PMHNP Boards - Scientific Foundation and Advance
Practice Skills
Which of the following is a contraindication to benzodiazepines?
a. Acute alcohol intoxication
b. Acute narrow angle glaucoma
c. Psychosis
d. All the above - ✔✔a. Acute alcohol intoxication
In the pharmacological treatment of psychosis, when antipsychotics are administered, which block
dopamine, a secondary effect is blocking in another tract, which causes potential prolactin problems,
such as gynecomastia in males. This tract is the:
a. mesolimbic
b. tuberoinfundibular
c. nigrostrial dopamine tract
d. mesocortical - ✔✔b. tuberoinfundibular
A six-year-old patient with autism spectrum disorder has not responded to six months of
psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger
sibling. The psychiatric-mental health nurse practitioner prescribes:
1. carbamazepine (Tegretol) 200 mg once a day.
2. haloperidol (Haldol) 2 mg once a day.
3. risperidone (Risperdal) 0.25 mg once a day.
4. venlafaxine ER (Effexor XR) 37.5 mg once a day. - ✔✔3. risperidone (Risperdal) 0.25 mg once a day.
Which drug is likely to produce liver failure and hepatitis?
1. Lamotrigine
2. Gabapentin
3. Carbamazepine
4. Topiramate - ✔✔3. Carbamazepine
EPS arises from:
a. D2 blockade in the nigrostriatial tract
b. D2 blockade in the tuberoinfundibular tract
c. D2 blockade in the alpha-1 adrenergic receptor blockade
,d. D2 blockade in the HPA axis - ✔✔a. D2 blockade in the nigrostriatial tract
Which drug carries a higher risk of metabolic effects than the other second generation
antipsychotics: weight gain, diabetes, dyslipidemia ?
a. Clozaril
b. Zyprexa
c. Risperdal
d. Geodon - ✔✔b. Zyprexa
A patient has not had any relief of symptoms with Fluoxetine, and is going to be started on an MAOI.
How long before starting the MAOI should the Fluoxetine be withdrawn?
a. 2 weeks
b. 3 weeks
c. 4 weeks
d. 5 weeks - ✔✔a. 2 weeks
Which drug can produce serious side effect of rash in some Asians, and the FDA has mandated
genetic testing before the administration of this drug?
a. Dilantin
b. Lamictal
c. Depakote
d. Tegretol - ✔✔d. Tegretol
Which is considered the most sedating SSRI?
a. Paroxetine
b. Sertraline
c. Fluoxetine
d. Escitalopram Oxalate - ✔✔a. Paroxetine (Paxil is EVIL)
Brain structure responsible for mediating mood, fear, emotion, and aggression; also responsible for
connecting sensory smell information with emotions - ✔✔amygdala
Regulates memory and converts short-term memory into long-term memory - ✔✔
Plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst,
water balance, circadian rhythms, body temperature, libido, and hormonal regulation - ✔✔
Patient on lithium and cipro Cipro _____________ lithium level - ✔✔
Patient on psych meds and dexamethasone will complain of what? - ✔✔
Patient w/ schizophrenia, structural changes of the brain on CT - ✔✔
,Which lab is checked with clozaril? - ✔✔ANC
Lobes of the Brain - Fred Tore his Pants Off - ✔✔Frontal - executive fx, logical thinking
Temporal (tempo) sound
Occipital (optic) vision
Parietal (pat) touch
You ask a patient to clench her teeth, which cranial nerve are you testing? - ✔✔Cranial nerve 5 -
TRIGEMINAL
What does the frontal lobe affect? (LIMP) - ✔✔Executive functions:
Language
Intelligence (cognitive functoning)
Motor Function
Personality
What does temporal lobe affect? (LAME) - ✔✔Language
Affective Component of speech
Memory
Emotion
In which lobe of the brain does the limbic system reside? - ✔✔The temporal lobe
What is Wernicke's area responsible for and where does it reside in the brain? - ✔✔Wernicke's area
is responsible for receptive speech and it resides in the temporal lobe.
