NURSING LICENSURE
LMR Georgette PMHNP Board Exam Review
(2026/2027) PDF | High-Yield Study Guide
2026/2027
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Psychopharmacology & Neurobiology
Assessment, Diagnosis & Formulation
Psychotherapy & Non-Pharmacologic Interventions
Psychiatric-Mental Health Disorders Across the Lifespan
Professional Role, Ethics & Legal Issues
STUVIAACTUALEXAM
, PSYCHOPHARMACOLOGY & NEUROBIOLOGY
Q1
A 34-year-old woman with major depressive disorder has failed two adequate trials of SSRIs. She now
presents with residual anhedonia and fatigue. The PMHNP decides to initiate bupropion. The patient asks
how this medication differs from the SSRIs she previously tried. Which neurochemical action primarily
distinguishes bupropion from SSRIs?
A. Selective inhibition of serotonin reuptake with minimal effect on dopamine
B. Dual inhibition of norepinephrine and dopamine reuptake without significant serotonergic activity
C. Potent antagonism at 5-HT2A receptors combined with serotonin reuptake inhibition
D. Irreversible inhibition of monoamine oxidase-A leading to increased synaptic serotonin
Correct Answer: B
Rationale:
Bupropion is an NDRI that primarily blocks norepinephrine and dopamine reuptake, producing activating effects useful
for residual fatigue and anhedonia. SSRIs act almost exclusively on the serotonin transporter; therefore option A
describes SSRIs rather than bupropion. Options C and D describe atypical antipsychotics or MAOIs, respectively.
Q2
A 28-year-old man with schizophrenia develops acute dystonia after the first dose of intramuscular
haloperidol. The PMHNP recognizes this extrapyramidal symptom as resulting from which receptor
interaction in the nigrostriatal pathway?
A. Excessive serotonergic agonism at 5-HT2A receptors in the cortex
B. Dopamine D2 receptor blockade leading to relative cholinergic excess
C. Histamine H1 receptor antagonism producing sedation and motor slowing
D. Alpha-1 adrenergic blockade causing orthostasis and subsequent dystonia
Correct Answer: B
Rationale:
Acute dystonia is caused by D2 blockade in the nigrostriatal pathway, which disinhibits striatal cholinergic interneurons
and produces relative cholinergic excess. Anticholinergic agents reverse the symptom. Options A, C, and D describe
other receptor actions that do not mediate acute dystonia.
, LMR Georgette PMHNP Board Exam Review (2026/2027) High-Yield Study Guide 2026/2027
PSYCHOPHARMACOLOGY & NEUROBIOLOGY
Q3
A 45-year-old patient with bipolar I disorder is stable on lithium 900 mg daily (serum level 0.8 mEq/L). She
begins a low-sodium diet for hypertension. Two weeks later she presents with coarse tremor, ataxia, and
confusion. The most likely pharmacokinetic explanation is:
A. Increased lithium absorption secondary to gastric pH change from diet
B. Reduced renal clearance of lithium due to compensatory sodium reabsorption
C. Induction of CYP3A4 by dietary components accelerating lithium metabolism
D. Displacement of lithium from plasma proteins by dietary free fatty acids
Correct Answer: B
Rationale:
Lithium is handled by the kidney similarly to sodium. Sodium restriction causes the proximal tubule to increase
reabsorption of both sodium and lithium, elevating serum lithium levels and producing toxicity. Lithium is not
metabolized by CYP enzymes and is not highly protein-bound, eliminating C and D.
Q4
A 22-year-old college student with first-episode psychosis is started on olanzapine. After six weeks the
patient gains 18 lb and fasting glucose rises to 118 mg/dL. The PMHNP explains that these metabolic
effects are most strongly associated with which receptor profile?
A. High affinity for dopamine D2 receptors with rapid dissociation
B. Potent antagonism of histamine H1 and serotonin 5-HT2C receptors
C. Selective partial agonism at dopamine D2 and serotonin 5-HT1A receptors
D. Strong anticholinergic activity at muscarinic M1 receptors alone
Correct Answer: B
Rationale:
Weight gain and metabolic dysregulation with olanzapine are driven primarily by H1 and 5-HT2C antagonism, which
increase appetite and alter glucose homeostasis. D2 affinity (A) relates more to efficacy and EPS; partial agonism (C)
describes aripiprazole; anticholinergic effects (D) contribute less to metabolic syndrome.
