GEORGETTE REVIEW PMHNP EXAM Questions & Answers
(Verified 2026/2027) Complete Psychiatric Mental Health Nurse
Practitioner Board Review
Pass your ANCC psychiatric-mental health nurse practitioner boards on your very first
try with this definitive 2026/2027 Georgette Review PMHNP practice exam bank. This
comprehensive preparation guide features high-yield exam questions paired with 100%
verified answers and rigorous clinical rationales covering advanced
psychopharmacology, DSM-5-TR diagnostic criteria, neurobiology, and
psychotherapeutic modalities. It is an indispensable resource for graduate nursing
students looking to streamline their study routines, build absolute clinical diagnostic
confidence, and secure a passing score.
1. When many answers are remarkably similar, they are usually _____________
A) Correct
B) Wrong
C) Distractors
D) Key words
Correct Answer: B) Wrong
Rationale: In the Georgette Review strategy, when answer choices are remarkably similar,
this often indicates they are incorrect distractors. The correct answer is typically the one
that stands out or is most clinically appropriate.
2. Interprofessional collaboration is encouraged in the PMHNP role. Which of the
following statements best reflects this principle?
A) Delegate tasks to unlicensed personnel whenever possible
B) Collaborate with other healthcare professionals to optimize patient outcomes
C) Refer all complex cases to psychiatry
D) Function independently without input from other disciplines
Correct Answer: B) Collaborate with other healthcare professionals to optimize
patient outcomes
Rationale: Collaboration is a core principle of the PMHNP role. "Collaborate" is usually the
correct answer choice in exam questions, while "Delegate" is often incorrect. The PMHNP
works as part of an interprofessional team to provide comprehensive care .
,3. ADPIER is a clinical decision-making framework. What is the correct sequence?
A) Plan, Assessment, Diagnosis, Intervention, Evaluation, Refer
B) Assessment, Diagnosis, Plan, Intervention, Evaluation, Refer
C) Assessment, Plan, Diagnosis, Intervention, Evaluation, Refer
D) Diagnosis, Assessment, Plan, Intervention, Refer, Evaluation
Correct Answer: B) Assessment, Diagnosis, Plan, Intervention, Evaluation, Refer
Rationale: ADPIER stands for Assessment, Diagnosis, Plan, Intervention, Evaluation, and
Refer. Refer is always the last step, representing referral out when needed .
4. What is the normal therapeutic range for serum lithium?
A) 0.3-0.6 mEq/L
B) 0.6-1.2 mEq/L
C) 1.0-1.5 mEq/L
D) 1.5-2.0 mEq/L
Correct Answer: B) 0.6-1.2 mEq/L
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. Levels above 1.5 mEq/L
indicate toxicity .
5. Lithium toxicity occurs at serum levels greater than:
A) 1.0 mEq/L
B) 1.2 mEq/L
C) 1.5 mEq/L
D) 2.0 mEq/L
Correct Answer: C) 1.5 mEq/L
Rationale: Lithium toxicity typically occurs when serum levels exceed 1.5 mEq/L. Signs
include severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, coarse
hand tremors, and unsteady gait .
6. Which of the following is a sign of lithium toxicity?
A) Fine hand tremors
B) Polyuria and polydipsia
C) Coarse hand tremors and unsteady gait
D) Weight gain
Correct Answer: C) Coarse hand tremors and unsteady gait
Rationale: Signs of lithium toxicity include severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitations, coarse hand tremors, and unsteady gait.
Fine tremors are common side effects at therapeutic levels .
7. Lithium is considered the gold standard treatment for:
A) Depression
B) Mania
,C) Schizophrenia
D) Anxiety
Correct Answer: B) Mania
Rationale: Lithium is the gold standard for treating acute mania and for maintenance
therapy in bipolar disorder. It has demonstrated efficacy in reducing manic episodes .
8. Lithium has been shown to reduce which of the following in patients with
bipolar disorder?
A) Anxiety symptoms
B) Suicidal ideation
C) Psychotic symptoms
D) Sleep disturbances
Correct Answer: B) Suicidal ideation
Rationale: Lithium has evidence demonstrating reduction in suicidal ideation and
completed suicides in patients with bipolar disorder, making it a unique agent in this
regard .
9. Which congenital anomaly is associated with first-trimester lithium exposure?
A) Spina bifida
B) Cleft palate
C) Ebstein anomaly
D) Neural tube defect
Correct Answer: C) Ebstein anomaly
Rationale: Lithium exposure during the first trimester is associated with Ebstein anomaly, a
congenital heart defect. This is a key teratogenic effect to consider in reproductive-age
women .
