LMR Georgette’s PMHNP Certification
Exam UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
What does ADPIE stand for? - CORRECT ANSWER Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the middle of the
night? - CORRECT 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? - CORRECT
ANSWER Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? - CORRECT
ANSWER Check renal function
What do you do if a patient presents with fever while on Clozaril? - CORRECT
ANSWER Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - CORRECT ANSWER Antidepressants, St.
John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - CORRECT ANSWER Elevated WBC (over
11,000) and elevated CPK
S/S of NMS - CORRECT 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? - CORRECT
ANSWER Check for rhabdo with CPK
S/s of serotonin syndrome - CORRECT ANSWER hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - CORRECT ANSWER bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - CORRECT ANSWER cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS? - CORRECT ANSWER Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - CORRECT ANSWER Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - CORRECT
ANSWER NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and nsaids? - CORRECT ANSWER Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - CORRECT 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? - CORRECT
ANSWER Risk of fatal nephrotoxicity
, What is a fetal side effect of lithium? - CORRECT ANSWER Epstein's anomaly
What lab should you check for athletes on lithium? - CORRECT ANSWER Specific
gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - CORRECT ANSWER Do not give the
next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - CORRECT ANSWER >3
S/S of lithium toxicity - CORRECT ANSWER vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - CORRECT ANSWER Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - CORRECT
ANSWER Synthroid
What do you do if patient is prescribed both depakote and lamictal? - CORRECT
ANSWER Decreased lamictal dose by 50%
Depakote and pregnancy - CORRECT ANSWER Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
CORRECT ANSWER Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
CORRECT ANSWER lfts
What lab means pregnancy? - CORRECT ANSWER HCG
Exam UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
What does ADPIE stand for? - CORRECT ANSWER Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the middle of the
night? - CORRECT 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? - CORRECT
ANSWER Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? - CORRECT
ANSWER Check renal function
What do you do if a patient presents with fever while on Clozaril? - CORRECT
ANSWER Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? - CORRECT ANSWER Antidepressants, St.
John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS? - CORRECT ANSWER Elevated WBC (over
11,000) and elevated CPK
S/S of NMS - CORRECT 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? - CORRECT
ANSWER Check for rhabdo with CPK
S/s of serotonin syndrome - CORRECT ANSWER hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? - CORRECT ANSWER bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? - CORRECT ANSWER cyproheptadine
(Periactin)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS? - CORRECT ANSWER Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? - CORRECT ANSWER Within 24 hours of starting/changing
medication and resolves within a few days
How do you distinguish between NMS and acute dystonia? - CORRECT
ANSWER NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and nsaids? - CORRECT ANSWER Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? - CORRECT 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? - CORRECT
ANSWER Risk of fatal nephrotoxicity
, What is a fetal side effect of lithium? - CORRECT ANSWER Epstein's anomaly
What lab should you check for athletes on lithium? - CORRECT ANSWER Specific
gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? - CORRECT ANSWER Do not give the
next dose and assess for s/s
At what level is lithium toxicity a medical emergency? - CORRECT ANSWER >3
S/S of lithium toxicity - CORRECT ANSWER vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? - CORRECT ANSWER Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? - CORRECT
ANSWER Synthroid
What do you do if patient is prescribed both depakote and lamictal? - CORRECT
ANSWER Decreased lamictal dose by 50%
Depakote and pregnancy - CORRECT ANSWER Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain? -
CORRECT ANSWER Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine? -
CORRECT ANSWER lfts
What lab means pregnancy? - CORRECT ANSWER HCG
