LATESTBARKLEY PMHNP 2026 ULTIMATE EXAM REVIEW
QUESTIONS AND ANSWERS |FALL 2025/2026 UPDATE | 100%
CORRECT LATEST
QUESTION 1:
Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A. Dopamine
B. GABA
C. Serotonin
D. Acetylcholine
CORRECT ANSWER: C
RATIONALE: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition.
QUESTION 2:
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A. Weight gain
B. Sexual dysfunction
C. Hypertension
D. Urinary retention
CORRECT ANSWER: B
RATIONALE: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs.
QUESTION 3:
Which of the following findings is most consistent with bipolar I disorder?
A. Hypomanic episodes without psychosis
B. Major depressive episodes only
,C. Mania with functional impairment
D. Cyclothymic mood variation
CORRECT ANSWER: C
RATIONALE: Bipolar I disorder requires at least one manic episode causing marked impairment.
Hypomania defines bipolar II, pure depression is MDD, and chronic mood fluctuation signifies
cyclothymia.
QUESTION 4:
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A. CBC, liver panel, and lipid profile
B. TSH, renal function, and electrolyte panel
C. Blood glucose, ECG, and vitamin D
D. Urinalysis and C-reactive protein
CORRECT ANSWER: B
RATIONALE: Lithium affects renal and thyroid function. Baseline kidney and thyroid studies
ensure safe initiation. CBC or liver tests are important for other medications like valproate.
QUESTION 5:
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A. Continue lithium at the same dose
B. Add propranolol to control tremors
C. Hold lithium and monitor hydration status
D. Decrease lithium by 50%
CORRECT ANSWER: C
RATIONALE: A level of 1.8 is toxic. The drug should be held, and hydration maintained to
promote excretion. Once the patient stabilizes, a lower dose may be restarted.
QUESTION 6:
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain?
A. Ziprasidone
B. Aripiprazole
C. Clozapine
D. Lurasidone
,CORRECT ANSWER: C
RATIONALE: Clozapine has strong metabolic side effects, including hyperglycemia and
dyslipidemia. Ziprasidone and lurasidone are more weight-neutral, while aripiprazole is
intermediate.
QUESTION 7:
A 28-year-old with panic disorder experiences physical symptoms of anxiety such as tachycardia
and sweating. Which neural structure primarily mediates these symptoms?
A. Hippocampus
B. Amygdala
C. Prefrontal cortex
D. Thalamus
CORRECT ANSWER: B
RATIONALE: The amygdala orchestrates fear and anxiety responses via the autonomic nervous
system, causing physical arousal symptoms.
QUESTION 8:
An adolescent presents with depressed mood but denies suicidal ideation. Which intervention
should be prioritized?
A. Immediate hospitalization
B. Psychoeducation and supportive psychotherapy
C. MAOI initiation
D. Electroconvulsive therapy
CORRECT ANSWER: B
RATIONALE: Supportive therapy and education are first-line for mild to moderate depression in
adolescents before pharmacologic or inpatient approaches.
QUESTION 9:
Which antidepressant has the additional benefit of aiding smoking cessation?
A. Fluoxetine
B. Bupropion
C. Mirtazapine
D. Sertraline
CORRECT ANSWER: B
, RATIONALE: Bupropion, a norepinephrine-dopamine reuptake inhibitor, also assists with nicotine
dependence due to its dopaminergic effects.
QUESTION 10:
A patient with schizophrenia reports improved hallucinations but experiences severe
restlessness. What is the most likely adverse effect?
A. Dystonia
B. Akathisia
C. Parkinsonism
D. Tardive dyskinesia
CORRECT ANSWER: B
RATIONALE: Akathisia is an inner sense of restlessness, often seen early in antipsychotic
treatment. It may be mistaken for agitation or worsening disease.
QUESTION 11:
Which benzodiazepine has the longest half-life and is suitable for tapering protocols?
A. Alprazolam
B. Lorazepam
C. Diazepam
D. Clonazepam
CORRECT ANSWER: C
RATIONALE: Diazepam has an extended half-life and active metabolites, providing smoother
withdrawal transition.
QUESTION 12:
A patient on clozapine complains of fatigue and fever. What laboratory test is indicated
immediately?
A. Liver function test
B. Absolute neutrophil count (ANC)
C. Serum prolactin
D. TSH
CORRECT ANSWER: B
RATIONALE: Clozapine can cause agranulocytosis; any infection-like symptoms necessitate
checking ANC.
