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Georgette Review PMHNP 400+ Study
Questions And Answers A+ Verified
1. When many answers are remarkably similar, they are usually
: wrong
2. Interprofessional collaboration is encouraged.: Collaborate is usually right.
Delegate is usually wrong.
3. ADPIER: Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
4. Lithium: Normal 0.6-1.
5. Lithium toxicity occurs at levels: > 1.
6. Signs of Lithium toxicity: severe nausea, diarrhea, vomiting, confusion, drowsi-
ness, muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
7. Lithium is gold standard for: MANIA
8. Lithium has evidence shown to: reduce suicidal ideation
9. What does lithium cause in neonate, especially 1st trimester: Ebstein anom- aly
(congenital heart defect)
10. dehydration and hyponatremia cause lithium levels to: rise
11. Baseline labs before initiation of lithium: 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)
12. Side Effects of Lithium: hypothyroidism
coase hand tremors with toxicity maculopapular rash diarrhea, vomiting, cramps--signs of toxicity. Monitor closely. anorexia t wave inversions leukocytosis
13. Pt education for lithimum: staying hydrated
avoiding NSAIDS compliance
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14. Depakote normal level: 50-
15. Depakote toxicity level: greater than 150
16. Teratogenic effects of Depakote: spina bifida
17. Adverse effects of depakote: alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue
18. Signs of Depakote toxicity: disorientation, lethargy, respiratory depression,
nausea/vomiting
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30. Lamotrigine is least likely to cause: sedation or weight gain
31. Carbamazepine (tegretol) black box warning: agranulocytosis (decrease
WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
32. Carbamazepine and asians: Screen for HLAB-1502 allele before initiating, due to
high incidence of SJS if positive for allele.
33. Child-bearing aged women: check for pregnancy before starting mood stabi- lizer
start on folic acid to support neural tube development during the first month that a woman is pregnant
34. Clozaril/clozapine can cause: agranulocytosis and neutropenia
35. For monitoring neutropenia in Clozaril, monitor: ANC
36. DC clozarli if ANC: less than 1000
37. DC clozaril if WBC: 2000-3000, risk of agranulocytosis
38. When on clozaril monitor for: signs and symptoms of infection: sudden fever,
chills, sore throat, weakness
39. Clozaril only known antipsychotic to: decrease risk of suicide in patients with
schizophrenia.
40. 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: Lithium can invert the t waves.
41. 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: Methylphenidate
42. 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: ANC less than 1000
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43. If given during pregnancy, socium valproate can cause which of the follow-
ing medical problems in the baby?
A. SJS
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate: A. Spina bifida
44. Which mood stabilizer is associated with potential life-threatening rash in
the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal: A. Carbamazepine
45. Bulimia, weight is : within the normal range.
46. Pharm treatment for bulimia: Fluoxetine
SSRIs and TCAs effective in reducing binging and purging
47. Signs of anorexia nervosa: low BMI
Amennorrhea Emaciation Bradycardua Hypotension
48. Pharm treatment for anorexia: there is none
therapy
49. 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: Low BMI
50. If a patient is depression, low energy, fatigued, you would prescribe: Well-
butrin
51. Wellbutrin is contraindicated in patients with: seizure disorder or conditions
that increase risk of seizures such as eating disorder.
52. 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): bupropion
53. CLozaril is metabolized by: cytochrome P450 enzyme CYP1A
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62. 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: A. decreased renal clearance of lithium
63. Where is norepinephrine produced: locus coeruleus and medullary reticular
formation
64. Norepinephrine is associated with: mood disorders
65. Serotonin is made where in the brain: raphe nuclei of the brainsteam
66. Serotonin is associated with: sleep and mood disorder
67. Dopamine is made in: substantia nigra, central tegmental area, ventral tegmen- tal
area,
68. Dopamine is associated with: addiction and psychosis
69. Acetylcholine is made: basal nucleus of Meynert
70. Most abundant inhibitory neurotransmitter in the brain: GABA
I don't have enough GABA, my anxiety is high
71. Med used to increase GABA: benzos Fred
flinstone needs a Zanny, Gabba dabba do.
72. Most excitatory neutransmitter: glutamate
73. Increased level of corticotropin releasing hormone in the amygdala, hip-
pocampus and locus coeruleus: increases symptoms of anxiety.
