PMHNP certification Exam KM questions and
answers
1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian
male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of
a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression): D.
68 y/o single white male with depression *5 risk factors (age, male, white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents what should you do?:
interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confiden- tial. Parents
may be upset but remember you are advocating for the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with olanzapine. Which of the
following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an- tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating),
Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or
if the patient is overly sedated try switching to ABILIFY
,6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
7. When presented with a question about typical vs atypical antipsychotic the answer is
usually to start of a: atypical
8. 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
9. When a patient is hesitant to participate in treatment you should encour- age?: Bring a
support person like a husband
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. 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
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM)
TSH secretion increased: TSH HIGH à COLD INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
,16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has reddish/brown urine:
Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
21. When taking Kava Kava in combinations with other medications you should caution
about: Risk of Hepatoxicity and Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters,
skin pain
24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
25. What nationality is most suseptible of getting steven johnson?: Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
, 28. Agranulocytosis when to discontinue medication: Less than 1000
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing age be sure to check?:
HCG
31. Which two medications may decrease the risk of suicide?: clozaril and lithium
32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-
hydrochlorithiazide ACE INHIBITORS-lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but HOW?: by reducing renal
clearance
35. When educating a patient about lithium teach them about: Hyponatremia
Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
37. Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium level
38. Lithium level of 1.4: Monitor for toxicity
answers
1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor B. 35 y/o single Asian
male with previous SI attempt *3 risk factors C. 38 y/o single AA male who is a manager of
a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression): D.
68 y/o single white male with depression *5 risk factors (age, male, white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents what should you do?:
interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confiden- tial. Parents
may be upset but remember you are advocating for the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with olanzapine. Which of the
following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor an- tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also least sedating),
Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or
if the patient is overly sedated try switching to ABILIFY
,6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
7. When presented with a question about typical vs atypical antipsychotic the answer is
usually to start of a: atypical
8. 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
9. When a patient is hesitant to participate in treatment you should encour- age?: Bring a
support person like a husband
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. 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
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HY- POTHYROIDISM)
TSH secretion increased: TSH HIGH à COLD INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
,16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has reddish/brown urine:
Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
21. When taking Kava Kava in combinations with other medications you should caution
about: Risk of Hepatoxicity and Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain, swelling, burning eyes, blisters,
skin pain
24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
25. What nationality is most suseptible of getting steven johnson?: Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
, 28. Agranulocytosis when to discontinue medication: Less than 1000
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing age be sure to check?:
HCG
31. Which two medications may decrease the risk of suicide?: clozaril and lithium
32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-
hydrochlorithiazide ACE INHIBITORS-lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but HOW?: by reducing renal
clearance
35. When educating a patient about lithium teach them about: Hyponatremia
Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
37. Lithium Toxicity: 1.5 or above
Discontinue and re-order lithium level
38. Lithium level of 1.4: Monitor for toxicity
