PMHNP BOARD EXAMINATION
REVIEW 2026/2027 QUESTIONS AND
ANSWERS
1.
A 45-year-old male with Schizophrenia is experiencing worsening auditory hallucinations and
paranoid delusions. Which dopamine pathway is primarily associated with these positive
symptoms?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: The mesolimbic pathway is associated with reward and
pleasure, and an overactivity of dopamine in this area leads to positive symptoms of
schizophrenia such as hallucinations and delusions.
2. Which of the following laboratory findings is most indicative of chronic heavy alcohol use?
A. Decreased Aspartate Aminotransferase (AST)
B. Decreased Mean Corpuscular Volume (MCV)
,C. Elevated Blood Urea Nitrogen (BUN)
D. Elevated Gamma-glutamyl transferase (GGT)
Answer: D
Conceptual Explanation: GGT is a sensitive marker for heavy alcohol consumption. MCV is
typically elevated (macrocytosis), and AST is usually higher than ALT in alcoholic liver
disease.
3. A patient is prescribed Lamotrigine for Bipolar II disorder. Which assessment finding
requires immediate discontinuation and emergency evaluation?
A. Dizziness and ataxia
B. Nausea and mild headache
C. Increased sedation
D. A diffuse, blistering rash on the torso
Answer: D
Conceptual Explanation: A blistering rash may indicate Stevens-Johnson Syndrome (SJS)
or Toxic Epidermal Necrolysis (TEN), which are life-threatening adverse reactions to
Lamotrigine.
4. A PMHNP is treating a patient with Clozapine. The patient’s Absolute Neutrophil Count
(ANC) is 1,200/mm³. What is the appropriate next step?
A. Continue treatment and recheck ANC in one month
, B. Discontinue Clozapine immediately
C. Continue treatment but monitor ANC twice weekly
D. Increase the dose of Clozapine
Answer: C
Conceptual Explanation: For mild neutropenia (ANC 1000-1499), treatment is typically
continued with more frequent monitoring (twice weekly) until the ANC returns to baseline.
5. Which legal case established the ‘Duty to Warn’ a third party when a patient makes a
specific threat?
A. Tarasoff v. Regents of the University of California
B. Rennie v. Klein
C. Durham v. United States
D. Ford v. Wainwright
Answer: A
Conceptual Explanation: The Tarasoff case established that mental health professionals
have a duty to warn third parties who are threatened with harm by a patient.
6. A 24-year-old female presents with rapid-cycling Bipolar Disorder. Which medication is
considered first-line for this specific presentation?
A. Valproate (Depakote)
B. Lithium
REVIEW 2026/2027 QUESTIONS AND
ANSWERS
1.
A 45-year-old male with Schizophrenia is experiencing worsening auditory hallucinations and
paranoid delusions. Which dopamine pathway is primarily associated with these positive
symptoms?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: The mesolimbic pathway is associated with reward and
pleasure, and an overactivity of dopamine in this area leads to positive symptoms of
schizophrenia such as hallucinations and delusions.
2. Which of the following laboratory findings is most indicative of chronic heavy alcohol use?
A. Decreased Aspartate Aminotransferase (AST)
B. Decreased Mean Corpuscular Volume (MCV)
,C. Elevated Blood Urea Nitrogen (BUN)
D. Elevated Gamma-glutamyl transferase (GGT)
Answer: D
Conceptual Explanation: GGT is a sensitive marker for heavy alcohol consumption. MCV is
typically elevated (macrocytosis), and AST is usually higher than ALT in alcoholic liver
disease.
3. A patient is prescribed Lamotrigine for Bipolar II disorder. Which assessment finding
requires immediate discontinuation and emergency evaluation?
A. Dizziness and ataxia
B. Nausea and mild headache
C. Increased sedation
D. A diffuse, blistering rash on the torso
Answer: D
Conceptual Explanation: A blistering rash may indicate Stevens-Johnson Syndrome (SJS)
or Toxic Epidermal Necrolysis (TEN), which are life-threatening adverse reactions to
Lamotrigine.
4. A PMHNP is treating a patient with Clozapine. The patient’s Absolute Neutrophil Count
(ANC) is 1,200/mm³. What is the appropriate next step?
A. Continue treatment and recheck ANC in one month
, B. Discontinue Clozapine immediately
C. Continue treatment but monitor ANC twice weekly
D. Increase the dose of Clozapine
Answer: C
Conceptual Explanation: For mild neutropenia (ANC 1000-1499), treatment is typically
continued with more frequent monitoring (twice weekly) until the ANC returns to baseline.
5. Which legal case established the ‘Duty to Warn’ a third party when a patient makes a
specific threat?
A. Tarasoff v. Regents of the University of California
B. Rennie v. Klein
C. Durham v. United States
D. Ford v. Wainwright
Answer: A
Conceptual Explanation: The Tarasoff case established that mental health professionals
have a duty to warn third parties who are threatened with harm by a patient.
6. A 24-year-old female presents with rapid-cycling Bipolar Disorder. Which medication is
considered first-line for this specific presentation?
A. Valproate (Depakote)
B. Lithium