74. Autism: deficits in social communication and social interaction across multiple
settings
75. Parents of kids with autism may report: 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.
76. Screenings for autism: ADOS
M-CHAT
ASQ
77. Pharm management for autism: antipsychotics are effective for symptoms such
as tantrums, aggressive behaviors, self-injurious behaviors
78. 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
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C. Locus coeruleus
D. Amygdala: raphe nuclei
79. Executive functioning, thinking, planning, organizing, and problem solv-
ing, emotions, and behavioral control, personality: frontal lobe
80. memory, understanding, language: temporal lobe
81. Both hemispheres of the brain are connected by the: corpus callosum
82. Area of sensorimotor information exchange between two hemispheres: -
corpus callosum
83. When there is disturbances in clock drawing test, which hemisphere is
compromised: right hemisphere/right parietal lobe
84. Area for expressive speech: frontal lobe
Broca's Area
85. Problems in the frontal lobe can lead to: personality changes, emotional
changes, and intellectual changes, social skills problems, and behavior changes
86. Area for receptive speech and language comprehension: Temporal lobe
Wernicke's area
87. Problems in the temporal lobe can lead to: auditory hallucinations, aphasia,
and amnesia
88. Occipital lobe: primary visual area
89. problems in the occipital lobe can lead to: Visual field deficits, blindness and
visual hallucinations.
90. primary sensory area of the brain: parietal lobe
91. problems in the parietal lobe can lead to: Sensory-perceptual disturbances and
agnosia(inability to perceive objects) R-L confusion Difficulty writing (agraphia) Aphasia(difficulty of language)
92. Cerebellum is responsible for: gross motor skills
fine motor skills balance
93. A client experiencing difficulties with working memory, planning, and pri-
oritizing, insight into his problems, and impulse control presents for assess- ment. 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: frontal lobe
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112. Restlessness, inability to sit still. Pacing.
Mistaken for anxiety.: Akathisia
113. Commonly used rating scale for akathisia is: Barnes Akathisia rating scale and
extrapyramidal symptom rating scale.
114. Treatment for akathisis
1st line 2nd line 3rd line: 1st: beta blocker 2nd: Cogentin 3rd: bnzodiazepine
115. Absence of movement or difficulty initiating movement: akinesia
Treatment: cogentin
116. Presence of symptoms of Parkinson's produced by D2 blockade in the
nigrostriatal pathway: Pseudo-Parkinsonism
117. Signs of Parkinsons: muscle rigidity
shuffling gait mask like facial expression pill rolling tremors cogwheel rigidity
118. Treatment for pseudo parkinsonism: cogentin
119. Involuntary abnormal muscle movement of the mouth tongue face and jaw
that may progress to limbs. Can take 1-2 years to occur.: Tardive dyskinesia
120. Signs of tar dive dyskinesia: lip smacking
protrusion of the tongue chewing motion facial dyskinesia involuntary movement.
121. Treatment for TD: Stop offending antipsychotic, reduce the dose, or switch to
clozapine. COGENTIN WORSENS IT Ingrezza or Austedo approved
122. Non-psych med that can cause TD: Reglan
123. 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
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C. Tardive dyskinesia
D. Acute dystonia: A. Pseudoparkinsonism
124. 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?: Are you experiencing pill rolling
tremors, shuffling gait, and mask like facial expression
125. Fetal alcohol syndrome: Everything is low
low weight, small features of the face.
126. Which if the following antidepressants is associated with the most car-
diovascular side effects?: Citalopram--causes QT prolongation
127. What the body does to drugs?: Pharmacokinetics
128. What the drug does to the body: pharmacodynamics
129. The drug binds to the receptors and activates a biological response
(opens the ion channel): agonist effect
130. drug causes the opposite effect of the agonist. Binds to the same receptor
but closes the channel: inverse agonist
131. drug does not fully activate the receptor: partial agonist
132. drug binds to the receptor but foes not activate a biological response: -
antagonist
133. The study of what the drug does to the body.: Pharmacodynamics
134. When studying pharmacodynamics involving receptor, you know that an
agonist produces the following effect?
A. Does not fully activate the receptor
B. Blocks the agonist from opening the channel
C. Causes the opposite effect
D. Activates a biological response and opens the ion channel.: Activates a
biological response and opens the channel.
