Last Minute Review Dr, G Exam Review PMHNP Georgette’s LMR Questions with Correct Answers, Exams of Psychiatry

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Walden University

PMNHP Psychiatric-Mental Health Nurse

Practitioner PMHNP Last Minute Review LMR

Exam

Course Title and Number: PMHNP Last Minute Review LMR

Exam

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Exam Date: Exam 2024- 2025

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11/5/24, For Inquiries about This or Any Other Exam HMU 8:06^ [email protected] AM

LMR - Dr. G Review PMHNP 2024

PMNHP Psychiatric-Mental Health Nurse Practitioner 2024-

Last Minute Review Dr, G Exam Review PMHNP Georgette’s LMR

Questions with Correct Answers | 100% Pass Guaranteed | Graded A+

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Number of Questions In This Bank (644)

According to

Erikson what

stage of

development

involves ability

to learn how

things work, to

understand an

organize. Ability

to work with a

sense of

competency and

achievement.

School

age (6 -

12 yrs.)

Industry

vs

inferiori

ty

Children with

inattentive ADHD

are most likely to

have an

prefrontal

11/5/24, 8:

AM

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abnormality in

which part of the

cortex?

What drugs

should be

avoided with

Kava Kava

(piper

Methysticum)?

-Alprazolam (benzos)

-CNS depressants (e.g., phenobarbital,

zolpidem, alcohol).

-Medications metabolized by the liver

What is the

normal range for

TSH?

0.5 - 5.0 mu/L

What are lab

values in

Hyperthyroidism

Decreas

ed TSH

Increas

ed T

and T

What are labs in

Hypothyroidism?

Increase

d TSH

Decreas

ed T

and T

What are 5

primary

Heat intolerance

Agitation,

Anxiety,

Irritability

11/5/24, 8:

AM

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symptoms

of

Hyperthyroi

dism?

Tachycard

ia

Moo

d

swin

gs

Weig

ht

loss

What are 4

primary

symptoms

of

Hypothyroidi

sm?

Cold

intole

rance

Letha

rgy

Weigh

t gain

Decreased libido

Hypothyroidism

mimics

symptoms of

what psychiatric

disorder?

Depression

Hyperthyroidism

mimics

symptoms of

Mania

11/5/24, 8:

AM

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what psychiatric

disorder?

Valproic acid produces what teratogenic Spina bifida (neural tube defect)

effect?

11/5/24, 8:

AM

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What is the primary organ where valproic

acid is toxic?

Liver ( hepatoxicity ), followed by pancreas

What are 4 signs

of hepatoxicity?

Abdominal

pain in the

URQ

Reddish-

brown

urine

Yellowing of

the skin and

sclera

Fatigue

What are the

symptoms of

pancreatitis

induced by

Depakote or

Valporic acid?

Oily stools

Upper abdominal pain

Abdominal pain

that radiates to

your back

Tenderness

when touching

the abdomen

Fever

Rabbit

pulse

LMR - Dr. G Review PMHNP 2024

11/5/24, 8:

AM

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Nause

a

vomiti

ng

What are symptoms of depakote induced

hyperammonemia?

What is the

therapeutic

range for

valproic acid?

50-125 mcg/ml

What is a toxic

level of valproic

acid?

150 mcg/ml

What are 4 signs

of valproic acid

toxicity?

Disor

ienta

tion

Letha

rgy

Respirat

ory

depressi

on

Nausea/

vomiting

A pt on

Depakote C/O

Hepatotoxicity; DC offending

agent and do a LFT. Checking

11/5/24, 8:

AM

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Abdominal pain

in the URQ and

Reddish-brown

urine. What do

you suspect?

What do you do?

AST 5-40, ALT 5-35. Also do VPA

level, ammonia levels.

With suspected

toxicity with

valproic acid,

what steps/labs

should be

drawn?

D/C drug

Check

drug

level

Obtain

LFTs

Obtain ammonia level

A pregnant pt is

taking

accutane,

zyprexa and

abilify; what

med needs to

be d/c'd?

Accutane (used for acne; Causes

birth Defects!!!)

