Page 1 of 100
PMHNP LMR GEORGETTE’S CERTIFICATION
ACTUAL EXAM QUESTIONS WITH
VERIFIEDANSWERS NEW MODIFIED EXAM!!!
What do you do if a patient comes in with fungus on their toenail? --
ANSWER--Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? -- ANSWER--
Check renal function
What do you do if a patient presents with fever while on Clozaril? -- ANSWER-
-Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? -- ANSWER--Antidepressants, St. John's
Wort, Same-
E, Kava Kava, and Tryptophan
What labs are indicative of NMS? -- ANSWER--Elevated WBC (over 11,000)
and elevated CPK
S/S of NMS -- ANSWER--muscle rigidity, hyperthermia, tachycardia, abnormal
bp, sweating, altered mental status, cherry colored urine
, Page 2 of 100
What should you do if a patient presents with cherry colored urine? --
ANSWER--Check for rhabdo with CPK
s/s of serotonin syndrome -- ANSWER--hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? -- ANSWER--bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? -- ANSWER--cyproheptadine (Periactin)-
5HT-2A receptor antagonist
What is the onset and typical length of NMS? -- ANSWER--Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? -- ANSWER--Within 24 hours of starting/changing
medication and resolves within a few days
What happens with lithium and NSAIDs? -- ANSWER--Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? -- ANSWER--Increased risk of
lithium toxicity related to the increased urination from the ACE inhibitors
, Page 3 of 100
Why should a patient on lithium avoid calcium channel blockers? -- ANSWER-
-Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? -- ANSWER--Epstein's anomaly
What lab should you check for athletes on lithium? -- ANSWER--Specific
gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? -- ANSWER--Do not give the next
dose and assess for s/s
At what level is lithium toxicity a medical emergency? -- ANSWER-->3
S/S of lithium toxicity -- ANSWER--vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? -- ANSWER--Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? --
ANSWER-Synthroid
What do you do if patient is prescribed both depakote and lamictal? --
ANSWER--Decreased lamictal dose by 50%
, Page 4 of 100
Depakote and pregnancy -- ANSWER--Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain? -- ANSWER--Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark
brown urine? --
ANSWER--LFTs
What does ADPIE stand for? -- 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? -- ANSWER--Ask her if it's happened before to assess for
sleep issue patterns
How do you distinguish between NMS and acute dystonia? -- ANSWER--NMS
has a slower onset while acute dystonia occurs within hours
PMHNP LMR GEORGETTE’S CERTIFICATION
ACTUAL EXAM QUESTIONS WITH
VERIFIEDANSWERS NEW MODIFIED EXAM!!!
What do you do if a patient comes in with fungus on their toenail? --
ANSWER--Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine? -- ANSWER--
Check renal function
What do you do if a patient presents with fever while on Clozaril? -- ANSWER-
-Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome? -- ANSWER--Antidepressants, St. John's
Wort, Same-
E, Kava Kava, and Tryptophan
What labs are indicative of NMS? -- ANSWER--Elevated WBC (over 11,000)
and elevated CPK
S/S of NMS -- ANSWER--muscle rigidity, hyperthermia, tachycardia, abnormal
bp, sweating, altered mental status, cherry colored urine
, Page 2 of 100
What should you do if a patient presents with cherry colored urine? --
ANSWER--Check for rhabdo with CPK
s/s of serotonin syndrome -- ANSWER--hyperreflexia, muscle spasms,
myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What two medications to give with NMS? -- ANSWER--bromocriptine
(Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS? -- ANSWER--cyproheptadine (Periactin)-
5HT-2A receptor antagonist
What is the onset and typical length of NMS? -- ANSWER--Slow onset (1-2
weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS? -- ANSWER--Within 24 hours of starting/changing
medication and resolves within a few days
What happens with lithium and NSAIDs? -- ANSWER--Increased risk of
lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors? -- ANSWER--Increased risk of
lithium toxicity related to the increased urination from the ACE inhibitors
, Page 3 of 100
Why should a patient on lithium avoid calcium channel blockers? -- ANSWER-
-Risk of fatal nephrotoxicity
What is a fetal side effect of lithium? -- ANSWER--Epstein's anomaly
What lab should you check for athletes on lithium? -- ANSWER--Specific
gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3? -- ANSWER--Do not give the next
dose and assess for s/s
At what level is lithium toxicity a medical emergency? -- ANSWER-->3
S/S of lithium toxicity -- ANSWER--vomiting, diarrhea, slurred speech, hand
tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium? -- ANSWER--Inverted T-waves
What medication should treat hypothyroidism caused by lithium use? --
ANSWER-Synthroid
What do you do if patient is prescribed both depakote and lamictal? --
ANSWER--Decreased lamictal dose by 50%
, Page 4 of 100
Depakote and pregnancy -- ANSWER--Spina bifida
What emergency may be occuring if patient on depakote reports upper
abdominal pain? -- ANSWER--Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark
brown urine? --
ANSWER--LFTs
What does ADPIE stand for? -- 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? -- ANSWER--Ask her if it's happened before to assess for
sleep issue patterns
How do you distinguish between NMS and acute dystonia? -- ANSWER--NMS
has a slower onset while acute dystonia occurs within hours