What is the first line drug for OCD? - ✔✔SSRIs
What is the drug of choice for ADHD for 8 y.o and above? - ✔✔Stimulants (specifically ritalin -
methyphenidate)
If child develops tics, what do you prescribe? - ✔✔Guanfacine
What does parietal lobe affect? (VAST) - ✔✔Visual spatial processing
Association cortex
Symbolic recognition
Topographic sense
what is sterognosis? how do you test it? - ✔✔Place objects in hand with closed eyes. Ability to
differentiate items comes from parietal lobe
What does the occipital lobe affect? (VIP) - ✔✔Visual integration
Primary visual cortex
, Patient was prescribed paroxetine 1 month ago and had since developed ED, he is not a candidate for
Wellbutrin because of a history of seizure disorder. What can you prescribe? - ✔✔Cialis (tadalafil) or
Viagra (sildenafil) phophodiasterase inhibitors
What is mechanism of action of phophodiasterase inhibitors? - ✔✔Rapid absorption. They pull blood
to corpus cavernosum.
What are the main functions of the limbic system? - ✔✔Regulation of emotion and memory
Olfactory sense is combined with memories
Hippocampus is located here - memory
Where are affective domains (emotions, feelings) originating in the brain? - ✔✔Anterior cingulate
gyrus (LIMBIC SYSTEM)
If a patient with OCD has failed on SSRIs, what should you switch to? - ✔✔TCA - anafranil
Mood disorder is most associated with which neurotransmitters? - ✔✔serotonin and norepinephrine
Serotonin DOMAINS - ✔✔Depression
Obsessions
Migraines
Anxiety
Intestines
Nausea
Sexual and sleep
Where is serotonin produced? - ✔✔The raphe nuclei (distributed near the midline of brainstem)
What are the symptoms of SEROTONIN SYNDROME? SHITS AND SHIVERS - ✔✔SHITS (diarrhea)
Shivering
Hyperreflexia
Increased body temp
Vital sign instability
Encephalopathy
Restlessness
Sweating
What is the treatment for serotonin syndrome? - ✔✔Cyproheptadine (PERIACTIN)
Patient has serotonin syndrome what are actions? - ✔✔1. stop SSRIs/other meds that are
contributing
2. Give Cyproheptadine(PERIACTIN)
Practice Skills
Which of the following is a contraindication to benzodiazepines?
a. Acute alcohol intoxication
b. Acute narrow angle glaucoma
c. Psychosis
d. All the above - ✔✔a. Acute alcohol intoxication
In the pharmacological treatment of psychosis, when antipsychotics are administered, which block
dopamine, a secondary effect is blocking in another tract, which causes potential prolactin problems,
such as gynecomastia in males. This tract is the:
a. mesolimbic
b. tuberoinfundibular
c. nigrostrial dopamine tract
d. mesocortical - ✔✔b. tuberoinfundibular
A six-year-old patient with autism spectrum disorder has not responded to six months of
psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger
sibling. The psychiatric-mental health nurse practitioner prescribes:
1. carbamazepine (Tegretol) 200 mg once a day.
2. haloperidol (Haldol) 2 mg once a day.
3. risperidone (Risperdal) 0.25 mg once a day.
4. venlafaxine ER (Effexor XR) 37.5 mg once a day. - ✔✔3. risperidone (Risperdal) 0.25 mg once a day.
Which drug is likely to produce liver failure and hepatitis?
1. Lamotrigine
2. Gabapentin
3. Carbamazepine
4. Topiramate - ✔✔3. Carbamazepine
EPS arises from:
a. D2 blockade in the nigrostriatial tract
b. D2 blockade in the tuberoinfundibular tract
c. D2 blockade in the alpha-1 adrenergic receptor blockade
,d. D2 blockade in the HPA axis - ✔✔a. D2 blockade in the nigrostriatial tract
Which drug carries a higher risk of metabolic effects than the other second generation
antipsychotics: weight gain, diabetes, dyslipidemia ?
a. Clozaril
b. Zyprexa
c. Risperdal
d. Geodon - ✔✔b. Zyprexa
A patient has not had any relief of symptoms with Fluoxetine, and is going to be started on an MAOI.
