PMHNP Exam 2025//2027 | ALL Verified Exam | Questions & 100% Correct
Answer | pass!!
Which mood stabilizer is least likely to cause weight gain? -answer-Lamotrigine
How long does it take SJS rash to disappear after discontinuing lamotrigine? -answer-
2-3 weeks
Which antipsychotics cause the least amount of weight gain? -answer-Ziprasidone,
aripiprazole, lurasidone - ZAL
Which antipsychotic is least sedating? -answer-Aripiprazole
What labs/assessments should you order when prescribing any antipsychotic? -
answer-Weight/BMI, waist circumference, glucose, lipids
If patient is gaining weight with an antipsychotic, what is your priority action? -answer-
Encourage exercise and diet changes; if that doesn't work, switch to ZAL med
What are the black box warnings for carbamezapine? -answer-Agranulocytosis and
aplastic anemia (for both - fatigue, fever, nosebleeds, bleeding gums, frequent infx)
What population is at risk for SJS with use of carbamezapine? What should you test
for? -answer-Asians; test for HLAB-1502 allele
Which class of medications can decrease the efficacy of oral contraceptives? -answer-
Antiepileptics
What is a sign that a patient prescribed carbamezapine or cloazaril is experiencing
agranulocytosis? -answer-Sudden s/s infx (fever, chills, sore throat, etc.)
,In carbamazepine or clozaril, what ANC and WBC would you discontinue meds at> -
answer-ANC <1000; WBC <3000
What is the only know antipsychotic show to reduce risk of suicide in patients with
schizophrenia? -answer-Clozaril
Therapeutic range for lithium level -answer-0.6-1.2
At what level is lithium toxic? -answer-1.5
What is the neuroprotective psychotropic treatment of choice for bipolar d/o? -answer-
Lithium
What is the gold standard psychotropic tx for mania? -answer-Lithium
Which psychotropic has been associated with decreased suicide in those with bipolar
d/o? -answer-Lithium
What labs should you order when prescribing lithium? -answer-TSH, BUN/Cr, UA
(check proteins for kidney damage), Hcg
Lithium side effects -answer-Hypothyroidism, fine hand tremors, rash, GI upset,
diabetes insipidus (polyruia/polydipsia), t-wave inversion, leukocytosis, kidney disease
Normal range for creatinine -answer-0.6-1.2
Normal range for BUN -answer-10-20
Lithium can cause which birth defect? -answer-Ebstein anomaly (congenital heart
defect); avoid in pregnancy esp 1st trimester
Which mood stabilizer is safest in pregnancy? -answer-Lamotrigine
What should you do if patient has hx of thyroid issues or experiences hypothyroidism
while rx'd lithium? -answer-Refer to endo - don't need to dc med
S/s lithium toxicity -answer-Severe nausea/vomiting/diarrhea, confusion, muscle
weakness, heart palpitations, ocarse hand tremors, unsteadiness
What should you do if you suspect lithium toxicity? -answer-d/c med, check lithium
levels
What medications should you avoid in patients prescribed lithium and why? -answer-
Those that reduce renal clearance because they will increase lithium levels; ex:
NSAIDs, thiazides, ACE inhibitors, lisinopril
,Dehydration can cause _____ lithium levels -answer-Increased; encourage proper
hydration
Hyponatremia can cause _____ lithium levels -answer-Increased
If a patient experiencing tics is diagnosed with ADHD, what psychotropic should you
prescribe to tx the ADHD? -answer-Non-stimulants; avoid stimulants b/c worsen tics
Which medications can precipitate mania sx? -answer-Steroids, disulfiram, isoniazid,
antidepressants if bipolar d/o
Which medications can precipitate depression sx? -answer-Steroids, beta blockers,
interferon, isotretinoin, retrovirals, antineoplastics, benzos, progesterone
Which psychiatric sx can result from steroid use? -answer-Mania, depression,
psychosis
What birth defect can occur if BNZ are rx'd during pregnancy? -answer-Floppy baby
syndrome