What herbal

supplement is

used for anxiety,

stress, and

insomnia? What

Kava Kava

(piper

Methysticu

m) liver

damage

11/5/24, 8:

AM

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is the major side

effect with Kava

Kava (piper

Methysticum)?

What are 5

symptoms of

Steven Johnson

Syndrome?

Fever -Key sx to

suspect SJS;

high yield (HY)

burning of

mouth/eyes -HY

Body

aches

Sever

e red

rash

Peelin

g skin

Facial and tongue swelling

Mood stabilizer

most likely to

cause Steven

Johnson

syndrome.

Lamotrigine

(Also tegretol in Asians with

specific gene type HLB. Noted

that Tramadol can also cause

SJS)

Which mood

stabilizer

causes the

Lamotrigine (Lamictal)

11/5/24, 8:

AM

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least weight

gain?

3 /

LMR - Dr. G Review PMHNP 2024

Ziprasidone (Geodon)

Which SGA is the

least sedating?

Aripiprazole (Abilify)

Your pt is taking

Kava (piper

Methysticum)

and you need to

add an AS to

manage their

SCZ, which do

you add?

Aripiprazole (least sedating)

What are 2

hallmark

symptoms of

delirium?

Acute disturbance of

LOC

impair

ed

cogniti

on

inatten

tion

How are

agitation and

psychotic

symptoms

treated in

Low dose Haldol (QTc check first)

4 /

delirium?

16 y/o C/O

feeling funny

after inhaling

Acetone (nail

polish remover).

What is your

action?

Do UDS; chances are they may be

abusing other substances

What 4 drugs can

cause mania?

"SAID"

S teroids

A ntidepre

ssants (in

BPD)

I soniazid

(INH)

D isulfira

m

(Antabus

e)

What 6 drugs can

induce

depression?

"SIP BARB"

S tero

ids

I nter

feron

,

5 /

P rog

ester

one

B eta blockers

A ccutane, (Isotretinoin)

R etroviral drugs, Antineoplastic drugs

B enzodiazepines

Steroids can

induce what 3

psychiatric

states?

Man

ia

Dep

ress

ion

Psy

cho

sis

REMEMBER

SAFETY FIRST; pt

s/p assault, 1st

thing you do is.

What is the best

environment to

interview this pt

in?

reassure safety,

provide

environment of

safety private

area with door

open/partially

open

What is the

therapeutic range

0.6-1.2 mEq/L

6 /

for lithium?

Many

postpartum

women have SI

after delivery,

yet they don't

have psych

evals before

leaving the

hospital, what

could a

possible

solution be?

collaborating care between psych and

OBGYN to provide the best care for

that pt

If collaborating

with a provider

who is not in the

same clinic or

hospital, the

informed

consent

[does/does not]

apply?

Does not, ie pt will need to sign

consent for labs/ chart to be sent

When

discharging

from inpatient

fax; so the new provider has them for

follow-up appointment

7 /

Lurasidone (Latuda)

Which 3 SGAs cause the least weight gain? Aripiprazole you want [to

fax/print off-give

to pt.] labs for

the outpatient

provider before

pt discharge?

Before referring a pt out or discharging is there something that I could do for this patient first?

them, it is good to ask yourself what

8 /

LMR - Dr. G Review PMHNP 2024

question?

What 3 unique

positive things

(MUST

KNOWS) about

Lithium?

• Neuroprotective effect for bipolar

disorder

• Gold standard for treating manic

episodes

- mood stabilizer w/ anti-suicidal

effects

How does lithium

work on

impulsivity?

Modulates glutamate

receptors, reducing impulsivity.

(Also work on serotonin and

norepinephrine unknown

mechanism of action)

What mood

stabilizer has

anti-suicidal

effects?

Lithium

What 5 labs

should be drawn

with lithium?

Thyroid panel (TSH 0.5 - 5)

Serum creatinine (0.6 -1.2)

BUN (10-20)

Urinalysis (+4 proteins)

HCG (12 - 51 yrs old, childbearing)

What is a normal

SerumCr range?

0.6-1.2 mg/dL

What is the

normal range for

BUN?

10-20 mg/dL

9 /

What is the A1c

measuring?

