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GEORGETTE REVIEW PMHNP NEWEST FINAL EXAM
LATEST 2025 UPDATED QUESTIONS AND 100% CORRECT
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When many answers are remarkably similar, they are usually _____________ - CORRECT ANSWER >>> wrong Interprofessional collaboration is encouraged. - CORRECT ANSWER >>> Collaborate is usually right. Delegate is usually wrong. ADPIER - CORRECT ANSWER >>> Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - CORRECT ANSWER >>> Normal 0.6-1. Lithium toxicity occurs at levels - CORRECT ANSWER >>> > 1. Signs of Lithium toxicity - CORRECT ANSWER >>> severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - CORRECT ANSWER >>> MANIA Lithium has evidence shown to - CORRECT ANSWER >>> reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - CORRECT ANSWER >>> Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - CORRECT ANSWER >>> rise Baseline labs before initiation of lithium - CORRECT ANSWER >>> TSH creatinine (0.6-1.2) BUN (10-20) HCG (all psychotropics females 12-51) EKG 50+ Urinalysis (check for proteins, 4+ may indicate kidney disease) Side Effects of Lithium - CORRECT ANSWER >>> hypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - CORRECT ANSWER >>> staying hydrated avoiding NSAIDS compliance Depakote normal level - CORRECT ANSWER >>> 50 - 125 Depakote toxicity level - CORRECT ANSWER >>> greater than 150
Treatment for hypertensive crisis - CORRECT ANSWER >>> DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos - CORRECT ANSWER >>> floppy baby, cleft palate Teratogenic effects of tegratol - CORRECT ANSWER >>> neural tube defect teratogenic effects of lithium - CORRECT ANSWER >>> ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote - CORRECT ANSWER >>> neural tube defects/spina bifida Adverse reaction to Lamictal - CORRECT ANSWER >>> Steven Johnson's Syndrome Signs of SJS - CORRECT ANSWER >>> FEVER --high yield sore throat facial swelling tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause - CORRECT ANSWER >>> sedation or weight gain
Carbamazepine (tegretol) black box warning - CORRECT ANSWER >>> agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA) Carbamazepine and asians - CORRECT ANSWER >>> Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women - CORRECT ANSWER >>> check for pregnancy before starting mood stabilizer start on folic acid to support neural tube development during the first month that a woman is pregnant Clozaril/clozapine can cause - CORRECT ANSWER >>> agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor - CORRECT ANSWER >>> ANC DC clozarli if ANC - CORRECT ANSWER >>> less than 1000 DC clozaril if WBC - CORRECT ANSWER >>> 2000 - 3000, risk of agranulocytosis When on clozaril monitor for - CORRECT ANSWER >>> signs and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to - CORRECT ANSWER >>> decrease risk of suicide in patients with schizophrenia.
B. Ebstein's anomaly C. Spina bifida D. Cleft palate - CORRECT ANSWER >>> A. Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal - CORRECT ANSWER >>> A. Carbamazepine Bulimia, weight is ___________ - CORRECT ANSWER >>> within the normal range. Pharm treatment for bulimia - CORRECT ANSWER >>> Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa - CORRECT ANSWER >>> low BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - CORRECT ANSWER >>> there is none therapy
Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands - CORRECT ANSWER >>> Low BMI If a patient is depression, low energy, fatigued, you would prescribe **- CORRECT ANSWER
** Wellbutrin Wellbutrin is contraindicated in patients with - CORRECT ANSWER >>> seizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta) - CORRECT ANSWER >>> bupropion CLozaril is metabolized by - CORRECT ANSWER >>> cytochrome P450 enzyme CYP1A2 INducers
- CORRECT ANSWER >>> induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - CORRECT ANSWER >>> decrease therapeutic levels of the drug
Chloramphenicol Erythromycin Sulfonamine Cipro Omeprazole Metronidazole Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine a. 2D b. 1A c. 2C d. 2C9 - CORRECT ANSWER >>> 1A (want A 2 cigarette break) When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration - CORRECT ANSWER >>> Decreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced:
A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium D. Decreased renal clearance of lithium - CORRECT ANSWER >>> A. decreased renal clearance of lithium Where is norepinephrine produced - CORRECT ANSWER >>> locus coeruleus and medullary reticular formation Norepinephrine is associated with - CORRECT ANSWER >>> mood disorders Serotonin is made where in the brain - CORRECT ANSWER >>> raphe nuclei of the brainsteam Serotonin is associated with - CORRECT ANSWER >>> sleep and mood disorder Dopamine is made in - CORRECT ANSWER >>> substantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with - CORRECT ANSWER >>> addiction and psychosis Acetylcholine is made - CORRECT ANSWER >>> basal nucleus of Meynert Most abundant inhibitory neurotransmitter in the brain - CORRECT ANSWER >>> GABA I don't have enough GABA, my anxiety is high
