Georgette Review: Modules 1 and 2 1
,Georgette Review: Modules 1 and 2 2
Georgette Review PMHNP Modules 1 & 2 | Test Strategies, Key Concepts & Psychiatric
Mental Health Nurse Practitioner Study Guide | PDF
Test Taking Strategies
1. Read the entire question carefully before answering and identify what the question is seeking. Do
not skim over the words or read them too quickly.
➢ When reading the question pay attention to keywords.
2. Do not read into the question. Only use the information provided by the examiner to answer the
question without making any assumptions or adding more information in the question.
3. Read all the answer choices.
➢ Narrow down options to 2 possible right answers.
➢ Partially correct answers are not the correct answer.
➢ When the two answer choices are the opposite of one another, one is usually the correct
answer.
➢ The right answer option might have the same word(s) as the test question; it can be the
same word or a synonym of the word.
➢ Choose client-focused answers.
• Best Answer/Choice: Answers that acknowledge a patient’s feelings and make
the patient feel heard.
➢ When many response choices are remarkably similar in meaning, they are usually wrong.
➢ Be wary of absolutes: all, only, always, every, must, never, none, everything, nothing, etc.
usually wrong.
4. Questions that use adjectives like “priority” or “initial action” test your ability to prioritize.
➢ Airway, breathing, and circulation.
➢ Maslow’s Hierarchy of needs (physiologic needs- food, water, warmth, rest- safety and
security, etc.).
➢ Nursing process (assessment before intervention). Assessment is collecting data to
support the problem towards a resolution.
5. Safety for the patient and others is usually the right answer.
6. Culture is important to be included in all nursing care.
7. Critical thinking is important.
8. Interprofessional collaboration is encouraged.
,Georgette Review: Modules 1 and 2 3
Lithium (0.6-1.2mEq/L) (PB pg. 180)
➢ Lithium toxicity can occur when this level reaches 1.5mEq/L or higher.
➢ Gold standard for treating manic episodes.
➢ Evidence of anti-suicidal effects.
➢ Neuroprotective treatment of choice for bipolar disorder. (neuroprotective=protects nerve cells from
damage)
Baseline labs before initiation of lithium to ensure safety and efficacy (PB pg. 180)
• Thyroid panel (TSH)
• Serum creatinine (0.6-1.2mg/dl)
• Blood urea nitrogen (BUN) (10-20mg/dl)
• Pregnancy test (human chorionic gonadotropin [HCG])
• ECG for clients older than age 50. (may cause congenital heart defects)
Side effects of Lithium (PB pg. 181)
Endocrine
Hypothyroidism
Weight gain
Central Nervous System
Fine hand tremors
Fatigue
Mental cloudiness
Headaches
Coarse hand tremors occur with toxicity
Nystagmus
Dermatological
Maculopapular rash
Pruritus (itching)
Acne
Gastrointestinal (GI) upset
Diarrhea
Vomiting
Cramps
Anorexia
Renal
Diabetes insipidus: polyuria (excessive urination), polydipsia (excess thirst)
Edema
Microscopic tubular changes
Cardiac
T-wave inversions (importance for EKG monitoring)
Dysrhythmia
Hematologic
Leukocytosis (increased WBCs)
• Kidney disease or drugs that reduce renal clearance, such as Nonsteriodal Anti-Inflammatory
drugs :
, Georgette Review: Modules 1 and 2 4
(NSAID’s ex: Ibuprofen, Indocin)
(Thiazides ex: Hydrochlorothiazide)
(ACE inhibitors ex: Lisinopril)
(may increase serum concentration of drugs that are excreted by the kidneys)
➢ Older adults are more sensitive to psychotropics because of their decreased intracellular
water, protein binding, low muscle mass, decreased metabolism, and increased body fat
concentration.
Signs of Lithium toxicity: severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred
vision, slurred speech, muscle weakness, heart palpitations, coarse hand tremors, and unsteadiness while
standing or walking (ataxia).
➢ Intervention: D/C Lithium and check serum Lithium levels. SAFETY FIRST
QUESTIONS:
A 46-year-old male with a history of bipolar disorder comes for a regular follow up appointment with a
PMHNP and presents with complaints of severe vomiting, diarrhea, muscle weakness, blurred vision, and
ataxia. The patient is currently taking 900mg of Lithium daily. The PMHNP identifies these symptoms as
signs of Lithium Toxicity. What is the priority action of the PMHNP?
A. Maintain medication regimen and monitor the symptoms.
B. Tells the patient to stop taking lithium and orders a serum lithium level.
C. Order an electrocardiogram
D. Take the patients vital signs.
For 12 years, a 65 year old with bipolar affective disorder has been treated with Lithium(Eskalith) 900mg
daily. When oral hydrochlorothiazide (HCTZ) 12.5mg daily is added for hypertension the patient
develops nausea, vomiting, ataxia muscle weakness and the patients serum lithium level is 2.0 mEq/L.
The interaction of the lithium and the Thiazide diuretic has induced.
