Georgette Review PMHNP. 2026 Complete Questions and Answers Solved 100%

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

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

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

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

B. Ebstein's anomaly

C. Spina bifida

D. Cleft palate

A. Spina bifida

Which mood stabilizer is associated with potential life-threatening rash in the Asian population?

A. Carbamazepine (tegretol)

B. Depakote

C. Lithium

D. Lamictal

A. Carbamazepine

Bulimia, weight is ___________

within the normal range.

Pharm treatment for bulimia

Fluoxetine

SSRIs and TCAs effective in reducing binging and purging

Signs of anorexia nervosa

low BMI

Amennorrhea

Emaciation

Bradycardua

Hypotension

Pharm treatment for anorexia

there is none

therapy

Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa?

A. Russell sign

B. Low BMI

C. Erosion of dental enamel

D. Hypertrophy of salivary glands

Low BMI

If a patient is depression, low energy, fatigued, you would prescribe

Wellbutrin

Wellbutrin is contraindicated in patients with

seizure disorder or conditions that increase risk of seizures such as eating disorder.

Which of the following medications has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor?

A. Bupropion (Wellbutrin)

B. Sertraline (Zoloft)

C. Clomipramine (Anafranil)

D. Duloxetine (Cymbalta)

bupropion

CLozaril is metabolized by

cytochrome P450 enzyme CYP1A2

INducers

induce metabolism and therefore decrease serum levels of other drugs that are substrates

Smoking will do what to drug levels

decrease therapeutic levels of the drug

Bull Shit CRAP GPS Induces my rage

Barbituates

St. Johns Wart

Carbamazepine

Rifampicin

Alcohol

Phenytoin

Griseofulvin

Phenobarbital

Sulphonylureas

If your patient is a smoker you will need ___________doses of their medication.

higher

Inhibitors

inhibit metabolism and therefore increase levels of the drug.

SICKFACES.com for Inhibitors

Sodium valproate

Isoniazid

Cimetidine

Ketoconazole

Alcohol

Chloramphenicol

Erythromycin

Sulfonamine

Cipro

Omeprazole

Metronidazole

Which cytochrome enzyme is implicated as a tobacco inducer when an individual is treated with clozapine

a. 2D6

b. 1A2

c. 2C19

d. 2C9

1A2

(want A 2 cigarette break)

When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons?

A. Decreased body fat

B. Increased liver capacity

C. Decreased protein binding

D. Increased muscle concentration

Decreased protein binding

For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTC 12.5 daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0. The interaction of the lithium and the thiazide diuretic has induced:

A. hypokalemia

B. hyponatremia

C. Increased renal clearance of lithium

D. Decreased renal clearance of lithium

A. decreased renal clearance of lithium

Where is norepinephrine produced

locus coeruleus and medullary reticular formation

Norepinephrine is associated with

mood disorders

Serotonin is made where in the brain

raphe nuclei of the brainsteam

Serotonin is associated with

sleep and mood disorder

Dopamine is made in

substantia nigra, central tegmental area, ventral tegmental area,

Dopamine is associated with

addiction and psychosis

Acetylcholine is made

basal nucleus of Meynert

Most abundant inhibitory neurotransmitter in the brain

GABA

I don't have enough GABA, my anxiety is high

Med used to increase GABA

benzos

Fred flinstone needs a Zanny, Gabba dabba do.

Most excitatory neutransmitter

glutamate

Increased level of corticotropin releasing hormone in the amygdala, hippocampus and locus coeruleus

increases symptoms of anxiety.

Autism

deficits in social communication and social interaction across multiple settings

Parents of kids with autism may report

No response when called by name

Little or no eye contact

Children with autism often like to line up, stack, or organize objects and toys.

Screenings for autism

ADOS

M-CHAT

ASQ

Pharm management for autism

antipsychotics are effective for symptoms such as tantrums, aggressive behaviors, self-injurious behaviors

Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons?

A. raphe nuclei

B. Nucleus acumbuns

C. Locus coeruleus

D. Amygdala

raphe nuclei

Executive functioning, thinking, planning, organizing, and problem solving, emotions, and behavioral control, personality

frontal lobe

memory, understanding, language

temporal lobe

Both hemispheres of the brain are connected by the

corpus callosum

Area of sensorimotor information exchange between two hemispheres

corpus callosum

When there is disturbances in clock drawing test, which hemisphere is compromised

right hemisphere/right parietal lobe

Area for expressive speech

frontal lobe

Broca's Area

Problems in the frontal lobe can lead to

personality changes, emotional changes, and intellectual changes, social skills problems, and behavior changes

Area for receptive speech and language comprehension

Temporal lobe

Wernicke's area

Problems in the temporal lobe can lead to

auditory hallucinations, aphasia, and amnesia

Occipital lobe

primary visual area

problems in the occipital lobe can lead to

Visual field deficits, blindness and visual hallucinations.

primary sensory area of the brain

parietal lobe

problems in the parietal lobe can lead to

Sensory-perceptual disturbances and agnosia(inability to perceive objects)

R-L confusion

Difficulty writing (agraphia)

Aphasia(difficulty of language)

Cerebellum is responsible for

gross motor skills

fine motor skills

balance

A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the

A. frontal lobe

B. Temporal lobe

C. Parietal lobe

D. Occipital lobe

frontal lobe

Impairments in the clock drawing test can be associated with

damage to the right parietal lobe

What part of the brain is responsible for regulating emotions?

A. Wernicke's area

B. Occipital lobe

C. Hippocampus

D. Parietal lobe

Hippocampus

Limbic system responsible for

emotions and memory

Hypothalamus

appetite, hunger, water balance, circadian rhythms, libido, hormonal regulation

thalamus

sensory relay for smell

emotions, memory, and regulated affective behaviors

amygdala

regulated emotion

mediates mood

emotional memories/meanings, fear, anxiety, stress emotion, aggression

substantia nigra

motor movements