PMHNP Exam Prep: Comprehensive Guide for Nurse Practitioners, Exams of Nursing

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Georgette Review PMHNP Exam Questions and Answers 2025 A patient has been treated for the past several years with fluphenazine (Prolixin). You tonic that he is drooling and has a slight pill rolling movement of the fingers. These are EPS symptoms known as A. pseudo parkinsonism b. anticholinergic effects C. Tardive dyskinesia D. Acute dystonia - ANSWER-A. Pseudo parkinsonism

A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway? A. Are you experiencing constipation? B. Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression? C. Are you experiencing increased thirst? D. Are you experiencing breast discharge? - ANSWER-Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is effecting his ECG. How do you respond?

A. Lithium can prolong the QT interval B. Lithium has no effect on his ECG C. Lithium can invert the t waves D. Lithium can shorten the PR interval - ANSWER- Answer: Lithium can invert the t waves. Interprofessional collaboration is encouraged. - ANSWER-Collaborate is usually right. Delegate is usually wrong. ADPIER - ANSWER-Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium - ANSWER-Normal 0.6-1. Lithium toxicity occurs at levels - ANSWER-> 1.

Signs of Lithium toxicity - ANSWER-severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for - ANSWER-MANIA Lithium has evidence shown to - ANSWER-reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester - ANSWER-Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to - ANSWER-rise Baseline labs before initiation of lithium - ANSWER- TSH

creatinine (0.6-1.2) BUN (10-20) HCG (all psychotropics females 12-51) EKG 50+ Urinalysis (check for proteins, 4+ may indicate kidney disease) Side Effects of Lithium - ANSWER-hypothyroidism coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis Pt education for lithimum - ANSWER-staying hydrated

avoiding NSAIDS compliance Depakote normal level - ANSWER- 50 - 125 Depakote toxicity level - ANSWER-greater than 150 Teratogenic effects of Depakote - ANSWER-spina bifida Adverse effects of depakote - ANSWER-alopecia hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue Signs of Depakote toxicity - ANSWER-disorientation, lethargy, respiratory depression, nausea/vomiting

Intervention for depakote toxicity - ANSWER-DC med check level LFT ammonia When many answers are remarkably similar, they are usually - ANSWER-wrong MAOI + tyramine causes - ANSWER-hypertensive crisis Symptoms of hypertensive crisis - ANSWER-elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation

diaphoresis fever Hypertensive crisis occurs with MAOI + - ANSWER- MEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds Treatment for hypertensive crisis - ANSWER-DC offending agent Administer PHENTOLAMINE

Teratogenic effects of benzos - ANSWER-floppy baby, cleft palate Teratogenic effects of tegratol - ANSWER-neural tube defect teratogenic effects of lithium - ANSWER-ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote - ANSWER-neural tube defects/spina bifida Adverse reaction to Lamictal - ANSWER-Steven Johnson's Syndrome Signs of SJS - ANSWER-FEVER --high yield sore throat facial swelling

tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes When on clozaril monitor for - ANSWER-signs and symptoms of infection: sudden fever, chills, sore throat, weakness Clozaril only known antipsychotic to - ANSWER- decrease risk of suicide in patients with schizophrenia.

Mary is a 45 - year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDS C. Methylphenidate D. Acetaminophen - ANSWER-Answer: Methylphenidate You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the client needs to discontinue treatment? A. WBC less than 1800 and ANC less than 1200 B. ANC less than 1, C. WBC less than 5, D. ANC less than 2000 - ANSWER-Answer: ANC less than 1000

If given during pregnancy, socium valproate can cause which of the following medical problems in the baby? A. SJS B. Ebstein's anomaly C. Spina bifida D. Cleft palate - ANSWER-A. Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? A. Carbamazepine (tegretol) B. Depakote C. Lithium D. Lamictal - ANSWER-A. Carbamazepine Bulimia, weight is - ANSWER-within the normal range.

