LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
Assessment
Diagnosis
Planning
What does ADPIE stand for? Implementation
Evaluation
Ask her if it's happened before to assess for sleep issue patterns
What should you do when a mother reports
her child woke up screaming in the middle
of the night?
Scrape nail and send for testing
What do you do if a patient comes in with
fungus on their toenail?
Check renal function
What do you do if a patient on lithium has
dark brown urine?
Check ANC level to assess for agranulocytosis
What do you do if a patient presents with
fever while on Clozaril?
What can cause serotonin syndrome? Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? Elevated WBC (over 11,000) and elevated CPK
muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental
S/S of NMS status, cherry colored urine
Check for rhabdo with CPK
What should you do if a patient presents
with cherry colored urine?
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
s/s of serotonin syndrome tachycardia, HTN, shits and shivers
What two medications to give with NMS? bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? cyproheptadine (Periactin)- 5HT-2A receptor antagonist
Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
What is the onset and typical length of
days
NMS?
What is the onset of SS? Within 24 hours of starting/changing medication and resolves within a few days
How do you distinguish between NMS and NMS has a slower onset while acute dystonia occurs within hours
acute dystonia?
What happens with lithium and NSAIDs? Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
Increased risk of lithium toxicity related to the increased urination from the ACE
What happens with lithium and ACE
inhibitors
inhibitors?
Why should a patient on lithium avoid Risk of fatal nephrotoxicity
calcium channel blockers?
What is a fetal side effect of lithium? Epstein's anomaly
Specific gravity to assess for dehydration (dehydration is >1.015)
What lab should you check for athletes on
lithium?
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 >3
emergency?
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
S/S of lithium toxicity weakness/twitching
Why check an EKG with lithium? Inverted T-waves
Synthroid
What medication should treat
hypothyroidism caused by lithium use?
, LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
Decreased lamictal dose by 50%
What do you do if patient is prescribed
both depakote and lamictal?
Depakote and pregnancy Spina bifida
Pancreatitis
What emergency may be occuring if
patient on depakote reports upper
abdominal pain?
LFTs
What lab should you check if patient has
right upper quadrant pain and dark brown
urine?
What lab means pregnancy? HCG
Treatment resistant schizophrenia, improves SI, and improves negative symptoms
Why is Clozaril used? of schizophrenia
Clozaril and Tegretol
What two medications have the highest
risk of agranulocytosis and aplastic
anemia?
Sore throats, sores in mouth/gums, fever
What symptoms may mean a Clozaril
induced infection?
WBC < 2000 or ANC <1000
When should you discontinue Clozaril or
Tegretol?
For the HLA-B*1502 allele (higher risk of SJS)
What should you check in Asian patients
taking Tegretol?
Toxic epidermal necrosis and SJS
What two epidermal issues can arise from
Tegretol or Lamictal?
Aspetic meningitis
What may be the issue if a patient on
Lamictal presents with a fever and severe
headache?
Geodon, Abilify, and Latuda
What three antipsychotics have very low
weight gaining effects?
3 word recall and
Mini-Cog clock drawing
24-30 severe impairment
18-23 mild impairment
MMSE scoring 17 and less no impairment
What happens during pruning? Brain eliminates extra synapses during infancy
Excess synapses caused by under-pruning (patient oversensitive to light/sounds
autism and pruning and seizures)
schizophrenia and pruning Fewer synapses caused by over-pruning
Grey matter- synapses, working area of brain, dendrites
grey matter vs white matter White matter- myelinated axons
axons and dendrites axon away from cell and dendrites to neuron's cell body
CNS is made up of brain and spinal cord
PNS consists of cranial nerves and spinal nerves- responsible for voluntary movement
the division of the peripheral nervous system that controls the body's skeletal
somatic nervous system muscles
the part of the peripheral nervous system that controls the glands and the muscles
autonomic nervous system of the internal organs
, LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
the division of the autonomic nervous system that calms the body, conserving its
parasympathetic nervous system energy
the division of the autonomic nervous system that arouses the body, mobilizing its
sympathetic nervous system energy in stressful situations
prefrontal cortex part of frontal lobe responsible for thinking, planning, and language
What part of the brain is responsible for Prefrontal cortex- Explains TMS
perception of pain?
