______________________________________
GEORGETTE PMHNP
EXCELLENT PMHNP BOARD EXAM
REVIEW GUIDE
LAST MINUTE REVISION
PMHNP CERTIFICATION
EXAM REVIEW GUIDE
EXCELLENT BOARD EXAM REVIEW
MATERIAL.
PMHNP BOARD EXAM
NEW
V1, V2, & V3
1
, V1
Georgette Review: Scientific Foundation (1) & Advanced Practice Skills(2)
Test taking strategies
• Assessment & Safety 1st!
• Do not read quickly, pay attention to keywords, don’t read into question or add information
• When 2 answers choices are opposite of one another, one is usually the correct answer
• When many responses are remarkably similar, they are usually wrong
• We wary of absolutes (all, only, always, every, must, never, everything, nothing, etc.)—usually
wrong
• Choose client-focused answers; answers that acknowledge a patient’s feelings and makes
the patient feel heard
• Right answer option might have the same word as test question
• If partially correct, it’s still WRONG
• Everything needed to answer the question is there, don’t make assumptions
• Narrow down to 2 possible right answers
• Partially correct answers are not the correct answer
• When many answers are remarkably similar, they are usually wrong
• Questions that use adjective like “priority”, “initial action” test ability to prioritize
o 1 Airway/breathing/circulation
o 2. Maslow’s Hierarchy of needs (physiological needs (food, water, warmth, rest), safety
and security, etc.)
o 3. Nursing process (assessment before intervention). Assessment is collecting data
to support the problems towards resolution
• Safety for the patient/others is usually RIGHT…safety first
• Cultures is important to be included in all nursing care, cultural question = cultural answer
o A cultural expected response to a stressor does not always mean a mental illness
(cultural syndrome), interpret symptoms based on cultural meaning
o Brief supportive therapy
• Critical thinking important
• Interprofessional collaboration is encouraged…” collaborate” is usually RIGHT, “delegate” is
wrong (ask a dietitian to perform a task)
• Chose answers where you are actively involved, doing things for the patient (RIGHT)
(example: obtained informed consent and fax to PCP for updated labs completed by PCP)
• If undecided (or more than 1 right answer), the umbrella is usually the right answer for non-
priority questions
• Delegation & refer out is usually wrong
• Answers about obtaining funding are usually wrong
• Medical evaluations are out of scope, but can refer out for medical eval
• Nursing Process (ADPIER):
o Assessment: collect subjective and objective data, “identify”
o Diagnosis: analyze assessment data to determine a working diagnosis
o Plan/Intervention: developing and implementing plan of care, use EBP and 1st line txs
o Evaluate: performed last to evaluate patient’s attainment of treatment goals, plan may
need adjusted
o Refer out last!!
2
,Lithium (PB p. 180)
• Normal 0.6-1.2
• Toxicity occurs when level reaches >1.5 (suspect toxicity—DC, check lithium levels)
o Severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart
palpitation, coarse hand tremors, unsteady gait
• Gold standard for MANIA
• Evidence for anti-suicidal effects
• Neuroprotective (protects nerves from damage)
• Can cause Ebstein anomaly (congenital heart defect) especially in 1st trimester
• ↑ lithium levels from dehydration and hyponatremia
• Baseline labs before initiation (ensure safety & efficacy)
o TSH
o Creatinine (0.6-1.2)
o BUN (10-20)
o HCG (all psychotropics females ages 12-51)
o EKG 50+ y/o
o Urinalysis (check for proteins, 4+ may indicate kidney disease)
• Side effects (PB p. 181)
o Endocrine
o Hypothyroidism
o Weight gain
o CNS
o Fine hand tremors
o Fatigue
o Mental cloudiness
o HA
o Coarse hand tremors occur with toxicity
o Nystagmus
o Maculopapular rash
o Pruritis
o Acne
o GI upset
o Diarrhea, vomiting, cramps
o Anorexia
o Polyuria
o Polydipsia
o Diabetes insipidus
o Edema
o Microscopic tubular changes
o T-wave inversions
o Dysrhythmia
o Leukocytosis (increased WBC)
• Pt education
o Staying hydrated, avoiding NSAIDS, compliance
3
, Depakote
• Normal: 50-125 (toxicity >150)
• Can cause:
o Spina bifida (neurotube defect) (importance of folic acid supplementation)
o Alopecia
o Hepatotoxicity
▪ RUQ pain or brown/red urine (order LFTs)
• AST 5-40, ALT 5-35
▪ Yellowing of the skin and white of eye
▪ Fatigue
• Toxicity
o Disorientation, lethargy, respiratory depression, nausea/vomiting
o Intervention: DC med and check VPA, LFT, ammonia
HTN Crisis (PB p. 157)
• MAOI + tyramine, a dietary precursor to norepinephrine
• Life threatening and cannot be reversed
• Can occur when MAOI +
o Meperidine
o Simulants and other sympathomimetics
o Decongestants
o TCA
o Atypicals
o St. John’s wort
o L-tryptophan
o Asthma meds
• Symptoms (PB p. 157)
o Elevated BP
o Sudden, explosive-like HA, usually in occipital region (back of head)
o Facial flushing
o Palpitations
o Pupillary dilation
o Diaphoresis
o Fever
• Treatment
o DC offending agent
o Administer phentolamine
Teratogenic Risks with Common Psychotropics (PB p. 118, 182)
• Benzos: floppy baby, cleft palate
• Tegretol: neural tube defect
4
GEORGETTE PMHNP
EXCELLENT PMHNP BOARD EXAM
REVIEW GUIDE
LAST MINUTE REVISION
PMHNP CERTIFICATION
EXAM REVIEW GUIDE
EXCELLENT BOARD EXAM REVIEW
MATERIAL.
