PMHNP Certification Exam Questions and Answers: Latest 2023-2024, Exams of Nursing

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LMR Georgette’s PMHNP Certification Exam Latest 2023- 2024

Questions And Correct Answers (Verified Answers

1. 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): D. 68 y/o single white male with depression *5 risk factors (age, male, white, depression) Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents what should you do?: 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.
  3. Which Ethnic group has the highest rate of suicide?: Native Americans

4. 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 antag-onism C. Increased Lipids D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
   5. Which antipsychotics have the least weight gain?: 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
   6. Which mood stabilizer have the least weight gain?: Lamictal

• But remember all mood stabilizers cause some weight gain
  7. When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a: atypical
  8. 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: Hypothalamus A, B, & D are all part of the limbic system so you can rule that out

9. When a patient is hesitant to participate in treatment you should encourage?: Bring a support person like a husband 10 Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
   11. When T4 and T3 are high and TSH is low what is the diagnosis: HYPERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms HEAT INTOLER- ANCE
   12. Key symptoms of Heat Intolerance: Hyperthyroidism
   13. When T4 and T3 are Low and TSH is high what is the diagnosis: (HYPOTHYROIDISM) TSH secretion increased: TSH HIGH à COLD INTERANCE
   14. Key symptoms of Cold Intolerance: Hypothyroidism

15. Hyperthyroid can mimic: Mania
16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has reddish/brown urine: Hepatoxicity

• Check LFTs

18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check - LFT

• Ammonia
• Depakote Level

20. What herbal supplement can cause hepatoxicity?: Kava Kava
21. When taking Kava Kava in combinations with other medications you should caution about: Risk of Hepatoxicity and Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: - fever, mouth pain, swelling, burning eyes, blisters, skin pain
24. two psychotropics known to cause steven johnson syndrome: lamictal and tegretol
25. What nationality is most suseptible of getting steven johnson?: Asians

26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
28. Agranulocytosis when to discontinue medication: Less than 1000
29. When monitoring for agranulocytosis in patients look for s/s of what?: Infection

• Fever, sore throat, fatigue, chills

30. Before starting any mood stabilizer in a female of childbearing age be sure to check?: HCG
31. Which two medications may decrease the risk of suicide?: clozaril and lithium
32. Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril 33 Ace inhibitors are treatment of choice for?: Heart Failure
33. Certain medications are known to increase lithium level, but HOW?: by reducing renal clearance
34. When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise
35. Normal Lithium Level: 0.6-1.

37. Lithium Toxicity: 1.5 or above Discontinue and re-order lithium level
38. Lithium level of 1.4: Monitor for toxicity
39. Labs before starting lithium: 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
40. 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY
41. Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)

• Some of these are also signs of toxicity

42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation, tremor
43. NMS: 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)
44. Cherry colored urine in a patient that exercises a lot: test for myoglobinuria may be a sign of rhabdo

45. Serotonin Syndrome: 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).

46. Treatment for NMS: Stop Offending Medication

• Dantrolene (muscle relaxer)
• Bromocriptine (Dopamine D2 agonist). *In question focus on what they are asking for....dopamine agonist vs muscle relaxer

47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI, SSNRI, TCA, MOAI)

• Cyproheptadine

48. Triptans: Used for MIGRAINES

• These meds increase serotonin example SUMATRIPTAN 49 patient taking Prozac and started on sumatriptan: - call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP

50. How long do you wait when switching between an SSRI to an MAOI?: 2 weeks
51. How long do you wait when switching between Prozac and MAOI?: 5 - 6 weeks wash out period
52. What is the first line treatment for depression and why?: SSRI-First line treatment for depression due to less risk of injury from OVERDOSE
53. If a cancer patient has depression what should you consider?: Treating with a medication with minimal drug/drug side effects like Lexapro
54. Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin
55. Primary symptoms of depression include fatigue and low energy what med would you chose?: Wellbutrin
56. Wellbutrin is contraindicated in patients with: Seizures and anorexia
57. Which medications are best for neuropathic pain?: SNRI Gabapentin TCA

58. Secondary to the black box warning providers caring for patients on antidepressants should assess for?: Suicidality, frequency, and severity at EVERY appointment
59. Which meds have the worse serotonin discontinuation syndrome: Those with short half lives such as zoloft
60. Symptoms of serotonin withdrawal syndrome: Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET Shits and Shivers
61. Ages of onset for schizophrenia in males vs females: - MALES 18- 25 years

• FEMALE 25-35 years

62. Schizophrenia increases the risk for: SUICIDE HIGH RISK OF SI in SCHIZOPHRENIA Just having schizophrenia increases your risk of suicide. MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts)