A. Hypokalemia
B. Hyponatremia (low sodium levels can increase lithium levels but they are not asking that)
C. Increased renal clearance of Lithium
D. Reduced renal clearance of Lithium.
• Answers C & D are opposites to each other, most likely one of the answers
Hypertensive crisis (Refer to PB pg. 157)
,Georgette Review: Modules 1 and 2 2
Georgette Review PMHNP Modules 1 & 2 | Test Strategies, Key Concepts & Psychiatric
Mental Health Nurse Practitioner Study Guide | PDF
Test Taking Strategies
1. Read the entire question carefully before answering and identify what the question is seeking. Do
not skim over the words or read them too quickly.
➢ When reading the question pay attention to keywords.
2. Do not read into the question. Only use the information provided by the examiner to answer the
question without making any assumptions or adding more information in the question.
3. Read all the answer choices.
➢ Narrow down options to 2 possible right answers.
➢ Partially correct answers are not the correct answer.
➢ When the two answer choices are the opposite of one another, one is usually the correct
answer.
➢ The right answer option might have the same word(s) as the test question; it can be the
same word or a synonym of the word.
➢ Choose client-focused answers.
• Best Answer/Choice: Answers that acknowledge a patient’s feelings and make
the patient feel heard.
➢ When many response choices are remarkably similar in meaning, they are usually wrong.
➢ Be wary of absolutes: all, only, always, every, must, never, none, everything, nothing, etc.
usually wrong.
4. Questions that use adjectives like “priority” or “initial action” test your ability to prioritize.
➢ Airway, breathing, and circulation.
➢ Maslow’s Hierarchy of needs (physiologic needs- food, water, warmth, rest- safety and
security, etc.).
➢ Nursing process (assessment before intervention). Assessment is collecting data to
support the problem towards a resolution.
5. Safety for the patient and others is usually the right answer.
6. Culture is important to be included in all nursing care.
7. Critical thinking is important.
8. Interprofessional collaboration is encouraged.
,Georgette Review: Modules 1 and 2 3
Lithium (0.6-1.2mEq/L) (PB pg. 180)
➢ Lithium toxicity can occur when this level reaches 1.5mEq/L or higher.
➢ Gold standard for treating manic episodes.
➢ Evidence of anti-suicidal effects.
➢ Neuroprotective treatment of choice for bipolar disorder. (neuroprotective=protects nerve cells from
damage)
Baseline labs before initiation of lithium to ensure safety and efficacy (PB pg. 180)
• Thyroid panel (TSH)
• Serum creatinine (0.6-1.2mg/dl)
• Blood urea nitrogen (BUN) (10-20mg/dl)
• Pregnancy test (human chorionic gonadotropin [HCG])
• ECG for clients older than age 50. (may cause congenital heart defects)
Side effects of Lithium (PB pg. 181)
Endocrine
Hypothyroidism
Weight gain
Central Nervous System
Fine hand tremors
Fatigue
Mental cloudiness
Headaches
Coarse hand tremors occur with toxicity
Nystagmus
Dermatological
Maculopapular rash
Pruritus (itching)
Acne
Gastrointestinal (GI) upset
Diarrhea
Vomiting
Cramps
Anorexia
Renal
Diabetes insipidus: polyuria (excessive urination), polydipsia (excess thirst)
Edema
Microscopic tubular changes
Cardiac
T-wave inversions (importance for EKG monitoring)
Dysrhythmia
Hematologic
Leukocytosis (increased WBCs)
• Kidney disease or drugs that reduce renal clearance, such as Nonsteriodal Anti-Inflammatory
drugs :
, Georgette Review: Modules 1 and 2 4
(NSAID’s ex: Ibuprofen, Indocin)
(Thiazides ex: Hydrochlorothiazide)
(ACE inhibitors ex: Lisinopril)
(may increase serum concentration of drugs that are excreted by the kidneys)
➢ Older adults are more sensitive to psychotropics because of their decreased intracellular
water, protein binding, low muscle mass, decreased metabolism, and increased body fat
concentration.
Signs of Lithium toxicity: severe nausea, vomiting, diarrhea, confusion, convulsions, drowsiness, blurred
vision, slurred speech, muscle weakness, heart palpitations, coarse hand tremors, and unsteadiness while
standing or walking (ataxia).
➢ Intervention: D/C Lithium and check serum Lithium levels. SAFETY FIRST
QUESTIONS:
A 46-year-old male with a history of bipolar disorder comes for a regular follow up appointment with a
PMHNP and presents with complaints of severe vomiting, diarrhea, muscle weakness, blurred vision, and
ataxia. The patient is currently taking 900mg of Lithium daily. The PMHNP identifies these symptoms as
signs of Lithium Toxicity. What is the priority action of the PMHNP?
A. Maintain medication regimen and monitor the symptoms.
B. Tells the patient to stop taking lithium and orders a serum lithium level.
C. Order an electrocardiogram
D. Take the patients vital signs.
For 12 years, a 65 year old with bipolar affective disorder has been treated with Lithium(Eskalith) 900mg
daily. When oral hydrochlorothiazide (HCTZ) 12.5mg daily is added for hypertension the patient
develops nausea, vomiting, ataxia muscle weakness and the patients serum lithium level is 2.0 mEq/L.
The interaction of the lithium and the Thiazide diuretic has induced.
A. Hypokalemia
B. Hyponatremia (low sodium levels can increase lithium levels but they are not asking that)
C. Increased renal clearance of Lithium
D. Reduced renal clearance of Lithium.
• Answers C & D are opposites to each other, most likely one of the answers
Hypertensive crisis (Refer to PB pg. 157)