10. Dehydration and hyponatremia cause lithium levels to:
A) Decrease
B) Remain stable
C) Rise
D) Fluctuate unpredictably
Correct Answer: C) Rise
Rationale: Dehydration and hyponatremia can cause lithium levels to rise because the
kidneys conserve sodium and lithium together, leading to increased reabsorption and
potential toxicity .
11. Which baseline lab tests should be obtained before initiating lithium therapy?
A) TSH, creatinine, BUN, HCG (for females 12-51), EKG (if 50+), urinalysis
B) CBC, CMP, TSH only
C) LFTs, BUN, creatinine
, D) TSH, CBC, creatinine
Correct Answer: A) TSH, creatinine, BUN, HCG (for females 12-51), EKG (if 50+),
urinalysis
Rationale: Baseline labs before lithium include TSH (monitor for hypothyroidism),
creatinine and BUN (renal function), HCG for females of childbearing age, EKG for patients
50+, and urinalysis (check for protein; 4+ may indicate kidney disease) .
12. Which of the following is a side effect of lithium therapy?
A) Hyperthyroidism
B) Hypothyroidism
C) Hypertension
D) Hyperglycemia
Correct Answer: B) Hypothyroidism
Rationale: Lithium can cause hypothyroidism, presenting as fatigue, weight gain, and cold
intolerance. Thyroid function should be monitored regularly in patients on lithium
therapy .
13. Patient education for lithium should include all of the following EXCEPT:
A) Staying hydrated
B) Avoiding NSAIDs
C) Compliance with medication
D) Increasing salt intake
Correct Answer: D) Increasing salt intake
Rationale: Patient education for lithium includes staying hydrated, avoiding NSAIDs
(which can increase lithium levels), and maintaining medication compliance. Patients
should maintain consistent salt intake, not increase it, as sodium fluctuations affect
lithium levels .
14. What is the normal therapeutic range for Depakote (valproic acid)?
A) 30-80 mcg/mL
B) 50-125 mcg/mL
C) 100-150 mcg/mL
D) 125-175 mcg/mL
Correct Answer: B) 50-125 mcg/mL
Rationale: The therapeutic range for valproic acid (Depakote) is 50-125 mcg/mL. Levels
greater than 150 mcg/mL indicate toxicity .
15. Depakote toxicity occurs at levels greater than:
A) 100 mcg/mL
B) 125 mcg/mL
C) 150 mcg/mL
(Verified 2026/2027) Complete Psychiatric Mental Health Nurse
Practitioner Board Review
Pass your ANCC psychiatric-mental health nurse practitioner boards on your very first
try with this definitive 2026/2027 Georgette Review PMHNP practice exam bank. This
comprehensive preparation guide features high-yield exam questions paired with 100%
verified answers and rigorous clinical rationales covering advanced
psychopharmacology, DSM-5-TR diagnostic criteria, neurobiology, and
psychotherapeutic modalities. It is an indispensable resource for graduate nursing
students looking to streamline their study routines, build absolute clinical diagnostic
confidence, and secure a passing score.
1. When many answers are remarkably similar, they are usually _____________
A) Correct
B) Wrong
C) Distractors
D) Key words
Correct Answer: B) Wrong
Rationale: In the Georgette Review strategy, when answer choices are remarkably similar,
this often indicates they are incorrect distractors. The correct answer is typically the one
that stands out or is most clinically appropriate.
2. Interprofessional collaboration is encouraged in the PMHNP role. Which of the
following statements best reflects this principle?
A) Delegate tasks to unlicensed personnel whenever possible
B) Collaborate with other healthcare professionals to optimize patient outcomes
C) Refer all complex cases to psychiatry
D) Function independently without input from other disciplines
Correct Answer: B) Collaborate with other healthcare professionals to optimize
patient outcomes
Rationale: Collaboration is a core principle of the PMHNP role. "Collaborate" is usually the
correct answer choice in exam questions, while "Delegate" is often incorrect. The PMHNP
works as part of an interprofessional team to provide comprehensive care .
,3. ADPIER is a clinical decision-making framework. What is the correct sequence?
A) Plan, Assessment, Diagnosis, Intervention, Evaluation, Refer
B) Assessment, Diagnosis, Plan, Intervention, Evaluation, Refer
C) Assessment, Plan, Diagnosis, Intervention, Evaluation, Refer
D) Diagnosis, Assessment, Plan, Intervention, Refer, Evaluation
Correct Answer: B) Assessment, Diagnosis, Plan, Intervention, Evaluation, Refer
Rationale: ADPIER stands for Assessment, Diagnosis, Plan, Intervention, Evaluation, and
Refer. Refer is always the last step, representing referral out when needed .
