WGU D344 PMHNP Objective Assessment
Exam Questions and Correct Answers
QUESTION 1:
A patient on lithium experiences tremor, nausea, and confusion. Serum lithium level is
2.0 mEq/L. What should the PMHNP do first?
A. Continue the same dose
B. Reduce the dose by half
C. Hold lithium and assess for toxicity
D. Add propranolol to control tremor
CORRECT ANSWER: ⬛
✓C
RATIONALE: A level of 2.0 mEq/L indicates lithium toxicity; immediate discontinuation and
assessment of renal function and hydration status are warranted before considering resumption
QUESTION 2:
Which neurotransmitter is primarily implicated in the pathophysiology of schizophrenia?
A. GABA
B. Dopamine
C. Serotonin
D. Acetylcholine
CORRECT ANSWER: ✓ ⬛ B
RATIONALE: The dopamine hypothesis suggests hyperactivity of dopaminergic transmission in
the mesolimbic pathway underlies positive symptoms of schizophrenia; though newer models
also involve glutamatergic dysregulation.
QUESTION 3:
A patient presents with restlessness, pacing, and inability to sit still after starting haloperidol.
What is the best management strategy?
A. Increase haloperidol dose
B. Add benztropine
C. Add propranolol or benzodiazepine
D. Discontinue medication immediately
CORRECT ANSWER: ⬛ ✓C
RATIONALE: Akathisia, a form of extrapyramidal symptom, responds to beta-blockers or
benzodiazepines; anticholinergics are less effective.
.
,QUESTION 4:
An adolescent presents with depressed mood, anhedonia, hypersomnia, and carbohydrate
craving. Which subtype of depression best describes this presentation?
A. Melancholic
B. Atypical
C. Psychotic
D. Seasonal
CORRECT ANSWER: ⬛ ✓B
RATIONALE: Atypical depression is characterized by mood reactivity, hypersomnia, increased
appetite, and sensitivity to rejection, distinguishing it from melancholic depression.
QUESTION 5:
Which of the following medications would be most appropriate for a patient with major
depressive disorder and concurrent neuropathic pain?
A. Sertraline
B. Venlafaxine
C. Citalopram
D. Buspirone
CORRECT ANSWER: ⬛ ✓B
RATIONALE: Venlafaxine, an SNRI, provides dual serotonin and norepinephrine reuptake
inhibition, effective for both depression and neuropathic pain. SSRIs lack robust analgesic
effects.
QUESTION 6:
A client with bipolar I disorder presents with acute mania. Which medication regimen is most
appropriate for immediate stabilization?
A. Lamotrigine monotherapy
B. Lithium and haloperidol
C. Carbamazepine alone
D. Sertraline and clonazepam
CORRECT ANSWER: ⬛ ✓B
RATIONALE: Acute mania is best managed by mood stabilizers (e.g., lithium) often combined
with an antipsychotic for rapid control of agitation and psychosis. Lamotrigine is used for
maintenance, not acute mania.
QUESTION 7:
Which therapy focuses on identifying dysfunctional core beliefs and altering unhelpful
automatic thoughts?
,A. Dialectical behavior therapy
B. Psychodynamic psychotherapy
C. Cognitive behavioral therapy
D. Solution-focused therapy
CORRECT ANSWER: ⬛ ✓ C
RATIONALE: CBT works to modify maladaptive thought patterns that drive emotional distress
and behavior, a core principle that differentiates it from insight- or skills-based modalities.
QUESTION 8:
The PMHNP evaluates a child with inattentiveness, distractibility, and poor academic
performance. Which diagnostic tool is most appropriate for assessment?
A. Hamilton Anxiety Rating Scale
B. Vanderbilt ADHD Diagnostic Rating Scale
C. Beck Depression Inventory
D. Yale-Brown Obsessive Compulsive Scale
CORRECT ANSWER: ⬛ ✓ B
RATIONALE: The Vanderbilt scale assesses ADHD symptoms based on DSM-5 criteria using
reports from parents and teachers, making it a validated assessment tool for pediatric ADHD.
QUESTION 9:
Which of the following physical findings would prompt urgent evaluation for neuroleptic
malignant syndrome (NMS)?
