ADVANCED PMHNP BOARD REVIEW
2026-2027 QUESTIONS AND ANSWERS
1. A 34-year-old patient with schizophrenia has been stable on Haloperidol. However, they
recently began experiencing severe muscle rigidity, a temperature of 103.5°F, and altered
mental status. Laboratory results show significantly elevated creatine kinase (CK). Which of
the following is the most appropriate immediate intervention?
A. Administer Cyproheptadine and provide cooling blankets.
B. Discontinue Haloperidol and initiate Bromocriptine or Dantrolene.
C. Increase the dose of Haloperidol to manage agitation.
D. Administer Benztropine IM to reverse dystonia.
Answer: B
Conceptual Explanation: The clinical presentation of high fever, muscle rigidity (lead-
pipe), and elevated CK is diagnostic of Neuroleptic Malignant Syndrome (NMS). The first
step is to stop the causative antipsychotic and provide supportive care, including dopamine
agonists like Bromocriptine or muscle relaxants like Dantrolene.
,2. In the neurobiology of schizophrenia, the ‘Negative Symptoms’ such as apathy, withdrawal,
and poverty of speech are primarily associated with decreased dopamine activity in which
pathway?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: While the mesolimbic pathway is associated with positive
symptoms (hallucinations/delusions), the mesocortical pathway is linked to negative
symptoms and cognitive impairment due to hypodopaminergic activity.
3. A PMHNP is treating a patient with Bipolar I Disorder. The patient is currently taking
Lithium 900mg daily. During a follow-up, the patient reports taking Ibuprofen daily for back
pain. What is the most likely risk associated with this combination?
A. Increased Lithium levels leading to toxicity.
B. Decreased Lithium levels leading to mania.
C. Increased risk of Serotonin Syndrome.
D. Development of Stevens-Johnson Syndrome.
Answer: A
, Conceptual Explanation: NSAIDs like Ibuprofen reduce the renal clearance of Lithium,
leading to increased serum levels and potential toxicity. Patients should be advised to use
Acetaminophen instead.
4. According to the DSM-5-TR, which of the following is a core requirement for the diagnosis
of Schizoaffective Disorder that distinguishes it from Schizophrenia with Mood Features?
A. Rapid cycling between depressive and manic symptoms.
B. Symptoms of a major mood episode present for the majority of the total duration of the
illness.
C. The presence of manic symptoms only.
D. Delusions or hallucinations for at least 2 weeks in the absence of a major mood episode.
Answer: D
Conceptual Explanation: To diagnose Schizoaffective Disorder, there must be a period of
at least 2 weeks where delusions or hallucinations occur without prominent mood
symptoms, though mood symptoms are present for the majority of the illness overall.
5. Which cytochrome P450 enzyme is induced by cigarette smoking, potentially requiring
higher doses of medications like Olanzapine and Clozapine?
A. CYP2D6
B. CYP3A4
C. CYP1A2
2026-2027 QUESTIONS AND ANSWERS
1. A 34-year-old patient with schizophrenia has been stable on Haloperidol. However, they
recently began experiencing severe muscle rigidity, a temperature of 103.5°F, and altered
mental status. Laboratory results show significantly elevated creatine kinase (CK). Which of
the following is the most appropriate immediate intervention?
A. Administer Cyproheptadine and provide cooling blankets.
B. Discontinue Haloperidol and initiate Bromocriptine or Dantrolene.
C. Increase the dose of Haloperidol to manage agitation.
D. Administer Benztropine IM to reverse dystonia.
Answer: B
Conceptual Explanation: The clinical presentation of high fever, muscle rigidity (lead-
pipe), and elevated CK is diagnostic of Neuroleptic Malignant Syndrome (NMS). The first
step is to stop the causative antipsychotic and provide supportive care, including dopamine
agonists like Bromocriptine or muscle relaxants like Dantrolene.
,2. In the neurobiology of schizophrenia, the ‘Negative Symptoms’ such as apathy, withdrawal,
and poverty of speech are primarily associated with decreased dopamine activity in which
pathway?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: While the mesolimbic pathway is associated with positive
symptoms (hallucinations/delusions), the mesocortical pathway is linked to negative
symptoms and cognitive impairment due to hypodopaminergic activity.
3. A PMHNP is treating a patient with Bipolar I Disorder. The patient is currently taking
Lithium 900mg daily. During a follow-up, the patient reports taking Ibuprofen daily for back
pain. What is the most likely risk associated with this combination?
A. Increased Lithium levels leading to toxicity.
B. Decreased Lithium levels leading to mania.
C. Increased risk of Serotonin Syndrome.
D. Development of Stevens-Johnson Syndrome.
Answer: A
, Conceptual Explanation: NSAIDs like Ibuprofen reduce the renal clearance of Lithium,
leading to increased serum levels and potential toxicity. Patients should be advised to use
Acetaminophen instead.
4. According to the DSM-5-TR, which of the following is a core requirement for the diagnosis
of Schizoaffective Disorder that distinguishes it from Schizophrenia with Mood Features?
A. Rapid cycling between depressive and manic symptoms.
B. Symptoms of a major mood episode present for the majority of the total duration of the
illness.
C. The presence of manic symptoms only.
D. Delusions or hallucinations for at least 2 weeks in the absence of a major mood episode.
Answer: D
Conceptual Explanation: To diagnose Schizoaffective Disorder, there must be a period of
at least 2 weeks where delusions or hallucinations occur without prominent mood
symptoms, though mood symptoms are present for the majority of the illness overall.
5. Which cytochrome P450 enzyme is induced by cigarette smoking, potentially requiring
higher doses of medications like Olanzapine and Clozapine?
A. CYP2D6
B. CYP3A4
C. CYP1A2
