LMR George e’s PMHNP Cer fica on Exam Latest 2025
Ques ons And Correct Answers(Verified Answers)
What does ADPIE stand for? - Assessment
Diagnosis
Planning
Implementa on
Evalua on
What should you do when a mother reports her child woke up screaming in the middle of the
night? - Ask her if it's happened before to assess for sleep issue pa"erns
What do you do if a pa ent comes in with fungus on their toenail? - Scrape nail and send for
tes ng
What do you do if a pa ent on lithium has dark brown urine? - Check renal func on
What do you do if a pa ent presents with fever while on Clozaril? - Check ANC level to assess
for agranulocytosis
What can cause serotonin syndrome? - An depressants, St. John's Wort, Same-E, Kava Kava,
and Tryptophan
What labs are indica ve of NMS? - Elevated WBC (over 11,000) and elevated CPK
S/S of NMS - muscle rigidity, hyperthermia, tachycardia, abnormal bp, swea ng, altered mental
status, cherry colored urine
,What should you do if a pa ent presents with cherry colored urine? - Check for rhabdo with
CPK
s/s of serotonin syndrome - hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk),
fever, tachycardia, HTN, shits and shivers
What two medica ons to give with NMS? - bromocrip ne (Parlodel)- D2 agonist dantrolene-
muscle relaxer
What medica on to give during SS? - cyproheptadine (Periac n)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS? - Slow onset (1-2 weeks a9er changing or star ng
therapy) and resolves within 9-14 days
What is the onset of SS? - Within 24 hours of star ng/changing medica on and resolves within
a few days
How do you dis nguish between NMS and acute dystonia? - NMS has a slower onset while
acute dystonia occurs within hours
What happens with lithium and NSAIDs? - Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - Increased risk of lithium toxicity related to the
increased urina on from the ACE inhibitors
Why should a pa ent on lithium avoid calcium channel blockers? - Risk of fatal nephrotoxicity
, What is a fetal side effect of lithium? - Epstein's anomaly
What lab should you check for athletes on lithium? - Specific gravity to assess for dehydra on
(dehydra on is >1.015)
What do you do if the lithium level is 1.3? - Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - >3
S/S of lithium toxicity - vomi ng, diarrhea, slurred speech, hand tremor, dry mouth/thirst,
muscle weakness/twitching
Why check an EKG with lithium? - Inverted T-waves
What medica on should treat hypothyroidism caused by lithium use? - Synthroid
What do you do if pa ent is prescribed both depakote and lamictal? - Decreased lamictal dose
by 50%
Depakote and pregnancy - Spina bifida
What emergency may be occuring if pa ent on depakote reports upper abdominal pain? -
Pancrea s
What lab should you check if pa ent has right upper quadrant pain and dark brown urine? -
LFTs
Ques ons And Correct Answers(Verified Answers)
What does ADPIE stand for? - Assessment
Diagnosis
Planning
Implementa on
Evalua on
What should you do when a mother reports her child woke up screaming in the middle of the
night? - Ask her if it's happened before to assess for sleep issue pa"erns
What do you do if a pa ent comes in with fungus on their toenail? - Scrape nail and send for
tes ng
What do you do if a pa ent on lithium has dark brown urine? - Check renal func on
What do you do if a pa ent presents with fever while on Clozaril? - Check ANC level to assess
for agranulocytosis
What can cause serotonin syndrome? - An depressants, St. John's Wort, Same-E, Kava Kava,
and Tryptophan
What labs are indica ve of NMS? - Elevated WBC (over 11,000) and elevated CPK
S/S of NMS - muscle rigidity, hyperthermia, tachycardia, abnormal bp, swea ng, altered mental
status, cherry colored urine
,What should you do if a pa ent presents with cherry colored urine? - Check for rhabdo with
CPK
s/s of serotonin syndrome - hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk),
fever, tachycardia, HTN, shits and shivers
What two medica ons to give with NMS? - bromocrip ne (Parlodel)- D2 agonist dantrolene-
muscle relaxer
What medica on to give during SS? - cyproheptadine (Periac n)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS? - Slow onset (1-2 weeks a9er changing or star ng
therapy) and resolves within 9-14 days
What is the onset of SS? - Within 24 hours of star ng/changing medica on and resolves within
a few days
How do you dis nguish between NMS and acute dystonia? - NMS has a slower onset while
acute dystonia occurs within hours
What happens with lithium and NSAIDs? - Increased risk of lithium toxicity (gout meds,
ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - Increased risk of lithium toxicity related to the
increased urina on from the ACE inhibitors
Why should a pa ent on lithium avoid calcium channel blockers? - Risk of fatal nephrotoxicity
, What is a fetal side effect of lithium? - Epstein's anomaly
What lab should you check for athletes on lithium? - Specific gravity to assess for dehydra on
(dehydra on is >1.015)
What do you do if the lithium level is 1.3? - Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - >3
S/S of lithium toxicity - vomi ng, diarrhea, slurred speech, hand tremor, dry mouth/thirst,
muscle weakness/twitching
Why check an EKG with lithium? - Inverted T-waves
What medica on should treat hypothyroidism caused by lithium use? - Synthroid
What do you do if pa ent is prescribed both depakote and lamictal? - Decreased lamictal dose
by 50%
Depakote and pregnancy - Spina bifida
What emergency may be occuring if pa ent on depakote reports upper abdominal pain? -
Pancrea s
What lab should you check if pa ent has right upper quadrant pain and dark brown urine? -
LFTs