A. Tremor and restlessness
B. Muscle rigidity with hyperthermia
C. Bradykinesia and sialorrhea
D. Oculogyric crisis
CORRECT ANSWER: ⬛ ✓B
RATIONALE: NMS is characterized by severe “lead-pipe” rigidity, fever, mental status change,
and autonomic instability, often due to dopamine blockade.
QUESTION 10:
A patient treated with an SSRI develops agitation, hyperreflexia, myoclonus, and hyperthermia.
What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Malignant hyperthermia
C. Serotonin syndrome
D. Anticholinergic toxicity
, CORRECT ANSWER: ⬛ ✓C
RATIONALE: Serotonin syndrome results from excessive serotonergic activity, often due to drug
interactions or overdose of serotonergic agents.
QUESTION 11:
Which sleep stage is most reduced in major depressive disorder?
A. Stage 1
B. Stage 2
C. REM latency
D. Slow-wave sleep
CORRECT ANSWER: ⬛ ✓D
RATIONALE: Depression is associated with shortened REM latency and reduced slow-wave
(deep) sleep, contributing to nonrestorative sleep complaints.
QUESTION 12:
A PMHNP suspects borderline personality disorder. Which therapeutic approach has the
strongest evidence base for treatment?
A. Acceptance and commitment therapy
B. Dialectical behavior therapy
C. Psychodynamic therapy
D. Family systems therapy
CORRECT ANSWER: ⬛ ✓B
RATIONALE: DBT, developed by Marsha Linehan, emphasizes emotion regulation, distress
tolerance, and interpersonal effectiveness and is empirically supported for borderline personality
disorder.
QUESTION 13:
What is the black box warning shared by all antidepressants prescribed to children and
adolescents?
A. Cardiotoxicity
B. Hepatotoxicity
C. Increased risk of suicidal thoughts
D. Risk of serotonin syndrome
CORRECT ANSWER: ⬛ ✓C
RATIONALE: SSRIs and other antidepressants may increase suicidal ideation in children,
adolescents, and young adults during early treatment phases.
QUESTION 14:
Exam Questions and Correct Answers
QUESTION 1:
A patient on lithium experiences tremor, nausea, and confusion. Serum lithium level is
2.0 mEq/L. What should the PMHNP do first?
A. Continue the same dose
B. Reduce the dose by half
C. Hold lithium and assess for toxicity
D. Add propranolol to control tremor
CORRECT ANSWER: ⬛
✓C
RATIONALE: A level of 2.0 mEq/L indicates lithium toxicity; immediate discontinuation and
assessment of renal function and hydration status are warranted before considering resumption
QUESTION 2:
Which neurotransmitter is primarily implicated in the pathophysiology of schizophrenia?
A. GABA
B. Dopamine
C. Serotonin
D. Acetylcholine
CORRECT ANSWER: ✓ ⬛ B
RATIONALE: The dopamine hypothesis suggests hyperactivity of dopaminergic transmission in
the mesolimbic pathway underlies positive symptoms of schizophrenia; though newer models
also involve glutamatergic dysregulation.
QUESTION 3:
A patient presents with restlessness, pacing, and inability to sit still after starting haloperidol.
What is the best management strategy?
A. Increase haloperidol dose
B. Add benztropine
C. Add propranolol or benzodiazepine
D. Discontinue medication immediately
CORRECT ANSWER: ⬛ ✓C
RATIONALE: Akathisia, a form of extrapyramidal symptom, responds to beta-blockers or
benzodiazepines; anticholinergics are less effective.
.
,QUESTION 4:
An adolescent presents with depressed mood, anhedonia, hypersomnia, and carbohydrate
craving. Which subtype of depression best describes this presentation?
A. Melancholic
B. Atypical
C. Psychotic
D. Seasonal
CORRECT ANSWER: ⬛ ✓B
RATIONALE: Atypical depression is characterized by mood reactivity, hypersomnia, increased
appetite, and sensitivity to rejection, distinguishing it from melancholic depression.
QUESTION 5:
Which of the following medications would be most appropriate for a patient with major
depressive disorder and concurrent neuropathic pain?