63. What increases the causes or increases the risk or schizophrenia: excessive pruning of synapses - inadequate synapse formation,

• intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation,
• first order relative (mom/dad)
  64. MRI or PET scan what is seen in schizophrenia: EVERYTHING DECREASES EXCEPT VENTRICLES
• You will see VENTRICULAR ENLARGEMENT
  65. Stimulants can potentiate the release of what neurotransmitter?: Dopamine which can worsen symptoms of schizophrenia
  66. Assertive Community Treatment (ACT): a form of rehabilitation post hospitalization, in home treatment
  67. What level of prevention is ACT?: Tertiary
  68. What adjunctive treatment is important in schizophrenia: - social skills training - Exercise
  69. Exercise for mental health patients can promote: Cognition Quality of Life Long-term health
  70. ACT is ideal for patients with a history of: Treatment non-compliance
• Think about making the treatment convenient for them-->bringing it to their home

71. What diagnosis has the highest risk of Homicidality: Antisocial
72. In the MMSE how do you test for abstraction?: proverb interpretation (everyone that lives in glass houses shouldn't throw stones) Are they able to think abstractly 73. Thought Process-Tangential: means that their response has nothing to do with the question
73. Circumstantial: means that their response goes in circles instead of getting to the point of the question
74. Mental Status-Thought Content includes: SI/HI/AH/VH
75. Another name for MMSE: Folstein Scale
76. How to assess concentration on MMSE: Serial 7s or perform an activity backwards i.e list the days of the week backwards
77. Assess ability to learn new material: repeat 3 words after me
78. Assess ability to recall: repeat 3 words after 5 minutes
79. Assess fund of knowledge: Who is the president
80. What is a quick and easy way to assess for neurological issues: Clock drawing test
81. If patient is unable to draw a clock this indicates: Problem with the right hemisphere, cerebrum, or parietal lobe

83. mesolimbic pathway: Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms

• Antagonism of D2 receptors in this pathway treats positive psychotic symptoms

84. mesocortical pathway: - Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia
85. Nigrostriatal Pathway: - This pathway mediates motor movements

• Dopamine blockade in this pathway can lead to increase acetylcholine levels
• Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia

86. Low Dopamine in the nigrostriatal pathway increases which neurotransmitter: - Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach)
87. Long-standing D2 blockade in the nigrostriatal pathway can lead to: tardrive dyskinesia
88. Tuberoinfundibular pathway: - Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which

clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia

• DECREASE DOPAMINE INCREASED PROLACTIN
  89. Long-term hyperprolactinemia can be associated with what condition: osteoporosis
  90. Normal Prolactin Level in Men: level less than 20ng/ml
  91. Normal Prolactin Level in Women: less than 25ng/ml
  92. Which medication is the highest offender for increasing prolactin: Risperdal
  93. Acute Dystonia + Treatment: neck stiffness, muscle spasm of upper body especially neck/face/tongue
• Treatment is IM COGENTIN + continue PO COGENTIN for several days
  94. Akathisia + Treatment: may mimic anxiety, restlessness, can't sit still, rocking, pacing
• First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal)
• Second line treatment is COGENTIN
• Third line treatment is benzos

95. Beta-Blockers such as Inderal are contraindicated with what type of asthma medication: - DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm
96. akinesia/bradykinesia + treatment: A. difficulty initiating movement; slowness of movement - Treatment Cogentin
97. PSEUDOPARKINSON or PARKINSONIAN + Treatment: caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing

• Treatment COGENTIN

98. tardive dyskinesia + Treatment: abnormal facial movements, grinding teeth, lip smacking, protruding tongue

• Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT

99. Does Cogentin Treat TD: COGENTIN MAKES TD WORSE
100. Typical onset of TD: OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO
101. What non-psych med can cause TD?: REGLAN (Metoclopramide) can

CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops

102. InDucers CYP450: DECREASE Carbamazepine Rifampin Alcoholics (chronic) Phenytoin Grisiofulvin Phenobarb Sulphonylureas Crap GPS Induces me to Madness!
103. InhIbitors of CYP450: INCREASE Ciprofloxacin Ritonavir Amiodarone

Cimetidine Ketoconazole Acute Etoh Macrolides INH Grapefruit Juice Omeprazole Crack Amigos

104. Erythromycin and Clarithromycin can cause: Increased tegretol levels
105. Patient started on Clozaril or Zyprexa and two months later starts smoking: as a provider you know that the smoking can decrease the medication effectiveness

• Increase medication dose
  106. Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey: as a provider you know that you must now decrease the dose of the antipyshcotic

107. Medications that cause mania: Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar

• If a patient must take steroids, the provider should increase the mood stabilizer

108. Medications that cause depression: steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone

• may need to increase antidepressant

109. Accutane (isotretinoin): Can cause depression and birth defects
110. Flonase: As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression
111. Flonase can trigger mood instability but it can also cause an increase in: Psychosis patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis

• increase the dose of antipsychotic

112. Neurotransmitters involved in Addiction: Dopamine and GABA

.

