PMHNP Georgette Review – 388 Expert-Verified
Questions & Answers for Guaranteed Success
(2025/2026)
### **PMHNP Georgette Review – Questions 1-50 (Lithium Toxicity, Interprofessional
Collaboration, ADPIER, & Foundational Knowledge)**
**1. A 52-year-old patient with bipolar I disorder presents with a coarse tremor, nausea,
vomiting, and diarrhea. Their partner mentions the patient has been complaining of being
"blurry-eyed" lately. What is the most appropriate initial action for the PMHNP?**
a) Order STAT serum lithium, electrolytes, BUN, and creatinine levels.
b) Administer an antiemetic for symptomatic relief.
c) Advise the patient to double their fluid intake and recheck levels in one week.
d) Immediately discontinue the lithium and schedule a follow-up appointment.
**Answer: A**
**Rationale:** These are classic signs of lithium toxicity. The initial action is to obtain STAT labs
to confirm toxicity and assess renal function. Discontinuing lithium is necessary but must be
done under medical supervision after confirming the diagnosis. Symptomatic treatment alone is
dangerous as it delays addressing the underlying, potentially life-threatening, condition.
**2. When using the ADPIER framework for clinical decision-making, the "A" primarily
involves:**
a) Formulating a list of potential differential diagnoses.
b) Prescribing the first-line medication for the suspected condition.
c) Gathering subjective and objective data from the patient.
d) Evaluating the effectiveness of the chosen intervention.
,**Answer: C**
**Rationale:** ADPIER stands for Assessment, Diagnosis, Planning, Implementation, Evaluation,
and Revision. The "A" (Assessment) is the systematic collection of all relevant subjective and
objective patient data (e.g., history, symptoms, lab results, mental status exam).
**3. A PMHNP is managing a patient taking lithium who develops a severe urinary tract
infection. Which interprofessional collaboration is most critical at this time?**
a) Collaboration with a social worker to find housing.
b) Consultation with the patient's primary care provider (PCP) or an infectious disease specialist.
c) Referral to a cognitive-behavioral therapist.
d) Coordination with a pharmacist to discuss antibiotic choices.
**Answer: D**
**Rationale:** Dehydration from illnesses like a UTI can precipitously increase lithium levels,
leading to toxicity. A pharmacist is the best collaborator to ensure the prescribed antibiotic does
not interact with lithium (e.g., some antibiotics like aminoglycosides can increase nephrotoxicity
risk) and to advise on hydration needs.
**4. The therapeutic serum level range for lithium in the maintenance treatment of bipolar
disorder is typically:**
a) 0.2-0.5 mEq/L
b) 0.6-1.2 mEq/L
c) 1.5-2.0 mEq/L
d) 2.5-3.0 mEq/L
**Answer: B**
**Rationale:** 0.6-1.2 mEq/L is the standard maintenance range. Acute manic episodes may be
treated at the higher end of this range (0.8-1.2 mEq/L). Levels below 0.6 are often
subtherapeutic, and levels above 1.2 mEq/L increase the risk of toxicity.
**5. During the "Planning" phase of ADPIER, the PMHNP is most involved in:**
,a) Conducting a suicide risk assessment.
b) Ordering a CBC and metabolic panel.
c) Mutually setting goals and outcomes with the patient.
d) Administering a rating scale like the PHQ-9.
**Answer: C**
**Rationale:** The "P" (Planning) phase involves collaborating with the patient to develop a
treatment plan with specific, measurable, achievable, relevant, and time-bound (SMART) goals.
The other options are part of the Assessment (A) phase.
**6. Early signs of lithium toxicity include:**
a) Seizures, coma, and oliguria.
b) Nausea, diarrhea, drowsiness, and fine hand tremor.
c) Hyperreflexia and nystagmus.
d) Cardiovascular collapse.
**Answer: B**
**Rationale:** Nausea, diarrhea, drowsiness, and fine tremor are early, common signs. Options
A, C, and D are signs of severe, life-threatening toxicity.
**7. A PMHNP working in a primary care clinic refers a patient with depression and poorly
controlled diabetes to a diabetes educator. This is an example of:**
a) Intraprofessional collaboration.
b) Interprofessional collaboration.
c) Multidisciplinary team meeting.
d) Scope of practice expansion.
**Answer: B**
**Rationale:** Interprofessional collaboration involves different professions (e.g., nursing and
diabetes education/specialized medicine) working together. Intraprofessional would be within
the same profession (e.g., PMHNP and RN).
, **8. Which long-term monitoring parameter is essential for a patient prescribed lithium?**
a) Annual echocardiogram.
b) Thyroid and renal function tests every 3-6 months.
c) Monthly liver function tests.
d) Quarterly EEG.
**Answer: B**
**Rationale:** Lithium can cause hypothyroidism and nephrogenic diabetes insipidus (affecting
renal function). Therefore, monitoring TSH and renal function (creatinine, BUN, estimated GFR)
is a standard of care.
**9. In the ADPIER model, the "R" (Revision) becomes necessary when:**
a) The assessment is complete.
b) The patient achieves all treatment goals.
c) The evaluation indicates the current plan is ineffective or harmful.
d) The diagnosis is confirmed.
**Answer: C**
**Rationale:** Revision is required if the "E" (Evaluation) shows that the patient is not
improving, is experiencing adverse effects, or if their condition changes, necessitating a change
in the plan.
**10. A patient's lithium level is 1.8 mEq/L. They are asymptomatic. The PMHNP should:**
a) Congratulate the patient on a therapeutic level.
b) Hold the next dose and recheck the level immediately.
c) Increase the dose to achieve a better prophylactic effect.
d) Add valproic acid as an augmenting agent.