Measures the average blood

sugar level over the past 2 to 3

months. It is a valuable tool

used to diagnose and monitor

diabetes mellitus type one in

type two.

What are some

key laboratory

tests that may

be ordered for a

patient with

gout and

hepatitis?

Serum

uric

acid

levels

Liver

function

test

Complet

e blood

count

When should

you suspect

kidney disease

with a

urinalysis?

4+ protein; if pt on Lithium--

monitor closely toxicity

(Order urinalysis for Lithium

patient)

What are 7 side

Hypothyroidism

Fine hand

tremors

(Coarse when

10 / 7

effects of

lithium?

toxic)

Maculopapular

rash

GI upset

(N/V/D,

cramps,

anorexia)

Polyuria,

polydipsia,

diabetes

insipidus T-

wave

inversions

Leucocytosis

Ebstein anomaly in newborn

(Teratogenic first trimester)

What are 7 signs

of lithium

toxicity?

Severe nausea, vomiting, diarrhea

Confus

ion

Drowsi

ness

Muscle

weakn

ess

Heart

palpita

11 / 7

tions

Coarse hand tremor

Unsteadiness while standing or

walking

Bold =must knows

Which 3 drugs

can increase

lithium levels by

decreasing renal

clearance?

NSAIDs

(ibuprofen,

indomethaci

n) Thiazides

(hydrochlorot

hiazide) ACE-

Inhibitors (-

prils)

(Renal disease also decreases renal

clearance)

What is a toxic

level of lithium?

mEq/L or

higher

Disconti

nue

medicati

on

At what level do

you monitor

lithium closely

but not

1.3 -1.4 mEq/L with

no signs of lithium

toxicity

(Discontinue with

12 / 7

discontinue? signs of lithium

toxicity)

With suspected lithium toxicity, what do you D/C Li and draw Lithium level (do that before Vital signs)

do first?

13 / 7

What is the appropriate action if lithium level

is 1.5 mEq/L?

D/C lithium

Check lithium level

What 2

conditions can

increase

lithium levels?

If this pt is going

on a hike, what

would you

recommend?

Dehydration

Hyponatremi

a (inverse

relationship)

(Also renal

disease)

Take extra water to avoid dehydration

A client has a

family history of

Hashimoto's

thyroiditis, and

begins to have

symptoms of

hypothyroidism.

What do you do?

Use collaboration, refer the

patient to endocrinologist. if the

patient is stable on lithium, and

the hypothyroidism can be

managed, no reason to

discontinue (if not toxicity

symptoms)

What birth defect

can lithium

cause?

Ebstein anomaly (congenital heart

defect)

When working

with

adolescents,

Ethical dilemma

LMR - Dr. G Review PMHNP 2024

14 / 7

parents often

feel they have a

right to know

what is going on

with their child,

but the teen has

a right to

confidentiality.

This can create

an

When building

a therapeutic

alliance w/

adolescents, it

is important to

stress

confidentiality;

what they say remains

confidential unless they are

wanting to harm self/ someone

else,

[or they are in a relationship with

someone much older (like 14 y/o

seeing a 30 y/o)]

if an adolescent

C/O abuse,

even if they

make the claim

in the presence

of the parents,

what should

you do?

interview the teen w/o the parents;

call CPS

15 / 7

What 3

neurotransmitt

ers are

associated with

ADHD?

DA, NE, 5HT aka serotonin -->(DNS)

The Frontal

cortex, Basal

ganglia ,

Reticular

Activating

System are

associated with

which

psychiatric

disorder?

ADHD

Inattentive

Type ADHD

demonstrates

abnormalities

in which part of

the brain?

Prefrontal cortex

What should be

done before

placing a

Cardiac history

16 / 7

patient on

stimulants for

ADHD

(priority)?

Excessive worry,

apprehension,

or anxiety about

events or

activities that

occurs more

days than not

for a period of at

least 6 months

is

GAD

if ADHD and

tic both

present, what

is

contraindicate

d?

Stimulants can worsen tics

if a stimulant

was tried and

provided some

effect but not

enough benefit

the medication has been cleared from

the body, increase the dosage

17 / 7

(helped, but not

long enough),

and the client is

re-

experiencing

symptoms

after some

time, what can

this mean?