PMHNP certification Exam 2023(Actual test verified A+)

PMHNP certification Exam

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) Correct answer- D. 68 y/o single white male with depression *5 risk factors

(age, male, white, depression)

Count the risk factors

When interview teenagers (16 y/o) that arrive with their parents what should you do?

Correct answer- interview them separately from parents.

-This helps Build therapeutic rapport with teens by telling them the info is confidential.

Parents may be upset but remember you are advocating for the child.

Which Ethnic group has the highest rate of suicide? Correct answer- Native Americans

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 Correct answer- D. Metabolic Syndrome (UMBRELLA

ANSWER)

Which antipsychotics have the least weight gain? Correct answer- 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? Correct answer- 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 a Correct answer- atypical

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 Correct answer- Hypothalamus

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? Correct

answer- Bring a support person like a husband

Thyroid-Stimulating hormone normal level Correct answer- 0.5-5.0 Mu/L

When T4 and T3 are high and TSH is low what is the diagnosis Correct answerHYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT

INTOLERANCE

Key symptoms of Heat Intolerance Correct answer- Hyperthyroidism

When T4 and T3 are Low and TSH is high what is the diagnosis Correct answer-

(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE

Key symptoms of Cold Intolerance Correct answer- Hypothyroidism

Hyperthyroid can mimic Correct answer- Mania

Hypothyroid can mimic Correct answer- Depression

A patient on depakote complains of RUQ pain and has reddish/brown urine Correct

answer- Hepatoxicity

-Check LFTs

Signs of Depakote toxicity Correct answer- Disorientation, confusion, lethargy

You suspect depakote toxicity what do you do? Correct answer- Check

-LFT

-Ammonia

-Depakote Level

What herbal supplement can cause hepatoxicity? Correct answer- Kava Kava

When taking Kava Kava in combinations with other medications you should caution

about Correct answer- Risk of Hepatoxicity and Sedation

TCAs carry a risk of Correct answer- Hepatotoxicity

Signs of Stevens-Johnson Syndrome Correct answer- -fever, mouth pain, swelling,

burning eyes, blisters, skin pain

two psychotropics known to cause steven johnson syndrome Correct answer- lamictal

and tegretol

What nationality is most suseptible of getting steven johnson? Correct answer- Asians

When treating asians with tegretal screen for? Correct answer- HLAB-1502 Allele

What two medications cause agranulocytosis? Correct answer- Clozaril & Tegretal

Agranulocytosis when to discontinue medication Correct answer- Less than 1000

When monitoring for agranulocytosis in patients look for s/s of what? Correct answerInfection

-Fever, sore throat, fatigue, chills

Before starting any mood stabilizer in a female of childbearing age be sure to check?

Correct answer- HCG

Which two medications may decrease the risk of suicide? Correct answer- clozaril and

lithium

Medications that increase lithium level Correct answer- NSAID-ibuprofen, INDOCIN

THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril

Ace inhibitors are treatment of choice for? Correct answer- Heart Failure

Certain medications are known to increase lithium level, but HOW? Correct answer- by

reducing renal clearance

When educating a patient about lithium teach them about Correct answerHyponatremia

Dehydration-hot days, exercise

Normal Lithium Level Correct answer- 0.6-1.2

Lithium Toxicity Correct answer- 1.5 or above

Discontinue and re-order lithium level

Lithium level of 1.4 Correct answer- Monitor for toxicity

Labs before starting lithium Correct answer- TSH, BUN, CREATININE, HCG, U/A to

check for presence of protein in the urine (4+ protein is concerning for renal

impairment)à4+ protein in urine=MONITOR FOR TOXICITY

4+ protein in the urine of a patient on lithium Correct answer- 4+ protein is concerning

for renal impairment

4+ protein in urine=MONITOR FOR TOXICITY

Lithium side effects Correct answer- hypothyroid, leukocytosis, maculopapular rash, twave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)

-Some of these are also signs of toxicity

Signs of lithium toxicity Correct answer- confusion, ataxia, GI upset, palpitation, tremor

NMS Correct answer- muscle rigidity, mutism (because of muscle rigidity), increased

CPK (caused by muscle contraction and muscle destruction), increase WBC, increased

WBC, myoglobinuria (also from muscle destruction)

Cherry colored urine in a patient that exercises a lot Correct answer- test for

myoglobinuria may be a sign of rhabdo

Serotonin Syndrome Correct answer- With any drug that increases 5-HT (e.g., MAO

inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability,

flushing, diarrhea, seizures.

-Treatment: cyproheptadine (5-HT2 receptor antagonist).

Treatment for NMS Correct answer- Stop Offending Medication

-Dantrolene (muscle relaxer)

-Bromocriptine (Dopamine D2 agonist).

*In question focus on what they are asking for....dopamine agonist vs muscle relaxer

Treatment for Serotonin Syndrome Correct answer- Stop Med (1 or more SSRI, SSNRI,

TCA, MOAI)

-Cyproheptadine

Triptans Correct answer- Used for MIGRAINES

-These meds increase serotonin

example SUMATRIPTAN

patient taking Prozac and started on sumatriptan Correct answer- -call PCP to ask them

to switch the migraine med if patient already on SUMATRIPTAN do not start

antidepressant without talking to PCP

How long do you wait when switching between an SSRI to an MAOI? Correct answer- 2

weeks

How long do you wait when switching between Prozac and MAOI? Correct answer- 5-6

weeks wash out period

What is the first line treatment for depression and why? Correct answer- SSRI-First line

treatment for depression due to less risk of injury from OVERDOSE