**Answer: B**
Questions & Answers for Guaranteed Success
(2025/2026)
### **PMHNP Georgette Review – Questions 1-50 (Lithium Toxicity, Interprofessional
Collaboration, ADPIER, & Foundational Knowledge)**
**1. A 52-year-old patient with bipolar I disorder presents with a coarse tremor, nausea,
vomiting, and diarrhea. Their partner mentions the patient has been complaining of being
"blurry-eyed" lately. What is the most appropriate initial action for the PMHNP?**
a) Order STAT serum lithium, electrolytes, BUN, and creatinine levels.
b) Administer an antiemetic for symptomatic relief.
c) Advise the patient to double their fluid intake and recheck levels in one week.
d) Immediately discontinue the lithium and schedule a follow-up appointment.
**Answer: A**
**Rationale:** These are classic signs of lithium toxicity. The initial action is to obtain STAT labs
to confirm toxicity and assess renal function. Discontinuing lithium is necessary but must be
done under medical supervision after confirming the diagnosis. Symptomatic treatment alone is
dangerous as it delays addressing the underlying, potentially life-threatening, condition.
**2. When using the ADPIER framework for clinical decision-making, the "A" primarily
involves:**
a) Formulating a list of potential differential diagnoses.
b) Prescribing the first-line medication for the suspected condition.
c) Gathering subjective and objective data from the patient.
d) Evaluating the effectiveness of the chosen intervention.
,**Answer: C**
**Rationale:** ADPIER stands for Assessment, Diagnosis, Planning, Implementation, Evaluation,
and Revision. The "A" (Assessment) is the systematic collection of all relevant subjective and
objective patient data (e.g., history, symptoms, lab results, mental status exam).
**3. A PMHNP is managing a patient taking lithium who develops a severe urinary tract
infection. Which interprofessional collaboration is most critical at this time?**
a) Collaboration with a social worker to find housing.
b) Consultation with the patient's primary care provider (PCP) or an infectious disease specialist.
c) Referral to a cognitive-behavioral therapist.
d) Coordination with a pharmacist to discuss antibiotic choices.
**Answer: D**
**Rationale:** Dehydration from illnesses like a UTI can precipitously increase lithium levels,
leading to toxicity. A pharmacist is the best collaborator to ensure the prescribed antibiotic does
not interact with lithium (e.g., some antibiotics like aminoglycosides can increase nephrotoxicity
risk) and to advise on hydration needs.
**4. The therapeutic serum level range for lithium in the maintenance treatment of bipolar
disorder is typically:**
a) 0.2-0.5 mEq/L
b) 0.6-1.2 mEq/L
c) 1.5-2.0 mEq/L
d) 2.5-3.0 mEq/L
**Answer: B**
**Rationale:** 0.6-1.2 mEq/L is the standard maintenance range. Acute manic episodes may be
treated at the higher end of this range (0.8-1.2 mEq/L). Levels below 0.6 are often
subtherapeutic, and levels above 1.2 mEq/L increase the risk of toxicity.
**5. During the "Planning" phase of ADPIER, the PMHNP is most involved in:**
,a) Conducting a suicide risk assessment.
b) Ordering a CBC and metabolic panel.
c) Mutually setting goals and outcomes with the patient.
d) Administering a rating scale like the PHQ-9.
**Answer: C**
**Rationale:** The "P" (Planning) phase involves collaborating with the patient to develop a
treatment plan with specific, measurable, achievable, relevant, and time-bound (SMART) goals.
The other options are part of the Assessment (A) phase.
**6. Early signs of lithium toxicity include:**
a) Seizures, coma, and oliguria.
b) Nausea, diarrhea, drowsiness, and fine hand tremor.
c) Hyperreflexia and nystagmus.
d) Cardiovascular collapse.
**Answer: B**
**Rationale:** Nausea, diarrhea, drowsiness, and fine tremor are early, common signs. Options
A, C, and D are signs of severe, life-threatening toxicity.
**7. A PMHNP working in a primary care clinic refers a patient with depression and poorly
controlled diabetes to a diabetes educator. This is an example of:**
a) Intraprofessional collaboration.
b) Interprofessional collaboration.
c) Multidisciplinary team meeting.
d) Scope of practice expansion.
**Answer: B**
**Rationale:** Interprofessional collaboration involves different professions (e.g., nursing and
diabetes education/specialized medicine) working together. Intraprofessional would be within
the same profession (e.g., PMHNP and RN).
, **8. Which long-term monitoring parameter is essential for a patient prescribed lithium?**
a) Annual echocardiogram.
b) Thyroid and renal function tests every 3-6 months.
c) Monthly liver function tests.
d) Quarterly EEG.
**Answer: B**
**Rationale:** Lithium can cause hypothyroidism and nephrogenic diabetes insipidus (affecting
renal function). Therefore, monitoring TSH and renal function (creatinine, BUN, estimated GFR)
is a standard of care.
**9. In the ADPIER model, the "R" (Revision) becomes necessary when:**
a) The assessment is complete.
b) The patient achieves all treatment goals.
c) The evaluation indicates the current plan is ineffective or harmful.
d) The diagnosis is confirmed.
**Answer: C**
**Rationale:** Revision is required if the "E" (Evaluation) shows that the patient is not
improving, is experiencing adverse effects, or if their condition changes, necessitating a change
in the plan.
**10. A patient's lithium level is 1.8 mEq/L. They are asymptomatic. The PMHNP should:**
a) Congratulate the patient on a therapeutic level.
b) Hold the next dose and recheck the level immediately.
c) Increase the dose to achieve a better prophylactic effect.
d) Add valproic acid as an augmenting agent.
**Answer: B**