What is the dorsolateral prefrontal cortex Executive functioning- undergoes maturation until adulthood
responsible for?
orbitofrontal cortex a region of the brain that controls impulses and attention (ADHD explained)
associated with reasoning, planning, parts of speech (Broca-forming), movement,
frontal lobe emotions, and problem solving
A region of the cerebral cortex whose functions include memory, attention,
parietal lobe perception, cognition, taste, and reading/writing
occipital lobe A region of the cerebral cortex that processes visual information
A region of the cerebral cortex responsible for hearing, agnosia, and language
temporal lobe (Wernicke's area-receptive speech)
Temporal
Issues with what lobe can lead to
visual/auditory hallucinations?
Sends signal to hypothalamus when in distress, which then communicates to the
How does the amygdala work? rest of the body through the nervous system
anterior cingulate cortex critical for stress; implicated in childhood trauma
basal ganglia directs intentional movements and is also called the corpus striatum
Hypothalamus brain region controlling appetite, sleep, libido, heart rate
A neural center located in the limbic system that helps process explicit memories for
Hippocampus storage.
mesolimbic pathway positive symptoms of schizophrenia due to increased dopamine
mesocortical pathway negative symptoms of schizophrenia due to decreased dopamine
Nigrostriatal pathway EPS with increased acetylcholine and decreased dopamine
Tuberoinfundibular pathway decreased dopamine causes increased prolactin levels
Monoamines dopamine, norepinephrine, serotonin, epinephrine
amino acids Glutamate and GABA
Cholinergic acetylcholine and neuropeptides
Brain Changes in Alzheimer's Disease amyloid plaques and neurofibrillary tangles
Increased- parkinson's
Increased and decreased acetylcholine Decreased-alzheimers
Where is Norepinephrine produced? locus coeruleus
Where is serotonin produced? raphe nuclei
Where is epinephrine produced? adrenal glands
Where is dopamine produced? substantia nigra and ventral tegmental area
Where is GABA synthesized? limbic system
Severe spasm of the tongue, neck, eyes, face and back; laryngeal spasms (mutism)
s/s of acute dystonia
Akathisia motor restlessness
, LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
Parkinonism s/s slouched posture, shuffling gait, rigid, bradykinesia, tremors at rest, pin-rolling
involuntary movements of the facial muscles, tongue, and limbs, protrusion of
tardive dyskinesia tongue, smacking lips
Aims abnormal involuntary movement scale
Neurotransmitters autism gaba, serotonin, glutamate
mood disorder neurotransmitters norepinephrine and serotonin
bipolar neurotransmitters increased glutamate
increased norepinephrine and
Anxiety neurotransmitters decreased GABA
OCD neurotransmitters decreased serotonin
Parkinson's neurotransmitters increased acetylcholine and decreased dopamine
ADHD neurotransmitters decrease in dopamine and norepinephrine
Tourette's Neurotransmitters dopamine, serotonin, GABA, and glutamate
What to prescribe for Tourette's Risperdal
Substance abuse neurotransmitters decrease in opioid neuropeptides
Alcohol abuse neurotransmitters increase in GABA and dopamine and decrease in serotonin
Depression neurotransmitters decrease in serotonin, dopamine, and norepinephrine
sleep neurotransmitters low serotonin causes insomnia (Melatonin is pre-cursor)
Schizophrenia neurotransmitters increased dopamine and decreased serotonin
disturbance of affect, blunting (severe reduction in the intensity of affect expression),
flat affect, inappropriate affect (might laugh hysterically while describing someones
negative symptoms of schizophrenia death)
Delusions of reference, delusions of persecution, delusions of grandeur, thought
broadcasting, though insertion, hallucinations, disorganized thought, disorganized
positive symptoms of schizophrenia behavior, catatonia
Risk of metabolic syndrome: increased weight, blood glucose, triglycerides, and
Side effects of atypical antipsychotics insulin resistance
Zyprexa (Olanzapine) side effect Excessive weight gain
Seroquel side effects weight gain and sedation; cataracts (assess with slit lamp)
Thorazine (chlorpromazine) corneal deposits
Geodon (ziprasidone) weight neutral, take with food, monitor for QT prolongation
Latuda (lurasidone) eat with med 360 calories
Reglan is a D2 dopamine antagonist and should be avoided with Risperdal for 2
Risperdal and Reglan hours. It decreases the absorption of the Risperdal.
First line antipsychotic in children Risperdal (max 3 mg/day)
gray-white arc or circle around the limbus of the iris that is common with aging;
arcus senilis hyperlipidemia
Protection of ischemic injuries atypical antipsychotics
18-25 males
Ages of Schizophrenia 25-35 females
They are inhibitors and will decrease the absorption of Risperdal in liver
Why dose cimetidine, zantac, and
omeprazole 2 hours apart from Risperdal?