135. Medications that can cause mania (very high yield): Steroids
Antabuse Isoniazid Antidepressants in persons with bipolar Flonase
136. Medications causing depression: steroids
beta blockers
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155. Exam ised to quantify cognitive status in adults: mini mental status exam
or may say Folstein
156. Component of Folstein/mini mental status: I would like you to could back-
wards from 100 by 7s or do serial 7s
157. Folstein/mini mental status registration/ability to learn new material: re-
peat after me, bed, bat, ball
158. Suiciidal risk factors: previous attempt
Male 45+ Female 55+ Divorced, single, separated white living alone psychiatric disorder physical illness substance abuse family history recent loss male gender
159. Characteristics of therapeutic relationship: Genuineness
Acceptance Nonjudgment Authenticity Empathy Respect Professional boundaries
160. displacement of feelings for significant people int he client's past onto
the PMHNP: transference
161. Nurses's emotional reaction to the client based on past experiences.: -
Countertransference
162. Sarah presents for her initial intake appointment with complaints of
depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression?
A. Omeprazole
B. Propranolol
C. Levothyroxine
D. Clarithromycin: Propranolol
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163. A patient with a known diagnosis of bipolar I disorder presents to your
clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months To determine if a medication change or increase is warranted, it is important to gather more information. You sus- pect a possible medication-induced manic episode when the patient endorses what?
A. She was recently placed on a beta blocker for anxiety.
B. She was recently prescribed a benzo
C. She recently had a flare up of her rheumatoid arthritis and received treat-
ment for one week (aka a steroid)
D. She recently began a new retroviral agent for hepatitis: recently treated for
RA
164. Scale to test for alcohol withdrawal: CIWA
165. Score on CIWA that warrants PRN: greater than 8
166. Medication that will make patient physically ill if combined with alcohol-
: disulfiram (Antabuse)
167. Antabuse shouldn't be taken for at leas after drinking-
: 12 hours.
168. Signs and symptoms of alcohol withdrawal: N/V/D
tremors sweats anxiety agitation tactile disturbances auditory disturbances visual disturbances headache altered sensorium agitation
169. Rating scale of opiate withdrawal: COWS
170. Signs and symptoms of opioid withdrawal: yawning, irritability, pupillary
dilation piloerection muscle aches lacrimation rhinorrhea
171. Treat COWS when score is greater than: 7
172. Moderate withdrawal on COWS: 13-
173. Moderate withdrawal on CIWA: scoring 15
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C. Dantrolene
D. Benztropine: Dantrolene
186. A week after raising the dose of clomipramine, a patient treated for
depression presents to the clinic with reports of change in mental status, fever, and hyperreflexxia. As the treating PMHNP, you know these symptoms are consistent with which of the following?
A. NMS
B. EPS
C. Hypertensive crisis
D. Serotonin syndrome: serotonin syndrome
187. A 24 year olf female attempts suicide by overdose on an MAOI phenelzine.
She is stabilized in the hospital. Ten days later she is started on venlafaxine and becomes tachycardia and diaphoretic, and develops myoclonic jerks. What condition is this?
A. NMS
B. Opisthotonos
C. Akathisia
D. Serotonin syndrome: serotonin syndrome
188. a 17 year old arrives at the emergency department with nonspecific
complaints The patient's temperature is 100.8, pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline for the treatment of depression. the patient has a history of substance use and smoked marijuana one week ago. The diagnosis is: serotonin syndrome
189. Patient being treated for psychosis for 2 weeks develops symptoms of
NMS. The following factors help the pMHNP to differentiate NMS from sero- tonin syndrome.
A. autonomic instability, diaphoresis, tremors
B. Hyperthermia, leukopenia, tachycardia
C. Rigidity, hyperrefelexia, orthostatic hypotension
D. Mutism, leukocytosis, myoglobinuria: mutism, leukocytosis, myoglobinuria
190. Appraisal of the patient's SI plan, intent and access to implement plan
would be documented in which part of standard psychiatric evaluation A Review of symptoms.
B. Diagnosis
C. Mental status exam
D. History of presenting illness: C mental status exam
191. a 48 year off Caucasian male presents for his therapy appointment. He is
sad about losing his wife recently to covid 19. He reports feeling thoughts of
16 / hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk of suicide?
