PMHNP certification Exam
Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression) Correct answer- D. 68 y/o single white male with depression *5 risk factors
(age, male, white, depression)
Count the risk factors
When interview teenagers (16 y/o) that arrive with their parents what should you do?
Correct answer- interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confidential.
Parents may be upset but remember you are advocating for the child.
Which Ethnic group has the highest rate of suicide? Correct answer- Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which of the
following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism
C. Increased Lipids
D. Metabolic Syndrome Correct answer- D. Metabolic Syndrome (UMBRELLA
ANSWER)
Which antipsychotics have the least weight gain? Correct answer- Latuda, Abilify, (also
least sedating), Geodon-if patient has metabolic syndrome consider switching to one of
the medications above. Or if the patient is overly sedated try switching to ABILIFY
Which mood stabilizer have the least weight gain? Correct answer- Lamictal
-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the answer is
usually to start of a Correct answer- atypical
A client presents with complains of changes in appetite, feeling fatigued, problems with
sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain
that is responsible for the normal regulation of these functions?
A. Thalamus
B. Hypothalamus
,C. Limbic System
D. Hippocampus Correct answer- Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage? Correct
answer- Bring a support person like a husband
Thyroid-Stimulating hormone normal level Correct answer- 0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis Correct answer-
HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT
INTOLERANCE
Key symptoms of Heat Intolerance Correct answer- Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis Correct answer-
(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
Key symptoms of Cold Intolerance Correct answer- Hypothyroidism
Hyperthyroid can mimic Correct answer- Mania
Hypothyroid can mimic Correct answer- Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine Correct
answer- Hepatoxicity
-Check LFTs
Signs of Depakote toxicity Correct answer- Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do? Correct answer- Check
-LFT
-Ammonia
-Depakote Level
What herbal supplement can cause hepatoxicity? Correct answer- Kava Kava
When taking Kava Kava in combinations with other medications you should caution
about Correct answer- Risk of Hepatoxicity and Sedation
TCAs carry a risk of Correct answer- Hepatotoxicity
Signs of Stevens-Johnson Syndrome Correct answer- -fever, mouth pain, swelling,
burning eyes, blisters, skin pain
,two psychotropics known to cause steven johnson syndrome Correct answer- lamictal
and tegretol
What nationality is most suseptible of getting steven johnson? Correct answer- Asians
When treating asians with tegretal screen for? Correct answer- HLAB-1502 Allele
What two medications cause agranulocytosis? Correct answer- Clozaril & Tegretal
Agranulocytosis when to discontinue medication Correct answer- Less than 1000
When monitoring for agranulocytosis in patients look for s/s of what? Correct answer-
Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age be sure to check?
Correct answer- HCG
Which two medications may decrease the risk of suicide? Correct answer- clozaril and
lithium
Medications that increase lithium level Correct answer- NSAID-ibuprofen, INDOCIN
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
Ace inhibitors are treatment of choice for? Correct answer- Heart Failure
Certain medications are known to increase lithium level, but HOW? Correct answer- by
reducing renal clearance
When educating a patient about lithium teach them about Correct answer-
Hyponatremia
Dehydration-hot days, exercise
Normal Lithium Level Correct answer- 0.6-1.2
Lithium Toxicity Correct answer- 1.5 or above
Discontinue and re-order lithium level
Lithium level of 1.4 Correct answer- Monitor for toxicity
Labs before starting lithium Correct answer- TSH, BUN, CREATININE, HCG, U/A to
check for presence of protein in the urine (4+ protein is concerning for renal
impairment)à4+ protein in urine=MONITOR FOR TOXICITY
4+ protein in the urine of a patient on lithium Correct answer- 4+ protein is concerning
for renal impairment
, 4+ protein in urine=MONITOR FOR TOXICITY
Lithium side effects Correct answer- hypothyroid, leukocytosis, maculopapular rash, t-
wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)
-Some of these are also signs of toxicity
Signs of lithium toxicity Correct answer- confusion, ataxia, GI upset, palpitation, tremor
NMS Correct answer- muscle rigidity, mutism (because of muscle rigidity), increased
CPK (caused by muscle contraction and muscle destruction), increase WBC, increased
WBC, myoglobinuria (also from muscle destruction)
Cherry colored urine in a patient that exercises a lot Correct answer- test for
myoglobinuria may be a sign of rhabdo
Serotonin Syndrome Correct answer- With any drug that increases 5-HT (e.g., MAO
inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability,
flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Treatment for NMS Correct answer- Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs muscle relaxer
Treatment for Serotonin Syndrome Correct answer- Stop Med (1 or more SSRI, SSNRI,
TCA, MOAI)
-Cyproheptadine
Triptans Correct answer- Used for MIGRAINES
-These meds increase serotonin
example SUMATRIPTAN
patient taking Prozac and started on sumatriptan Correct answer- -call PCP to ask them
to switch the migraine med if patient already on SUMATRIPTAN do not start
antidepressant without talking to PCP
How long do you wait when switching between an SSRI to an MAOI? Correct answer- 2
weeks
How long do you wait when switching between Prozac and MAOI? Correct answer- 5-6
weeks wash out period
What is the first line treatment for depression and why? Correct answer- SSRI-First line
treatment for depression due to less risk of injury from OVERDOSE
Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white,
depression) Correct answer- D. 68 y/o single white male with depression *5 risk factors
(age, male, white, depression)
Count the risk factors
When interview teenagers (16 y/o) that arrive with their parents what should you do?