LMR Georgette PMHNP Board Exam Review
(2026/2027) PDF | High-Yield Study Guide
2026/2027
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Psychopharmacology & Neurobiology
Assessment, Diagnosis & Formulation
Psychotherapy & Non-Pharmacologic Interventions
Psychiatric-Mental Health Disorders Across the Lifespan
Professional Role, Ethics & Legal Issues
STUVIAACTUALEXAM
, PSYCHOPHARMACOLOGY & NEUROBIOLOGY
Q1
A 34-year-old woman with major depressive disorder has failed two adequate trials of SSRIs. She now
presents with residual anhedonia and fatigue. The PMHNP decides to initiate bupropion. The patient asks
how this medication differs from the SSRIs she previously tried. Which neurochemical action primarily
distinguishes bupropion from SSRIs?
A. Selective inhibition of serotonin reuptake with minimal effect on dopamine
B. Dual inhibition of norepinephrine and dopamine reuptake without significant serotonergic activity
C. Potent antagonism at 5-HT2A receptors combined with serotonin reuptake inhibition
D. Irreversible inhibition of monoamine oxidase-A leading to increased synaptic serotonin
Correct Answer: B
Rationale:
Bupropion is an NDRI that primarily blocks norepinephrine and dopamine reuptake, producing activating effects useful
for residual fatigue and anhedonia. SSRIs act almost exclusively on the serotonin transporter; therefore option A
describes SSRIs rather than bupropion. Options C and D describe atypical antipsychotics or MAOIs, respectively.
Q2
A 28-year-old man with schizophrenia develops acute dystonia after the first dose of intramuscular
haloperidol. The PMHNP recognizes this extrapyramidal symptom as resulting from which receptor
interaction in the nigrostriatal pathway?
A. Excessive serotonergic agonism at 5-HT2A receptors in the cortex
B. Dopamine D2 receptor blockade leading to relative cholinergic excess
C. Histamine H1 receptor antagonism producing sedation and motor slowing
D. Alpha-1 adrenergic blockade causing orthostasis and subsequent dystonia
Correct Answer: B
Rationale:
Acute dystonia is caused by D2 blockade in the nigrostriatal pathway, which disinhibits striatal cholinergic interneurons
and produces relative cholinergic excess. Anticholinergic agents reverse the symptom. Options A, C, and D describe
other receptor actions that do not mediate acute dystonia.
, LMR Georgette PMHNP Board Exam Review (2026/2027) High-Yield Study Guide 2026/2027
PSYCHOPHARMACOLOGY & NEUROBIOLOGY
Q3
A 45-year-old patient with bipolar I disorder is stable on lithium 900 mg daily (serum level 0.8 mEq/L). She
begins a low-sodium diet for hypertension. Two weeks later she presents with coarse tremor, ataxia, and
confusion. The most likely pharmacokinetic explanation is:
A. Increased lithium absorption secondary to gastric pH change from diet
B. Reduced renal clearance of lithium due to compensatory sodium reabsorption
C. Induction of CYP3A4 by dietary components accelerating lithium metabolism
D. Displacement of lithium from plasma proteins by dietary free fatty acids
Correct Answer: B
Rationale:
Lithium is handled by the kidney similarly to sodium. Sodium restriction causes the proximal tubule to increase
reabsorption of both sodium and lithium, elevating serum lithium levels and producing toxicity. Lithium is not
metabolized by CYP enzymes and is not highly protein-bound, eliminating C and D.
Q4
A 22-year-old college student with first-episode psychosis is started on olanzapine. After six weeks the
patient gains 18 lb and fasting glucose rises to 118 mg/dL. The PMHNP explains that these metabolic
effects are most strongly associated with which receptor profile?
A. High affinity for dopamine D2 receptors with rapid dissociation
B. Potent antagonism of histamine H1 and serotonin 5-HT2C receptors
C. Selective partial agonism at dopamine D2 and serotonin 5-HT1A receptors
D. Strong anticholinergic activity at muscarinic M1 receptors alone
Correct Answer: B
Rationale:
Weight gain and metabolic dysregulation with olanzapine are driven primarily by H1 and 5-HT2C antagonism, which
increase appetite and alter glucose homeostasis. D2 affinity (A) relates more to efficacy and EPS; partial agonism (C)
describes aripiprazole; anticholinergic effects (D) contribute less to metabolic syndrome.
