1|Page
GEORGETTE'S LMR (GEORGETTE'S PMHNP
CERTIFICATION) EXAM 300 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH EXPERT
FEEDBACK 2 ALREADY A GRADED|BRAND NEW!!
What does ADPIE stand for?
Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the middle of
the night?
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?
Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
Check renal function
What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
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?
,2|Page
Check for rhabdo with CPK
s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever, tachycardia,
HTN, shits and shivers
What two medications to give with NMS?
bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS?
cyproheptadine (Periactin)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS?
Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS?
Within 24 hours of starting/changing medication and resolves within a few days
How do you distinguish between NMS and acute dystonia?
NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs?
Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors?
Increased risk of lithium toxicity related to the increased urination from the ACE
inhibitors
Why should a patient on lithium avoid calcium channel blockers?
Risk of fatal nephrotoxicity
What is a fetal side effect of lithium?
Epstein's anomaly
What lab should you check for athletes on lithium?
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3?
Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
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>3
S/S of lithium toxicity
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Why check an EKG with lithium?
Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
Synthroid
What do you do if patient is prescribed both depakote and lamictal?
Decreased lamictal dose by 50%
Depakote and pregnancy
Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown
urine?
LFTs
What lab means pregnancy?
HCG
Why is Clozaril used?
Treatment resistant schizophrenia, improves SI, and improves negative symptoms of
schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia?
Clozaril and Tegretol
What symptoms may mean a Clozaril induced infection?
Sore throats, sores in mouth/gums, fever
When should you discontinue Clozaril or Tegretol?
WBC < 2000 or ANC <1000
, 4|Page
What should you check in Asian patients taking Tegretol?
For the HLA-B*1502 allele (higher risk of SJS)
What two epidermal issues can arise from Tegretol or Lamictal?
Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe headache?
Aspetic meningitis
What three antipsychotics have very low weight gaining effects?
Geodon, Abilify, and Latuda
Mini-Cog
3 word recall and
clock drawing
MMSE scoring
24-30 severe impairment
18-23 mild impairment
17 and less no impairment
What happens during pruning?
Brain eliminates extra synapses during infancy
autism and pruning
Excess synapses caused by under-pruning (patient oversensitive to light/sounds and
seizures)
schizophrenia and pruning
Fewer synapses caused by over-pruning
grey matter vs white matter
Grey matter- synapses, working area of brain, dendrites
White matter- myelinated axons
axons and dendrites
axon away from cell and dendrites to neuron's cell body
GEORGETTE'S LMR (GEORGETTE'S PMHNP
CERTIFICATION) EXAM 300 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH EXPERT
FEEDBACK 2 ALREADY A GRADED|BRAND NEW!!
What does ADPIE stand for?
Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the middle of
the night?
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?
Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
Check renal function
What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
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?
,2|Page
Check for rhabdo with CPK
s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever, tachycardia,
HTN, shits and shivers
What two medications to give with NMS?
bromocriptine (Parlodel)- D2 agonist dantrolene- muscle relaxer
What medication to give during SS?
cyproheptadine (Periactin)- 5HT-2A receptor antagonist
What is the onset and typical length of NMS?
Slow onset (1-2 weeks after changing or starting therapy) and resolves within 9-14 days
What is the onset of SS?
Within 24 hours of starting/changing medication and resolves within a few days
How do you distinguish between NMS and acute dystonia?
NMS has a slower onset while acute dystonia occurs within hours
What happens with lithium and NSAIDs?
Increased risk of lithium toxicity (gout meds, ibuprophen, naproxen, etc.)
What happens with lithium and ACE inhibitors?
Increased risk of lithium toxicity related to the increased urination from the ACE
inhibitors
Why should a patient on lithium avoid calcium channel blockers?
Risk of fatal nephrotoxicity
What is a fetal side effect of lithium?
Epstein's anomaly
What lab should you check for athletes on lithium?
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3?
Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
,3|Page
>3
S/S of lithium toxicity
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle
weakness/twitching
Why check an EKG with lithium?
Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
Synthroid
What do you do if patient is prescribed both depakote and lamictal?
Decreased lamictal dose by 50%
Depakote and pregnancy
Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown
urine?
LFTs
What lab means pregnancy?
HCG
Why is Clozaril used?
Treatment resistant schizophrenia, improves SI, and improves negative symptoms of
schizophrenia
What two medications have the highest risk of agranulocytosis and aplastic anemia?
Clozaril and Tegretol
What symptoms may mean a Clozaril induced infection?
Sore throats, sores in mouth/gums, fever
When should you discontinue Clozaril or Tegretol?
WBC < 2000 or ANC <1000
, 4|Page
What should you check in Asian patients taking Tegretol?
For the HLA-B*1502 allele (higher risk of SJS)
What two epidermal issues can arise from Tegretol or Lamictal?
Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe headache?
Aspetic meningitis
What three antipsychotics have very low weight gaining effects?
Geodon, Abilify, and Latuda
Mini-Cog
3 word recall and
clock drawing
MMSE scoring
24-30 severe impairment
18-23 mild impairment
17 and less no impairment
What happens during pruning?
Brain eliminates extra synapses during infancy
autism and pruning
Excess synapses caused by under-pruning (patient oversensitive to light/sounds and
seizures)
schizophrenia and pruning
Fewer synapses caused by over-pruning
grey matter vs white matter
Grey matter- synapses, working area of brain, dendrites
White matter- myelinated axons
axons and dendrites
axon away from cell and dendrites to neuron's cell body
