PMHNP BOARD EXAMINATION
PREPARATION 2026/2027 QUESTIONS
AND ANSWERS
1. A 24-year-old female patient started on Haloperidol presents with severe muscle rigidity, a
temperature of 103.2°F, and elevated creatine kinase levels. What is the most likely
diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Extrapyramidal Side Effects (EPS)
Answer: A
Conceptual Explanation: NMS is characterized by ‘lead-pipe’ rigidity, hyperthermia, and
autonomic instability. Unlike Serotonin Syndrome, it lacks hyperreflexia and is associated
with dopamine antagonists.
2. Which dopamine pathway is primarily responsible for the positive symptoms of
Schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
,B. Mesolimbic pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: Overactivity in the mesolimbic pathway is associated with
positive symptoms of schizophrenia. The mesocortical pathway is associated with negative
symptoms.
3. In the metabolism of psychotropic medications, which Cytochrome P450 enzyme is most
commonly inhibited by Fluoxetine and Paroxetine?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which can lead to increased serum levels of drugs like TCAs or beta-blockers.
4. A PMHNP is treating a patient for Bipolar I Disorder. The patient is planning to become
pregnant. Which medication carries the highest risk for Ebstein’s anomaly?
A. Valproic Acid
, B. Lamotrigine
C. Lithium
D. Quetiapine
Answer: C
Conceptual Explanation: Lithium use during the first trimester is specifically associated
with Ebstein’s anomaly, a rare cardiac defect involving the tricuspid valve.
5. According to the Hierarchy of Evidence, which of the following provides the strongest level
of evidence for clinical decision-making?
A. Randomized Controlled Trials (RCTs)
B. Systematic reviews or meta-analyses of RCTs
C. Case-Control Studies
D. Cohort Studies
Answer: B
Conceptual Explanation: Systematic reviews and meta-analyses represent Level I
evidence, the highest level, as they synthesize results from multiple high-quality RCTs.
6. Which brain region is primarily responsible for executive functions such as planning,
decision-making, and impulse control?
A. Prefrontal Cortex
B. Hippocampus
PREPARATION 2026/2027 QUESTIONS
AND ANSWERS
1. A 24-year-old female patient started on Haloperidol presents with severe muscle rigidity, a
temperature of 103.2°F, and elevated creatine kinase levels. What is the most likely
diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Extrapyramidal Side Effects (EPS)
Answer: A
Conceptual Explanation: NMS is characterized by ‘lead-pipe’ rigidity, hyperthermia, and
autonomic instability. Unlike Serotonin Syndrome, it lacks hyperreflexia and is associated
with dopamine antagonists.
2. Which dopamine pathway is primarily responsible for the positive symptoms of
Schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
,B. Mesolimbic pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: Overactivity in the mesolimbic pathway is associated with
positive symptoms of schizophrenia. The mesocortical pathway is associated with negative
symptoms.
3. In the metabolism of psychotropic medications, which Cytochrome P450 enzyme is most
commonly inhibited by Fluoxetine and Paroxetine?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which can lead to increased serum levels of drugs like TCAs or beta-blockers.
4. A PMHNP is treating a patient for Bipolar I Disorder. The patient is planning to become
pregnant. Which medication carries the highest risk for Ebstein’s anomaly?
A. Valproic Acid
, B. Lamotrigine
C. Lithium
D. Quetiapine
Answer: C
Conceptual Explanation: Lithium use during the first trimester is specifically associated
with Ebstein’s anomaly, a rare cardiac defect involving the tricuspid valve.
5. According to the Hierarchy of Evidence, which of the following provides the strongest level
of evidence for clinical decision-making?
A. Randomized Controlled Trials (RCTs)
B. Systematic reviews or meta-analyses of RCTs
C. Case-Control Studies
D. Cohort Studies
Answer: B
Conceptual Explanation: Systematic reviews and meta-analyses represent Level I
evidence, the highest level, as they synthesize results from multiple high-quality RCTs.
6. Which brain region is primarily responsible for executive functions such as planning,
decision-making, and impulse control?
A. Prefrontal Cortex
B. Hippocampus
