GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
When many answers are remarkably similar, they are usually _____________
wrong
Interprofessional collaboration is encouraged.
Collaborate is usually right.
Delegate is usually wrong.
ADPIER
Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium
Normal 0.6-1.2
Lithium toxicity occurs at levels
> 1.5
Signs of Lithium toxicity
severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart
palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for
MANIA
Lithium has evidence shown to
reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester
Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to
rise
Baseline labs before initiation of lithium
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
,GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
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
staying hydrated
avoiding NSAIDS
compliance
Depakote normal level
50-125
Depakote toxicity level
greater than 150
Teratogenic effects of Depakote
spina bifida
Adverse effects of depakote
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
disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity
DC med
check level
LFT
ammonia
MAOI + tyramine causes
hypertensive crisis
Symptoms of hypertensive crisis
elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI +
MEPERIDINE
STIMULANTS
,GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis
DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos
floppy baby, cleft palate
Teratogenic effects of tegratol
neural tube defect
teratogenic effects of lithium
ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote
neural tube defects/spina bifida
Adverse reaction to Lamictal
Steven Johnson's Syndrome
Signs of SJS
FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
arthralgia
painful mucus membranes
Lamotrigine is least likely to cause
sedation or weight gain
Carbamazepine (tegretol) black box warning
agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians
Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for
allele.
Child-bearing aged women
, GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
check for pregnancy before starting mood stabilizer
start on folic acid to support neural tube development during the first month that a
woman is pregnant
Clozaril/clozapine can cause
agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor
ANC
DC clozarli if ANC
less than 1000
DC clozaril if WBC
2000-3000, risk of agranulocytosis
When on clozaril monitor for
signs and symptoms of infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to
decrease risk of suicide in patients with schizophrenia.
Your patient with bipolar disorder is admitted to a medical hospital. The internist
contacts your office and asks whether the lithium you prescribed him is effecting
his ECG. How do you respond?
A. Lithium can prolong the QT interval
B. Lithium has no effect on his ECG
C. Lithium can invert the t waves
D. Lithium can shorten the PR interval
Answer: Lithium can invert the t waves.
Mary is a 45-year-old African American female who has been treated on
Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical
procedure. Which medication is strictly contraindicated with Isocarboxazid?
A. Morphine
B. NSAIDS
C. Methylphenidate
D. Acetaminophen
Answer: Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab values
will indicate the client needs to discontinue treatment?
A. WBC less than 1800 and ANC less than 1200
B. ANC less than 1,000
C. WBC less than 5,000
D. ANC less than 2000
Answer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the following
medical problems in the baby?
A. SJS
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
When many answers are remarkably similar, they are usually _____________
wrong
Interprofessional collaboration is encouraged.
Collaborate is usually right.
Delegate is usually wrong.
ADPIER
Assessment, diagnosis, Plan, intervention, evaluate, refer out last.
Lithium
Normal 0.6-1.2
Lithium toxicity occurs at levels
> 1.5
Signs of Lithium toxicity
severe nausea, diarrhea, vomiting, confusion, drowsiness, muscle weakness, heart
palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard for
MANIA
Lithium has evidence shown to
reduce suicidal ideation
What does lithium cause in neonate, especially 1st trimester
Ebstein anomaly (congenital heart defect)
dehydration and hyponatremia cause lithium levels to
rise
Baseline labs before initiation of lithium
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
,GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
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
staying hydrated
avoiding NSAIDS
compliance
Depakote normal level
50-125
Depakote toxicity level
greater than 150
Teratogenic effects of Depakote
spina bifida
Adverse effects of depakote
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
disorientation, lethargy, respiratory depression, nausea/vomiting
Intervention for depakote toxicity
DC med
check level
LFT
ammonia
MAOI + tyramine causes
hypertensive crisis
Symptoms of hypertensive crisis
elevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI +
MEPERIDINE
STIMULANTS
,GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
decongestants
TCAs
atypicals
St. John's wart
L-tryptophan
asthma meds
Treatment for hypertensive crisis
DC offending agent
Administer PHENTOLAMINE
Teratogenic effects of benzos
floppy baby, cleft palate
Teratogenic effects of tegratol
neural tube defect
teratogenic effects of lithium
ebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of depakote
neural tube defects/spina bifida
Adverse reaction to Lamictal
Steven Johnson's Syndrome
Signs of SJS
FEVER --high yield
sore throat
facial swelling
tongue swelling
red rash
skin sloughing
body aches
prodromal headache
malaise
arthralgia
painful mucus membranes
Lamotrigine is least likely to cause
sedation or weight gain
Carbamazepine (tegretol) black box warning
agranulocytosis (decrease WBCs)
aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and asians
Screen for HLAB-1502 allele before initiating, due to high incidence of SJS if positive for
allele.
Child-bearing aged women
, GEORGETTE REVIEW PMHNP ACCURATE
EXPERT QUESTIONS AND CORRECT
ANSWERS 2025-2026
check for pregnancy before starting mood stabilizer
start on folic acid to support neural tube development during the first month that a
woman is pregnant
Clozaril/clozapine can cause
agranulocytosis and neutropenia
For monitoring neutropenia in Clozaril, monitor
ANC
DC clozarli if ANC
less than 1000
DC clozaril if WBC
2000-3000, risk of agranulocytosis
When on clozaril monitor for
signs and symptoms of infection: sudden fever, chills, sore throat, weakness
Clozaril only known antipsychotic to
decrease risk of suicide in patients with schizophrenia.
Your patient with bipolar disorder is admitted to a medical hospital. The internist
contacts your office and asks whether the lithium you prescribed him is effecting
his ECG. How do you respond?
A. Lithium can prolong the QT interval
B. Lithium has no effect on his ECG
C. Lithium can invert the t waves
D. Lithium can shorten the PR interval
Answer: Lithium can invert the t waves.
Mary is a 45-year-old African American female who has been treated on
Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical
procedure. Which medication is strictly contraindicated with Isocarboxazid?
A. Morphine
B. NSAIDS
C. Methylphenidate
D. Acetaminophen
Answer: Methylphenidate
You are treating a client with schizophrenia who takes clozapine. What lab values
will indicate the client needs to discontinue treatment?
A. WBC less than 1800 and ANC less than 1200
B. ANC less than 1,000
C. WBC less than 5,000
D. ANC less than 2000
Answer: ANC less than 1000
If given during pregnancy, socium valproate can cause which of the following
medical problems in the baby?
A. SJS