PMHNP BOARD EXAM
NEW
V1, V2, & V3
1
, V1
Georgette Review: Scientific Foundation (1) & Advanced Practice Skills(2)
Test taking strategies
• Assessment & Safety 1st!
• Do not read quickly, pay attention to keywords, don’t read into question or add information
• When 2 answers choices are opposite of one another, one is usually the correct answer
• When many responses are remarkably similar, they are usually wrong
• We wary of absolutes (all, only, always, every, must, never, everything, nothing, etc.)—usually
wrong
• Choose client-focused answers; answers that acknowledge a patient’s feelings and makes
the patient feel heard
• Right answer option might have the same word as test question
• If partially correct, it’s still WRONG
• Everything needed to answer the question is there, don’t make assumptions
• Narrow down to 2 possible right answers
• Partially correct answers are not the correct answer
• When many answers are remarkably similar, they are usually wrong
• Questions that use adjective like “priority”, “initial action” test ability to prioritize
o 1 Airway/breathing/circulation
o 2. Maslow’s Hierarchy of needs (physiological needs (food, water, warmth, rest), safety
and security, etc.)
o 3. Nursing process (assessment before intervention). Assessment is collecting data
to support the problems towards resolution
• Safety for the patient/others is usually RIGHT…safety first
• Cultures is important to be included in all nursing care, cultural question = cultural answer
o A cultural expected response to a stressor does not always mean a mental illness
(cultural syndrome), interpret symptoms based on cultural meaning
o Brief supportive therapy
• Critical thinking important
• Interprofessional collaboration is encouraged…” collaborate” is usually RIGHT, “delegate” is
wrong (ask a dietitian to perform a task)
• Chose answers where you are actively involved, doing things for the patient (RIGHT)
(example: obtained informed consent and fax to PCP for updated labs completed by PCP)
• If undecided (or more than 1 right answer), the umbrella is usually the right answer for non-
priority questions
• Delegation & refer out is usually wrong
• Answers about obtaining funding are usually wrong
• Medical evaluations are out of scope, but can refer out for medical eval
• Nursing Process (ADPIER):
o Assessment: collect subjective and objective data, “identify”
o Diagnosis: analyze assessment data to determine a working diagnosis
o Plan/Intervention: developing and implementing plan of care, use EBP and 1st line txs
o Evaluate: performed last to evaluate patient’s attainment of treatment goals, plan may
need adjusted
o Refer out last!!
2
,Lithium (PB p. 180)
• Normal 0.6-1.2
• Toxicity occurs when level reaches >1.5 (suspect toxicity—DC, check lithium levels)
o Severe nausea, vomiting, diarrhea, confusion, drowsiness, muscle weakness, heart
palpitation, coarse hand tremors, unsteady gait
• Gold standard for MANIA
• Evidence for anti-suicidal effects
• Neuroprotective (protects nerves from damage)
• Can cause Ebstein anomaly (congenital heart defect) especially in 1st trimester
• ↑ lithium levels from dehydration and hyponatremia
• Baseline labs before initiation (ensure safety & efficacy)
o TSH
o Creatinine (0.6-1.2)
o BUN (10-20)
o HCG (all psychotropics females ages 12-51)
o EKG 50+ y/o
o Urinalysis (check for proteins, 4+ may indicate kidney disease)
• Side effects (PB p. 181)
o Endocrine
o Hypothyroidism
o Weight gain
o CNS
o Fine hand tremors
o Fatigue
o Mental cloudiness
o HA
o Coarse hand tremors occur with toxicity
o Nystagmus
o Maculopapular rash
o Pruritis
o Acne
o GI upset
o Diarrhea, vomiting, cramps
o Anorexia
o Polyuria
o Polydipsia
o Diabetes insipidus
o Edema
o Microscopic tubular changes
o T-wave inversions
o Dysrhythmia
o Leukocytosis (increased WBC)
• Pt education
o Staying hydrated, avoiding NSAIDS, compliance
3
, Depakote
• Normal: 50-125 (toxicity >150)
• Can cause:
o Spina bifida (neurotube defect) (importance of folic acid supplementation)
o Alopecia
o Hepatotoxicity
▪ RUQ pain or brown/red urine (order LFTs)
• AST 5-40, ALT 5-35
▪ Yellowing of the skin and white of eye
▪ Fatigue
• Toxicity
o Disorientation, lethargy, respiratory depression, nausea/vomiting
o Intervention: DC med and check VPA, LFT, ammonia
HTN Crisis (PB p. 157)
• MAOI + tyramine, a dietary precursor to norepinephrine
• Life threatening and cannot be reversed
• Can occur when MAOI +
o Meperidine
o Simulants and other sympathomimetics
o Decongestants
o TCA
o Atypicals
o St. John’s wort
o L-tryptophan
o Asthma meds
• Symptoms (PB p. 157)
o Elevated BP
o Sudden, explosive-like HA, usually in occipital region (back of head)
o Facial flushing
o Palpitations
o Pupillary dilation
o Diaphoresis
o Fever
• Treatment
o DC offending agent
o Administer phentolamine
Teratogenic Risks with Common Psychotropics (PB p. 118, 182)
• Benzos: floppy baby, cleft palate
• Tegretol: neural tube defect
4