Pharm treatment for bulimia - ANSWER-Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa - ANSWER-low BMI Amennorrhea Emaciation Bradycardua Hypotension Pharm treatment for anorexia - ANSWER-there is none therapy Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa?

A. Russell sign B. Low BMI C. Erosion of dental enamel D. Hypertrophy of salivary glands - ANSWER-Low BMI If a patient is depression, low energy, fatigued, you would prescribe - ANSWER-Wellbutrin Wellbutrin is contraindicated in patients with - ANSWER-seizure disorder or conditions that increase risk of seizures such as eating disorder. Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Clomipramine (Anafranil)

D. Duloxetine (Cymbalta) - ANSWER-bupropion CLozaril is metabolized by - ANSWER-cytochrome P450 enzyme CYP1A INducers - ANSWER-induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels - ANSWER- decrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage - ANSWER- Barbituates St. Johns Wart Carbamazepine Rifampicin Alcohol

Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need doses of their medication. - ANSWER- higher Inhibitors - ANSWER-inhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors - ANSWER-Sodium valproate Isoniazid Cimetidine Ketoconazole Alcohol

Chloramphenicol Erythromycin Sulfonamine Cipro Omeprazole Metronidazole Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine a. 2D b. 1A c. 2C d. 2C9 - ANSWER-1A (want A 2 cigarette break)

When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? A. Decreased body fat B. Increased liver capacity C. Decreased protein binding D. Increased muscle concentration - ANSWER- Decreased protein binding For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced: A. hypokalemia B. hyponatremia C. Increased renal clearance of lithium

D. Decreased renal clearance of lithium - ANSWER- A. decreased renal clearance of lithium Where is norepinephrine produced - ANSWER-locus coeruleus and medullary reticular formation Norepinephrine is associated with - ANSWER-mood disorders Serotonin is made where in the brain - ANSWER- raphe nuclei of the brainsteam Serotonin is associated with - ANSWER-sleep and mood disorder Dopamine is made in - ANSWER-substantia nigra, central tegmental area, ventral tegmental area,

Dopamine is associated with - ANSWER-addiction and psychosis Acetylcholine is made - ANSWER-basal nucleus of Meynert Most abundant inhibitory neurotransmitter in the brain - ANSWER-GABA I don't have enough GABA, my anxiety is high Med used to increase GABA - ANSWER-benzos Fred flinstone needs a Zanny, Gabba dabba do. Most excitatory neutransmitter - ANSWER- glutamate Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus - ANSWER-increases symptoms of anxiety.

Autism - ANSWER-deficits in social communication and social interaction across multiple settings Parents of kids with autism may report - ANSWER- No response when called by name Little or no eye contact Children with autism often like to line up, stack, or organize objects and toys. Screenings for autism - ANSWER-ADOS M-CHAT ASQ Pharm management for autism - ANSWER- antipsychotics are effective for symptoms such as tantrums, aggressive behaviors, self-injurious behaviors

Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons? A. raphe nuclei B. Nucleus acumbuns C. Locus coeruleus D. Amygdala - ANSWER-raphe nuclei Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality - ANSWER-frontal lobe memory, understanding, language - ANSWER- temporal lobe Both hemispheres of the brain are connected by the

• ANSWER-corpus callosum

Area of sensorimotor information exchange between two hemispheres - ANSWER-corpus callosum When there is disturbances in clock drawing test, which hemisphere is compromised - ANSWER-right hemisphere/right parietal lobe Area for expressive speech - ANSWER-frontal lobe Broca's Area Problems in the frontal lobe can lead to - ANSWER- personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension - ANSWER-Temporal lobe Wernicke's area

Problems in the temporal lobe can lead to - ANSWER-auditory hallucinations, aphasia, and amnesia Occipital lobe - ANSWER-primary visual area problems in the occipital lobe can lead to - ANSWER-Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain - ANSWER- parietal lobe problems in the parietal lobe can lead to - ANSWER- Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia)

Aphasia(difficulty of language) Cerebellum is responsible for - ANSWER-gross motor skills fine motor skills balance A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the A. frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe - ANSWER-frontal lobe