AANP PMHNP Certification Board
Exam – Ultimate Study Bank 2026-
2027
1. A 45-year-old male with schizophrenia is non-adherent to oral
antipsychotics. What is the most appropriate next step?
A. Increase the dose of oral antipsychotic
B. Add a second oral antipsychotic
C. Consider a long-acting injectable (LAI) antipsychotic
D. Discharge with continued oral medication
Correct Answer: C. Consider a long-acting injectable (LAI)
antipsychotic.
Rationale: For patients with adherence concerns, the PMHNP should consider
long-acting injectable antipsychotics to ensure medication delivery and
improve outcomes . LAIs eliminate the need for daily oral medication and
provide consistent drug levels .
2. A 23-year-old female with Bulimia Nervosa is being started on an
SSRI. What is the most appropriate medication and dose?
A. Fluoxetine 60 mg daily
B. Sertraline 50 mg daily
C. Paroxetine 20 mg daily
D. Escitalopram 10 mg daily
,Correct Answer: A. Fluoxetine 60 mg daily.
Rationale: Fluoxetine 60 mg daily is FDA-approved for Bulimia Nervosa.
Higher doses of SSRIs are often needed for this indication compared to
depression . The full therapeutic dose is typically required for efficacy in
eating disorders .
3. A 52-year-old female with anxiety and insomnia is prescribed
zolpidem. What is the most important patient education?
A. Take immediately before bedtime, limit to short-term use, avoid alcohol
B. Take in the morning with breakfast
C. Can drive safely after taking
D. No concerns with long-term use
Correct Answer: A. Take immediately before bedtime, limit to short-
term use, avoid alcohol.
Rationale: Zolpidem should be taken immediately before bedtime due to
rapid onset. It is indicated for short-term use only and alcohol should be
avoided. Patients should not drive or operate machinery after taking it .
4. A 65-year-old male with Major Depressive Disorder has not
responded to SSRIs or SNRIs and has BPH. Which augmentation
strategy is most appropriate?
A. Add aripiprazole augmentation
B. Switch to clomipramine
C. Start ECT
D. Add memantine
Correct Answer: A. Add aripiprazole augmentation.
,Rationale: Augmentation with low-dose atypical antipsychotics (aripiprazole,
risperidone) is evidence-based for treatment-resistant depression.
Aripiprazole is preferred over clomipramine given the BPH and
anticholinergic effects of TCAs .
5. A patient being evaluated for ADHD has a history of hypertension.
What is the most important assessment before prescribing stimulants?
A. Baseline weight
B. Cardiovascular status and blood pressure
C. Liver function tests
D. Complete blood count
Correct Answer: B. Cardiovascular status and blood pressure.
Rationale: Stimulants can increase blood pressure and heart rate. The
PMHNP must assess cardiovascular status before prescribing stimulants . This
includes baseline blood pressure, heart rate, and cardiac history .
6. A 29-year-old female with Generalized Anxiety Disorder is pregnant.
What is the most appropriate SSRI?
A. Paroxetine
B. Sertraline
C. Fluoxetine
D. Citalopram
Correct Answer: B. Sertraline.
Rationale: Sertraline is generally preferred in pregnancy due to the most
favorable safety data among SSRIs. Paroxetine is best avoided due to
teratogenicity concerns .
, 7. A 38-year-old male with Alcohol Use Disorder reports a desire to
stop drinking. What is the most appropriate medication?
A. Naltrexone
B. Bupropion
C. Fluoxetine
D. Diazepam
Correct Answer: A. Naltrexone.
Rationale: Naltrexone is FDA-approved for Alcohol Use Disorder to reduce
cravings and heavy drinking. The PMHNP must select and prescribe
appropriate pharmacotherapeutics for substance use disorders .
8. A patient on an MAOI should avoid which of the following foods
due to the risk of hypertensive crisis?
A. Bananas
B. Aged cheese
C. Apples
D. Rice
Correct Answer: B. Aged cheese.
Rationale: MAOIs require avoidance of tyramine-rich foods including aged
cheese, cured meats, fermented foods, and red wine. Tyramine can cause a
hypertensive crisis when combined with MAOIs .
