PMHNP BOARDS 2026/2027
COMPREHENSIVE EXAMINATION
QUESTIONS AND ANSWERS
1. A 45-year-old patient taking Lithium for Bipolar I Disorder presents with nausea, coarse
tremors, and ataxia. A concomitant medication recently started for back pain is suspected to
have caused Lithium toxicity. Which medication is the most likely culprit?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Gabapentin
Answer: A
Conceptual Explanation: NSAIDs like Ibuprofen reduce renal clearance of Lithium, leading
to increased serum levels and toxicity. Acetaminophen and Aspirin generally do not affect
Lithium levels significantly.
2. The mesolimbic pathway is primarily associated with which aspect of psychiatric symptoms
in schizophrenia?
A. Negative symptoms and cognitive impairment
,B. Prolactin elevation
C. Extrapyramidal side effects
D. Positive symptoms such as hallucinations and delusions
Answer: D
Conceptual Explanation: Overactivity in the mesolimbic pathway is associated with
positive symptoms of schizophrenia. The mesocortical pathway is linked to negative
symptoms.
3. According to the DSM-5-TR, what is the minimum duration of symptoms required to
diagnose Cyclothymic Disorder in an adult?
A. 6 months
B. 1 year
C. 5 years
D. 2 years
Answer: D
Conceptual Explanation: Cyclothymic Disorder requires at least 2 years of symptoms in
adults (1 year in children/adolescents) during which symptoms are present at least half
the time.
, 4. Which cytochrome P450 enzyme is most notably inhibited by Fluoxetine and Paroxetine,
potentially increasing levels of certain beta-blockers and antipsychotics?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
Answer: A
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which metabolizes many psychotropics and cardiovascular medications.
5. A PMHNP is treating a patient with Clozapine. The Absolute Neutrophil Count (ANC) is
1200/mm³. What is the appropriate clinical action based on Clozapine REMS guidelines for a
general population patient?
A. Continue Clozapine and monitor ANC weekly
B. Interrupt treatment and consult hematology
C. Continue treatment but increase frequency of monitoring to 3 times per week
D. Permanently discontinue Clozapine
Answer: C
Conceptual Explanation: For mild neutropenia (ANC 1000-1499/mm³), the guideline is to
continue Clozapine but monitor the ANC three times weekly until ANC is ≥ 1500/mm³.
COMPREHENSIVE EXAMINATION
QUESTIONS AND ANSWERS
1. A 45-year-old patient taking Lithium for Bipolar I Disorder presents with nausea, coarse
tremors, and ataxia. A concomitant medication recently started for back pain is suspected to
have caused Lithium toxicity. Which medication is the most likely culprit?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Gabapentin
Answer: A
Conceptual Explanation: NSAIDs like Ibuprofen reduce renal clearance of Lithium, leading
to increased serum levels and toxicity. Acetaminophen and Aspirin generally do not affect
Lithium levels significantly.
2. The mesolimbic pathway is primarily associated with which aspect of psychiatric symptoms
in schizophrenia?
A. Negative symptoms and cognitive impairment
,B. Prolactin elevation
C. Extrapyramidal side effects
D. Positive symptoms such as hallucinations and delusions
Answer: D
Conceptual Explanation: Overactivity in the mesolimbic pathway is associated with
positive symptoms of schizophrenia. The mesocortical pathway is linked to negative
symptoms.
3. According to the DSM-5-TR, what is the minimum duration of symptoms required to
diagnose Cyclothymic Disorder in an adult?
A. 6 months
B. 1 year
C. 5 years
D. 2 years
Answer: D
Conceptual Explanation: Cyclothymic Disorder requires at least 2 years of symptoms in
adults (1 year in children/adolescents) during which symptoms are present at least half
the time.
, 4. Which cytochrome P450 enzyme is most notably inhibited by Fluoxetine and Paroxetine,
potentially increasing levels of certain beta-blockers and antipsychotics?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
Answer: A
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which metabolizes many psychotropics and cardiovascular medications.
5. A PMHNP is treating a patient with Clozapine. The Absolute Neutrophil Count (ANC) is
1200/mm³. What is the appropriate clinical action based on Clozapine REMS guidelines for a
general population patient?
A. Continue Clozapine and monitor ANC weekly
B. Interrupt treatment and consult hematology
C. Continue treatment but increase frequency of monitoring to 3 times per week
D. Permanently discontinue Clozapine
Answer: C
Conceptual Explanation: For mild neutropenia (ANC 1000-1499/mm³), the guideline is to
continue Clozapine but monitor the ANC three times weekly until ANC is ≥ 1500/mm³.