What are the best tx for anxiety in pregnancy? -answer-Buspar, sertraline
Which P450 cytochrome metabolizes clozapine? -answer-CYP1A2
What P450 cytochrome does nicotine effect? -answer-CYP2A6
Enzyme inducers ____ serum levels of drugs -answer-Decrease; INDUCE metabolism;
increase dosage to reach therapeutic levels
A patient prescribed olanzapine begins smoking during treatment. How should you
adjust their medication? -answer-Nicotine is an inducer so need to increase med dose
to return to therapeutic levels
Enzyme inhibitors ____ serum levels of drugs -answer-Increase; INHIBIT metabolism;
decrease dosage to avoid toxicity
If a patient is prescribed both an inducer and an inhibitor, which takes priority? -
answer-The inhibitor; want to decrease levels of med to avoid toxicity
What role does MTHFR serve? -answer-Plays important role in metabolism of folate
(B9) and homoscysteine
What does an MTHFR genetic mutation result in? -answer-Decreased metabolism of
folate -> decreased B12 absorbed by body -> B12 deficiency
, MTHFR gene mutation interventions -answer-Increase folate intake, methylfolate
supplement, B12 supplement
What neurotransmitter changes occur with EPS? -answer-Increased ACh, decreased
DA
What psychotropic is used to treat EPS? -answer-benztropine
What antiemetic can cause EPS? -answer-Metoclopramide (reglan)
If a patient presents with TD, how would you proceed? -answer-Lower current dose or
switch to SGA
What medications are FDA approved for tx of TD? -answer-Deutetrabenezine,
valbenazine
Sx of NMS -answer-FEVER/HYPERTHERMIA, tachy, diaphoretic, muscle rigidity,
mutism, immobility, myoglobinuria, elevated CPK
If an antipsychotic is causing SE, the sx are likely r/t ___ or ___; if an antidepressant is
causing SE, the sx are likely r/t ___ -answer-antipsychotic: NMS or EPS;
antidepressant: SSRI
Hallmark sx of NMS -answer-Hyperthermia, extreme muscle rigidity
Psychopharm tx for NMS overall sx -answer-Bromocriptine (D2 agonist)
Psychopharm tx for NMS muscle rigidity -answer-Dantrolene (muscle relaxant)
Halmark of serotonin syndrome -answer-Hyperreflexia, myoclonic jerks
If a patient is exhibiting s/s serotonin syndrome, what is your course of action? -
answer-d/c offending agent, administer cyproheptadine
SE of St. John's Wort -answer-Elevated serotonin, impaired glucose tolerance,
decreased insulin response
How long should you wait to wash out from SSRI to MAOI? -answer-2 weeks
How long should you wait to wash out from fluoxetine to MAOI? -answer-5 weeks
How long should you wait to wash out from MAOI to fluoxetine? -answer-2 weeks
Answer | pass!!
Which mood stabilizer is least likely to cause weight gain? -answer-Lamotrigine
How long does it take SJS rash to disappear after discontinuing lamotrigine? -answer-
2-3 weeks
Which antipsychotics cause the least amount of weight gain? -answer-Ziprasidone,
aripiprazole, lurasidone - ZAL
Which antipsychotic is least sedating? -answer-Aripiprazole
What labs/assessments should you order when prescribing any antipsychotic? -
answer-Weight/BMI, waist circumference, glucose, lipids
If patient is gaining weight with an antipsychotic, what is your priority action? -answer-
Encourage exercise and diet changes; if that doesn't work, switch to ZAL med
What are the black box warnings for carbamezapine? -answer-Agranulocytosis and
aplastic anemia (for both - fatigue, fever, nosebleeds, bleeding gums, frequent infx)
What population is at risk for SJS with use of carbamezapine? What should you test
for? -answer-Asians; test for HLAB-1502 allele
Which class of medications can decrease the efficacy of oral contraceptives? -answer-
Antiepileptics
What is a sign that a patient prescribed carbamezapine or cloazaril is experiencing
agranulocytosis? -answer-Sudden s/s infx (fever, chills, sore throat, etc.)
