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LMR Georgette’s PMHNP Certification Exam Latest
Questions And Correct Answers(Verified Answers)
Interprofessional collaboration is encouraged. - ANSWER>>Collaborate is usually right. Delegate is usually wrong.
ADPIER - ANSWER>>Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium - ANSWER>>Normal 0.6-1.
Lithium toxicity occurs at levels - ANSWER>>> 1.
Signs of Lithium toxicity - ANSWER>>severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for - ANSWER>>MANIA
Lithium has evidence shown to - ANSWER>>reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester - ANSWER>>Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to - ANSWER>>rise
Baseline labs before initiation of lithium - 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 - 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 - ANSWER>>staying hydrated avoiding NSAIDS compliance
Depakote normal level - ANSWER>>50-
Depakote toxicity level - ANSWER>>greater than 150
Teratogenic effects of Depakote - ANSWER>>spina bifida
Adverse effects of depakote - ANSWER>>alopecia hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue
Signs of Depakote toxicity - ANSWER>>disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity - ANSWER>>DC med check level LFT ammonia
MAOI + tyramine causes - ANSWER>>hypertensive crisis
Symptoms of hypertensive crisis - ANSWER>>elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever
Hypertensive crisis occurs with MAOI + - ANSWER>>MEPERIDINE STIMULANTS
Carbamazepine and asians - ANSWER>>Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele.
Child-bearing aged women - 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 - ANSWER>>agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor - ANSWER>>ANC
DC clozarli if ANC - ANSWER>>less than 1000
DC clozaril if WBC - ANSWER>>2000-3000, risk of agranulocytosis
When on clozaril monitor for - ANSWER>>signs and symptoms of infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to - ANSWER>>decrease risk of suicide in patients with schizophrenia.
Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond? A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval - ANSWER>>ANSWER: Lithium can invert the t waves.
Mary is a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDS C. Methylphenidate D. Acetaminophen - ANSWER>>ANSWER: Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1, C. WBC less than 5, D. ANC less than 2000 - ANSWER>>ANSWER: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate - 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 - ANSWER>>A. Carbamazepine
Bulimia, weight is ___________ - ANSWER>>within the normal range.
Pharm treatment for bulimia - ANSWER>>Fluoxetine SSRIs and TCAs effective in reducing binging and purging
Signs of anorexia nervosa - ANSWER>>low BMI Amennorrhea Emaciation Bradycardua Hypotension
Pharm treatment for anorexia - 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
SICKFACES.com for Inhibitors - ANSWER>>Sodium valproate Isoniazid Cimetidine Ketoconazole Alcohol 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 - 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 - 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 - ANSWER>>A. decreased renal clearance of lithium
Where is norepinephrine produced - ANSWER>>locus coeruleus and medullary reticular formation
Norepinephrine is associated with - ANSWER>>mood disorders
Serotonin is made where in the brain - ANSWER>>raphe nuclei of the brainsteam
Serotonin is associated with - ANSWER>>sleep and mood disorder
Dopamine is made in - ANSWER>>substantia nigra, central tegmental area, ventral tegmental area,
Dopamine is associated with - ANSWER>>addiction and psychosis
Acetylcholine is made - ANSWER>>basal nucleus of Meynert
Most abundant inhibitory neurotransmitter in the brain - ANSWER>>GABA I don't have enough GABA, my anxiety is high
Med used to increase GABA - ANSWER>>benzos Fred flinstone needs a Zanny, Gabba dabba do.
Most excitatory neutransmitter - ANSWER>>glutamate
Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus - ANSWER>>increases symptoms of anxiety.
Autism - ANSWER>>deficits in social communication and social interaction across multiple settings
Parents of kids with autism may report - ANSWER>>No response when called by name Little or no eye contact Children with autism often like to line up, stack, or organize objects and toys.