Exam – Ultimate Study Bank 2026-
2027
1. A 45-year-old male with schizophrenia is non-adherent to oral
antipsychotics. What is the most appropriate next step?
A. Increase the dose of oral antipsychotic
B. Add a second oral antipsychotic
C. Consider a long-acting injectable (LAI) antipsychotic
D. Discharge with continued oral medication
Correct Answer: C. Consider a long-acting injectable (LAI)
antipsychotic.
Rationale: For patients with adherence concerns, the PMHNP should consider
long-acting injectable antipsychotics to ensure medication delivery and
improve outcomes . LAIs eliminate the need for daily oral medication and
provide consistent drug levels .
2. A 23-year-old female with Bulimia Nervosa is being started on an
SSRI. What is the most appropriate medication and dose?
A. Fluoxetine 60 mg daily
B. Sertraline 50 mg daily
C. Paroxetine 20 mg daily
D. Escitalopram 10 mg daily
,Correct Answer: A. Fluoxetine 60 mg daily.
Rationale: Fluoxetine 60 mg daily is FDA-approved for Bulimia Nervosa.
Higher doses of SSRIs are often needed for this indication compared to
depression . The full therapeutic dose is typically required for efficacy in
eating disorders .
3. A 52-year-old female with anxiety and insomnia is prescribed
zolpidem. What is the most important patient education?
A. Take immediately before bedtime, limit to short-term use, avoid alcohol
B. Take in the morning with breakfast
C. Can drive safely after taking
D. No concerns with long-term use
Correct Answer: A. Take immediately before bedtime, limit to short-
term use, avoid alcohol.
Rationale: Zolpidem should be taken immediately before bedtime due to
rapid onset. It is indicated for short-term use only and alcohol should be
avoided. Patients should not drive or operate machinery after taking it .
4. A 65-year-old male with Major Depressive Disorder has not
responded to SSRIs or SNRIs and has BPH. Which augmentation
strategy is most appropriate?
A. Add aripiprazole augmentation
B. Switch to clomipramine
C. Start ECT
D. Add memantine
Correct Answer: A. Add aripiprazole augmentation.
,Rationale: Augmentation with low-dose atypical antipsychotics (aripiprazole,
risperidone) is evidence-based for treatment-resistant depression.
Aripiprazole is preferred over clomipramine given the BPH and
anticholinergic effects of TCAs .
5. A patient being evaluated for ADHD has a history of hypertension.
What is the most important assessment before prescribing stimulants?
A. Baseline weight
B. Cardiovascular status and blood pressure
C. Liver function tests
D. Complete blood count
Correct Answer: B. Cardiovascular status and blood pressure.
Rationale: Stimulants can increase blood pressure and heart rate. The
PMHNP must assess cardiovascular status before prescribing stimulants . This
includes baseline blood pressure, heart rate, and cardiac history .
6. A 29-year-old female with Generalized Anxiety Disorder is pregnant.
What is the most appropriate SSRI?
A. Paroxetine
B. Sertraline
C. Fluoxetine
D. Citalopram
Correct Answer: B. Sertraline.
Rationale: Sertraline is generally preferred in pregnancy due to the most
favorable safety data among SSRIs. Paroxetine is best avoided due to
teratogenicity concerns .
, 7. A 38-year-old male with Alcohol Use Disorder reports a desire to
stop drinking. What is the most appropriate medication?
A. Naltrexone
B. Bupropion
C. Fluoxetine
D. Diazepam
Correct Answer: A. Naltrexone.
Rationale: Naltrexone is FDA-approved for Alcohol Use Disorder to reduce
cravings and heavy drinking. The PMHNP must select and prescribe
appropriate pharmacotherapeutics for substance use disorders .
8. A patient on an MAOI should avoid which of the following foods
due to the risk of hypertensive crisis?
A. Bananas
B. Aged cheese
C. Apples
D. Rice
Correct Answer: B. Aged cheese.
Rationale: MAOIs require avoidance of tyramine-rich foods including aged
cheese, cured meats, fermented foods, and red wine. Tyramine can cause a
hypertensive crisis when combined with MAOIs .