,In carbamazepine or clozaril, what ANC and WBC would you discontinue meds at> -
answer-ANC <1000; WBC <3000
What is the only know antipsychotic show to reduce risk of suicide in patients with
schizophrenia? -answer-Clozaril
Therapeutic range for lithium level -answer-0.6-1.2
At what level is lithium toxic? -answer-1.5
What is the neuroprotective psychotropic treatment of choice for bipolar d/o? -answer-
Lithium
What is the gold standard psychotropic tx for mania? -answer-Lithium
Which psychotropic has been associated with decreased suicide in those with bipolar
d/o? -answer-Lithium
What labs should you order when prescribing lithium? -answer-TSH, BUN/Cr, UA
(check proteins for kidney damage), Hcg
Lithium side effects -answer-Hypothyroidism, fine hand tremors, rash, GI upset,
diabetes insipidus (polyruia/polydipsia), t-wave inversion, leukocytosis, kidney disease
Normal range for creatinine -answer-0.6-1.2
Normal range for BUN -answer-10-20
Lithium can cause which birth defect? -answer-Ebstein anomaly (congenital heart
defect); avoid in pregnancy esp 1st trimester
Which mood stabilizer is safest in pregnancy? -answer-Lamotrigine
What should you do if patient has hx of thyroid issues or experiences hypothyroidism
while rx'd lithium? -answer-Refer to endo - don't need to dc med
S/s lithium toxicity -answer-Severe nausea/vomiting/diarrhea, confusion, muscle
weakness, heart palpitations, ocarse hand tremors, unsteadiness
What should you do if you suspect lithium toxicity? -answer-d/c med, check lithium
levels
What medications should you avoid in patients prescribed lithium and why? -answer-
Those that reduce renal clearance because they will increase lithium levels; ex:
NSAIDs, thiazides, ACE inhibitors, lisinopril
,Dehydration can cause _____ lithium levels -answer-Increased; encourage proper
hydration
Hyponatremia can cause _____ lithium levels -answer-Increased
If a patient experiencing tics is diagnosed with ADHD, what psychotropic should you
prescribe to tx the ADHD? -answer-Non-stimulants; avoid stimulants b/c worsen tics
Which medications can precipitate mania sx? -answer-Steroids, disulfiram, isoniazid,
antidepressants if bipolar d/o
Which medications can precipitate depression sx? -answer-Steroids, beta blockers,
interferon, isotretinoin, retrovirals, antineoplastics, benzos, progesterone
Which psychiatric sx can result from steroid use? -answer-Mania, depression,
psychosis
What birth defect can occur if BNZ are rx'd during pregnancy? -answer-Floppy baby
syndrome
What are the best tx for anxiety in pregnancy? -answer-Buspar, sertraline
Which P450 cytochrome metabolizes clozapine? -answer-CYP1A2
What P450 cytochrome does nicotine effect? -answer-CYP2A6
Enzyme inducers ____ serum levels of drugs -answer-Decrease; INDUCE metabolism;
increase dosage to reach therapeutic levels
A patient prescribed olanzapine begins smoking during treatment. How should you
adjust their medication? -answer-Nicotine is an inducer so need to increase med dose
to return to therapeutic levels
Enzyme inhibitors ____ serum levels of drugs -answer-Increase; INHIBIT metabolism;
decrease dosage to avoid toxicity
If a patient is prescribed both an inducer and an inhibitor, which takes priority? -
answer-The inhibitor; want to decrease levels of med to avoid toxicity
What role does MTHFR serve? -answer-Plays important role in metabolism of folate
(B9) and homoscysteine
What does an MTHFR genetic mutation result in? -answer-Decreased metabolism of
folate -> decreased B12 absorbed by body -> B12 deficiency
, MTHFR gene mutation interventions -answer-Increase folate intake, methylfolate
supplement, B12 supplement
What neurotransmitter changes occur with EPS? -answer-Increased ACh, decreased
DA
What psychotropic is used to treat EPS? -answer-benztropine
What antiemetic can cause EPS? -answer-Metoclopramide (reglan)
If a patient presents with TD, how would you proceed? -answer-Lower current dose or
switch to SGA
What medications are FDA approved for tx of TD? -answer-Deutetrabenezine,
valbenazine
Sx of NMS -answer-FEVER/HYPERTHERMIA, tachy, diaphoretic, muscle rigidity,
mutism, immobility, myoglobinuria, elevated CPK
If an antipsychotic is causing SE, the sx are likely r/t ___ or ___; if an antidepressant is
causing SE, the sx are likely r/t ___ -answer-antipsychotic: NMS or EPS;
antidepressant: SSRI
Hallmark sx of NMS -answer-Hyperthermia, extreme muscle rigidity
Psychopharm tx for NMS overall sx -answer-Bromocriptine (D2 agonist)
Psychopharm tx for NMS muscle rigidity -answer-Dantrolene (muscle relaxant)
Halmark of serotonin syndrome -answer-Hyperreflexia, myoclonic jerks
If a patient is exhibiting s/s serotonin syndrome, what is your course of action? -
answer-d/c offending agent, administer cyproheptadine
SE of St. John's Wort -answer-Elevated serotonin, impaired glucose tolerance,
decreased insulin response
How long should you wait to wash out from SSRI to MAOI? -answer-2 weeks
How long should you wait to wash out from fluoxetine to MAOI? -answer-5 weeks
How long should you wait to wash out from MAOI to fluoxetine? -answer-2 weeks
