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PMHNP CERTIFICATION EXAM|| 2025 - 202 6||ACTUAL TEST
QUESTIONS WITH CORRECT DETAILED AND VERIFIED
ANSWERS. A+ GRADE
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 confiden- tial. 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 an- tagonism
C. Increased Lipids D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER )
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also leastsedating), Geodon-if patient has metabolic syndrome consider switching to one ofthe 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 antipsychoticthe answer is usually to start of a: a typical 8. A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical 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 encour-age?:
- 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, burningeyes, blisters, skin pain 24. two psychotropics known to cause steven johnson syndrome: lamictaland 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
45. Serotonin Syndrome: With any drug that increases 5-HT (e.g., MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular insta- bility, 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 themto 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?: Treatingwith a medication with minimal drug/drug side effects like Lexapro 54. Patient with depression worries about sexual dysfunction what would bethe medication of choice?: Wellbutrin 55. Primary symptoms of depression include fatigue and low energy whatmed 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 anti- depressants 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: exces- sive 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 DECREAS-ES 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 hospi- talization, in home treatment 67. What level of prevention is ACT?: Tertiary 68. What adjunctive treatment is important in schizophrenia: - social skills training
- Exercise
- Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dysto- nia, parkinsonian symptoms and akathisia 86. Low Dopamine in the nigrostriatal pathway increases which neurotrans- mitter: - 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 AL- BUTERAL this combination can cause bronchospasm 96. akinesia/bradykinesia + treatment: A. difficulty initiating movement; slow- ness 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 discon- tinue 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
- euphoria
- elevated BP
- tachycardia
- dilated pupils
- hallucinations
- TREMORS
- IMSOMNIA
- If an anorexic patient complains of pain or bloating after eating this may indicate: delayed gastric emptying
- Medications that delay gastric emptying: Omeprazole, ranitidine, famoti- dine
- Proton Pump Inhibitors (omeprazole & Protonix): Decrease absorption of antipsychotics & SSRI
- MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI
- When initiating an SSRI on an elderly patient you should advise about- : increased anxiety
- Paradoxical effect: when meds cause the opposite effect than expected
- Apoptosis: programmed cell death/neuronal loss
- At age 45 and above the patient displays mania for first time what shouldbe ruled out: MEDICAL CONDITION
- Patient with bipolar disorder presents with depressed mood & emotion-al lability: Give Depakote
- Hallmark sx of Borderline Personality: Recurrent self harm
- Treatment for Borderline Personality: DBT
- Creator of DBT: Marsha Linehan
- What activity is helpful in making a diagnosis of borderline personality- : Journaling or diary keeping
- Conversion Disorder: STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism
- 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
- factitious disorder: when patients introduce foreign substances into their body or contaminate their food
- Faking illness but NO MOTIVE BEHIND IT
- Malingering: Faking illness for financial gain
- Reactive Attachment: common in children in foster care, abuse from parents
- Withdrawn and shows no emotion towards caregiver
- 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
- Conduct Disorder: violence, criminal, fire setting, killing animals, gang activ- ity, +AGGRESSION, NO REMORSE
- May need meds and therapy
- Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsy- chotics, alpha agonists/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine)
- Monitor BP with guanfacine and clonidine
- Acute Stress Disorder: similar to PTSD but the timeline differs
- heightened arousal, nightmares, flashbacks
- LESS THAN ONE MONTH
- PTSD: - OVER ONE MONTH
- 3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoid- ance
- May also have NIGHTMARESà GIVE PRAZOSIN
- Non-pharm tx of PTSD- EMDR, CBT
- Panic attack vs Panic disorder (treatment): Panic attack = BZ Panic disorder = SSRI Panic Attack is ACUTE Panic Disorder is CHRONIC Feels like impending doom
- 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
- Neurotransmitters involved in OCD: serotonin, dopamine, glutamate & GABA
- A tic may also be a : Compulsion
- 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
- Streptococcal infections increase risk of OCD
- Treatment SSRI-prozac, Zoloft, if adult you may also use TCA such as clomipramine
- If question asks if the patient has Tourette's vs OCD listen for mentionof streptococcal treatment this will trigger you to think OCD:
- DMDD: 6 - 17 years ONLY
