PMHNP COMPREHENSIVE EXAM PREP
(2026/2027) QUESTIONS AND ANSWERS
1. A 45-year-old male patient on Lithium reports increased tremors, nausea, and ataxia. His
serum lithium level is 1.8 mEq/L. Which of the following medications, if recently added for
back pain, likely caused this elevation?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Gabapentin
Answer: A
Conceptual Explanation: NSAIDs like Ibuprofen reduce renal clearance of Lithium,
potentially increasing serum levels to toxic ranges. Acetaminophen and Aspirin have
minimal impact on lithium levels.
2. According to the DSM-5-TR, which symptom is required to meet the diagnostic criteria for a
Major Depressive Episode?
A. Anhedonia or depressed mood
B. Significant weight loss or gain
,C. Excessive guilt or feelings of worthlessness
D. Psychomotor agitation or retardation
Answer: A
Conceptual Explanation: At least one of the two core symptoms—depressed mood or loss
of interest/pleasure (anhedonia)—must be present for a diagnosis of MDD.
3. A patient is started on Clozapine (Clozaril). The PMHNP must monitor the Absolute
Neutrophil Count (ANC). What is the minimum ANC level required to initiate treatment?
A. 500/mm³
B. 1000/mm³
C. 1500/mm³
D. 2000/mm³
Answer: C
Conceptual Explanation: Per FDA REMS, a patient must have an ANC of at least
1500/mm³ to initiate Clozapine treatment (1000/mm³ for those with benign ethnic
neutropenia).
4. Which neurobiological pathway is primarily associated with the negative symptoms of
Schizophrenia?
A. Mesolimbic pathway
B. Nigrostriatal pathway
, C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms (hypodopaminergic state), whereas the mesolimbic pathway is
associated with positive symptoms (hyperdopaminergic state).
5. A PMHNP is treating a patient with history of heavy tobacco use. If the patient suddenly
stops smoking, how might this affect their serum levels of Olanzapine?
A. Serum levels will decrease
B. Serum levels will increase
C. Serum levels will remain unchanged
D. The drug will become ineffective
Answer: B
Conceptual Explanation: Cigarette smoke induces the CYP1A2 enzyme. When a patient
stops smoking, the induction ceases, leading to higher serum levels of drugs metabolized by
1A2, such as Olanzapine and Clozapine.
6. Which antidepressant is most likely to cause a hypertensive crisis if consumed with
tyramine-rich foods?
A. Sertraline
(2026/2027) QUESTIONS AND ANSWERS
1. A 45-year-old male patient on Lithium reports increased tremors, nausea, and ataxia. His
serum lithium level is 1.8 mEq/L. Which of the following medications, if recently added for
back pain, likely caused this elevation?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Gabapentin
Answer: A
Conceptual Explanation: NSAIDs like Ibuprofen reduce renal clearance of Lithium,
potentially increasing serum levels to toxic ranges. Acetaminophen and Aspirin have
minimal impact on lithium levels.
2. According to the DSM-5-TR, which symptom is required to meet the diagnostic criteria for a
Major Depressive Episode?
A. Anhedonia or depressed mood
B. Significant weight loss or gain
,C. Excessive guilt or feelings of worthlessness
D. Psychomotor agitation or retardation
Answer: A
Conceptual Explanation: At least one of the two core symptoms—depressed mood or loss
of interest/pleasure (anhedonia)—must be present for a diagnosis of MDD.
3. A patient is started on Clozapine (Clozaril). The PMHNP must monitor the Absolute
Neutrophil Count (ANC). What is the minimum ANC level required to initiate treatment?
A. 500/mm³
B. 1000/mm³
C. 1500/mm³
D. 2000/mm³
Answer: C
Conceptual Explanation: Per FDA REMS, a patient must have an ANC of at least
1500/mm³ to initiate Clozapine treatment (1000/mm³ for those with benign ethnic
neutropenia).
4. Which neurobiological pathway is primarily associated with the negative symptoms of
Schizophrenia?
A. Mesolimbic pathway
B. Nigrostriatal pathway
, C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms (hypodopaminergic state), whereas the mesolimbic pathway is
associated with positive symptoms (hyperdopaminergic state).
5. A PMHNP is treating a patient with history of heavy tobacco use. If the patient suddenly
stops smoking, how might this affect their serum levels of Olanzapine?
A. Serum levels will decrease
B. Serum levels will increase
C. Serum levels will remain unchanged
D. The drug will become ineffective
Answer: B
Conceptual Explanation: Cigarette smoke induces the CYP1A2 enzyme. When a patient
stops smoking, the induction ceases, leading to higher serum levels of drugs metabolized by
1A2, such as Olanzapine and Clozapine.
6. Which antidepressant is most likely to cause a hypertensive crisis if consumed with
tyramine-rich foods?
A. Sertraline
