Last Minute Review LMR Georgette’s PMHNP Certification Exam Latest Questions And Correct A, Exams of Psychiatry

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Walden University

PMNHP Psychiatric-Mental Health Nurse

Practitioner PMHNP Last Minute Review LMR

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Course Title and Number: PMHNP Last Minute Review LMR Exam Exam Title: Board Exam Exam Date: Exam 2024- 2025 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]

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PMNHP Psychiatric-Mental Health Nurse Practitioner 2024- 2025 Last Minute Review LMR Georgette’s PMHNP Certification Exam Latest Questions And Correct Answers | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - What are assessed in the Thought Content of the MSE - ANSWER>> SI/HI, Plan, Hallucinations

• What does a 17 on MMSE mean? - ANSWER>> • Moderate Cognitive impairment
• What does a decreased retic count indicate? - ANSWER>> • Anemia: Acute or chronic bleeding
• Normal range: 0.5 percent to 1.5 percent

• What does an increased retic count indicate? - ANSWER>> • Bone marrow disorder or Vitamin deficiency
• Normal range: 0.5 percent to 1.5 percent
• What does a sed rate measure? - ANSWER>> • Inflammation (ESR: Erythrocyte Sedimentation Rate) = distance in mm RBC's have descended in 1 hour.
• The sed rate test measures how fast red blood cells fall to the bottom of a tube. Inflammation creates proteins that make red blood cells fall more quickly.
• Infection (including of the bones)
• Cancer
• Arteritis (inflammation of the blood vessels)
• Lupus (an autoimmune disease that damages the skin, joints, and other parts of your body)
• Polymyalgia rheumatica (causes stiff and painful muscles)
• Rheumatoid arthritis (autoimmune disease in which the immune system attacks your joints)
• Systematic vasculitis (inflammation in your blood vessels)
• What does Depakote do to Lamictal - ANSWER>> • Depakote inhibit (note that it is not related to CYP)

Lamictal metabolism and cause INCREASING Lamictal level

• Lamictal is well known for Risk of Rash and Steven- Johnson Syndrome
• What does Erythromycin to Trileptal? - ANSWER>> • Erythromycin is INHIBITOR which Increase Trileptal level
• You will need to decrease Trileptal dose
• What does it mean when an Asian patient does not make eye contact with the NP? - ANSWER>> • Sign of respect

What does messenger RNA code for? - ANSWER>> • Amino Acids

• What do you do when a patient is on Tegretol and their ANC < 1000? - ANSWER>> • Stop and repeat lab
• Normal is 1500-8000 mm
• What happens to the brain during adolescence? - ANSWER>> • Dendritic pruning
• Emotions are controlled by amygdala
• By adulthood, PFC involved as well
• What happens when you mix Tegretol and Macrolides (Macrolides are a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin) - ANSWER>> • Macrolides are inhibitors so it increases Tegretol levels. You will need to decrease Tegretol dose
• What happens with a patient taking lithium and who drinks a lot of water? - ANSWER>> • Level decreased
• Patient taking lithium who gets dehydrated? - ANSWER>> • Levels increased

LITHIUM - ANSWER>> • WEIGHT GAIN

• Impaired Thyroid Functioning CNS
• Fine hand tremors
• Fatigue
• Mental cloudiness
• Headaches
• Coarse hand tremors (WITH TOXICITY)
• Nystagmus

Dermatological

• Pruritis
• Acne GI
• Diarrhea
• Vomiting
• Cra mps Anore xia RENAL POLYURIA with POLYDIPSIA
• Diabetes Insipidus
• Edema
• Microscopic tubular Changes CARDIAC
• T-Wave INVERSIONS
• FOCUS on SE's and TOXICITY
• Patient taking lithium who decreases sodium intake? - ANSWER>> • Levels increase
• What is drug half-life? - ANSWER>> • The time it takes for 50% of a drug to be eliminated from the

body

• What is a normal CKMB? - ANSWER>> • 0.3 mmcg/L What is normal sed rate or ESR? - ANSWER>> • Male 0- 22
• Female 0- 29

• What is a risk of using Tramadol? - ANSWER>> • Serotonin syndrome as it is very serotonergic
• What is a type II error in research? - ANSWER>> • There is no difference, but you say there is a difference
• What is type I error in research? - ANSWER>> there is a difference but say there isn't a difference
• What is epigenetic? - ANSWER>> • Factors that affect genes
• Environmental
• Smoking
• Stress
• Etc.
• What is HIV related dementia often mistaken for, especially at the beginning? - ANSWER>> • Depression
• What is incident to billing? - ANSWER>> • Means MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD
• Allows NP to get reimbursed at 100% rather than 85%
• What is included in the treatment of fibromyalgia? -

