GEORGETTE REVIEW PMHNP 388
COMPREHENSIVE STUDY GUIDE 2026
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER PRINCIPLES
◉ Interprofessional collaboration is encouraged.
Answer: Collaborate is usually right.
Delegate is usually wrong.
◉ ADPIER.
Answer: Assessment, diagnosis, Plan, intervention, evaluate, refer
out last.
◉ Lithium.
Answer: Normal 0.6-1.2
◉ Lithium toxicity occurs at levels.
Answer: > 1.5
◉ Signs of Lithium toxicity.
,Answer: severe nausea, diarrhea, vomiting, confusion, drowsiness,
muscle weakness, heart palpitation, coarse hand tremors, unsteady
gait
◉ Lithium is gold standard for.
Answer: MANIA
◉ Lithium has evidence shown to.
Answer: reduce suicidal ideation
◉ What does lithium cause in neonate, especially 1st trimester.
Answer: Ebstein anomaly (congenital heart defect)
◉ dehydration and hyponatremia cause lithium levels to.
Answer: rise
◉ Baseline labs before initiation of lithium.
Answer: 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)
◉ Side Effects of Lithium.
Answer: hypothyroidism
coase hand tremors with toxicity
maculopapular rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
◉ Pt education for lithimum.
Answer: staying hydrated
avoiding NSAIDS
compliance
◉ Depakote normal level.
Answer: 50-125
◉ Depakote toxicity level.
Answer: greater than 150
, ◉ Teratogenic effects of Depakote.
Answer: spina bifida
◉ Adverse effects of depakote.
Answer: alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-
40, ALT 5-35, yellowing of skin or eyes, fatigue
◉ Signs of Depakote toxicity.
Answer: disorientation, lethargy, respiratory depression,
nausea/vomiting
◉ Intervention for depakote toxicity.
Answer: DC med
check level
LFT
ammonia
◉ MAOI + tyramine causes.
Answer: hypertensive crisis
◉ Symptoms of hypertensive crisis.
COMPREHENSIVE STUDY GUIDE 2026
PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER PRINCIPLES
◉ Interprofessional collaboration is encouraged.
Answer: Collaborate is usually right.
Delegate is usually wrong.
◉ ADPIER.
Answer: Assessment, diagnosis, Plan, intervention, evaluate, refer
out last.
◉ Lithium.
Answer: Normal 0.6-1.2
◉ Lithium toxicity occurs at levels.
Answer: > 1.5
◉ Signs of Lithium toxicity.
,Answer: severe nausea, diarrhea, vomiting, confusion, drowsiness,
muscle weakness, heart palpitation, coarse hand tremors, unsteady
gait
◉ Lithium is gold standard for.
Answer: MANIA
◉ Lithium has evidence shown to.
Answer: reduce suicidal ideation
◉ What does lithium cause in neonate, especially 1st trimester.
Answer: Ebstein anomaly (congenital heart defect)
◉ dehydration and hyponatremia cause lithium levels to.
Answer: rise
◉ Baseline labs before initiation of lithium.
Answer: 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)
◉ Side Effects of Lithium.
Answer: hypothyroidism
coase hand tremors with toxicity
maculopapular rash
diarrhea, vomiting, cramps--signs of toxicity. Monitor closely.
anorexia
t wave inversions
leukocytosis
◉ Pt education for lithimum.
Answer: staying hydrated
avoiding NSAIDS
compliance
◉ Depakote normal level.
Answer: 50-125
◉ Depakote toxicity level.
Answer: greater than 150
, ◉ Teratogenic effects of Depakote.
Answer: spina bifida
◉ Adverse effects of depakote.
Answer: alopecia
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-
40, ALT 5-35, yellowing of skin or eyes, fatigue
◉ Signs of Depakote toxicity.
Answer: disorientation, lethargy, respiratory depression,
nausea/vomiting
◉ Intervention for depakote toxicity.
Answer: DC med
check level
LFT
ammonia
◉ MAOI + tyramine causes.
Answer: hypertensive crisis
◉ Symptoms of hypertensive crisis.
