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Georgette's LMR; Georgette's PMHNP
Certification Exam Review 202 5 V2 with complete
solutions | 100% pass
What should you not do when advocating for a patient? {{Ans- Judge or confront
What class of medication is contraindicated with tics? {{Ans- Stimulants
What should you provide for prior to assessing abuse victims? {{Ans- A safe
environment
What are your actions if a child reports abuse?
{{Ans- First interview separately from parents then report to CPS
What should you do if a child plays with toys in a way that you suspect abuse?
{{Ans- Report to CPS
In what setting as an inpatient provider should you interview a patient?
{{Ans- Use a private room with the door partially open
How should you begin your interview with adolescents?
{{Ans- By building rapport with them by ensuring confidentiality absent exceptions
Should you interview adolescents with or without parents? {{Ans- Without
What if an adolescent tells you they are homosexual and they don't want their parents
to know?
{{Ans- This is confidential
The patient is being discharged and would like their labs faxed to the rehab facility.
What is your initialaction? {{Ans- Get informed consent/ROI
What do you do if a medical evaluation is needed? {{Ans- Refer out - this is out of
scope
What do you do if a patient is takes something and is feeling really funny/unwell in
What ethnic group has the highest rate of suicidality in the US?
{{Ans- Native Americans
If a patient believes they need a healing stick in their room, but the staff nurses
removed it from them - what should you do?
{{Ans- Teach cultural sensitivity and make accommodations for patient to have
healing stick availablesuch as 1:
Psychoeducation should be based on? {{Ans- Cultural context
How do you promote health in a location with multiple ethnicities and education
levels?
{{Ans- Multiple cultural education and ethnospecific assessment parameters
What if a patient wants a traditional healer? {{Ans- Allow this - remember
ROI/informed consent
Normal TSH? {{Ans- 0.5-5.
TSH < 0.5 =? {{Ans- Hyperthyroidism
TSH > 5.0 =? {{Ans- Hypothyroidism
Relationship between TSH & T3/T4? {{Ans- Inverse
Hyperthyroidism can present as? {{Ans- Mania
Hypothyroidism can present as? {{Ans- Depression
Normal depakote level? {{Ans- 50 - 125
Toxic depakote level? {{Ans- 150+
Birth defect caused by depakote? {{Ans- Spina Bifida
S/S of depakote toxicity? {{Ans- Disorientation, lethargy, decreased respiratory rate,
Kava kava can cause? {{Ans- Liver damage and heavy sedation
Kava kava is c/i with? {{Ans- Benzos or sedatives
Mood stabilizer most associated with SJS? {{Ans- Lamictal
Mood stabilizer with least weight gain? {{Ans- Lamictal
SGAs with least weight gain? {{Ans- ziprasidone, abilify, and latuda
Least sedating SGA? {{Ans- Abilify
Routine labs with SGAs? {{Ans- BMI, hip to waist ratio, glucose, A1C, and lipid
panel
Management of metabolic syndrome with SGAs?
{{Ans- 1. Nonpharm = exercise or nutritional counseling
- Pharm = switch to other SGA with lower chance of metabolic syndrome
Carbamazepine can cause? {{Ans- Agranulocytosis and aplastic anemia
What should you screen for prior to starting Asians on carbamazepine and why?
{{Ans- HLAB1502 Allele; risk of SJS
When should you d/c carbamazepine if agranulocytosis is suspected?
{{Ans- If ANC is < 1000 with or without s/s of infection
Lithium range? {{Ans- 0.6 - 1.
What to do if lithium is 1.3 or 1.4? {{Ans- Monitor
What to do if lithium is 1.5+? {{Ans- D/C
Benefits of lithium? {{Ans- Gold standard for mania, neuroprotective, and
antisuicidal effects
What demonstrates understanding of education on lithium?
{{Ans- Taking extra water with patient when they go hiking
NMS s/s?
{{Ans- Extreme muscle rigidity, mutism, elevated CPK (muscle contraction and
destruction), myoglobinuria (breakdown of muscle cells, rhabdomyolysis), increased
WBCs, and increased LFTs
Treatment of NMS and MOAs?
{{Ans- D/C med, bromocriptine (D2 agonist), and dantrolene (muscle relaxant)
Serotonin syndrome s/s? {{Ans- Hyperreflexia and myoclonic jerks
Serotonin syndrome causes?
{{Ans- SSRIs, SNRIs, MAOIs, - triptans (for migraines like sumatriptan/imitrex)
Treatment for serotonin syndrome? {{Ans- D/C med and administer cyproheptadine
Wash out from SSRI to MAOI or vice-versa? {{Ans- 14 days
Wash out from Prozac to MAOI? {{Ans- 5 - 6 weeks
Drug choice for patient that is depressed and also has cancer?
{{Ans- Celexa or lexapro d/t fewer drug to drug interactions
Drug choice for patient with low energy and fatigue with depression? {{Ans-
Wellbutrin
Drug choice for patient with sexual problems d/t medication or depression? {{Ans-
Wellbutrin
C/I for Wellbutrin? {{Ans- Seizure disorder or hx or present eating disorder
Drug choices for patient with chronic neuropathic pain and depression?
