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LMR Georgette’s PMHNP Certification
Exam Latest 2025/2026 Questions And
Correct Detailed And (Verified Answers)
What does ADPIE stand for?
Assessment
Diagnosis
Planning
Implementation
Evaluation
What should you do when a mother reports her child woke up screaming in the middle of the night?
Ask her if it's happened before to assess for sleep issue patterns
What do you do if a patient comes in with fungus on their toenail?
Scrape nail and send for testing
What do you do if a patient on lithium has dark brown urine?
Check renal function
What do you do if a patient presents with fever while on Clozaril?
Check ANC level to assess for agranulocytosis
What can cause serotonin syndrome?
Antidepressants, St. John's Wort, Same-E, Kava Kava, and Tryptophan
What labs are indicative of NMS?
Elevated WBC (over 11,000) and elevated CPK
S/S of NMS
muscle rigidity, hyperthermia, tachycardia, abnormal bp, sweating, altered mental status, cherry colored urine
What should you do if a patient presents with cherry colored urine?
Check for rhabdo with CPK
s/s of serotonin syndrome
hyperreflexia, muscle spasms, myoclonus (involuntary muscle jerk), fever, tachycardia, HTN, shits and shivers
What happens with lithium and ACE inhibitors?
Increased risk of lithium toxicity related to the increased urination from the ACE inhibitors
Why should a patient on lithium avoid calcium channel blockers?
Risk of fatal nephrotoxicity
What is a fetal side effect of lithium?
Epstein's anomaly
What lab should you check for athletes on lithium?
Specific gravity to assess for dehydration (dehydration is >1.015)
What do you do if the lithium level is 1.3?
Do not give the next dose and assess for s/s
At what level is lithium toxicity a medical emergency?
S/S of lithium toxicity
vomiting, diarrhea, slurred speech, hand tremor, dry mouth/thirst, muscle weakness/twitching
Why check an EKG with lithium?
Inverted T-waves
What medication should treat hypothyroidism caused by lithium use?
Synthroid
What do you do if patient is prescribed both depakote and lamictal?
Decreased lamictal dose by 50%
Depakote and pregnancy
Spina bifida
What emergency may be occuring if patient on depakote reports upper abdominal pain?
Pancreatitis
What lab should you check if patient has right upper quadrant pain and dark brown urine?
What two epidermal issues can arise from Tegretol or Lamictal?
Toxic epidermal necrosis and SJS
What may be the issue if a patient on Lamictal presents with a fever and severe headache?
Aspetic meningitis
What three antipsychotics have very low weight gaining effects?
Geodon, Abilify, and Latuda
Mini-Cog
3 word recall and
clock drawing
MMSE scoring
24 - 30 severe impairment
18 - 23 mild impairment
17 and less no impairment
What happens during pruning?
Brain eliminates extra synapses during infancy
autism and pruning
Excess synapses caused by under-pruning (patient oversensitive to light/sounds and seizures)
schizophrenia and pruning
Fewer synapses caused by over-pruning
grey matter vs white matter
Grey matter- synapses, working area of brain, dendrites
White matter- myelinated axons
axons and dendrites
axon away from cell and dendrites to neuron's cell body
CNS is made up of
brain and spinal cord
Prefrontal cortex- Explains TMS
What is the dorsolateral prefrontal cortex responsible for?
Executive functioning- undergoes maturation until adulthood
orbitofrontal cortex
a region of the brain that controls impulses and attention (ADHD explained)
frontal lobe
associated with reasoning, planning, parts of speech (Broca-forming), movement, emotions, and problem solving
parietal lobe
A region of the cerebral cortex whose functions include memory, attention, perception, cognition, taste, and reading/writing
occipital lobe
A region of the cerebral cortex that processes visual information
temporal lobe
A region of the cerebral cortex responsible for hearing, agnosia, and language (Wernicke's area-receptive speech)
Issues with what lobe can lead to visual/auditory hallucinations?
Temporal
How does the amygdala work?
Sends signal to hypothalamus when in distress, which then communicates to the rest of the body through the nervous system
anterior cingulate cortex
critical for stress; implicated in childhood trauma
basal ganglia
directs intentional movements and is also called the corpus striatum
Hypothalamus
brain region controlling appetite, sleep, libido, heart rate
Hippocampus
Cholinergic
acetylcholine and neuropeptides
Brain Changes in Alzheimer's Disease
amyloid plaques and neurofibrillary tangles
Increased and decreased acetylcholine
Increased- parkinson's
Decreased-alzheimers
Where is Norepinephrine produced?
locus coeruleus
Where is serotonin produced?
raphe nuclei
Where is epinephrine produced?
adrenal glands
Where is dopamine produced?
substantia nigra and ventral tegmental area
Where is GABA synthesized?
limbic system
s/s of acute dystonia
Severe spasm of the tongue, neck, eyes, face and back; laryngeal spasms (mutism)
Akathisia
motor restlessness
Parkinonism s/s
slouched posture, shuffling gait, rigid, bradykinesia, tremors at rest, pin-rolling
tardive dyskinesia
involuntary movements of the facial muscles, tongue, and limbs, protrusion of tongue, smacking lips
Parkinson's neurotransmitters
increased acetylcholine and decreased dopamine
ADHD neurotransmitters
decrease in dopamine and norepinephrine
Tourette's Neurotransmitters
dopamine, serotonin, GABA, and glutamate
What to prescribe for Tourette's
Risperdal
Substance abuse neurotransmitters
decrease in opioid neuropeptides
Alcohol abuse neurotransmitters
increase in GABA and dopamine and decrease in serotonin
Depression neurotransmitters
decrease in serotonin, dopamine, and norepinephrine
sleep neurotransmitters
low serotonin causes insomnia (Melatonin is pre-cursor)
Schizophrenia neurotransmitters
increased dopamine and decreased serotonin
negative symptoms of schizophrenia
disturbance of affect, blunting (severe reduction in the intensity of affect expression), flat affect, inappropriate affect (might laugh hysterically while describing someones death)
positive symptoms of schizophrenia
Delusions of reference, delusions of persecution, delusions of grandeur, thought broadcasting, though insertion, hallucinations, disorganized thought, disorganized behavior, catatonia
Side effects of atypical antipsychotics
Risk of metabolic syndrome: increased weight, blood glucose, triglycerides, and insulin resistance
Zyprexa (Olanzapine) side effect
arcus senilis
gray-white arc or circle around the limbus of the iris that is common with aging; hyperlipidemia
Protection of ischemic injuries
atypical antipsychotics
Ages of Schizophrenia
18 - 25 males
25 - 35 females
Why dose cimetidine, zantac, and omeprazole 2 hours apart from Risperdal?
They are inhibitors and will decrease the absorption of Risperdal in liver
What alpha 2 delta ligands are approved for neuropathic pain tx?
Lyrica and gabapentin
Celexa and Lexapro side effect
Prolonged QT interval
Effexor side effect
elevated bp
false positives
benzos- zoloft
what to avoid with MAOIs
Tyramine (aged cheese, wine, pickled herring)
What can happen when TCAs and MAOIs are combined?
Increased norepinephrine causing a hypertensive crisis (flushing, explosive headache in the back of head)
How to treat hypertensive crisis from MAOI and TCA combo
Phentolamine
What is 1st line antidepressant for children?
Prozac