Assessment
Diagnosis
Planning
What does ADPIE stand for? Implementation
Evaluation
Ask her if it's happened before to assess for sleep issue patterns
What should you do when a mother reports
her child woke up screaming in the middle
of the night?
Scrape nail and send for testing
What do you do if a patient comes in with
fungus on their toenail?
Check renal function
What do you do if a patient on lithium has
dark brown urine?
Check ANC level to assess for agranulocytosis
What do you do if a patient presents with
fever while on Clozaril?
What can cause serotonin syndrome? Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? Elevated WBC (over 11,000) and elevated CPK
muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental
S/S of NMS status, cherry colored urine
Check for rhabdo with CPK
What should you do if a patient presents
with cherry colored urine?
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever,
s/s of serotonin syndrome tachycardia, HTN, shits and shivers
What two medications to give with NMS? bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? cyproheptadine (Periactin)- 5HT-2A receptor antagonist
Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14
What is the onset and typical length of
days
NMS?
What is the onset of SS? Within 24 hours of starting/changing medication and resolves within a few days
How do you distinguish between NMS and NMS has a slower onset while acute dystonia occurs within hours
acute dystonia?
What happens with lithium and NSAIDs? Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
Increased risk of lithium toxicity related to the increased urination from the ACE
What happens with lithium and ACE
inhibitors
inhibitors?
Why should a patient on lithium avoid Risk of fatal nephrotoxicity
calcium channel blockers?
What is a fetal side effect of lithium? Epstein's anomaly
Specific gravity to assess for dehydration (dehydration is >1.015)
What lab should you check for athletes on
lithium?
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 >3
emergency?
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
S/S of lithium toxicity weakness/twitching
Why check an EKG with lithium? Inverted T-waves
Synthroid
What medication should treat
hypothyroidism caused by lithium use?
, LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
Decreased lamictal dose by 50%
What do you do if patient is prescribed
both depakote and lamictal?
Depakote and pregnancy Spina bifida
Pancreatitis
What emergency may be occuring if
patient on depakote reports upper
abdominal pain?
LFTs
What lab should you check if patient has
right upper quadrant pain and dark brown
urine?
What lab means pregnancy? HCG
Treatment resistant schizophrenia, improves SI, and improves negative symptoms
Why is Clozaril used? of schizophrenia
Clozaril and Tegretol
What two medications have the highest
risk of agranulocytosis and aplastic
anemia?
Sore throats, sores in mouth/gums, fever
What symptoms may mean a Clozaril
induced infection?
WBC < 2000 or ANC <1000
When should you discontinue Clozaril or
Tegretol?
For the HLA-B*1502 allele (higher risk of SJS)
What should you check in Asian patients
taking Tegretol?
Toxic epidermal necrosis and SJS
What two epidermal issues can arise from
Tegretol or Lamictal?
Aspetic meningitis
What may be the issue if a patient on
Lamictal presents with a fever and severe
headache?
Geodon, Abilify, and Latuda
What three antipsychotics have very low
weight gaining effects?
3 word recall and
Mini-Cog clock drawing
24-30 severe impairment
18-23 mild impairment
MMSE scoring 17 and less no impairment
What happens during pruning? Brain eliminates extra synapses during infancy
Excess synapses caused by under-pruning (patient oversensitive to light/sounds
autism and pruning and seizures)
schizophrenia and pruning Fewer synapses caused by over-pruning
Grey matter- synapses, working area of brain, dendrites
grey matter vs white matter White matter- myelinated axons
axons and dendrites axon away from cell and dendrites to neuron's cell body
CNS is made up of brain and spinal cord
PNS consists of cranial nerves and spinal nerves- responsible for voluntary movement
the division of the peripheral nervous system that controls the body's skeletal
somatic nervous system muscles
the part of the peripheral nervous system that controls the glands and the muscles
autonomic nervous system of the internal organs
, LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
the division of the autonomic nervous system that calms the body, conserving its
parasympathetic nervous system energy
the division of the autonomic nervous system that arouses the body, mobilizing its
sympathetic nervous system energy in stressful situations
prefrontal cortex part of frontal lobe responsible for thinking, planning, and language
What part of the brain is responsible for Prefrontal cortex- Explains TMS
perception of pain?
What is the dorsolateral prefrontal cortex Executive functioning- undergoes maturation until adulthood
responsible for?
orbitofrontal cortex a region of the brain that controls impulses and attention (ADHD explained)
associated with reasoning, planning, parts of speech (Broca-forming), movement,
frontal lobe emotions, and problem solving
A region of the cerebral cortex whose functions include memory, attention,
parietal lobe perception, cognition, taste, and reading/writing
occipital lobe A region of the cerebral cortex that processes visual information
A region of the cerebral cortex responsible for hearing, agnosia, and language
temporal lobe (Wernicke's area-receptive speech)
Temporal
Issues with what lobe can lead to
visual/auditory hallucinations?
