PMHNP Board Certification Practice Questions 1. A patient with schizophrenia has been stable on clozapine for several years. Which of the following monitoring parameters is most critical for the PMHNP to assess on a regular basis? A. Fasting blood glu

PMHNP Board Certification Practice Questions 1. A patient with schizophrenia has been stable on clozapine for several years. Which of the following monitoring parameters is most critical for the PMHNP to assess on a regular basis? A. Fasting blood glucose and lipid panel B. Absolute neutrophil count (ANC) C. Serum creatinine and BUN D. Liver function tests (AST, ALT) Answer: B. Absolute neutrophil count (ANC) Rationale: Clozapine carries a black box warning for severe neutropenia and agranulocytosis. Regular monitoring of the ANC is mandatory through the REMS program. While metabolic monitoring (A) is important for clozapine and other atypical antipsychotics, the ANC monitoring is the most critical and unique safety requirement for this medication. --- 2. A 16-year-old female is brought to the clinic by her mother, who reports the patient has been restricting her food intake and has lost 15% of her body weight over the past 3 months. The patient expresses an intense fear of gaining weight and has a distorted body image. Which of the following is the most likely diagnosis? A. Bulimia Nervosa B. Anorexia Nervosa C. Avoidant/Restrictive Food Intake Disorder (ARFID) D. Binge-Eating Disorder Answer: B. Anorexia Nervosa Rationale: Anorexia nervosa is characterized by restriction of energy intake relative to requirements leading to significantly low body weight, intense fear of gaining weight, and disturbance in self-perceived weight or shape. ARFID (C) involves eating disturbances without the body image disturbance or fear of weight gain. Bulimia (A) involves binge eating and compensatory behaviors. --- 3. A PMHNP is seeing a patient for an initial psychiatric evaluation. During the interview, the patient speaks at a rapid rate, jumps from one topic to another, and is easily distractible. The clinician notes the patient is wearing brightly colored, mismatched clothing and appears to have grandiose plans. Which of the following describes the patient's thought process? A. Circumstantiality B. Tangentiality C. Flight of ideas D. Perseveration Answer: C. Flight of ideas Rationale: Flight of ideas is a thought process characterized by a rapid, continuous flow of speech with abrupt shifts from one topic to another, often based on superficial associations. This is commonly seen in manic episodes. Circumstantiality (A) involves over-inclusion of unnecessary detail. Tangentiality (B) involves replies that are obliquely related or unrelated. Perseveration (D) is the repetition of a particular response. --- 4. Which of the following best describes the primary mechanism of action of SSRIs? A. Inhibition of monoamine oxidase B. Blockade of dopamine D2 receptors C. Antagonism of 5-HT2A receptors D. Inhibition of serotonin reuptake at the presynaptic neuron Answer: D. Inhibition of serotonin reuptake at the presynaptic neuron Rationale: SSRIs work by selectively blocking the reuptake of serotonin (5-HT) into the presynaptic neuron, thereby increasing the concentration of serotonin in the synaptic cleft. MAOIs (A) inhibit monoamine oxidase. Antipsychotics often block dopamine D2 (B) and 5-HT2A (C) receptors.