- Irritability for no reason, sad, depressed mood, tantrums, crying, moody, always mad
- If patient presents with irritability or labile mood and you need help further delineating symptoms: Administer MOOD QUESTIONAIRE 7/13 Bipolar Diagnosis Likely
- Sleep Disorders are often So what should you assess if a parent reports that a child is having night- mares: GENETIC ask if someone in the family has a similar issue with sleep...look for family patterns of sleep problems
- GAD: Worry, apprehension, fear must LAST ATLEAST 6 MONTHS
- Delirium: - ACUTE (within hours to days) onset of disturbance of LOC, COG- NITION, inattention
- Urinary Tract Infections are common cause for DELIRIUM always check UA
- Treatment is antipsychotics like HALDOL
- Dementia: - Chronic and slow onset (months to years to develop)
- Mental decline in cognition, irritability, personality changes
- When asked questions they may try to answer or MAKE UP ANSWERS (confab- ulate)
- Low levels of what labs may mimic dementia: Vit B12 and Folic Acid
- Cortical Dementia: Language and memory (aphasia and amnesia)
- Subcortical Dementia: Motor abnormalities/Mood issues like apathy, de- pression, irritability HIV Dementia is a type of subcortical dementia
- Early signs of HIV dementia: subcortical form of dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordina- tion, unsteady gait
- Treatment for HIV dementia: Antivirals
- Pseudo Dementia: Depression causes the memory issues, common in older adults
- Also assess onset of symptoms, pseudo dementia is more acute onset
- When asked questions they often say "I DON'T KNOW"
- Instruments to use to differentiate between dementia and pseudo de- mentia: - Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE
- Older individuals with depression may present with irritability and agitation If question is asking you to differentiate between depression and dementialook at the amount of time that the symptoms have been present:
- hallmark of lewy body dementia: visual hallucinations
- Frontotemporal lobe Dementia: PICKs Disease
- Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes
- May see slurred speech or difficulty getting words out
- What lobe is associated with ability to understand what others are saying (comprehending speech): Temporal Lobe
- Neurotransmitters involved in Autism: GABA, Glutamate, Serotonin
- Autism: a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement When play they often like to line up their toys, stack them in tidy rows
- signs of lead toxicity: developmental delay, learning diff., irritability, loss of appetite, weight loss, sluggishness, fatigue, abdominal pain, vomiting, constipa- tion, hearing loss, seizures, eating non-food items PICA Hint home built before 1970's TEST FOR LEAD
- When caring for an infant that is about to die?: GIVE THE BABY TO THE PARENTS and allow them to grieve
- Risk factors for osteoporosis: Age smoking caffeine lack of exercise diet lacking calcium and vit D Provide Education
- If discharging a patient that is not following up with outpatient care, organize ways to help the patient get to the appointment REMEMBER STAY INVOLVED IN THE CARE:
- Assume you are doing group therapy and there is a patient that is not comfortable sharing but you are trying to promote interpersonal learning. What should you do?: Provide adjunctive individual session that will help facilitategroup participation
- Cognitive Therapy: - Aaron Beck Replacing irrational or distortive thoughts with positive thoughts
- Behavioral Therapy: - Arnold Lazarus focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors
- Exposure
- Relaxation
- Skills training
- Role Playing
- Humanistic Therapy: - Carl Rogers person-centered therapy
- Self-actualization
- Self-Directive Growth
- Everyone has the potential to actualize and find meaning in life
- Existential Therapy: Victor Frankl - an insight therapy that focuses on the ele- mental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices.
- Emphasizes accepting freedom and making responsible choices
- Focus on the present Why am I here, What is my purpose
- Interpersonal Therapy: Gerald Kierman & Myrna Weissman --Used for people who have trouble interacting with others, relationship distress
- Marital conflict
- 12 - 16 weeks (3- 4 months)
- EMDR Phases: Desensitization Phase: visualize the trauma, verbalize neg- ative thoughts but remain attentive to physical sensations Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within
- Group therapy: Installation of hope: participants develop hope for creatinga different life; they gain hope from others
- Group therapy: Universality: people have similar problems, thoughts, and feelings and they are NOT ALONE
- Group Therapy: Altruism: sharing of oneself with another and helping an- other
- Group Therapy: Imitative Behavior: Patients can increase their skills by imitating the bx of others
- Group Therapy: Interpersonal learning: interacting with others increases adaptive interpersonal relationships
- Group Therapy: Group Cohesiveness: Patients develop an attraction to the group and other members as well as a sense of belonging
- Group Therapy: Catharsis: Patients openly express their feelings which were previously suppressed
- Group Therapy: Existential Factors: Groups enable participants to dealwith the mean of their own existance
