PMHNP Certification Exam with complete solution
1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci-
nations
2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital
(12 +)
3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC
STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty
things
• This is NORMAL for children this age.
4. What do you do when a patient has an increased prolactin level?: • Stop
prolactin (stop the agent that cause increase prolactin)
5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks -
UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
6. What would you do if a 5-year-old tells you his brother sodomized him?: •
Tell mom don't leave him alone with patient and call CPS implement crisis
7. If a child is playing with doll in a sexual way, what do you do first?: •
You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER
ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You
HAVE to report but you have to have something (assessment data) to report -
Assess = FIRST
8. If a 13-year-old tells you he want to smoke, what would be an appropriate
response?: • Ask him of his plan to stop smoking
9. If a 14-year-old girl clenching her teeth, what cranial nerve would you
suspect?: • Cranial nerve V-Trigeminal nerve (FIVE)
10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis
11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7
12. What cranial nerves do you assess for papillary reaction to light and
accommodation?: Nerves 3,4,& 6
13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc-
ular movements?: Nerves 3, 4, & 6
, PMHNP Certification Exam with complete solution
14. What cranial nerves do you assess for corneal light reflex?: 3, 4, & 6
15. Cranial Nerve 1: Olfactory (smell)
16. Cranial Nerve 2: Optic - vision
17. Cranial Nerve 3: Oculomotor (eye movement): The occulomotor nerve is re-
sponsible for motor enervation of upper eyelid muscle, extraocular muscle and
pupillary muscle.
18. Cranial Nerve 4: Trochlear (eye movement): The trochlear nerve controls an
extraocular muscle.
19. Cranial Nerve 5: Trigeminal: The trigeminal nerve is responsible for sensory
enervation of the face and motor enervation to muscles of mastication (chewing).
20. Cranial Nerve 6: Abducens (motor): The abducent nerve enervates a muscle,
which moves the eyeball.
21. Cranial Nerve 7: Facial nerve: The facial nerve enervates the muscles of the
face (facial expression).
22. Cranial Nerve 8: Vestibulocochlear (hearing and balance): The vestibulo-
cochlear nerve is responsible for the sense of hearing and balance (body position
sense).
23. Cranial Nerve 9: Glossopharyngeal: The glossopharyngeal nerve enervates
muscles involved in swallowing and taste. Lesions of the ninth nerve result in
difficulty swallowing and disturbance of taste.
24. Cranial Nerve 10: vagus nerve: The vagus nerve enervates the gut (gastroin-
testinal tract), heart and larynx.
25. Cranial Nerve 11: accessory: The accessory nerve enervates the sternoclei-
domastoid muscles and the trapezius muscles.
26. Cranial Nerve 12: Hypoglossal (tongue movement): The hypoglossal nerve
enervates the muscles of the tongue.