Screenings for autism - ANSWER>>ADOS M-CHAT ASQ
Pharm management for autism - ANSWER>>antipsychotics are effective for symptoms such as tantrums, aggressive behaviors, self-injurious behaviors
primary sensory area of the brain - ANSWER>>parietal lobe
problems in the parietal lobe can lead to - ANSWER>>Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language)
Cerebellum is responsible for - 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 D. Occipital lobe - ANSWER>>frontal lobe
Impairments in the clock drawing test can be associated with - ANSWER>>damage to the right parietal lobe
What part of the brain is responsible for regulating emotions? A. Wernicke's area B. Occipital lobe C. Hippocampus D. Parietal lobe - ANSWER>>Hippocampus
Limbic system responsible for - ANSWER>>emotions and memory
Hypothalamus - ANSWER>>appetite, hunger, water balance, circadian rhythms, libido, hormonal regulation
thalamus - ANSWER>>sensory relay for smell emotions, memory, and regulated affective behaviors
amygdala - ANSWER>>regulated emotion
mediates mood emotional memories/meanings, fear, anxiety, stress emotion, aggression
substantia nigra - ANSWER>>motor movements
amygdala= - ANSWER>>emotional memory
Which of these brain structures puts emotional meaning on a stimulus, forms, emotional memories and is involved with rage and fear - ANSWER>>amygdala
A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep- rest cycle, and changes in libido. What is the neuroanatomical areas off the brain that is responsible for the regulation of these functions? - ANSWER>>Hypothalamus
Which serotonin receptor antagonism makes an antipsychotic "atypical" - ANSWER>>5HT2A
Excess dopamine in this area causes positive schizophrenic symptoms - ANSWER>>meoslimbic pathway
decreased dopamine leads to negative symptoms of schizophrenia - ANSWER>>mesocortical pathway
Increased blockade of dopamine here leads to EPS - ANSWER>>nigrostriatal pathway
Blockade of dopamine in this pathway can lead to increased prolactin levels - ANSWER>>tuberoinfundibular pathway
Muscle spasms ninth face, neck, tongue, back/neck muscles - ANSWER>>acute dystonia
Oculogyric crisis, which can lead to permanent injury. Patients have prolonged involuntary upwards deviation of the eyes bilaterally. - ANSWER>>Rare presentation of acute dystonia.
Pharm treatment for dystonia - ANSWER>>cogentin (IM first then oral)
Restlessness, inability to sit still. Pacing. Mistaken for anxiety. - ANSWER>>Akathisia
Ingrezza or Austedo approved
Non-psych med that can cause TD - ANSWER>>Reglan
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 - 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? - ANSWER>>Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression
Fetal alcohol syndrome - ANSWER>>Everything is low low weight, small features of the face.
Which if the following antidepressants is associated with the most cardiovascular side effects? - ANSWER>>Citalopram--causes QT prolongation
What the body does to drugs? - ANSWER>>Pharmacokinetics
What the drug does to the body - ANSWER>>pharmacodynamics
The drug binds to the receptors and activates a biological response (opens the ion channel) - ANSWER>>agonist effect
drug causes the opposite effect of the agonist. Binds to the same receptor but closes the channel - ANSWER>>inverse agonist
drug does not fully activate the receptor - ANSWER>>partial agonist
drug binds to the receptor but foes not activate a biological response - ANSWER>>antagonist
The study of what the drug does to the body. - 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. - ANSWER>>Activates a biological response and opens the channel.
Medications that can cause mania (very high yield) - ANSWER>>Steroids Antabuse Isoniazid Antidepressants in persons with bipolar Flonase
Medications causing depression - ANSWER>>steroids beta blockers interferon accutate some retroviral drugs antineoplastic drugs benzos progesterone
Fragile X syndrome - ANSWER>>all their facial structures are larger.
