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PMHNP certification Exam Questions and
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**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 least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the 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 antipsychotic the answer is usually to start of a: atypical
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, burning eyes, blisters, skin pain 24) two psychotropics known to cause steven johnson syndrome: lamictal and 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
29) When monitoring for agranulocytosis in patients look for s/s of what?: - Infection -Fever, sore throat, fatigue, chills 30) Before starting any mood stabilizer in a female of childbearing age be sure to check?: HCG 31) Which two medications may decrease the risk of suicide?: clozaril and lithium 32) Medications that increase lithium level: NSAID-ibuprofen, INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril 33) Ace inhibitors are treatment of choice for?: Heart Failure 34) Certain medications are known to increase lithium level, but HOW?: by reducing renal clearance 35) When educating a patient about lithium teach them about: Hyponatremia Dehydration-hot days, exercise 36) Normal Lithium Level: 0.6-1. 37) Lithium Toxicity: 1.5 or above Discontinue and re-order lithium level 38) Lithium level of 1.4: Monitor for toxicity 39) Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to check for presence of protein in the urine (4+ protein is concerning for renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY 40) 4+ protein in the urine of a patient on lithium: 4+ protein is concerning for renal impairment 4+ protein in urine=MONITOR FOR TOXICITY 41) Lithium side effects: hypothyroid, leukocytosis, maculopapular rash, t- wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia) -Some of these are also signs of toxicity
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 them to 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?: Treating with a medication with minimal drug/drug side effects like Lexapro 54) Patient with depression worries about sexual dysfunction what would be the medication of choice?: Wellbutrin 55) Primary symptoms of depression include fatigue and low energy
what med 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
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
69) Exercise for mental health patients can promote: Cognition Quality of Life Long-term health 70) ACT is ideal for patients with a history of: Treatment non-compliance -Think about making the treatment convenient for them-->bringing it to their home 71) What diagnosis has the highest risk of Homicidality: Antisocial 72) In the MMSE how do you test for abstraction?: proverb interpretation (every- one that lives in glass houses shouldn't throw stones) Are they able to think abstractly 73) Thought Process-Tangential: means that their response has nothing to do with the question 74) Circumstantial: means that their response goes in circles instead of getting to the point of the question 75) Mental Status-Thought Content includes: SI/HI/AH/VH 76) Another name for MMSE: Folstein Scale 77) How to assess concentration on MMSE: Serial 7s or perform an activity backwards i.e list the days of the week backwards 78) Assess ability to learn new material: repeat 3 words after me 79) Assess ability to recall: repeat 3 words after 5 minutes 80) Assess fund of knowledge: Who is the president 81) What is a quick and easy way to assess for neurological issues: Clock drawing test 82) If patient is unable to draw a clock this indicates: Problem with the right hemisphere, cerebrum, or parietal lobe 83) mesolimbic pathway: Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms
-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
Ciprofloxaci n Ritonavir Amiodarone Cimetidine Ketoconazol e Acute Etoh
Macrolide s INH Grapefruit Juice Omeprazole Crack Amigos 104) Erythromycin and Clarithromycin can cause: Increased tegretol levels 105) Patient started on Clozaril or Zyprexa and two months later starts smoking: as a provider you know that the smoking can decrease the medication effectiveness -Increase medication dose 106) Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey: as a provider you know that you must now decrease the dose of the antipyshcotic 107) Medications that cause mania: Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar -If a patient must take steroids, the provider should increase the mood stabilizer 108) Medications that cause depression: steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodi- azepines, progesterone -may need to increase antidepressant 109) Accutane (isotretinoin): Can cause depression and birth defects 110) Flonase: As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms Increase mood stabilizer to maintain stability, steroids can also trigger depression
- 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 117. 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 should be 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 125. 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)