Sends signal to hypothalamus when in distress, which then communicates to the
How does the amygdala work? rest of the body through the nervous system
anterior cingulate cortex critical for stress; implicated in childhood trauma
basal ganglia directs intentional movements and is also called the corpus striatum
Hypothalamus brain region controlling appetite, sleep, libido, heart rate
A neural center located in the limbic system that helps process explicit memories for
Hippocampus storage.
mesolimbic pathway positive symptoms of schizophrenia due to increased dopamine
mesocortical pathway negative symptoms of schizophrenia due to decreased dopamine
Nigrostriatal pathway EPS with increased acetylcholine and decreased dopamine
Tuberoinfundibular pathway decreased dopamine causes increased prolactin levels
Monoamines dopamine, norepinephrine, serotonin, epinephrine
amino acids Glutamate and GABA
Cholinergic acetylcholine and neuropeptides
Brain Changes in Alzheimer's Disease amyloid plaques and neurofibrillary tangles
Increased- parkinson's
Increased and decreased acetylcholine Decreased-alzheimers
Where is Norepinephrine produced? locus coeruleus
Where is serotonin produced? raphe nuclei
Where is epinephrine produced? adrenal glands
Where is dopamine produced? substantia nigra and ventral tegmental area
Where is GABA synthesized? limbic system
Severe spasm of the tongue, neck, eyes, face and back; laryngeal spasms (mutism)
s/s of acute dystonia
Akathisia motor restlessness
, LMR Georgette?s PMHNP Certification Exam Latest 2025 Questions And Correct Answers
Parkinonism s/s slouched posture, shuffling gait, rigid, bradykinesia, tremors at rest, pin-rolling
involuntary movements of the facial muscles, tongue, and limbs, protrusion of
tardive dyskinesia tongue, smacking lips
Aims abnormal involuntary movement scale
Neurotransmitters autism gaba, serotonin, glutamate
mood disorder neurotransmitters norepinephrine and serotonin
bipolar neurotransmitters increased glutamate
increased norepinephrine and
Anxiety neurotransmitters decreased GABA
OCD neurotransmitters decreased serotonin
Parkinson's neurotransmitters increased acetylcholine and decreased dopamine
ADHD neurotransmitters decrease in dopamine and norepinephrine
Tourette's Neurotransmitters dopamine, serotonin, GABA, and glutamate
What to prescribe for Tourette's Risperdal
Substance abuse neurotransmitters decrease in opioid neuropeptides
Alcohol abuse neurotransmitters increase in GABA and dopamine and decrease in serotonin
Depression neurotransmitters decrease in serotonin, dopamine, and norepinephrine
sleep neurotransmitters low serotonin causes insomnia (Melatonin is pre-cursor)
Schizophrenia neurotransmitters increased dopamine and decreased serotonin
disturbance of affect, blunting (severe reduction in the intensity of affect expression),
flat affect, inappropriate affect (might laugh hysterically while describing someones
negative symptoms of schizophrenia death)
Delusions of reference, delusions of persecution, delusions of grandeur, thought
broadcasting, though insertion, hallucinations, disorganized thought, disorganized
positive symptoms of schizophrenia behavior, catatonia
Risk of metabolic syndrome: increased weight, blood glucose, triglycerides, and
Side effects of atypical antipsychotics insulin resistance
Zyprexa (Olanzapine) side effect Excessive weight gain
Seroquel side effects weight gain and sedation; cataracts (assess with slit lamp)
Thorazine (chlorpromazine) corneal deposits
Geodon (ziprasidone) weight neutral, take with food, monitor for QT prolongation
Latuda (lurasidone) eat with med 360 calories
Reglan is a D2 dopamine antagonist and should be avoided with Risperdal for 2
Risperdal and Reglan hours. It decreases the absorption of the Risperdal.
First line antipsychotic in children Risperdal (max 3 mg/day)
gray-white arc or circle around the limbus of the iris that is common with aging;
arcus senilis hyperlipidemia
Protection of ischemic injuries atypical antipsychotics
18-25 males
Ages of Schizophrenia 25-35 females
They are inhibitors and will decrease the absorption of Risperdal in liver
Why dose cimetidine, zantac, and
omeprazole 2 hours apart from Risperdal?
