PMHNP COMPREHENSIVE BOARD
REVIEW 2026/2027 QUESTIONS AND
ANSWERS
1. A 32-year-old patient on Clozapine presents for a routine check-up. The Absolute
Neutrophil Count (ANC) is reported as 950/mm³. According to the Clozapine REMS program,
what is the most appropriate action?
A. Interrupt treatment, notify the REMS registry, and monitor ANC daily until >1000/mm³.
B. Increase dosage to compensate for metabolic changes.
C. Continue current dosage and repeat labs in one week.
D. Permanently discontinue Clozapine and never rechallenge.
Answer: A
Conceptual Explanation: For mild to moderate neutropenia (ANC 500-999/mm³),
treatment should be interrupted, the registry notified, and daily monitoring initiated until
the ANC stabilizes above 1000/mm³.
2. Which cytochrome P450 (CYP450) enzyme is primarily responsible for the metabolism of
approximately 25% of all clinical drugs, including many antidepressants and antipsychotics,
and is known for genetic polymorphism?
A. CYP3A4
,B. CYP1A2
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: CYP2D6 is responsible for metabolizing a significant portion of
psychotropic medications and exhibits high genetic variability (poor, intermediate,
extensive, and ultra-rapid metabolizers).
3. A patient with PTSD exhibits significant hyperarousal and exaggerated startle response.
Which brain structure is primarily associated with the ‘top-down’ failure to inhibit the fear
response in the amygdala?
A. Hippocampus
B. Basal Ganglia
C. Prefrontal Cortex
D. Thalamus
Answer: C
Conceptual Explanation: In PTSD, the Prefrontal Cortex (specifically the ventromedial
PFC) fails to provide adequate top-down inhibition of the amygdala, leading to sustained
fear and hyperarousal.
, 4. When initiating Lithium for a patient with Bipolar I Disorder, which of the following sets of
baseline labs is most critical to obtain?
A. LFTs, Albumin, and CBC
B. Lipid Profile and Fasting Glucose
C. TSH, BUN/Creatinine, and Pregnancy Test
D. Amylase, Lipase, and Electrolytes
Answer: C
Conceptual Explanation: Lithium is renally excreted and can affect thyroid function and
fetal development (Ebstein’s anomaly); therefore, renal function (BUN/Cr), TSH, and HCG
are mandatory.
5. The ‘Tarasoff Rule’ refers to a mental health professional’s legal obligation to do which of
the following?
A. Maintain strict confidentiality regardless of the patient’s threats.
B. Report any suspicion of child or elder abuse.
C. Involuntarily commit any patient expressing suicidal ideation.
D. Warn an identifiable third party of a serious threat of harm.
Answer: D
Conceptual Explanation: The Tarasoff case established the ‘duty to warn’ and ‘duty to
protect’ third parties when a patient makes a specific threat against an identifiable victim.
REVIEW 2026/2027 QUESTIONS AND
ANSWERS
1. A 32-year-old patient on Clozapine presents for a routine check-up. The Absolute
Neutrophil Count (ANC) is reported as 950/mm³. According to the Clozapine REMS program,
what is the most appropriate action?
A. Interrupt treatment, notify the REMS registry, and monitor ANC daily until >1000/mm³.
B. Increase dosage to compensate for metabolic changes.
C. Continue current dosage and repeat labs in one week.
D. Permanently discontinue Clozapine and never rechallenge.
Answer: A
Conceptual Explanation: For mild to moderate neutropenia (ANC 500-999/mm³),
treatment should be interrupted, the registry notified, and daily monitoring initiated until
the ANC stabilizes above 1000/mm³.
2. Which cytochrome P450 (CYP450) enzyme is primarily responsible for the metabolism of
approximately 25% of all clinical drugs, including many antidepressants and antipsychotics,
and is known for genetic polymorphism?
A. CYP3A4
,B. CYP1A2
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: CYP2D6 is responsible for metabolizing a significant portion of
psychotropic medications and exhibits high genetic variability (poor, intermediate,
extensive, and ultra-rapid metabolizers).
3. A patient with PTSD exhibits significant hyperarousal and exaggerated startle response.
Which brain structure is primarily associated with the ‘top-down’ failure to inhibit the fear
response in the amygdala?
A. Hippocampus
B. Basal Ganglia
C. Prefrontal Cortex
D. Thalamus
Answer: C
Conceptual Explanation: In PTSD, the Prefrontal Cortex (specifically the ventromedial
PFC) fails to provide adequate top-down inhibition of the amygdala, leading to sustained
fear and hyperarousal.
, 4. When initiating Lithium for a patient with Bipolar I Disorder, which of the following sets of
baseline labs is most critical to obtain?
A. LFTs, Albumin, and CBC
B. Lipid Profile and Fasting Glucose
C. TSH, BUN/Creatinine, and Pregnancy Test
D. Amylase, Lipase, and Electrolytes
Answer: C
Conceptual Explanation: Lithium is renally excreted and can affect thyroid function and
fetal development (Ebstein’s anomaly); therefore, renal function (BUN/Cr), TSH, and HCG
are mandatory.
5. The ‘Tarasoff Rule’ refers to a mental health professional’s legal obligation to do which of
the following?
A. Maintain strict confidentiality regardless of the patient’s threats.
B. Report any suspicion of child or elder abuse.
C. Involuntarily commit any patient expressing suicidal ideation.
D. Warn an identifiable third party of a serious threat of harm.
Answer: D
Conceptual Explanation: The Tarasoff case established the ‘duty to warn’ and ‘duty to
protect’ third parties when a patient makes a specific threat against an identifiable victim.
