PMHNP LMR Questions and Answers 2025: A Review of Key Concepts and Medications, Exams of Nursing

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GEORGETTE'S REVIEW PMHNP LMR Questions and Answers 2025

When many answers are remarkably similar, they are usually _____________ ANS: ✔✔- wrong Interprofessional collaboration is encouraged. ANS: ✔✔- Collaborate is usually right. Delegate is usually wrong. ADPIER ANS: ✔✔- Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Lithium ANS: ✔✔- Normal 0.6-1. Lithium toxicity occurs at levels ANS: ✔✔- > 1.

Signs of Lithium toxicity ANS: ✔✔- severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait Lithium is gold standard for ANS: ✔✔- MANIA Lithium has evidence shown to ANS: ✔✔- reduce suicidal ideation What does lithium cause in neonate, especially 1st trimester ANS: ✔✔- Ebstein anomaly (congenital heart defect) dehydration and hyponatremia cause lithium levels to ANS: ✔✔- rise Baseline labs before initiation of lithium ANS: ✔✔- 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 ANS: ✔✔- 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 ANS: ✔✔- staying hydrated avoiding NSAIDS compliance Depakote normal level ANS: ✔✔- 50 - 125 Depakote toxicity level ANS: ✔✔- greater than 150

Teratogenic effects of Depakote ANS: ✔✔- spina bifida Adverse effects of depakote ANS: ✔✔- 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 ANS: ✔✔- disorientation, lethargy, respiratory depression, nausea/vomiting Intervention for depakote toxicity ANS: ✔✔- DC med check level LFT ammonia MAOI + tyramine causes ANS: ✔✔- hypertensive crisis

Symptoms of hypertensive crisis ANS: ✔✔- elevated BP sudden explosive like headache facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis occurs with MAOI + ANS: ✔✔- MEPERIDINE STIMULANTS decongestants TCAs atypicals St. John's wart L-tryptophan asthma meds

Treatment for hypertensive crisis ANS: ✔✔- DC offending agent Administer PHENTOLAMINE Teratogenic effects of benzos ANS: ✔✔- floppy baby, cleft palate Teratogenic effects of tegratol ANS: ✔✔- neural tube defect teratogenic effects of lithium ANS: ✔✔- ebstein anomaly (heart defect) (avoid, especially 1st trimester) teratogenic effects of depakote ANS: ✔✔- neural tube defects/spina bifida Adverse reaction to Lamictal ANS: ✔✔- Steven Johnson's Syndrome Signs of SJS ANS: ✔✔- FEVER --high yield sore throat

facial swelling tongue swelling red rash skin sloughing body aches prodromal headache malaise arthralgia painful mucus membranes Lamotrigine is least likely to cause ANS: ✔✔- sedation or weight gain Carbamazepine (tegretol) black box warning ANS: ✔✔- agranulocytosis (decrease WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)

Carbamazepine and asians ANS: ✔✔- Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for allele. Child-bearing aged women ANS: ✔✔- check for pregnancy before starting mood stabilizer start on folic acid to support neural tube development during the first month that a woman is pregnant Clozaril/clozapine can cause ANS: ✔✔- agranulocytosis and neutropenia For monitoring neutropenia in Clozaril, monitor ANS: ✔✔- ANC DC clozarli if ANC ANS: ✔✔- less than 1000 DC clozaril if WBC ANS: ✔✔- 2000 - 3000, risk of agranulocytosis When on clozaril monitor for ANS: ✔✔- signs and symptoms of infection: sudden fever, chills, sore throat, weakness

Clozaril only known antipsychotic to ANS: ✔✔- decrease risk of suicide in patients with schizophrenia. 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 ANS: ✔✔- Answer: Lithium can invert the t waves. 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 ANS: ✔✔- 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 ANS: ✔✔- 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 ANS: ✔✔- 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 ANS: ✔✔- A. Carbamazepine Bulimia, weight is ___________ ANS: ✔✔- within the normal range. Pharm treatment for bulimia ANS: ✔✔- Fluoxetine SSRIs and TCAs effective in reducing binging and purging Signs of anorexia nervosa ANS: ✔✔- low BMI Amennorrhea Emaciation Bradycardua Hypotension

Pharm treatment for anorexia ANS: ✔✔- 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 ANS: ✔✔- Low BMI If a patient is depression, low energy, fatigued, you would prescribe ANS: ✔✔- Wellbutrin Wellbutrin is contraindicated in patients with ANS: ✔✔- 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) ANS: ✔✔- bupropion CLozaril is metabolized by ANS: ✔✔- cytochrome P450 enzyme CYP1A INducers ANS: ✔✔- induce metabolism and therefore decrease serum levels of other drugs that are substrates Smoking will do what to drug levels ANS: ✔✔- decrease therapeutic levels of the drug Bull Shit CRAP GPS Induces my rage ANS: ✔✔- Barbituates St. Johns Wart

