LMR GEORGETTE PMHNP EXAM 4 2026
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER ASSESSMENT TEST PAPER
QUESTIONS SOLUTIONS GRADED A+
◉ What should you do when a mother reports her child woke up
screaming in the middle of the night?
Answer: Ask her if it's happened before to assess for sleep issue
patterns
◉ What do you do if a patient comes in with fungus on their toenail?
Answer: Scrape nail and send for testing
◉ What do you do if a patient on lithium has dark brown urine?
Answer: Check renal function
◉ What do you do if a patient presents with fever while on Clozaril?
Answer: Check ANC level to assess for agranulocytosis
◉ What can cause serotonin syndrome?
Answer: Antidepressants, St. John's Wort, Same-E, Kava Kava, and
Tryptophan
,◉ What labs are indicative of NMS?
Answer: Elevated WBC (over 11,000) and elevated CPK
◉ S/S of NMS
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?
Answer: Check for rhabdo with CPK
◉ s/s of serotonin syndrome
Answer: hyperreflexia, muscle spasms, myoclonus (involuntary
muscle jerk), fever, tachycardia, HTN, shits and shivers
◉ What two medications to give with NMS?
Answer: bromocriptine (Parlodel)- D2 agonist dantrolene- muscle
relaxer
◉ What medication to give during SS?
Answer: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
,◉ What is the onset and typical length of NMS?
Answer: Slow onset (1-2 weeks after changing or starting therapy)
and resolves within 9-14 days
◉ What is the onset of SS?
Answer: Within 24 hours of starting/changing medication and
resolves within a few days
◉ How do you distinguish between NMS and acute dystonia?
Answer: NMS has a slower onset while acute dystonia occurs within
hours
◉ What happens with lithium and NSAIDs?
Answer: Increased risk of lithium toxicity (gout meds, ibuprophen,
naproxen, etc.)
◉ What happens with lithium and ACE inhibitors?
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?
Answer: Risk of fatal nephrotoxicity
, ◉ What is a fetal side effect of lithium?
Answer: Epstein's anomaly
◉ What lab should you check for athletes on lithium?
Answer: Specific gravity to assess for dehydration (dehydration is
>1.015)
◉ What do you do if the lithium level is 1.3?
Answer: Do 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
Answer: vomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
◉ Why check an EKG with lithium?
Answer: Inverted T-waves
◉ What medication should treat hypothyroidism caused by lithium
use?
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER ASSESSMENT TEST PAPER
QUESTIONS SOLUTIONS GRADED A+
◉ What should you do when a mother reports her child woke up
screaming in the middle of the night?
Answer: Ask her if it's happened before to assess for sleep issue
patterns
◉ What do you do if a patient comes in with fungus on their toenail?
Answer: Scrape nail and send for testing
◉ What do you do if a patient on lithium has dark brown urine?
Answer: Check renal function
◉ What do you do if a patient presents with fever while on Clozaril?
Answer: Check ANC level to assess for agranulocytosis
◉ What can cause serotonin syndrome?
Answer: Antidepressants, St. John's Wort, Same-E, Kava Kava, and
Tryptophan
,◉ What labs are indicative of NMS?
Answer: Elevated WBC (over 11,000) and elevated CPK
◉ S/S of NMS
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?
Answer: Check for rhabdo with CPK
◉ s/s of serotonin syndrome
Answer: hyperreflexia, muscle spasms, myoclonus (involuntary
muscle jerk), fever, tachycardia, HTN, shits and shivers
◉ What two medications to give with NMS?
Answer: bromocriptine (Parlodel)- D2 agonist dantrolene- muscle
relaxer
◉ What medication to give during SS?
Answer: cyproheptadine (Periactin)- 5HT-2A receptor antagonist
,◉ What is the onset and typical length of NMS?
Answer: Slow onset (1-2 weeks after changing or starting therapy)
and resolves within 9-14 days
◉ What is the onset of SS?
Answer: Within 24 hours of starting/changing medication and
resolves within a few days
◉ How do you distinguish between NMS and acute dystonia?
Answer: NMS has a slower onset while acute dystonia occurs within
hours
◉ What happens with lithium and NSAIDs?
Answer: Increased risk of lithium toxicity (gout meds, ibuprophen,
naproxen, etc.)
◉ What happens with lithium and ACE inhibitors?
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?
Answer: Risk of fatal nephrotoxicity
, ◉ What is a fetal side effect of lithium?
Answer: Epstein's anomaly
◉ What lab should you check for athletes on lithium?
Answer: Specific gravity to assess for dehydration (dehydration is
>1.015)
◉ What do you do if the lithium level is 1.3?
Answer: Do 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
Answer: vomiting, diarrhea, slurred speech, hand tremor, dry
mouth/thirst, muscle weakness/twitching
◉ Why check an EKG with lithium?
Answer: Inverted T-waves
◉ What medication should treat hypothyroidism caused by lithium
use?
