PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
A client presents with complains of changes in appetite, feeling
fatigued, problems with sleep-rest cycle, and changes in libido. What is
the neu- roanatomical area of the brain that is responsible for the normal
regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: 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
encour- age?: Bring a support person like a husband
Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis: HY-
PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms
HEAT INTOLERANCE
Key symptoms of Heat Intolerance: Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis: (HY-
POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD
INTERANCE
Key symptoms of Cold Intolerance: Hypothyroidism
Hyperthyroid can mimic: Mania
Hypothyroid can mimic: Depression
A patient on depakote complains of RUQ pain and has
reddish/brown urine: Hepatoxicity
-Check LFTs
Signs of Depakote toxicity: Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
What herbal supplement can cause hepatoxicity?: Kava Kava
When taking Kava Kava in combinations with other medications
you should caution about: Risk of Hepatoxicity and Sedation
TCAs carry a risk of: Hepatotoxicity
,PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling,
burning eyes, blisters, skin pain
two psychotropics known to cause steven johnson syndrome:
lamictal and tegretol
What nationality is most suseptible of getting steven johnson?: Asians
When treating asians with tegretal screen for?: HLAB-1502 Allele
What two medications cause agranulocytosis?: Clozaril & Tegretal
Agranulocytosis when to discontinue medication: Less than 1000
When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age
be sure to check?: HCG
Which two medications may decrease the risk of suicide?: clozaril
and lithium
Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-
lisinopril
Ace inhibitors are treatment of choice for?: Heart Failure
Certain medications are known to increase lithium level, but HOW?:
by reducing renal clearance
When educating a patient about lithium teach them about:
Hyponatremia Dehydration-hot days, exercise
Normal Lithium Level: 0.6-1.2
Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium
level
Lithium level of 1.4: Monitor for toxicity
Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to
check for presence of protein in the urine (4+ protein is concerning
for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY
4+ protein in the urine of a patient on lithium: 4+ protein is
concerning for renal impairment
,PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
4+ protein in urine=MONITOR FOR TOXICITY
Lithium side effects: 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: confusion, ataxia, GI upset, palpitation,
tremor
NMS: 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: test for
myoglobinuria may be a sign of rhabdo
Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO
in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus,
cardiovascular insta- bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Treatment for NMS: 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: Stop Med (1 or more SSRI,
SSNRI, TCA, MOAI)
-Cyproheptadine
Triptans: Used for MIGRAINES
-These meds increase
serotonin example
SUMATRIPTAN
patient taking Prozac and started on sumatriptan: -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?:
2 weeks
, PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
How long do you wait when switching between Prozac and MAOI?: 5-
6 weeks wash out period
What is the first line treatment for depression and why?: SSRI-First
line treatment for depression due to less risk of injury from
OVERDOSE
If a cancer patient has depression what should you consider?:
Treating with a medication with minimal drug/drug side effects like
Lexapro
Patient with depression worries about sexual dysfunction what would
be the medication of choice?: Wellbutrin
Primary symptoms of depression include fatigue and low energy
what med would you chose?: Wellbutrin
Wellbutrin is contraindicated in patients with: Seizures and anorexia
Which medications are best for neuropathic pain?:
SNRI Gabapentin
TCA
Secondary to the black box warning providers caring for patients on anti-
depressants should assess for?: Suicidality, frequency, and severity at
EVERY appointment
Which meds have the worse serotonin discontinuation syndrome:
Those with short half lives
such as zoloft
Symptoms of serotonin withdrawal syndrome: Fever, achiness,
soreness, lethargy, fatigue, impaired memory, decreased
concentration, GI UPSET
Shits and Shivers
Ages of onset for schizophrenia in males vs females: -MALES 18-25
years
-FEMALE 25-35 years
Schizophrenia increases the risk for: SUICIDE
*HIGH RISK OF SI in SCHIZOPHRENIA*
Just having schizophrenia increases your risk of suicide.
MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts)
CORRECT ANSWERS 2022
A client presents with complains of changes in appetite, feeling
fatigued, problems with sleep-rest cycle, and changes in libido. What is
the neu- roanatomical area of the brain that is responsible for the normal
regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: 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
encour- age?: Bring a support person like a husband
Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
When T4 and T3 are high and TSH is low what is the diagnosis: HY-
PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms
HEAT INTOLERANCE
Key symptoms of Heat Intolerance: Hyperthyroidism
When T4 and T3 are Low and TSH is high what is the diagnosis: (HY-
POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD
INTERANCE
Key symptoms of Cold Intolerance: Hypothyroidism
Hyperthyroid can mimic: Mania
Hypothyroid can mimic: Depression
A patient on depakote complains of RUQ pain and has
reddish/brown urine: Hepatoxicity
-Check LFTs
Signs of Depakote toxicity: Disorientation, confusion, lethargy
You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
What herbal supplement can cause hepatoxicity?: Kava Kava
When taking Kava Kava in combinations with other medications
you should caution about: Risk of Hepatoxicity and Sedation
TCAs carry a risk of: Hepatotoxicity
,PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling,
burning eyes, blisters, skin pain
two psychotropics known to cause steven johnson syndrome:
lamictal and tegretol
What nationality is most suseptible of getting steven johnson?: Asians
When treating asians with tegretal screen for?: HLAB-1502 Allele
What two medications cause agranulocytosis?: Clozaril & Tegretal
Agranulocytosis when to discontinue medication: Less than 1000
When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
Before starting any mood stabilizer in a female of childbearing age
be sure to check?: HCG
Which two medications may decrease the risk of suicide?: clozaril
and lithium
Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-
lisinopril
Ace inhibitors are treatment of choice for?: Heart Failure
Certain medications are known to increase lithium level, but HOW?:
by reducing renal clearance
When educating a patient about lithium teach them about:
Hyponatremia Dehydration-hot days, exercise
Normal Lithium Level: 0.6-1.2
Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium
level
Lithium level of 1.4: Monitor for toxicity
Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to
check for presence of protein in the urine (4+ protein is concerning
for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY
4+ protein in the urine of a patient on lithium: 4+ protein is
concerning for renal impairment
,PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
4+ protein in urine=MONITOR FOR TOXICITY
Lithium side effects: 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: confusion, ataxia, GI upset, palpitation,
tremor
NMS: 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: test for
myoglobinuria may be a sign of rhabdo
Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO
in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus,
cardiovascular insta- bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
Treatment for NMS: 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: Stop Med (1 or more SSRI,
SSNRI, TCA, MOAI)
-Cyproheptadine
Triptans: Used for MIGRAINES
-These meds increase
serotonin example
SUMATRIPTAN
patient taking Prozac and started on sumatriptan: -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?:
2 weeks
, PMHNP NURS 706 CERTIFICATION EXAM QUESTIONS WITH
CORRECT ANSWERS 2022
How long do you wait when switching between Prozac and MAOI?: 5-
6 weeks wash out period
What is the first line treatment for depression and why?: SSRI-First
line treatment for depression due to less risk of injury from
OVERDOSE
If a cancer patient has depression what should you consider?:
Treating with a medication with minimal drug/drug side effects like
Lexapro
Patient with depression worries about sexual dysfunction what would
be the medication of choice?: Wellbutrin
Primary symptoms of depression include fatigue and low energy
what med would you chose?: Wellbutrin
Wellbutrin is contraindicated in patients with: Seizures and anorexia
Which medications are best for neuropathic pain?:
SNRI Gabapentin
TCA
Secondary to the black box warning providers caring for patients on anti-
depressants should assess for?: Suicidality, frequency, and severity at
EVERY appointment
Which meds have the worse serotonin discontinuation syndrome:
Those with short half lives
such as zoloft
Symptoms of serotonin withdrawal syndrome: Fever, achiness,
soreness, lethargy, fatigue, impaired memory, decreased
concentration, GI UPSET
Shits and Shivers
Ages of onset for schizophrenia in males vs females: -MALES 18-25
years
-FEMALE 25-35 years
Schizophrenia increases the risk for: SUICIDE
*HIGH RISK OF SI in SCHIZOPHRENIA*
Just having schizophrenia increases your risk of suicide.
MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts)