27. What is the best action for a 16 y/o with conduct disorder that refuses
tx?: • Send to psych specialist for acting out kids - Referrals - Have to see if you are
going to refer the same patient to the same provider - Cannot refer the patient to
another provider that is the same as you (ie psych) - you must refer to a neurologist
or another specialist or PCP
28. What is a priority consideration for a 16-year-old that shows up with
mother for first therapy?: • Confidentiality (ex. mom sits in lobby)
, PMHNP Certification Exam with complete solution
29. What is important to know about ACE inhibitors (Meds for Heart fail-
ure/HTN): • This medication can cause increased lithium levels to toxic levels -
must collaborate with PCP to determine whether to change ACE or change Lithium
- Can't use both
30. What medication INCREASES Lithium serum level up to double: Ibuprofen
31. Why is Lithium used?: • First-line neuro-protective for bipolar
32. • Lab Values concerning for patient on Lithium:: • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• + Pregnancy Test
33. • Lithium (Eskalith/Lithobid) Toxicity: • Normal Range of LITHIUM LEVEL -
0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
34. Common side effects of Lithium (Eskalith/Lithobid): Nausea, fine-hand
tremors (start monitoring for toxicity), increased urination and thirst
35. What pregnancy category is Lithium (Eskalith/Lithobid): CATEGORY D:
AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect
36. What increases risk of lithium (Eskalith/Lithobid) toxicity?: NSAID, dehy-
dration and Thiazides
37. What co-morbid risk in increased with Lithium (Eskalith/Lithobid)?: • Risk
of Hypothyroidism
38. What do symptoms of hypothyroidism (decreased T4 & increased TSH)
mimic?: Unipolar mood disorders:
- confusion
- decreased libido
- impotence
- decreased apetite
- memory loss
- lethargy
- constipation
- headaches
, PMHNP Certification Exam with complete solution
- slow or clumsy movements
- syncope
- weight gain
- fluid retention
- muscle aches and stiffness
- slowed reflexes
- somatic discomfort including aching and joint stiffness
- slowed speech and thinking
- sensory disturbances including hearing
- cerebellar ataxia (may present with symptoms of an inability to coordinate
balance, gait, extremity and eye movements)
- loss of amplitude in ECG
39. What do symptoms of hyperthyroidism (decreased TSH & increased T4)
mimic?: Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias
40. What does ADPIE stand for?: • Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
41. Recommend CBT for: Depression & Anxiety (keep a daily log)
42. pg 209 and every PB pages for each dx: all thing for each disorder
43. What medication is best for an aggressive patient?: IM Geodon
1. What are assessed in the Thought Content of the MSE: SI/HI, Plan, Halluci-
nations
2. • PNEUMOIC - Old Age Parents Love Grandchildren: • Oral (0-18 months),
Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital
(12 +)
3. • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC
STAGE - 3-6 years old: • 3-year-old masturbates, play with self, says naughty
things
• This is NORMAL for children this age.
4. What do you do when a patient has an increased prolactin level?: • Stop
prolactin (stop the agent that cause increase prolactin)
5. • ACUTE STRESS DISORDER: • A d/o resulting from exposure to a major
stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep
disturbances, problems in concentrations, reliving the event, dreams, flashbacks -
UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
- Symptoms that occur immediately after the event but resolve in less than 3 days
would not meet criteria for acute stress disorder
6. What would you do if a 5-year-old tells you his brother sodomized him?: •
Tell mom don't leave him alone with patient and call CPS implement crisis
7. If a child is playing with doll in a sexual way, what do you do first?: •
You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER
ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You
HAVE to report but you have to have something (assessment data) to report -
Assess = FIRST
8. If a 13-year-old tells you he want to smoke, what would be an appropriate
response?: • Ask him of his plan to stop smoking
9. If a 14-year-old girl clenching her teeth, what cranial nerve would you
suspect?: • Cranial nerve V-Trigeminal nerve (FIVE)
10. What cranial nerve is responsible for Bells Palsy?: 7 = Facial Paralysis
11. What cranial nerves do you assess for corneal sensation: Nerves 5 & 7
12. What cranial nerves do you assess for papillary reaction to light and
accommodation?: Nerves 3,4,& 6
13. What cranial nerves do you assess for 6 cardinal fields of gaze & extra-oc-
ular movements?: Nerves 3, 4, & 6
, PMHNP Certification Exam with complete solution
14. What cranial nerves do you assess for corneal light reflex?: 3, 4, & 6
15. Cranial Nerve 1: Olfactory (smell)
16. Cranial Nerve 2: Optic - vision
17. Cranial Nerve 3: Oculomotor (eye movement): The occulomotor nerve is re-
sponsible for motor enervation of upper eyelid muscle, extraocular muscle and
pupillary muscle.
18. Cranial Nerve 4: Trochlear (eye movement): The trochlear nerve controls an
extraocular muscle.
19. Cranial Nerve 5: Trigeminal: The trigeminal nerve is responsible for sensory
enervation of the face and motor enervation to muscles of mastication (chewing).