Severe adverse effect caused by antipsychotics - ANSWER>>neuroleptic malignant syndrome
Extreme muscle regidity Mutism elevated CPK Myoglobinura (cherry colored urine) Elevated WBCs Elevated LFts - ANSWER>>signs of NMS
Exam ised to quantify cognitive status in adults - ANSWER>>mini mental status exam or may say Folstein
Component of Folstein/mini mental status - ANSWER>>I would like you to could backwards from 100 by 7s or do serial 7s
Folstein/mini mental status registration/ability to learn new material - ANSWER>>repeat after me, bed, bat, ball
Suiciidal risk factors - ANSWER>>previous attempt Male 45+ Female 55+ Divorced, single, separated white living alone psychiatric disorder physical illness substance abuse family history recent loss male gender
Characteristics of therapeutic relationship - ANSWER>>Genuineness Acceptance Nonjudgment Authenticity Empathy Respect Professional boundaries
displacement of feelings for significant people int he client's past onto the PMHNP - ANSWER>>transference
Nurses's emotional reaction to the client based on past experiences. - ANSWER>>Countertransference
Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? A. Omeprazole B. Propranolol C. Levothyroxine D. Clarithromycin - ANSWER>>Propranolol
A patient with a known diagnosis of bipolar I disorder presents to your clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months To determine if a medication change or increase is warranted, it is important to gather more information. You suspect a possible medication-induced manic episode when the patient endorses what? A. She was recently placed on a beta blocker for anxiety. B. She was recently prescribed a benzo C. She recently had a flare up of her rheumatoid arthritis and received treatment for one week (aka a steroid) D. She recently began a new retroviral agent for hepatitis - ANSWER>>recently treated for RA
Scale to test for alcohol withdrawal - ANSWER>>CIWA
Score on CIWA that warrants PRN - ANSWER>>greater than 8
Medication that will make patient physically ill if combined with alcohol - ANSWER>>disulfiram (Antabuse)
Antabuse shouldn't be taken for at leas ________________ after drinking - ANSWER>> hours.
Signs and symptoms of alcohol withdrawal - ANSWER>>N/V/D tremors sweats anxiety agitation tactile disturbances auditory disturbances visual disturbances
Treatment of choice for delirium - ANSWER>>haloperidol
Avoid which class in delirium as it tends to prolong it - ANSWER>>benzos
impaired executive functioning, impaired problem solving, impaired organizational skills, altered memory. slow onset - ANSWER>>dementia
John is a 58 year old male patient with Bipolar 1 disorder and has been stable for 5 years on valproate and Seroquel. He was recently started on Flonase by his primary care. As the PMHNP, you are concerned that the addition of the Flonase may cause A. A hypertensive crisis B. SJS C. NMS D. a manic episode - ANSWER>>a manic episode
A 16-year off boy presents with a long head, large ears, and hyper extensible joints, is very shy, and starts rocking and flapping his hands when he is upset. Which of the following is your most likely diagnosis? A. Tourette disorder B. Autism C. Fragile X D. Rett disorder - ANSWER>>Fragile X
What muscle relaxant is recommended to be used in treatment of NMS? A. Bromocriptine B. Trihexyphenidyl C. Dantrolene D. Benztropine - ANSWER>>Dantrolene
A week after raising the dose of clomipramine, a patient treated for depression presents to the clinic with reports of change in mental status, fever, and hyperreflexxia. As the treating PMHNP, you know these symptoms are consistent with which of the following? A. NMS B. EPS C. Hypertensive crisis D. Serotonin syndrome - ANSWER>>serotonin syndrome
A 24 year olf female attempts suicide by overdose on an MAOI phenelzine. She is stabilized in the hospital. Ten days later she is started on venlafaxine and becomes tachycardia and diaphoretic, and develops myoclonic jerks. What condition is this? A. NMS B. Opisthotonos C. Akathisia D. Serotonin syndrome - ANSWER>>serotonin syndrome
a 17 year old arrives at the emergency department with nonspecific complaints The patient's temperature is 100.8, pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline for the treatment of depression. the patient has a history of substance use and smoked marijuana one week ago. The diagnosis is - ANSWER>>serotonin syndrome
Patient being treated for psychosis for 2 weeks develops symptoms of NMS. The following factors help the pMHNP to differentiate NMS from serotonin syndrome. A. autonomic instability, diaphoresis, tremors B. Hyperthermia, leukopenia, tachycardia C. Rigidity, hyperrefelexia, orthostatic hypotension D. Mutism, leukocytosis, myoglobinuria - ANSWER>>mutism, leukocytosis, myoglobinuria
Appraisal of the patient's SI plan, intent and access to implement plan would be documented in which part of standard psychiatric evaluation A Review of symptoms. B. Diagnosis C. Mental status exam D. History of presenting illness - ANSWER>>C mental status exam
a 48 year off Caucasian male presents for his therapy appointment. He is sad about losing his wife recently to covid 19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk of suicide? A. Previous attempt B. Age C. Gender D. Marital Status - ANSWER>>A previous attempt
Which of the following patients is at higher risk of suicidie?
