Download 2025 PMHNP CERTIFICATION EXAM QUESTIONS AND ANSWERS GRADED A and more Exams Nursing in PDF only on Docsity!
2025 PMHNP CERTIFICATION EXAM QUESTIONS
AND ANSWERS GRADED A
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 antagonism C. Increased Lipids D. Metabolic Syndrome 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) 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
Which mood stabilizer have the least weight gain? Lamictal
- But remember all mood stabilizers cause some weight gain When presented with a question about typical vs atypical antipsychotic the answer is usually to start of aatypical A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic System D. Hippocampus Count the risk factorsCOWS scale components · Opioid W/D How long do you wait when switching between an SSRI to an MAOI? 2 weeks How long do you wait when switching between Prozac and MAOI? 5-6 weeks wash out period
Symptoms of discontinuation syndrome flu like symptoms (fatigue, lethargy, myalgia, decreased concentration), n/v, impaired memory, paresthesia, irritability, anxiety, insomnia, crying w/o reason, dizziness, and vertigoTx w/periactin Ages of onset for schizophrenia in males vs females -MALES 18-25 years -FEMALE 25-35 years What nationality is most suseptible of getting steven johnson? Asians When treating asians with tegretol screen for? HLAB-1502 Allele What two medications cause agranulocytosis? Clozaril & Tegretol 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 Pulse, sweating, restlessness, pupil size- dilation (if pinpoint= opioid intoxication, not w/d), body aches, Rhinorrhea (running nose), Lacrimation (eye tearing), GI upset (N/V/D), yawning, tremors, anxiety/irritability, Piloerection (gooseflesh skin), insomnia What does COWS stand for? Clinical Opiate Withdrawal Scale What does CIWA stand for? Clinical Institute Withdrawal Assessment What does CIWA assess for? --used to determine likelihood of ETOH withdrawal or DTs --usually occur within the first 24-72 hours after cessation o used to determine when to administer medications for ETOH withdrawal What does CIWA NOT test for? Alcohol Use Disorder
Which Ethnic group has the highest rate of suicide? Native Americans 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 encourage? 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 HYPERTHYROIDISM, 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 (HYPOTHYROIDISM) 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 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 Medications that increase lithium level NSAID-ibuprofen,
4+ protein in urine=MONITOR FOR TOXICITY 4+ protein in the urine of a patient on lithium 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY Lithium side effects "LITHIUM GI" L-Leukocytosis I-inverted t-waves T-tremors of the hand (fine)/teratogenic Ebstein's H-hypothroidism IU-Increased Urination M-maculopapular rash
GI- GI upset (nausea, vomiting, anorexia) Signs of lithium toxicity confusion, ataxia, severe GI upset, palpitation, coarse hand tremor, slurred speech, metallic taste in mouth NMS is caused by "think 'Antipsychotics'"; usually Atypicals NMS “NMS is like S&M” o First Sx: -You get a lil crazy (altered LOC) -you get hot (hyperpyrexia) and stiff (extreme muscle rigidity) o Then: -You get sweaty (diaphoresis)
-Dantrolene (Mr Dan the relaxed muscle man) -Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for….dopamine agonist vs muscle relaxer Serotonin Syndrome s/s most common sx : SAD AF-shivering -anxiety/restless-diaphoretic -Agitation-Fever “Shits and Shivers” -Diarrhea (shits) -Shivering, -Hyperreflexia/myoclonus -Increased temperature
-Vital sign instability -Encephalopathy (agitation/restlessness/anxious/SZ) -Restlessness -Sweating Treatment for Serotonin Syndrome Stop Med (1 or more SSRI, SSNRI, TCA, MOAI) -Cyproheptadine (5-HT2 receptor antagonist). Triptans Used for MIGRAINES -These meds increase serotonin example SUMATRIPTAN patient taking Prozac and started on sumatriptan
MRI or PET scan what is seen in schizophrenia EVERYTHING DECREASES EXCEPT VENTRICLES enlarged ventricles, decreased activity in the frontal cortex, decreased Gaba and glutamate decrease total brain volume. Stimulants can potentiate the release of what neurotransmitter? Dopamine which can worsen symptoms of schizophrenia Assertive Community Treatment (ACT) a form of rehabilitation post hospitalization, in home treatment
- for people w/ serious mental illness ACT is provided once they d/c from hospital -Primary goal: to help people become independent
-Secondary Goal: reduce the reliance on hospitals
- Treatment is centered around the patient’s personal strengths, needs, and desires for the future What level of prevention is ACT? Tertiary What adjunctive treatment is important in schizophrenia -social skills training -Exercise Exercise for mental health patients can promote Cognition Quality of Life Long-term health ACT is ideal for patients with a history of Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home What diagnosis has the highest risk of Homicidality Antisocial
Assess fund of knowledge Who is the president What is a quick and easy way to assess for neurological issues Clock drawing test If patient is unable to draw a clock this indicates Problem with the right hemisphere, cerebrum, or parietal lobe mesolimbic pathway Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms mesocortical pathway -Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia Nigrostriatal Pathway -This pathway mediates motor movements -Dopamine blockade in this pathway can lead to increase acetylcholine levels
-Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia Low Dopamine in the nigrostriatal pathway increases which neurotransmitter -Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach) Long-standing D2 blockade in the nigrostriatal pathway can lead to tardrive dyskinesia Tuberoinfundibular pathway -Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia -DECREASE DOPAMINE INCREASED PROLACTIN Long-term hyperprolactinemia can be associated with what condition osteoporosis