113 Symptoms of Stimulant Abuse: 1. agitation/aggression

2. impaired judgment
3. euphoria
4. elevated BP
5. tachycardia
6. dilated pupils
7. hallucinations
8. TREMORS
9. IMSOMNIA
10. If an anorexic patient complains of pain or bloating after eating this may indicate: delayed gastric emptying
11. Medications that delay gastric emptying: Omeprazole, ranitidine, famotidine 116. Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption of antipsychotics & SSRI

• MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI

117. When initiating an SSRI on an elderly patient you should advise about: increased anxiety

.

118. Paradoxical effect: when meds cause the opposite effect than expected
119. Apoptosis: programmed cell death/neuronal loss
120. At age 45 and above the patient displays mania for first time what should be ruled out: MEDICAL CONDITION
121. Patient with bipolar disorder presents with depressed mood & emotional lability: Give Depakote
122. Hallmark sx of Borderline Personality: Recurrent self harm
123. Treatment for Borderline Personality: DBT
124. Creator of DBT: Marsha Linehan
125. What activity is helpful in making a diagnosis of borderline personality: Journaling or diary keeping
126. Conversion Disorder: STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism
127. Adjustment Disorder: adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying)

• Symptoms occur within 3 months of the stressor

.

If question states recently moved, recent death....THINK ADJUSTMENT 128 factitious disorder: when patients introduce foreign substances into their body or contaminate their food

• Faking illness but NO MOTIVE BEHIND IT
  129. Malingering: Faking illness for financial gain
  130. Reactive Attachment: common in children in foster care, abuse from parents
• Withdrawn and shows no emotion towards caregiver
  131. ODD: They deliberately annoy others, no aggression, defiance of authority - Family Therapy is mainstay
• Child management /Parent management skills is the focus in therapy
• Positive reinforcement
• Boundary Setting
  132. Conduct Disorder: violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE
• May need meds and therapy

.

• Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine)
• Monitor BP with guanfacine and clonidine
  133. Acute Stress Disorder: similar to PTSD but the timeline differs
• heightened arousal, nightmares, flashbacks
• LESS THAN ONE MONTH
  134. PTSD: - OVER ONE MONTH
• 3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance
• May also have NIGHTMARESà GIVE PRAZOSIN
• Non-pharm tx of PTSD- EMDR, CBT
  135. Panic attack vs Panic disorder (treatment): Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom

.

136. Tourette's Syndrome: Criteria for diagnosis

• TWO moto tics and ONE vocal tics
• LASTS more than ONE YEAR
• By age 18 CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL 137 Child presents with one tic and the parent is worried: CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL

138. Neurotransmitters involved in Tourettes: DNS: Dopamine, Norepinephrine, Serotonin
139. Treatment for tourettes: Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine
140. What type of medication can cause tics or exacerbate them: Stimulants
141. Neurotransmitters involved in mood disorders: DNS: Dopamine, Norepinephrine, Serotonin + GABA
142. Neurotransmitters involved in ADHD: DNS: Dopamine, Norepinephrine, Serotonin
143. part of brain implicated in ADHD: prefrontal cortex basal ganglia

.

reticular activating system

144. ADHD inattentive type is caused in what part of the brain: Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION
145. dorsolateral prefrontal cortex: Attention Executive Function Cognition Processing Working Memory Problem Solving
146. Deficit in the _____ can lead to ADHD inattentive type: Prefrontal Cortex
147. Teacher reports that the stimulant only works for first few hours of class: medication has worn off too fast. Order multiple dosing throughout the day
148. When does the aftercare plan start: on admission
149. If parents become anxious while you are educating about a new diagnosis what should you do: - Provide patient and parents information immediately don't wait till discharge

.

• Parents may become anxious after a diagnosis of mental illness such as ADHD, stop teaching offer support because they will not absorb the education. Provide supportive therapy
  150. Neurotransmitters involved in OCD: serotonin, dopamine, glutamate & GABA
  151. A tic may also be a ___: Compulsion
  152. Facts about OCD: Obsession/Compulsion
• A tic may be a compulsion
• If first order relative has OCD the child's risk of developing OCD is increased