4. What is the normal therapeutic range for serum lithium?
A) 0.3-0.6 mEq/L
B) 0.6-1.2 mEq/L
C) 1.0-1.5 mEq/L
D) 1.5-2.0 mEq/L
Correct Answer: B) 0.6-1.2 mEq/L
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. Levels above 1.5 mEq/L
indicate toxicity .
5. Lithium toxicity occurs at serum levels greater than:
A) 1.0 mEq/L
B) 1.2 mEq/L
C) 1.5 mEq/L
D) 2.0 mEq/L
Correct Answer: C) 1.5 mEq/L
Rationale: Lithium toxicity typically occurs when serum levels exceed 1.5 mEq/L. Signs
include severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, coarse
hand tremors, and unsteady gait .
6. Which of the following is a sign of lithium toxicity?
A) Fine hand tremors
B) Polyuria and polydipsia
C) Coarse hand tremors and unsteady gait
D) Weight gain
Correct Answer: C) Coarse hand tremors and unsteady gait
Rationale: Signs of lithium toxicity include severe nausea, diarrhea, vomiting, confusion,
drowsiness, muscle weakness, heart palpitations, coarse hand tremors, and unsteady gait.
Fine tremors are common side effects at therapeutic levels .
7. Lithium is considered the gold standard treatment for:
A) Depression
B) Mania
,C) Schizophrenia
D) Anxiety
Correct Answer: B) Mania
Rationale: Lithium is the gold standard for treating acute mania and for maintenance
therapy in bipolar disorder. It has demonstrated efficacy in reducing manic episodes .
8. Lithium has been shown to reduce which of the following in patients with
bipolar disorder?
A) Anxiety symptoms
B) Suicidal ideation
C) Psychotic symptoms
D) Sleep disturbances
Correct Answer: B) Suicidal ideation
Rationale: Lithium has evidence demonstrating reduction in suicidal ideation and
completed suicides in patients with bipolar disorder, making it a unique agent in this
regard .
9. Which congenital anomaly is associated with first-trimester lithium exposure?
A) Spina bifida
B) Cleft palate
C) Ebstein anomaly
D) Neural tube defect
Correct Answer: C) Ebstein anomaly
Rationale: Lithium exposure during the first trimester is associated with Ebstein anomaly, a
congenital heart defect. This is a key teratogenic effect to consider in reproductive-age
women .
10. Dehydration and hyponatremia cause lithium levels to:
A) Decrease
B) Remain stable
C) Rise
D) Fluctuate unpredictably
Correct Answer: C) Rise
Rationale: Dehydration and hyponatremia can cause lithium levels to rise because the
kidneys conserve sodium and lithium together, leading to increased reabsorption and
potential toxicity .
11. Which baseline lab tests should be obtained before initiating lithium therapy?
A) TSH, creatinine, BUN, HCG (for females 12-51), EKG (if 50+), urinalysis
B) CBC, CMP, TSH only
C) LFTs, BUN, creatinine
, D) TSH, CBC, creatinine
Correct Answer: A) TSH, creatinine, BUN, HCG (for females 12-51), EKG (if 50+),
urinalysis
Rationale: Baseline labs before lithium include TSH (monitor for hypothyroidism),
creatinine and BUN (renal function), HCG for females of childbearing age, EKG for patients
50+, and urinalysis (check for protein; 4+ may indicate kidney disease) .
12. Which of the following is a side effect of lithium therapy?
A) Hyperthyroidism
B) Hypothyroidism
C) Hypertension
D) Hyperglycemia
Correct Answer: B) Hypothyroidism
Rationale: Lithium can cause hypothyroidism, presenting as fatigue, weight gain, and cold
intolerance. Thyroid function should be monitored regularly in patients on lithium
therapy .
13. Patient education for lithium should include all of the following EXCEPT:
A) Staying hydrated
B) Avoiding NSAIDs
C) Compliance with medication
D) Increasing salt intake
Correct Answer: D) Increasing salt intake
Rationale: Patient education for lithium includes staying hydrated, avoiding NSAIDs
(which can increase lithium levels), and maintaining medication compliance. Patients
should maintain consistent salt intake, not increase it, as sodium fluctuations affect
lithium levels .
14. What is the normal therapeutic range for Depakote (valproic acid)?
A) 30-80 mcg/mL
B) 50-125 mcg/mL
C) 100-150 mcg/mL
D) 125-175 mcg/mL
Correct Answer: B) 50-125 mcg/mL
Rationale: The therapeutic range for valproic acid (Depakote) is 50-125 mcg/mL. Levels
greater than 150 mcg/mL indicate toxicity .
15. Depakote toxicity occurs at levels greater than:
A) 100 mcg/mL
B) 125 mcg/mL
C) 150 mcg/mL