A. Previous attempt
B. Age
C. Gender
D. Marital Status: A previous attempt
192. Which of the following patients is at higher risk of suicidie?
A. 30 year old married African American female with previous attempt
B. A 35 year old single Asian male with previous suicide attempt
C. A 38 year old single African American male who is manager of a bank
D. A 68 year off single Caucasian male with depression: D. 68 year old single,
caucasian male, depression
193. A 64 year old caucasian male referred for treatment of refractory de-
pression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority?
A. Prior and current meds, dose, clinical response, side effects.
B. Thoughts of self-harm, plan, intent, access
C. Extent of alcohol use, and motivation to reduce to safe levels
D. Sleep patterns and hygiene: thoughts of self-harm, plan, intent, access
194. A married female patient has been in therapy with an adult psychiatric
and mental health nurse practitioner for 3 months. The patient's husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the clinical nurse specialist stating that her husband is drunk, violent, and threatening to kill her. The PMHNPs priority intervention is
A. To arrange for an emergency psychiatric intervention
B. Arrange for the woman's safety
C. Request a restraining order
D. Request to speak to the husband: Arrange for the woman's safety.
195. A client says to the PMHNP, Some days life is just not worth it. All my wife
and I do is fight and scream. Things at home were be calmer and simpler if I just wasn't there anymore." The most therapeutic response is:
A. Do you mean yo are thinking about leaving your wife to moving out?"
B. Tell me what you mean by "it would be simpler if you weren't there any-
more."
C. So you are thinking suicide might be an option for you?
D. Remain silent.: B. Tell me what you mean by "it would be simpler if you weren't
there anymore"
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216. A 69 year old man with diagnosis of delirium has symptoms of psychosis
which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms?
A. Haloperidol
B. Quetiapine
C. Valium
D. Olanzapine: haloperidol.
217. An 81 year old female with a history of vascular dementia is brought to the
hospital for increased agitation and UTI. Which of the following features most distinguishes the effects of delirium from dementia?
A. Altered level of consciousness
B. Behavioral disturbances
C. Cognitive deficits
D. Language difficulties: altered level of consciousness
218. What is the best treatment for AIDS dementia complex
A. Acetylcholinesterase inhibitors
B. Symptom targeted pharmacologic treatments
C. Nonpharmacologic supportive care
D. Antiretroviral therapy: Antiretroviral therapy.
219. Aimed at deceasing the number of new cases: primary prevention
220. Any form of screening is what Level of prevention: secondary
221. Aimed at decaying disability and severity: tertiary
222. decreased effects of the same dose over time: tolerance
223. tendency of some regions of the brine to react to repeated low-level bio-
electrical stimulation, by progressively boosting synaptic discharges, thereby lowering seizure threshold (alcohol and benzos): kindling
224. Where in the brain are abnormalities found causing ADHD: frontal cortex
--high yield basal ganglia abnormalities in the reticular activating system
225. Neurotransmitters involved in ADHD: DNS
dopamine norepineph serotonin
226. ADHD causes DNS: dopamine
noreip serotonin
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227. Hallmarks of ADHD: persistent pattern of inattention or hyperactivity, impulsiv-
ity, or both.
228. What to check prior to prescribing a stimulant?: cardiac history, family
history of CVD and get an EKG prior to starting
229. Amphetamines are approved in children as young as: 3
230. Signs of stimulant abuse: insomnia
tremors heart palpiations increased BP and HR
231. Rating scale for ADHD: Connors and Vanderbilt
Must monitor in two settings
232. Hallmarks of borderline personality disorder: impulsivity with self-damaging
behavior Recurrent suicidal behavior
233. Treatment for Borderline: DBT
234. Hallmarks of antisocial personality: reckless disregard for welfare of others lack
of remorse indifference to the feelings of others INCREASED HOMICIDAL IDEATION --HIGH YIELD
235. Primarily in girls
normal development then decline loss of purposeful hand movements stereotypic hand movements --flapping of hands deceleration of head growth: Rett syndrome
236. Chronically moody, sad irritable for no reason: Disruptive mood dysregula-
tion disorder
237. patient reacts grossly out of proportion to situation
sudden rage/anger outbursts: Intermittent explosive disorder
238. Mnemonic for depression SIGECAPS: Sleep disturbance
interest reduced guilt and self-blame energy loss and fatigue concentration problems appetite changes psychomotor changes suicidial thoughts
239. Neurotransmitters involved in depression: DNS
dopamine, norepinephrine, serotonin