ANSWER>> • Sleeping meds

• Antidepressants
• Pain meds
• MEDICATION: Lyrica, Cymbalta, Gabapentin.
• What are Lyrica & Gabapentin Used for? - ANSWER>> • Med Class: Alpha-2 delta Ligands (know class)
• Lyrica & Gabapentin are FDA-approved for four PAIN uses:
• Postherpetic Neuralgia (PHN) - pain that appears before, during, or after having shingles (Lyrica & Gabapentin)
• FIBROMYALGIA - LYRICA ONLY
• Neuropathic Pain associated with spinal cord injuries ( LYRICA)
• Neuropathic pain associated with Diabetes (LYRICA ONLY)
• What is often common to patients with fibromyalgia? - ANSWER>> • Sexual abuse
• What is pseudo-dementia? - ANSWER>> • Cognitive impairment secondary to depression that clears when treated in the elderly. Dementia won't improve
• What is Tegretol (Carbamazepine) in

the CYP 450 system? - ANSWER>> •INDUCER!!! Inducer: Will decrease level of Lamictal and birth control pills

• What is the benefit of play therapy? - ANSWER>> • Don't have to confront emotions head on
• What is the concern when prescribing Lamictal with Depakote? - ANSWER>> • divalproex added to lamotrigine will essentially double lamotrigine blood levels and can increase risk of a serious rash
• What is the different between a healthcare agent, proxy, surrogate, and attorney in fact? - ANSWER>> • Nothing, they are all the same
• What is the evil eye? (CULTURAL) - ANSWER>> • When a stronger or more powerful person looks at a weaker person- often infant/child resulting in a hex which presents in illness such as headache, fever, diarrhea, disturbed sleep, increased fussiness
• What is the impact of steroid inhalers on children? - ANSWER>> • Slows bone growth and may decrease ultimate height

• PNEUMOIC - Old Age Parents Love Grandchildren - ANSWER>> • Oral (0-18 months), Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +)
  • FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3- 6 years old - ANSWER>> • 3-year-old masturbates, play with self, says naughty things
• This is NORMAL for children this age. What do you do when a patient has an increased prolactin level? - ANSWER>> • Stop prolactin (stop the agent that cause increase prolactin)
• ACUTE STRESS DISORDER - ANSWER>> • A d/o resulting from exposure to a major stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP to ONE MONTH - Less than 1 month.
  • If LONGER than 1 month = PTSD
• Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder

What would you do if a 5-year-old tells you his brother sodomized him? - ANSWER>> • Tell mom don't leave him alone with patient and call CPS implement crisis If a child is playing with doll in a sexual way, what do you do first? - ANSWER>> • You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH

INFO BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you have to have something (assessment data) to report - Assess = FIRST If a 13-year-old tells you he want to smoke, what would be an appropriate response? - ANSWER>> • Ask him of his plan to stop smoking If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect? - ANSWER>> • Cranial nerve V- Trigeminal nerve (FIVE) What cranial nerve is responsible for Bells Palsy? - ANSWER>> 7 = Facial Paralysis What cranial nerves do you assess for corneal sensation - ANSWER>> Nerves 5 & 7 What cranial nerves do you assess for papillary reaction to light and accommodation? - ANSWER>> Nerves 3,4,& 6 What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular movements? - ANSWER>> Nerves 3, 4, & 6 What cranial nerves do you assess for corneal light reflex?

- ANSWER>> 3, 4, & 6

Cranial Nerve 1 - ANSWER>> Olfactory (smell) Cranial Nerve 2 - ANSWER>> Optic - vision Cranial Nerve 3 - ANSWER>> Oculomotor (eye movement): The occulomotor nerve is responsible for motor enervation of upper eyelid muscle, extraocular muscle and pupillary muscle. Cranial Nerve 4 - ANSWER>> Trochlear (eye movement): The trochlear nerve controls an extraocular muscle.