20. Cranial Nerve 6: Abducens (motor): The abducent nerve enervates a muscle,
which moves the eyeball.
21. Cranial Nerve 7: Facial nerve: The facial nerve enervates the muscles of the
face (facial expression).
22. Cranial Nerve 8: Vestibulocochlear (hearing and balance): The vestibulo-
cochlear nerve is responsible for the sense of hearing and balance (body position
sense).
23. Cranial Nerve 9: Glossopharyngeal: The glossopharyngeal nerve enervates
muscles involved in swallowing and taste. Lesions of the ninth nerve result in
difficulty swallowing and disturbance of taste.
24. Cranial Nerve 10: vagus nerve: The vagus nerve enervates the gut (gastroin-
testinal tract), heart and larynx.
25. Cranial Nerve 11: accessory: The accessory nerve enervates the sternoclei-
domastoid muscles and the trapezius muscles.
26. Cranial Nerve 12: Hypoglossal (tongue movement): The hypoglossal nerve
enervates the muscles of the tongue.
27. What is the best action for a 16 y/o with conduct disorder that refuses
tx?: • Send to psych specialist for acting out kids - Referrals - Have to see if you are
going to refer the same patient to the same provider - Cannot refer the patient to
another provider that is the same as you (ie psych) - you must refer to a neurologist
or another specialist or PCP
28. What is a priority consideration for a 16-year-old that shows up with
mother for first therapy?: • Confidentiality (ex. mom sits in lobby)
, PMHNP Certification Exam with complete solution
29. What is important to know about ACE inhibitors (Meds for Heart fail-
ure/HTN): • This medication can cause increased lithium levels to toxic levels -
must collaborate with PCP to determine whether to change ACE or change Lithium
- Can't use both
30. What medication INCREASES Lithium serum level up to double: Ibuprofen
31. Why is Lithium used?: • First-line neuro-protective for bipolar
32. • Lab Values concerning for patient on Lithium:: • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• + Pregnancy Test
33. • Lithium (Eskalith/Lithobid) Toxicity: • Normal Range of LITHIUM LEVEL -
0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic
taste and SEVERE tremor.
34. Common side effects of Lithium (Eskalith/Lithobid): Nausea, fine-hand
tremors (start monitoring for toxicity), increased urination and thirst
35. What pregnancy category is Lithium (Eskalith/Lithobid): CATEGORY D:
AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect
36. What increases risk of lithium (Eskalith/Lithobid) toxicity?: NSAID, dehy-
dration and Thiazides
37. What co-morbid risk in increased with Lithium (Eskalith/Lithobid)?: • Risk
of Hypothyroidism
38. What do symptoms of hypothyroidism (decreased T4 & increased TSH)
mimic?: Unipolar mood disorders:
- confusion
- decreased libido
- impotence
- decreased apetite
- memory loss
- lethargy
- constipation
- headaches
, PMHNP Certification Exam with complete solution
- slow or clumsy movements
- syncope
- weight gain
- fluid retention
- muscle aches and stiffness
- slowed reflexes
- somatic discomfort including aching and joint stiffness
- slowed speech and thinking
- sensory disturbances including hearing
- cerebellar ataxia (may present with symptoms of an inability to coordinate
balance, gait, extremity and eye movements)
- loss of amplitude in ECG
39. What do symptoms of hyperthyroidism (decreased TSH & increased T4)
mimic?: Bipolar affective disorders
- motor restlessness
- emotional lability
- short attention span
- compulsive movements
- fatigue
- tremor
- insomnia
- impotence
- weight loss
- increased appetite
- abdominal pain
- excessive sweating
- flushing
- elevated upper eyelid leading to decreased blinking, starring, and fine tremor
- tachycardia
- dysrhythmias
40. What does ADPIE stand for?: • Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
41. Recommend CBT for: Depression & Anxiety (keep a daily log)
42. pg 209 and every PB pages for each dx: all thing for each disorder
43. What medication is best for an aggressive patient?: IM Geodon