Carbamazepine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbital Sulphonylureas If your patient is a smoker you will need ___________doses of their medication. ANS: ✔✔- higher Inhibitors ANS: ✔✔- inhibit metabolism and therefore increase levels of the drug. SICKFACES.com for Inhibitors ANS: ✔✔- 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 ANS: ✔✔- 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 ANS: ✔✔- 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 ANS: ✔✔- A. decreased renal clearance of lithium

Where is norepinephrine produced ANS: ✔✔- locus coeruleus and medullary reticular formation Norepinephrine is associated with ANS: ✔✔- mood disorders Serotonin is made where in the brain ANS: ✔✔- raphe nuclei of the brainsteam Serotonin is associated with ANS: ✔✔- sleep and mood disorder Dopamine is made in ANS: ✔✔- substantia nigra, central tegmental area, ventral tegmental area, Dopamine is associated with ANS: ✔✔- addiction and psychosis Acetylcholine is made ANS: ✔✔- basal nucleus of Meynert

Most abundant inhibitory neurotransmitter in the brain ANS: ✔✔- GABA I don't have enough GABA, my anxiety is high Med used to increase GABA ANS: ✔✔- benzos Fred flinstone needs a Zanny, Gabba dabba do. Most excitatory neutransmitter ANS: ✔✔- glutamate Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus ANS: ✔✔- increases symptoms of anxiety. Autism ANS: ✔✔- deficits in social communication and social interaction across multiple settings Parents of kids with autism may report ANS: ✔✔- 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 ANS: ✔✔- ADOS M-CHAT ASQ Pharm management for autism ANS: ✔✔- 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 ANS: ✔✔- raphe nuclei

Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality ANS: ✔✔- frontal lobe memory, understanding, language ANS: ✔✔- temporal lobe Both hemispheres of the brain are connected by the ANS: ✔✔- corpus callosum Area of sensorimotor information exchange between two hemispheres ANS: ✔✔- corpus callosum When there is disturbances in clock drawing test, which hemisphere is compromised ANS: ✔✔- right hemisphere/right parietal lobe Area for expressive speech ANS: ✔✔- frontal lobe Broca's Area

Problems in the frontal lobe can lead to ANS: ✔✔- personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes Area for receptive speech and language comprehension ANS: ✔✔- Temporal lobe Wernicke's area Problems in the temporal lobe can lead to ANS: ✔✔- auditory hallucinations, aphasia, and amnesia Occipital lobe ANS: ✔✔- primary visual area problems in the occipital lobe can lead to ANS: ✔✔- Visual field deficits, blindness and visual hallucinations. primary sensory area of the brain ANS: ✔✔- parietal lobe

problems in the parietal lobe can lead to ANS: ✔✔- Sensory-perceptual disturbances and agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language) Cerebellum is responsible for ANS: ✔✔- 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 ANS: ✔✔- frontal lobe

Impairments in the clock drawing test can be associated with ANS: ✔✔- damage to the right parietal lobe What part of the brain is responsible for regulating emotions? A. Wernicke's area B. Occipital lobe C. Hippocampus D. Parietal lobe ANS: ✔✔- Hippocampus Limbic system responsible for ANS: ✔✔- emotions and memory Hypothalamus ANS: ✔✔- appetite, hunger, water balance, circadian rhythms, libido, hormonal regulation thalamus ANS: ✔✔- sensory relay for smell emotions, memory, and regulated affective behaviors

amygdala ANS: ✔✔- regulated emotion mediates mood emotional memories/meanings, fear, anxiety, stress emotion, aggression substantia nigra ANS: ✔✔- motor movements amygdala= ANS: ✔✔- emotional memory Which of these brain structures puts emotional meaning on a stimulus, forms, emotional memories and is involved with rage and fear ANS: ✔✔- amygdala A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical areas off the brain that is responsible for the regulation of these functions? ANS: ✔✔- Hypothalamus

Which serotonin receptor antagonism makes an antipsychotic "atypical" ANS: ✔✔- 5HT2A Excess dopamine in this area causes positive schizophrenic symptoms ANS: ✔✔- meoslimbic pathway decreased dopamine leads to negative symptoms of schizophrenia ANS: ✔✔- mesocortical pathway Increased blockade of dopamine here leads to EPS ANS: ✔✔- nigrostriatal pathway Blockade of dopamine in this pathway can lead to increased prolactin levels ANS: ✔✔- tuberoinfundibular pathway Muscle spasms ninth face, neck, tongue, back/neck muscles ANS: ✔✔- acute dystonia