Cranial Nerve 5 - ANSWER>> Trigeminal: The trigeminal nerve is responsible for sensory enervation of the face and motor enervation to muscles of mastication (chewing). Cranial Nerve 6 - ANSWER>> Abducens (motor): The abducent nerve enervates a muscle, which moves the eyeball. Cranial Nerve 7 - ANSWER>> Facial nerve: The facial nerve enervates the muscles of the face (facial expression). Cranial Nerve 8 - ANSWER>> Vestibulocochlear (hearing and balance): The vestibulocochlear nerve is responsible for the sense of hearing and balance (body position sense). Cranial Nerve 9 - ANSWER>> Glossopharyngeal: The glossopharyngeal nerve enervates muscles involved in swallowing and taste. Lesions of the ninth nerve result in difficulty swallowing and disturbance of taste. Cranial Nerve 10 - ANSWER>> vagus nerve: The vagus nerve enervates the gut (gastrointestinal tract), heart and

larynx. Cranial Nerve 11 - ANSWER>> accessory: The accessory nerve enervates the sternocleidomastoid muscles and the trapezius muscles. Cranial Nerve 12 - ANSWER>> Hypoglossal (tongue movement): The hypoglossal nerve enervates the muscles of the tongue. What is the best action for a 16 y/o with conduct disorder that refuses tx? - ANSWER>> • Send to psych specialist for acting out kids - Referrals - Have to see if you are going to refer the same patient to the same provider - Cannot refer the patient to

another provider that is the same as you (ie psych) - you must refer to a neurologist or another specialist or PCP What is a priority consideration for a 16-year-old that shows up with mother for first therapy? - ANSWER>> • Confidentiality (ex. mom sits in lobby) What is important to know about ACE inhibitors (Meds for Heart failure/HTN) - ANSWER>> • This medication can cause increased lithium levels to toxic levels - must collaborate with PCP to determine whether to change ACE or change Lithium - Can't use both What medication INCREASES Lithium serum level up to double - ANSWER>> Ibuprofen Why is Lithium used? - ANSWER>> • First-line neuro- protective for bipolar

• Lab Values concerning for patient on Lithium: - ANSWER>> • Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• • Pregnancy Test

• Lithium (Eskalith/Lithobid) Toxicity - ANSWER>> • Normal Range of LITHIUM LEVEL - 0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic taste and SEVERE tremor. Common side effects of Lithium (Eskalith/Lithobid) - ANSWER>> Nausea, fine-hand tremors (start monitoring for toxicity), increased urination and thirst

What pregnancy category is Lithium (Eskalith/Lithobid) - ANSWER>> CATEGORY D: AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect What increases risk of lithium (Eskalith/Lithobid) toxicity? - ANSWER>> NSAID, dehydration and Thiazides What co-morbid risk in increased with Lithium (Eskalith/Lithobid)? - ANSWER>> • Risk of Hypothyroidism What do symptoms of hypothyroidism (decreased T4 & increased TSH) mimic? - ANSWER>> Unipolar mood disorders:

• confusion
• decreased libido
• impotence
• decreased apetite
• memory loss
• lethargy
• constipation
• headaches
• slow or clumsy movements
• syncope
• weight gain
• fluid retention

• muscle aches and stiffness
• slowed reflexes
• somatic discomfort including aching and joint stiffness
• slowed speech and thinking
• sensory disturbances including hearing
• cerebellar ataxia (may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements)

• loss of amplitude in ECG What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic? - ANSWER>> Bipolar affective disorders
• motor restlessness
• emotional lability
• short attention span
• compulsive movements
• fatigue
• tremor
• insomnia
• impotence
• weight loss
• increased appetite
• abdominal pain
• excessive sweating
• flushing
• elevated upper eyelid leading to decreased blinking, starring, and fine tremor
• tachycardia
• dysrhythmias What does ADPIE stand for? - ANSWER>> • Assessment
• Diagnosis
• Planning
• Implementation

• Evaluation Recommend CBT for - ANSWER>> Depression & Anxiety (keep a daily log) pg 209 and every PB pages for each dx - ANSWER>> all thing for each disorder

What medication is best for an aggressive patient? - ANSWER>> IM Geodon Medications to improve anxiety... - ANSWER>> act directly or indirectly on GABA system

• SSRIs
• Benzodiazepines
• Tricyclics (TCA)
• Buspirone
• Tiagabine (Gabitril)
• gabapentin
• propranolol in children:
• alpha agonists : clonidine (catapres) & guanfacine (tenex) advantages of Benzodiazepines with short have lives - ANSWER>> - less daytime sedation
• less drug accumulation
• quick onset
• useful for tx of insomnia disadvantages of Benzodiazepines with short have lives - ANSWER>> increase risk of addiction non-pharmacological Management for anxiety -

ANSWER>> - behavioral therapy

• CBT
• interpersonal therapies
• community self help groups
• alternate therapies as adjunct tx