats, sores in mouth/gums, fever
When should you discontinue Clozaril or Tegretol? - CORRECT ANSWER-
WBC < 2000 or ANC <1000
What should you check in Asian patients taking Tegretol? - CORRECT
ANSWER- For the HLA-B*1502 allele (higher risk of SJS)
What two epidermal issues can arise from Tegretol or Lamictal? - CORRECT
ANSWER- Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe
headache? - CORRECT ANSWER- Aspetic meningitis
What three antipsychotics have very low weight gaining effects? - CORRECT
ANSWER- Geodon, Abilify, and Latuda
Mini-Cog - CORRECT ANSWER- 3 word recall and
clock drawing
MMSE scoring - CORRECT ANSWER- 24-30 severe impairment
18-23 mild impairment
17 and less no impairment
What happens during pruning? - CORRECT ANSWER- Brain eliminates extra
synapses during infancy
AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS (100%
CORRECT) | LATEST EXAM UPDATE
What do you do if a patient on lithium has dark brown urine? - CORRECT
ANSWER- Check renal function
What do you do if a patient presents with fever while on Clozaril? -
CORRECT ANSWER- Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - CORRECT ANSWER-
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - CORRECT ANSWER- Elevated WBC
(over 11,000) and elevated CPK
S/S of NMS - CORRECT 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? -
CORRECT ANSWER- Check for rhabdo with CPK
s/s of serotonin syndrome - CORRECT ANSWER- hyperreflexia, muscle
spasms, myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits
and shivers
What two medications to give with NMS? - CORRECT ANSWER-
bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
,What medication to give during SS? - CORRECT ANSWER- cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS? - CORRECT ANSWER- Slow
onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
days
What is the onset of SS? - CORRECT ANSWER- Within 24 hours of
starting/changing medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - CORRECT
ANSWER- NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs? - CORRECT ANSWER- Increased
risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - CORRECT 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? - CORRECT
ANSWER- Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? - CORRECT ANSWER- Epstein's
anomaly
What lab should you check for athletes on lithium? - CORRECT ANSWER-
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - CORRECT ANSWER- Do not
give the next dose and assess for s/s
,At what level is lithium toxicity a medical emergency? - CORRECT
ANSWER- >3
S/S of lithium toxicity - CORRECT ANSWER- vomiting, diarrhea, slurred
speech, hand tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - CORRECT ANSWER- Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? -
CORRECT ANSWER- Synthroid
What do you do if patient is prescribed both depakote and lamictal? -
CORRECT ANSWER- Decreased lamictal dose by 50%
Depakote and pregnancy - CORRECT ANSWER- Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain? - CORRECT ANSWER- Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark
brown urine? - CORRECT ANSWER- LFTs
What lab means pregnancy? - CORRECT ANSWER- HCG
Why is Clozaril used? - CORRECT ANSWER- Treatment resistant
schizophrenia, improves SI, and improves negative symptoms of schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic
anemia? - CORRECT ANSWER- Clozaril and Tegretol
, What symptoms may mean a Clozaril induced infection? - CORRECT
ANSWER- Sore throats, sores in mouth/gums, fever
When should you discontinue Clozaril or Tegretol? - CORRECT ANSWER-
WBC < 2000 or ANC <1000
What should you check in Asian patients taking Tegretol? - CORRECT
ANSWER- For the HLA-B*1502 allele (higher risk of SJS)
What two epidermal issues can arise from Tegretol or Lamictal? - CORRECT
ANSWER- Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe
headache? - CORRECT ANSWER- Aspetic meningitis
What three antipsychotics have very low weight gaining effects? - CORRECT
ANSWER- Geodon, Abilify, and Latuda
Mini-Cog - CORRECT ANSWER- 3 word recall and
clock drawing
MMSE scoring - CORRECT ANSWER- 24-30 severe impairment
18-23 mild impairment
17 and less no impairment
What happens during pruning? - CORRECT ANSWER- Brain eliminates extra
synapses during infancy
