PMHNP Certification 2024-2025: Hannah White Book 2026 Complete Questions and Answers Solved 100%

first antipsychotic?

C) A& B

first antidepressant (Came out in late 1950s)?

A) Imipramine (Tofranil)

3 multiple choice options

when/which anxiety meds become a pharmaceutical drug?

D) all of the above

3 multiple choice options

first mood stabilizer

lithium-- found in the natural elements, first step in the development of a mood stabilizer/ tx bipolar

when did the atypical antipsychotics come out

latter half of the 20th century

first atypical antipsychotics to come to market?

C) A&B

3 multiple choice options

the neurochemical basis for psychiatric drugs:

is the fact they act on particular neurotransmitter systems in the brain

two SNRIs?

A) Venlafaxine & Duloextine

Imipramine and amitryptiline are what type of meds?

TCAs

Phenelzine

C) A&B

3 multiple choice options

tranylcypromine

B) also known as 'Parnate' and is an MAOI

3 multiple choice options

anticholinergics are medications that are utilized for what?

C) EPS treatment that is a consequence of using antipsychotic drugs

3 multiple choice options

benztropine:

A) cogentin; anticholinergic

1 multiple choice option

trihexphenidyl:

D) All of the above

3 multiple choice options

PMHNPs are required to educate patients when starting a new medication:

D) all of the above

3 multiple choice options

palmar erthema:

no blanching of palm-- physical sign of alcohol use disorder

dupuytren's contracture:

C) A&B

3 multiple choice options

telangiectasia:

pin point hemorrhages on the mucous membranes (example- on the lips) related to alcohol use disorder

lab findings suggestive of alcohol use disorder:

D) All of the above

3 multiple choice options

screening tests for problematic drinking

D) All of the above

3 multiple choice options

lab findings in a 58 year old man with a 10 year hx of alcohol abuse

D) All of the above

3 multiple choice options

example of an AST in a person with alcohol use disorder x 10 years

C) A &B

3 multiple choice options

example of hemoglobin, hematocrit & MVC in a person with 10 year hx of alcohol use disorder

C) A&B

2 multiple choice options

example of triglyceride levels of a person with a 10 year hx of alcohol use disorder

C) A&B

2 multiple choice options

disulifiram is used for:

C) alcohol use disorder

3 multiple choice options

naltrexone is used to

reduce alcohol cravings

acamprosate is used to

decrease desire for alcohol

bupropion is used ton

decrease desire for nicotine

vivitrol is used for

C) A& B

2 multiple choice options

COWS: over 36 indicates

severe withdrawal

COWS: 5-12

mild opioid withdrawal

Prochaska's Stages of Change

also describes in DiClemente Model-- includes pre-contemplation; contemplation; preparation; action & maintainence

_______ is a test, hair or urine that tests for detection of alcohol 2-5 days after last drink

Ethyl glucuronide (EtG)

phosphatidyl ethanol (PEth)--

serum marker for low to moderate and heavy alcohol use--at least 2-4 drinks each day for several week---- remains elevated for 2-3 weeks after stopping alcohol

wet brain

korsakoff's syndrome`

in those with suspected wernickes encephalopathy, rule is:

give thiamine before glucose in those with suspected wernickes encephalopathy

Triad of Wernicke's encephalopathy

delirium, ataxia and ophthalmoplegia

ophthalmoplegia

paralysis or weakness of the eye muscles

glucose is needed to maintain

homeostasis

thiamine

B1

high dose thiamine is needed during alcohol withdrawal in order to prevent what

korsakoff's syndrome

alcohol anemic disorder:

korsakoff's syndrome

alcohol withdrawal

D) All of the above

3 multiple choice options

APA recommendation for alcohol use disorder:

offer acamprosate, naltrexone, topiramate, or gabapentin

goal of alcohol use disorder

reducing consumption or achieving abstinence

acamprosate or naltrexone is preferred for those with

A) moderate to severe alcohol use disorder

3 multiple choice options

aversion med that causes noxious reaction if taken with alcohol

Disulfiram (antabuse)

*inhibits aldehyde dehydrogenase and prevents metabolism of acetyadehyde, alcohol's main metabolite

acetaldehyde build up causes what s/s: (antabuse's way of causing a noxious reaction)

flushing, H/A throbbing in neck/head, dyspnea, hyperventilation, tachycardia, hypotension, sweating, anxiety, weakness and confusion

disulfiram is used

temporarily to establish long term pattern of sobriety; have to use in severe/extreme caution due to can have a reaction to mouthwash if alcohol is present

naltrexone (vivitrol)

craving reducing med

-prevents the positive high of alcohol use by blocking the release of endogenous opioids

naltrexone (vivitrol) is contraindicated in

acute hepatitis or liver failure

vivitrol is NOT to be given to whom?

those taking opioids

vivitrol may be more effective in what patients?

those with a genetic suspectibility

SE of vivitrol IM:

nausea, fatigue, decreased appetite

acamprosate (campral) is used in whom?

used in those who have achieved abstinence

can acamprosate be used with individuals with liver disease?