Correct answer- interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confidential.
Parents may be upset but remember you are advocating for the child.
Which Ethnic group has the highest rate of suicide? Correct answer- Native Americans
Example A patient is being treated for schizophrenia with olanzapine. Which of the
following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor antagonism
C. Increased Lipids
D. Metabolic Syndrome Correct answer- D. Metabolic Syndrome (UMBRELLA
ANSWER)
Which antipsychotics have the least weight gain? Correct answer- Latuda, Abilify, (also
least sedating), Geodon-if patient has metabolic syndrome consider switching to one of
the medications above. Or if the patient is overly sedated try switching to ABILIFY
Which mood stabilizer have the least weight gain? Correct answer- Lamictal
-But remember all mood stabilizers cause some weight gain
When presented with a question about typical vs atypical antipsychotic the answer is
usually to start of a Correct answer- atypical
A client presents with complains of changes in appetite, feeling fatigued, problems with
sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain
that is responsible for the normal regulation of these functions?
A. Thalamus
B. Hypothalamus
,C. Limbic System
D. Hippocampus Correct answer- Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
When a patient is hesitant to participate in treatment you should encourage? Correct
answer- Bring a support person like a husband
Thyroid-Stimulating hormone normal level Correct answer- 0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis Correct answer-
HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT
INTOLERANCE
Key symptoms of Heat Intolerance Correct answer- Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis Correct answer-
(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
Key symptoms of Cold Intolerance Correct answer- Hypothyroidism
Hyperthyroid can mimic Correct answer- Mania
Hypothyroid can mimic Correct answer- Depression
A patient on depakote complains of RUQ pain and has reddish/brown urine Correct
answer- Hepatoxicity
-Check LFTs
Signs of Depakote toxicity Correct answer- Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do? Correct answer- Check
-LFT
-Ammonia
-Depakote Level
What herbal supplement can cause hepatoxicity? Correct answer- Kava Kava
When taking Kava Kava in combinations with other medications you should caution
about Correct answer- Risk of Hepatoxicity and Sedation
TCAs carry a risk of Correct answer- Hepatotoxicity
Signs of Stevens-Johnson Syndrome Correct answer- -fever, mouth pain, swelling,
burning eyes, blisters, skin pain
,two psychotropics known to cause steven johnson syndrome Correct answer- lamictal
and tegretol
What nationality is most suseptible of getting steven johnson? Correct answer- Asians
When treating asians with tegretal screen for? Correct answer- HLAB-1502 Allele
What two medications cause agranulocytosis? Correct answer- Clozaril & Tegretal
Agranulocytosis when to discontinue medication Correct answer- Less than 1000
When monitoring for agranulocytosis in patients look for s/s of what? Correct answer-
Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age be sure to check?
Correct answer- HCG
Which two medications may decrease the risk of suicide? Correct answer- clozaril and
lithium
Medications that increase lithium level Correct answer- NSAID-ibuprofen, INDOCIN
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril
Ace inhibitors are treatment of choice for? Correct answer- Heart Failure
Certain medications are known to increase lithium level, but HOW? Correct answer- by
reducing renal clearance
When educating a patient about lithium teach them about Correct answer-
Hyponatremia
Dehydration-hot days, exercise
Normal Lithium Level Correct answer- 0.6-1.2
Lithium Toxicity Correct answer- 1.5 or above
Discontinue and re-order lithium level
Lithium level of 1.4 Correct answer- Monitor for toxicity
Labs before starting lithium Correct answer- TSH, BUN, CREATININE, HCG, U/A to
check for presence of protein in the urine (4+ protein is concerning for renal
impairment)à4+ protein in urine=MONITOR FOR TOXICITY
4+ protein in the urine of a patient on lithium Correct answer- 4+ protein is concerning
for renal impairment
, 4+ protein in urine=MONITOR FOR TOXICITY
Lithium side effects Correct answer- hypothyroid, leukocytosis, maculopapular rash, t-
wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)
-Some of these are also signs of toxicity
Signs of lithium toxicity Correct answer- confusion, ataxia, GI upset, palpitation, tremor
NMS Correct answer- muscle rigidity, mutism (because of muscle rigidity), increased
CPK (caused by muscle contraction and muscle destruction), increase WBC, increased
WBC, myoglobinuria (also from muscle destruction)
Cherry colored urine in a patient that exercises a lot Correct answer- test for
myoglobinuria may be a sign of rhabdo
Serotonin Syndrome Correct answer- With any drug that increases 5-HT (e.g., MAO
inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability,
flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Treatment for NMS Correct answer- Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs muscle relaxer
Treatment for Serotonin Syndrome Correct answer- Stop Med (1 or more SSRI, SSNRI,
TCA, MOAI)
-Cyproheptadine
Triptans Correct answer- Used for MIGRAINES
-These meds increase serotonin
example SUMATRIPTAN
patient taking Prozac and started on sumatriptan Correct answer- -call PCP to ask them
to switch the migraine med if patient already on SUMATRIPTAN do not start
antidepressant without talking to PCP
How long do you wait when switching between an SSRI to an MAOI? Correct answer- 2
weeks
How long do you wait when switching between Prozac and MAOI? Correct answer- 5-6
weeks wash out period
What is the first line treatment for depression and why? Correct answer- SSRI-First line
treatment for depression due to less risk of injury from OVERDOSE