A. Sertraline
B. Venlafaxine
C. Citalopram
D. Buspirone
CORRECT ANSWER: ⬛ ✓B
RATIONALE: Venlafaxine, an SNRI, provides dual serotonin and norepinephrine reuptake
inhibition, effective for both depression and neuropathic pain. SSRIs lack robust analgesic
effects.
QUESTION 6:
A client with bipolar I disorder presents with acute mania. Which medication regimen is most
appropriate for immediate stabilization?
A. Lamotrigine monotherapy
B. Lithium and haloperidol
C. Carbamazepine alone
D. Sertraline and clonazepam
CORRECT ANSWER: ⬛ ✓B
RATIONALE: Acute mania is best managed by mood stabilizers (e.g., lithium) often combined
with an antipsychotic for rapid control of agitation and psychosis. Lamotrigine is used for
maintenance, not acute mania.
QUESTION 7:
Which therapy focuses on identifying dysfunctional core beliefs and altering unhelpful
automatic thoughts?
,A. Dialectical behavior therapy
B. Psychodynamic psychotherapy
C. Cognitive behavioral therapy
D. Solution-focused therapy
CORRECT ANSWER: ⬛ ✓ C
RATIONALE: CBT works to modify maladaptive thought patterns that drive emotional distress
and behavior, a core principle that differentiates it from insight- or skills-based modalities.
QUESTION 8:
The PMHNP evaluates a child with inattentiveness, distractibility, and poor academic
performance. Which diagnostic tool is most appropriate for assessment?
A. Hamilton Anxiety Rating Scale
B. Vanderbilt ADHD Diagnostic Rating Scale
C. Beck Depression Inventory
D. Yale-Brown Obsessive Compulsive Scale
CORRECT ANSWER: ⬛ ✓ B
RATIONALE: The Vanderbilt scale assesses ADHD symptoms based on DSM-5 criteria using
reports from parents and teachers, making it a validated assessment tool for pediatric ADHD.
QUESTION 9:
Which of the following physical findings would prompt urgent evaluation for neuroleptic
malignant syndrome (NMS)?
A. Tremor and restlessness
B. Muscle rigidity with hyperthermia
C. Bradykinesia and sialorrhea
D. Oculogyric crisis
CORRECT ANSWER: ⬛ ✓B
RATIONALE: NMS is characterized by severe “lead-pipe” rigidity, fever, mental status change,
and autonomic instability, often due to dopamine blockade.
QUESTION 10:
A patient treated with an SSRI develops agitation, hyperreflexia, myoclonus, and hyperthermia.
What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Malignant hyperthermia
C. Serotonin syndrome
D. Anticholinergic toxicity
, CORRECT ANSWER: ⬛ ✓C
RATIONALE: Serotonin syndrome results from excessive serotonergic activity, often due to drug
interactions or overdose of serotonergic agents.
QUESTION 11:
Which sleep stage is most reduced in major depressive disorder?
A. Stage 1
B. Stage 2
C. REM latency
D. Slow-wave sleep
CORRECT ANSWER: ⬛ ✓D
RATIONALE: Depression is associated with shortened REM latency and reduced slow-wave
(deep) sleep, contributing to nonrestorative sleep complaints.
QUESTION 12:
A PMHNP suspects borderline personality disorder. Which therapeutic approach has the
strongest evidence base for treatment?
A. Acceptance and commitment therapy
B. Dialectical behavior therapy
C. Psychodynamic therapy
D. Family systems therapy
CORRECT ANSWER: ⬛ ✓B
RATIONALE: DBT, developed by Marsha Linehan, emphasizes emotion regulation, distress
tolerance, and interpersonal effectiveness and is empirically supported for borderline personality
disorder.
QUESTION 13:
What is the black box warning shared by all antidepressants prescribed to children and
adolescents?
A. Cardiotoxicity
B. Hepatotoxicity
C. Increased risk of suicidal thoughts
D. Risk of serotonin syndrome
CORRECT ANSWER: ⬛ ✓C
RATIONALE: SSRIs and other antidepressants may increase suicidal ideation in children,
adolescents, and young adults during early treatment phases.
QUESTION 14:
