GEORGETTE REVIEW PMHNP PSYCHIATRIC-
MENTAL
HEALTH NURSE PRACTITIONER 2025-2026
EXAM
QUESTIONS AND ANSWERS
Lithium toxicity occurs at - ANSWER- levels> 1.5
Signs of Lithium - ANSWER- toxicitysevere nausea, diarrhea, vomiting, confusion, drowsiness,
muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard - ANSWER- forMANIA
Lithium has evidence shown - ANSWER- toreduce suicidal ideation
What does lithium cause in neonate, especially 1st - ANSWER- trimesterEbstein anomaly
(congenital heart defect)
dehydration and hyponatremia cause lithium levels - ANSWER- torise
Baseline labs before initiation of - ANSWER- lithiumTSH
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 - ANSWER- courses
hand tremors with toxicity
maculopapular rash diarrhea, vomiting, cramps--signs of
toxicity. Monitor closely.
anorexia t wave
inversions
leukocytosis
Pt education for - ANSWER- lithimumstaying
hydrated avoiding NSAIDS compliance
Depakote normal - ANSWER- level50-125
Depakote toxicity - ANSWER- levelgreater than 150
Teratogenic effects of - ANSWER- Depakotespina bifida
Adverse effects of depakotealopecia - ANSWER-
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or
eyes, fatigue
Signs of Depakote - ANSWER- toxicitydisorientation, lethargy, respiratory depression,
nausea/vomiting
,Intervention for depakote - ANSWER- toxicityDC med
check level
LFT
ammonia
MAOI + tyramine - ANSWER- causeshypertensive crisis
Symptoms of hypertensive - ANSWER- crisiselevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI - ANSWER- +MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart L-
tryptophan asthma
meds
Treatment for hypertensive - ANSWER- crisisDC offending agent
Administer PHENTOLAMINE
Teratogenic effects of - ANSWER- benzosfloppy baby, cleft palate
Teratogenic effects of tegratolneural tube
defect - ANSWER- - ANSWER-
teratogenic effects of lithiumebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of - ANSWER- depakoteneural tube defects/spina bifida
Adverse reaction to - ANSWER- LamictalSteven Johnson's Syndrome
Signs of - ANSWER- SJSFEVER --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 - ANSWER- causesedation or weight gain
Carbamazepine (tegretol) black box - ANSWER- warningagranulocytosis (decrease
WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and - ANSWER- asiansScreen for HLAB-1502 allele before initiating, due to high
incidence of SJS if positive for allele.
Child-bearing aged - ANSWER- womencheck 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 - ANSWER- causeagranulocytosis and neutropenia
, For monitoring neutropenia in Clozaril, - ANSWER-
monitorANC DC clozarli if ANCless than
1000 - ANSWER-
DC clozaril if WBC2000-3000, - ANSWER- risk of agranulocytosis
When on clozaril monitor - ANSWER- forsigns and symptoms of infection: sudden fever, chills, sore
throat, weakness
Clozaril only known antipsychotic - ANSWER- todecrease 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 - ANSWER- intervalAnswer: 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
- ANSWER- D. AcetaminophenAnswer: 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 - ANSWER- 2000Answer: 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 - ANSWER- palateA. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
- ANSWER- D. LamictalA. Carbamazepine
Bulimia, weight is - ANSWER- ___________within the normal range.
Pharm treatment for - ANSWER- bulimiaFluoxetine
SSRIs and TCAs effective in reducing binging and purging
Signs of anorexia - ANSWER- nervosalow BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
MENTAL
HEALTH NURSE PRACTITIONER 2025-2026
EXAM
QUESTIONS AND ANSWERS
Lithium toxicity occurs at - ANSWER- levels> 1.5
Signs of Lithium - ANSWER- toxicitysevere nausea, diarrhea, vomiting, confusion, drowsiness,
muscle weakness, heart palpitation, coarse hand tremors, unsteady gait
Lithium is gold standard - ANSWER- forMANIA
Lithium has evidence shown - ANSWER- toreduce suicidal ideation
What does lithium cause in neonate, especially 1st - ANSWER- trimesterEbstein anomaly
(congenital heart defect)
dehydration and hyponatremia cause lithium levels - ANSWER- torise
Baseline labs before initiation of - ANSWER- lithiumTSH
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 - ANSWER- courses
hand tremors with toxicity
maculopapular rash diarrhea, vomiting, cramps--signs of
toxicity. Monitor closely.
anorexia t wave
inversions
leukocytosis
Pt education for - ANSWER- lithimumstaying
hydrated avoiding NSAIDS compliance
Depakote normal - ANSWER- level50-125
Depakote toxicity - ANSWER- levelgreater than 150
Teratogenic effects of - ANSWER- Depakotespina bifida
Adverse effects of depakotealopecia - ANSWER-
hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or
eyes, fatigue
Signs of Depakote - ANSWER- toxicitydisorientation, lethargy, respiratory depression,
nausea/vomiting
,Intervention for depakote - ANSWER- toxicityDC med
check level
LFT
ammonia
MAOI + tyramine - ANSWER- causeshypertensive crisis
Symptoms of hypertensive - ANSWER- crisiselevated BP
sudden explosive like headache
facial flushing
palpitations
pupillary dilation
diaphoresis
fever
Hypertensive crisis occurs with MAOI - ANSWER- +MEPERIDINE
STIMULANTS
decongestants
TCAs
atypicals
St. John's wart L-
tryptophan asthma
meds
Treatment for hypertensive - ANSWER- crisisDC offending agent
Administer PHENTOLAMINE
Teratogenic effects of - ANSWER- benzosfloppy baby, cleft palate
Teratogenic effects of tegratolneural tube
defect - ANSWER- - ANSWER-
teratogenic effects of lithiumebstein anomaly (heart defect) (avoid, especially 1st trimester)
teratogenic effects of - ANSWER- depakoteneural tube defects/spina bifida
Adverse reaction to - ANSWER- LamictalSteven Johnson's Syndrome
Signs of - ANSWER- SJSFEVER --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 - ANSWER- causesedation or weight gain
Carbamazepine (tegretol) black box - ANSWER- warningagranulocytosis (decrease
WBCs) aplastic anemia (pallor, fatigue, HA, fever, nosebleeds, bleeding gums, skin rash, SOA)
Carbamazepine and - ANSWER- asiansScreen for HLAB-1502 allele before initiating, due to high
incidence of SJS if positive for allele.
Child-bearing aged - ANSWER- womencheck 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 - ANSWER- causeagranulocytosis and neutropenia
, For monitoring neutropenia in Clozaril, - ANSWER-
monitorANC DC clozarli if ANCless than
1000 - ANSWER-
DC clozaril if WBC2000-3000, - ANSWER- risk of agranulocytosis
When on clozaril monitor - ANSWER- forsigns and symptoms of infection: sudden fever, chills, sore
throat, weakness
Clozaril only known antipsychotic - ANSWER- todecrease 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 - ANSWER- intervalAnswer: 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
- ANSWER- D. AcetaminophenAnswer: 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 - ANSWER- 2000Answer: 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 - ANSWER- palateA. Spina bifida
Which mood stabilizer is associated with potential life-threatening rash in the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
- ANSWER- D. LamictalA. Carbamazepine
Bulimia, weight is - ANSWER- ___________within the normal range.
Pharm treatment for - ANSWER- bulimiaFluoxetine
SSRIs and TCAs effective in reducing binging and purging
Signs of anorexia - ANSWER- nervosalow BMI
Amennorrhea
Emaciation
Bradycardua
Hypotension