QUESTIONS AND ANSWERS |FALL 2025/2026 UPDATE | 100%
CORRECT LATEST
QUESTION 1:
Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A. Dopamine
B. GABA
C. Serotonin
D. Acetylcholine
CORRECT ANSWER: C
RATIONALE: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition.
QUESTION 2:
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A. Weight gain
B. Sexual dysfunction
C. Hypertension
D. Urinary retention
CORRECT ANSWER: B
RATIONALE: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs.
QUESTION 3:
Which of the following findings is most consistent with bipolar I disorder?
A. Hypomanic episodes without psychosis
B. Major depressive episodes only
,C. Mania with functional impairment
D. Cyclothymic mood variation
CORRECT ANSWER: C
RATIONALE: Bipolar I disorder requires at least one manic episode causing marked impairment.
Hypomania defines bipolar II, pure depression is MDD, and chronic mood fluctuation signifies
cyclothymia.
QUESTION 4:
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A. CBC, liver panel, and lipid profile
B. TSH, renal function, and electrolyte panel
C. Blood glucose, ECG, and vitamin D
D. Urinalysis and C-reactive protein
CORRECT ANSWER: B
RATIONALE: Lithium affects renal and thyroid function. Baseline kidney and thyroid studies
ensure safe initiation. CBC or liver tests are important for other medications like valproate.
QUESTION 5:
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A. Continue lithium at the same dose
B. Add propranolol to control tremors
C. Hold lithium and monitor hydration status
D. Decrease lithium by 50%
CORRECT ANSWER: C
RATIONALE: A level of 1.8 is toxic. The drug should be held, and hydration maintained to
promote excretion. Once the patient stabilizes, a lower dose may be restarted.
QUESTION 6:
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain?
A. Ziprasidone
B. Aripiprazole
C. Clozapine
D. Lurasidone
,CORRECT ANSWER: C
RATIONALE: Clozapine has strong metabolic side effects, including hyperglycemia and
dyslipidemia. Ziprasidone and lurasidone are more weight-neutral, while aripiprazole is
intermediate.
QUESTION 7:
A 28-year-old with panic disorder experiences physical symptoms of anxiety such as tachycardia
and sweating. Which neural structure primarily mediates these symptoms?
A. Hippocampus
B. Amygdala
C. Prefrontal cortex
D. Thalamus
CORRECT ANSWER: B
RATIONALE: The amygdala orchestrates fear and anxiety responses via the autonomic nervous
system, causing physical arousal symptoms.
QUESTION 8:
An adolescent presents with depressed mood but denies suicidal ideation. Which intervention
should be prioritized?
A. Immediate hospitalization
B. Psychoeducation and supportive psychotherapy
C. MAOI initiation
D. Electroconvulsive therapy
CORRECT ANSWER: B
RATIONALE: Supportive therapy and education are first-line for mild to moderate depression in
adolescents before pharmacologic or inpatient approaches.
QUESTION 9:
Which antidepressant has the additional benefit of aiding smoking cessation?
A. Fluoxetine
B. Bupropion
C. Mirtazapine
D. Sertraline
CORRECT ANSWER: B
, RATIONALE: Bupropion, a norepinephrine-dopamine reuptake inhibitor, also assists with nicotine
dependence due to its dopaminergic effects.
QUESTION 10:
A patient with schizophrenia reports improved hallucinations but experiences severe
restlessness. What is the most likely adverse effect?
A. Dystonia
B. Akathisia
C. Parkinsonism
D. Tardive dyskinesia
CORRECT ANSWER: B
RATIONALE: Akathisia is an inner sense of restlessness, often seen early in antipsychotic
treatment. It may be mistaken for agitation or worsening disease.
QUESTION 11:
Which benzodiazepine has the longest half-life and is suitable for tapering protocols?
A. Alprazolam
B. Lorazepam
C. Diazepam
D. Clonazepam
CORRECT ANSWER: C
RATIONALE: Diazepam has an extended half-life and active metabolites, providing smoother
withdrawal transition.
QUESTION 12:
A patient on clozapine complains of fatigue and fever. What laboratory test is indicated
immediately?
A. Liver function test
B. Absolute neutrophil count (ANC)
C. Serum prolactin
D. TSH
CORRECT ANSWER: B
RATIONALE: Clozapine can cause agranulocytosis; any infection-like symptoms necessitate
checking ANC.