How long before starting the MAOI should the Fluoxetine be withdrawn?
a. 2 weeks
b. 3 weeks
c. 4 weeks
d. 5 weeks - ✔✔a. 2 weeks
Which drug can produce serious side effect of rash in some Asians, and the FDA has mandated
genetic testing before the administration of this drug?
a. Dilantin
b. Lamictal
c. Depakote
d. Tegretol - ✔✔d. Tegretol
Which is considered the most sedating SSRI?
a. Paroxetine
b. Sertraline
c. Fluoxetine
d. Escitalopram Oxalate - ✔✔a. Paroxetine (Paxil is EVIL)
Brain structure responsible for mediating mood, fear, emotion, and aggression; also responsible for
connecting sensory smell information with emotions - ✔✔amygdala
Regulates memory and converts short-term memory into long-term memory - ✔✔
Plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst,
water balance, circadian rhythms, body temperature, libido, and hormonal regulation - ✔✔
Patient on lithium and cipro Cipro _____________ lithium level - ✔✔
Patient on psych meds and dexamethasone will complain of what? - ✔✔
Patient w/ schizophrenia, structural changes of the brain on CT - ✔✔
,Which lab is checked with clozaril? - ✔✔ANC
Lobes of the Brain - Fred Tore his Pants Off - ✔✔Frontal - executive fx, logical thinking
Temporal (tempo) sound
Occipital (optic) vision
Parietal (pat) touch
You ask a patient to clench her teeth, which cranial nerve are you testing? - ✔✔Cranial nerve 5 -
TRIGEMINAL
What does the frontal lobe affect? (LIMP) - ✔✔Executive functions:
Language
Intelligence (cognitive functoning)
Motor Function
Personality
What does temporal lobe affect? (LAME) - ✔✔Language
Affective Component of speech
Memory
Emotion
In which lobe of the brain does the limbic system reside? - ✔✔The temporal lobe
What is Wernicke's area responsible for and where does it reside in the brain? - ✔✔Wernicke's area
is responsible for receptive speech and it resides in the temporal lobe.
What is the first line drug for OCD? - ✔✔SSRIs
What is the drug of choice for ADHD for 8 y.o and above? - ✔✔Stimulants (specifically ritalin -
methyphenidate)
If child develops tics, what do you prescribe? - ✔✔Guanfacine
What does parietal lobe affect? (VAST) - ✔✔Visual spatial processing
Association cortex
Symbolic recognition
Topographic sense
what is sterognosis? how do you test it? - ✔✔Place objects in hand with closed eyes. Ability to
differentiate items comes from parietal lobe
What does the occipital lobe affect? (VIP) - ✔✔Visual integration
Primary visual cortex
, Patient was prescribed paroxetine 1 month ago and had since developed ED, he is not a candidate for
Wellbutrin because of a history of seizure disorder. What can you prescribe? - ✔✔Cialis (tadalafil) or
Viagra (sildenafil) phophodiasterase inhibitors
What is mechanism of action of phophodiasterase inhibitors? - ✔✔Rapid absorption. They pull blood
to corpus cavernosum.
What are the main functions of the limbic system? - ✔✔Regulation of emotion and memory
Olfactory sense is combined with memories
Hippocampus is located here - memory
Where are affective domains (emotions, feelings) originating in the brain? - ✔✔Anterior cingulate
gyrus (LIMBIC SYSTEM)
If a patient with OCD has failed on SSRIs, what should you switch to? - ✔✔TCA - anafranil
Mood disorder is most associated with which neurotransmitters? - ✔✔serotonin and norepinephrine
Serotonin DOMAINS - ✔✔Depression
Obsessions
Migraines
Anxiety
Intestines
Nausea
Sexual and sleep
Where is serotonin produced? - ✔✔The raphe nuclei (distributed near the midline of brainstem)
What are the symptoms of SEROTONIN SYNDROME? SHITS AND SHIVERS - ✔✔SHITS (diarrhea)
Shivering
Hyperreflexia
Increased body temp
Vital sign instability
Encephalopathy
Restlessness
Sweating
What is the treatment for serotonin syndrome? - ✔✔Cyproheptadine (PERIACTIN)
Patient has serotonin syndrome what are actions? - ✔✔1. stop SSRIs/other meds that are
contributing
2. Give Cyproheptadine(PERIACTIN)