C) A& B

2 multiple choice options

how does acamprosate (campral) help people remain abstinent?

through restoring balance between activities with neurotransmitters GABA and glutamine

withdrawal s/s of amphetamine/cocaine

depressed mood, fatigue, vivid dreams and psychomotor agitation

alcohol use s/s withdrawal

increased HR, increased BP, diaphoresis, hand tremor, agitation, hallucinations

opioid WD s/s

muscle cramps, arthralgia, diarrhea

_____ targets alcohol cravings

naltrexone (vivitrol injections)

region brain that is responsiblle for conditioned learning, and connecting and experience with emotion:

D) amgydala

3 multiple choice options

Marcus, a 24-year-old student who is at risk for failing out of law school, is referred by his academic advisor for psychiatric evaluation. He states that he drinks an average of 6 beers per night and last year had a driving under the influence (DUI) arrest. Marcus states, “I don’t think my beer drinking has anything to do with my bad grades. I really only have a couple of beers every night and it helps me to relax.” This statement is an example of:

D) Denial

3 multiple choice options

The PMHNP’s response to Marcus that best illustrates motivational interviewing would be:

A) "relaxing is important to you after you have worked hard in school"

3 multiple choice options

Gary, a 54-year-old man with moderate liver disease, has a history of alcohol use disorder but has been abstinent for the past 3.5 years. At this visit, he reports a number of unfortunate events that have happened recently, including the death of a close sibling and loss of employment. As a result, he states that he is having increased urges to drink again. The PMHNP realizes that:

B) stressful life events can be a trigger for a relapse

3 multiple choice options

To prevent a possible relapse by Gary, the PMHNP recommends counseling and treatment with:

A) acamprosate

3 multiple choice options

Randy, a 32-year-old single manager of a sporting goods store, is being seen for follow-up after a 30-day inpatient stay for alcohol dependence. He has been sober for 45 days and continues to crave alcohol throughout the day. Which medication can be prescribed for Randy as a part of his treatment recovery plan to target alcohol cravings?

C) Naltrexone

3 multiple choice options

Dana, a 44-year-old registered nurse, is preparing to be discharged from a 30-day inpatient treatment facility for alcohol and methamphetamine dependence. She wishes to start a medication to help keep her abstinent from alcohol. She has extensive dental work planned to begin within the next month. Which medication would be contraindicated for use given this information?

B) naltrexone

3 multiple choice options

Strategies to prevent relapse among patients with substance use disorders include all of the following except:

B) Confront drug using peers for closure

3 multiple choice options

A 19-year-old man is brought into the emergency department by his friends who are concerned about his health. Physical examination reveals muscle weakness, dilated pupils, heart rate=140 bpm, blood pressure=180/115 mm Hg. His friends say that he may have “taken something” orally about 2 hours ago. Which of the following is the most likely illicit substance?

B) Dextramphetamine

3 multiple choice options

______ is widely distributed throughout the CNS and the primary neurotransmitter at the neuromuscular junction?

A) Acetylcholine

3 multiple choice options

______ involved in a wide variety of behaviors and emotions asociated with parkinsonisms and perhaps schizophrenia:

C) Dopamine

3 multiple choice options

_____ involved in sleep regulation, dreaming, mood, eating, pain and aggression associated with depressio

D) Serotonin

3 multiple choice options

______ an exitatory transmitter, associated in memory, arousal and pain

B) Glutamate

3 multiple choice options

______ is widely distributed, largely an inhibitory neurotransmitter

D) GABA

3 multiple choice options

blocking means?

B) antagonism

3 multiple choice options

mimicking means

A) agonist

3 multiple choice options

axonal conduction means:

process of conducting an action potential down the axon of a neuron

______ transmission means:

the process of carrying information across a synapse between the neuron and the postsynaptic cell; requires release of neurotransmitters and binding of these transmitters to receptors on the postsynaptic cell

in order for a drug to be able to exert its effect, what must take place?:

it must be able to directly or indirectly influence the receptor activity on the target cell

drugs act on the receptors in a variety of ways:

A) by binding to them & causing activation?

B) agonist

3 multiple choice options

drugs act on the receptors in a variety of ways:

B) by binding to them & blocking their activation by other agents?

C) antagonist

3 multiple choice options

drugs act on the receptors in a variety of ways:

C) by binding to their components which leads to?

D) indirectly enhancing their activation by the natural transmitter

a key goal of pharmacotherapy is to modify?

a patient's pathogenic nervous system activity

what a drug does to the body

B) pharmacodynamics

what the body does to a drug>?

A) pharmacokinetics

1 multiple choice option

pharmacokinetics is associated with what?

D) the processess of absorption, distribution, metabolism and excretion

_______ _____ effect refers to the inaction of an orally administered drug by liver enzymes immediately following absorption from the GI tract and prior to the drug reaching general circulation

A) First pass effect

drugs with high lipid solubility

will more readily cross cell membranes, including the BBB and the placenta. these drugs will more readily localize in tissues with high lipid content (the brain and adipose tissue)

drugs with a low level of plasma protein binding:

C) A&B only

3 multiple choice options

the most abundant plasma protein is?

B) albumin

& the terms plasma protein binding and albumin binding are used interchangeably

what process makes a drug more readily asorbed into the circulatory system as well as makes the drug more readily distributed throughout the body

C) the biochemical properties

example: high lipid solubility and low molecular weight

ion trapping means/occurs

when a drug classified as weak acid transfers from a body compartment that is more acidic to one that is more alkaline

passive diffusion means

the movement of a drug across a cell membrane down its concentration gradient

active transport:

faciiitated movement of a drug across a cell membrane

examples of high protein binding psych drugs:

D) Abilify, Geodon (>99); Strattera, Valium (99%); sertaline (98%) buspar (95%) and valproic acid (93%)

examples of low protein binding drugs

C) lithium (0%); gabapentin (3%); keppra (10%); topamax (15%); ritalin (15%); clonidine (20%); effexor (28%)

patients suffering from manutritino or acute/chronic inflammation responses may present with:

B) hypoalbuminemia--this decrease in serum protein caused by this hypoalbuminemia may result in greater drug bioavailability, particular for those that are highly protein bound, leading to potentially toxic effects

Cytochrome P450 (CYP) refers to

the large family of enzymes, found primarily in the liver, responsible for facilitating the majority of drug metabolism in the body

each CYP family member has what

an unique collection of substrates (drugs and compounds) which it metabolizes