B. Nucleus acumbuns C. Locus coeruleus D. Amygdala - CORRECT ANSWER >>> raphe nuclei Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality - CORRECT ANSWER >>> frontal lobe memory, understanding, language - CORRECT ANSWER >>> temporal lobe Both hemispheres of the brain are connected by the - CORRECT ANSWER >>> corpus callosum Area of sensorimotor information exchange between two hemispheres **- CORRECT ANSWER
** corpus callosum When there is disturbances in clock drawing test, which hemisphere is compromised - CORRECT ANSWER >>> right hemisphere/right parietal lobe Area for expressive speech - CORRECT ANSWER >>> frontal lobe Broca's Area Problems in the frontal lobe can lead to - CORRECT ANSWER >>> personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes
Area for receptive speech and language comprehension - CORRECT ANSWER >>> Temporal lobe Wernicke's area
Problems in the temporal lobe can lead to - CORRECT ANSWER >>> auditory hallucinations, aphasia, and amnesia Occipital lobe - CORRECT ANSWER >>> primary visual area problems in the occipital lobe can lead to - CORRECT ANSWER >>> Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain - CORRECT ANSWER >>> parietal lobe problems in the parietal lobe can lead to - CORRECT ANSWER >>> Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) Cerebellum is responsible for - CORRECT ANSWER >>> gross motor skills fine motor skills balance A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the A. frontal lobe B. Temporal lobe C. Parietal lobe
Which of these brain structures puts emotional meaning on a stimulus, forms, emotional memories and is involved with rage and fear - CORRECT ANSWER >>> amygdala A client presents with complaints of changes in appetite, feeling fatigued, problems with sleeprest cycle, and changes in libido. What is the neuroanatomical areas off the brain that is responsible for the regulation of these functions? - CORRECT ANSWER >>> Hypothalamus Which serotonin receptor antagonism makes an antipsychotic "atypical" **- CORRECT ANSWER
** 5HT2A Excess dopamine in this area causes positive schizophrenic symptoms **- CORRECT ANSWER ** meoslimbic pathway decreased dopamine leads to negative symptoms of schizophrenia **- CORRECT ANSWER ** mesocortical pathway Increased blockade of dopamine here leads to EPS - CORRECT ANSWER >>> nigrostriatal pathway Blockade of dopamine in this pathway can lead to increased prolactin levels - CORRECT ANSWER >>> tuberoinfundibular pathway Muscle spasms ninth face, neck, tongue, back/neck muscles - CORRECT ANSWER >>> acute dystonia
Oculogyric crisis, which can lead to permanent injury. Patients have prolonged involuntary upwards deviation of the eyes bilaterally. - CORRECT ANSWER >>> Rare presentation of acute dystonia. Pharm treatment for dystonia - CORRECT ANSWER >>> cogentin (IM first then oral) Restlessness, inability to sit still. Pacing. Mistaken for anxiety. - CORRECT ANSWER >>> Akathisia Commonly used rating scale for akathisia is - CORRECT ANSWER >>> Barnes Akathisia rating scale and extrapyramidal symptom rating scale. Treatment for akathisis 1st line 2nd line 3rd line - CORRECT ANSWER >>> 1st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine Absence of movement or difficulty initiating movement - CORRECT ANSWER >>> akinesia Treatment: cogentin Presence of symptoms of Parkinson's produced by D2 blockade in the nigrostriatal pathway - CORRECT ANSWER >>> Pseudo-Parkinsonism
A patient has been treated for the past several years with fluphenazine (Prolixin). You tonic that he is drooling and has a slight pill rolling movement of the fingers. These are EPS symptoms known as A. pseudo parkinsonism b. anticholinergic effects C. Tardive dyskinesia D. Acute dystonia - CORRECT ANSWER >>> A. Pseudoparkinsonism A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway? A. Are you experiencing constipation? B. Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression? C. Are you experiencing increased thirst? D. Are you experiencing breast discharge? - CORRECT ANSWER >>> Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression Fetal alcohol syndrome - CORRECT ANSWER >>> Everything is low low weight, small features of the face. Which if the following antidepressants is associated with the most cardiovascular side effects?
- CORRECT ANSWER >>> Citalopram--causes QT prolongation What the body does to drugs? - CORRECT ANSWER >>> Pharmacokinetics What the drug does to the body - CORRECT ANSWER >>> pharmacodynamics
The drug binds to the receptors and activates a biological response (opens the ion channel) - CORRECT ANSWER >>> agonist effect drug causes the opposite effect of the agonist. Binds to the same receptor but closes the channel - CORRECT ANSWER >>> inverse agonist drug does not fully activate the receptor - CORRECT ANSWER >>> partial agonist drug binds to the receptor but foes not activate a biological response **- CORRECT ANSWER
** antagonist The study of what the drug does to the body. - CORRECT ANSWER >>> Pharmacodynamics When studying pharmacodynamics involving receptor, you know that an agonist produces the following effect? A. Does not fully activate the receptor B. Blocks the agonist from opening the channel C. Causes the opposite effect D. Activates a biological response and opens the ion channel. - CORRECT ANSWER >>> Activates a biological response and opens the channel. Medications that can cause mania (very high yield) - CORRECT ANSWER >>> Steroids Antabuse Isoniazid Antidepressants in persons with bipolar Flonase