{{Ans- 1. SNRI (cymbalta) 2. TCA (amitriptyline)
- Alpha 2 delta ligand (gabapentin or lyrica)
{{Ans- Insomnia; take in AM
Disorder that most greatly increases thoughts of self-harm? {{Ans- Depression
Disorder that most greatly increases homicidal ideation? {{Ans- Antisocial
personality
Why is there less evidence available supporting the use of antidepressants in
children? {{Ans- Lower placebo rates
Schizophrenia age of onset in men? Women? {{Ans- 18 - 25; 25 - 35
Findings on PET scan or MRI in schizophrenia? {{Ans- INCREASED ventricle size;
DECREASED everything else
No stimulants in schizophrenia due to? {{Ans- Increased dopamine release Tertiary
prevention for schizophrenia? {{Ans- Social skills training
Why should you refer a patient with schizophrenia to exercise programs, especially
aerobic exercise?
{{Ans- It improves cognition, quality of life, and long term health
Benefits of assertive community treatment (ACT)? {{Ans- Rehab post-
hospitalization, case management approach, and good for long term hx of
noncompliance
Oral haldol to IM conversion? {{Ans- 20x daily dose of oral dose
Max IM dose of haldol per visit? How long until next injection? {{Ans- 100 mg; 5- 7
days5 mg oral haldol BID =? IM {{Ans- 200 mg
Firm belief that is maintained despite lack of evidence? {{Ans- Delusion
Example of a delusion? {{Ans- Believing church members or class members are a
cult
MSE in preschooler (3- 5 yo)? {{Ans- Listen and observe; dependent on clinical
observationThought process? {{Ans- Organization of patients thoughts and ideas
Circumstantial speech? {{Ans- Go in circles but eventually answers Tangential
speech? {{Ans- Never gets to answer of question
lead to amenorrhea, galactorrhea, sexual dysfunction, and gynecomastia
Long term increased prolactin causes? {{Ans- Osteoporosis Normal prolactin levels
for men? Women? {{Ans- <20; <25 Which CYP450 enzyme metabolizes clozaril?
{{Ans- 1A2 Cigarettes are inducers of what CYP450 enzyme? {{Ans- 1A
Cigarette smoking in patients taking clozaril requires increased or decreased doses?
{{Ans- Increased Cigarette cessation in patients taking clozaril requires increased or
decreased doses? {{Ans- Decreased
Most antibiotics are inducers or inhibitors? Intervention with substrate? {{Ans-
Inhibitors; reduce substrate
Medications that cause mania? {{Ans- Steroids, antabuse, isoniazid (INH), and
antidepressants in patients with bipolar disorder
Medications that cause depression? {{Ans- Steroids, accutane, interferon, retrovirals,
antineoplastics,BZDs, progesterone, and beta blockers
Accutane can cause? {{Ans- Birth defectsSteroids can also cause? {{Ans- Psychosis
Intervention for patient on flonase or prednisone? {{Ans- Increase mood stabilizer,
antidepressant, orantipsychotic based on targeted disorder
Neurotransmitters indicated in addiction? {{Ans- Dopamine and GABA
S/S of stimulant abuse? {{Ans- Insomnia, anxiety, irritability, tremors, palpitations,
increased HR, andincreased BP
Patients with anorexia complain of pain, bloating, and fullness with eating due to?
{{Ans- Delayed gastricemptying
Conversion disorder presents after? S/S? {{Ans- Stressful event like losing sibling;
blindness, mutism, paralysis, paresthesia all medically unexplained
Adjustment disorder presents after? Timeline? {{Ans- Stressful event like loss of pet
or parent; within 3months of event
Subtypes of adjustment disorder? Examples? {{Ans- With depressed mood, with
anxiety, with mixed anxiety and depressed mood, with disturbances of conduct
(think change in school), and with mixed disturbances of emotions and conduct
(think of divorce leading to truancy, peer conflict, verbal altercations, insomnia, and
frequent crying)
ODD timeline? {{Ans- Lasts 6+ months
ODD s/s? {{Ans- Deliberately annoys others, is spiteful, and is vindictive; NO
AGGRESSIONTx for ODD? {{Ans- Family therapy
Conduct disorder s/s? {{Ans- Think juvenile detention, AGGRESSION, NO
REMORSE
Tx of conduct disorder? {{Ans- Target mood and aggression (antipsychotics, mood
stabilizers, SSRIs, andalpha agonists); therapy
Dx of Tourette's syndrome? {{Ans- 2 motor tics and 1 vocal tic lasting 1 year+
Childrens motor tics are? {{Ans- Fairly common and can be temporary
Primary neurotransmitters indicated in tics? {{Ans- DOPAMINE, NE, and serotonin
Tx of tics? {{Ans- Haldol, pimozide, abilify, clonidine, and guanfacine
Acute stress disorder timeline? {{Ans- 4 weeks or less
A patient assaults you at work and you don't want to return to work for 2-3 weeks.
This can be anexample of? {{Ans- Acute stress disorder
PTSD timeline? {{Ans- Lasts 1 month or more
S/S of PTSD? {{Ans- Intrusive re-experiencing, increased arousal, and avoidance of
stimuli Tx for PTSD? {{Ans- SSRI, TCAs, prazosin for nightmares, EMDR, and CBT
