PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER (PMHNP)
BOARD REVIEW 2026/2027 QUESTIONS
AND ANSWERS
1. A 45-year-old male with Schizophrenia is experiencing significant gynecomastia and
galactorrhea. Which dopaminergic pathway is most likely involved in this side effect?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Answer: B
Conceptual Explanation: The tuberoinfundibular pathway regulates prolactin secretion.
Blockade of D2 receptors in this pathway by antipsychotics leads to hyperprolactinemia,
which can cause gynecomastia, galactorrhea, and sexual dysfunction.
2. When prescribing Lithium, which of the following medication combinations would most
significantly increase the risk of Lithium toxicity?
A. Lithium and Theophylline
,B. Lithium and Aspirin
C. Lithium and Hydrochlorothiazide
D. Lithium and Caffeine
Answer: C
Conceptual Explanation: Thiazide diuretics like Hydrochlorothiazide reduce renal
clearance of lithium, potentially increasing serum levels by 40%. Theophylline and caffeine
actually decrease lithium levels, while Aspirin has minimal effect compared to NSAIDs.
3. A PMHNP is treating a patient with Borderline Personality Disorder who uses ‘splitting’ as a
defense mechanism. According to Object Relations Theory, this arises from a failure in which
developmental stage?
A. Object Constancy
B. Rapprochement
C. Symbiosis
D. Differentiation
Answer: A
Conceptual Explanation: Splitting is a failure to achieve object constancy, where the
individual cannot integrate the ‘good’ and ‘bad’ aspects of a person into a single, cohesive
whole.
, 4. Which of the following laboratory findings is most characteristic of a patient with Bulimia
Nervosa who engages in frequent self-induced vomiting?
A. Hyperkalemia and metabolic acidosis
B. Hyperchloremia and metabolic alkalosis
C. Hyponatremia and metabolic acidosis
D. Hypokalemia and metabolic alkalosis
Answer: D
Conceptual Explanation: Frequent vomiting leads to the loss of stomach acid (HCl) and
potassium, resulting in hypokalemia and metabolic alkalosis.
5. A 24-year-old female presents with symptoms of depression, but mentions she has a ‘rash’
that appeared after starting a new medication for mood stabilization. The PMHNP suspects
Stevens-Johnson Syndrome (SJS). Which medication is the most likely culprit?
A. Valproic acid
B. Lithium
C. Quetiapine
D. Lamotrigine
Answer: D
Conceptual Explanation: Lamotrigine carries a Black Box Warning for serious rashes,
including SJS, especially if titrated too quickly.
NURSE PRACTITIONER (PMHNP)
BOARD REVIEW 2026/2027 QUESTIONS
AND ANSWERS
1. A 45-year-old male with Schizophrenia is experiencing significant gynecomastia and
galactorrhea. Which dopaminergic pathway is most likely involved in this side effect?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Answer: B
Conceptual Explanation: The tuberoinfundibular pathway regulates prolactin secretion.
Blockade of D2 receptors in this pathway by antipsychotics leads to hyperprolactinemia,
which can cause gynecomastia, galactorrhea, and sexual dysfunction.
2. When prescribing Lithium, which of the following medication combinations would most
significantly increase the risk of Lithium toxicity?
A. Lithium and Theophylline
,B. Lithium and Aspirin
C. Lithium and Hydrochlorothiazide
D. Lithium and Caffeine
Answer: C
Conceptual Explanation: Thiazide diuretics like Hydrochlorothiazide reduce renal
clearance of lithium, potentially increasing serum levels by 40%. Theophylline and caffeine
actually decrease lithium levels, while Aspirin has minimal effect compared to NSAIDs.
3. A PMHNP is treating a patient with Borderline Personality Disorder who uses ‘splitting’ as a
defense mechanism. According to Object Relations Theory, this arises from a failure in which
developmental stage?
A. Object Constancy
B. Rapprochement
C. Symbiosis
D. Differentiation
Answer: A
Conceptual Explanation: Splitting is a failure to achieve object constancy, where the
individual cannot integrate the ‘good’ and ‘bad’ aspects of a person into a single, cohesive
whole.
, 4. Which of the following laboratory findings is most characteristic of a patient with Bulimia
Nervosa who engages in frequent self-induced vomiting?
A. Hyperkalemia and metabolic acidosis
B. Hyperchloremia and metabolic alkalosis
C. Hyponatremia and metabolic acidosis
D. Hypokalemia and metabolic alkalosis
Answer: D
Conceptual Explanation: Frequent vomiting leads to the loss of stomach acid (HCl) and
potassium, resulting in hypokalemia and metabolic alkalosis.
5. A 24-year-old female presents with symptoms of depression, but mentions she has a ‘rash’
that appeared after starting a new medication for mood stabilization. The PMHNP suspects
Stevens-Johnson Syndrome (SJS). Which medication is the most likely culprit?
A. Valproic acid
B. Lithium
C. Quetiapine
D. Lamotrigine
Answer: D
Conceptual Explanation: Lamotrigine carries a Black Box Warning for serious rashes,
including SJS, especially if titrated too quickly.
