LMR GEORGETTE’S PMHNP CERTIFICATION EXAM |COMPLETE QUESTIONS WITH EXPERT
SOLUTIONS | 2026 LATEST UPDATED | GET 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? - (answer)Synthroid
What do you do if patient is prescribed both depakote and lamictal? - (answer)Decreased
lamictal dose by 50%
Depakote and pregnancy - (answer)Spina bifida
SOLUTIONS | 2026 LATEST UPDATED | GET 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? - (answer)Synthroid
What do you do if patient is prescribed both depakote and lamictal? - (answer)Decreased
lamictal dose by 50%
Depakote and pregnancy - (answer)Spina bifida
