PMHNP BOARD EXAM PREPARATION
2026/2027 QUESTIONS AND ANSWERS
1. A 34-year-old patient with Schizophrenia is started on Risperidone. The patient is already
taking Fluoxetine for comorbid Depression. Which of the following is the most likely outcome
of this combination?
A. Risperidone levels will decrease due to CYP2D6 induction.
B. Risperidone levels will increase due to CYP2D6 inhibition.
C. Fluoxetine levels will decrease due to CYP3A4 induction.
D. No significant interaction is expected between these medications.
Answer: B
Conceptual Explanation: Fluoxetine is a potent inhibitor of the CYP2D6 enzyme.
Risperidone is a substrate of CYP2D6. Inhibiting this enzyme leads to higher plasma
concentrations of Risperidone, increasing the risk of extrapyramidal symptoms.
2. The mesolimbic dopamine pathway is primarily associated with which set of symptoms in
Schizophrenia?
A. Negative symptoms such as flat affect and alogia.
B. Cognitive symptoms such as impaired executive function.
,C. Extrapyramidal side effects from medications.
D. Positive symptoms such as hallucinations and delusions.
Answer: D
Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
hypothesized to mediate the positive symptoms of Schizophrenia. Hypoactivity in the
mesocortical pathway is linked to negative symptoms.
3. A PMHNP is treating a patient with Lithium for Bipolar I Disorder. The patient is recently
diagnosed with hypertension and started on a new medication. Which medication would
most likely cause Lithium toxicity?
A. Amlodipine
B. Hydrochlorothiazide
C. Propranolol
D. Metoprolol
Answer: B
Conceptual Explanation: Thiazide diuretics like Hydrochlorothiazide increase Lithium
levels by decreasing renal clearance, potentially leading to toxicity. Calcium channel
blockers and Beta-blockers generally have less impact.
, 4. 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. 2 years
D. 5 years
Answer: C
Conceptual Explanation: For adults, the symptoms of Cyclothymic Disorder (hypomanic
and depressive periods that do not meet full criteria) must persist for at least 2 years. In
children and adolescents, the requirement is 1 year.
5. Which brain region is primarily responsible for the ‘fear circuitry’ and the processing of
emotional responses in Anxiety Disorders?
A. Hippocampus
B. Prefrontal Cortex
C. Amygdala
D. Basal Ganglia
Answer: C
2026/2027 QUESTIONS AND ANSWERS
1. A 34-year-old patient with Schizophrenia is started on Risperidone. The patient is already
taking Fluoxetine for comorbid Depression. Which of the following is the most likely outcome
of this combination?
A. Risperidone levels will decrease due to CYP2D6 induction.
B. Risperidone levels will increase due to CYP2D6 inhibition.
C. Fluoxetine levels will decrease due to CYP3A4 induction.
D. No significant interaction is expected between these medications.
Answer: B
Conceptual Explanation: Fluoxetine is a potent inhibitor of the CYP2D6 enzyme.
Risperidone is a substrate of CYP2D6. Inhibiting this enzyme leads to higher plasma
concentrations of Risperidone, increasing the risk of extrapyramidal symptoms.
2. The mesolimbic dopamine pathway is primarily associated with which set of symptoms in
Schizophrenia?
A. Negative symptoms such as flat affect and alogia.
B. Cognitive symptoms such as impaired executive function.
,C. Extrapyramidal side effects from medications.
D. Positive symptoms such as hallucinations and delusions.
Answer: D
Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
hypothesized to mediate the positive symptoms of Schizophrenia. Hypoactivity in the
mesocortical pathway is linked to negative symptoms.
3. A PMHNP is treating a patient with Lithium for Bipolar I Disorder. The patient is recently
diagnosed with hypertension and started on a new medication. Which medication would
most likely cause Lithium toxicity?
A. Amlodipine
B. Hydrochlorothiazide
C. Propranolol
D. Metoprolol
Answer: B
Conceptual Explanation: Thiazide diuretics like Hydrochlorothiazide increase Lithium
levels by decreasing renal clearance, potentially leading to toxicity. Calcium channel
blockers and Beta-blockers generally have less impact.
, 4. 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. 2 years
D. 5 years
Answer: C
Conceptual Explanation: For adults, the symptoms of Cyclothymic Disorder (hypomanic
and depressive periods that do not meet full criteria) must persist for at least 2 years. In
children and adolescents, the requirement is 1 year.
5. Which brain region is primarily responsible for the ‘fear circuitry’ and the processing of
emotional responses in Anxiety Disorders?
A. Hippocampus
B. Prefrontal Cortex
C. Amygdala
D. Basal Ganglia
Answer: C
