PMHNP COMPREHENSIVE FINAL
EXAM REVIEW 2026/2027 QUESTIONS
AND ANSWERS
1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of about 25%
of all drugs, including many antidepressants and antipsychotics, and is highly prone to genetic
polymorphism?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Answer: B
Conceptual Explanation: CYP2D6 is responsible for metabolizing a significant portion of
psychotropic medications and exhibits high genetic variability, leading to ultra-rapid or
poor metabolizer phenotypes.
,2. A patient on Clozapine presents with an Absolute Neutrophil Count (ANC) of 900/mm³.
What is the most appropriate next step according to REMS guidelines?
A. Continue treatment but monitor ANC daily
B. Reduce the dose by 50% and retest in 48 hours
C. Add Granulocyte-Colony Stimulating Factor (G-CSF) and continue treatment
D. Interrupt treatment, consult hematology, and report to the registry
Answer: D
Conceptual Explanation: For general population patients, an ANC below 1000/mm³
constitutes severe neutropenia, requiring immediate treatment interruption and specialist
consultation.
3. Which brain region is primarily associated with the ‘negative symptoms’ of schizophrenia,
such as flat affect and alogia, due to mesocortical dopamine deficiency?
A. Nucleus Accumbens
B. Substantia Nigra
C. Dorsolateral Prefrontal Cortex
D. Amygdala
Answer: C
, Conceptual Explanation: Hypofunction of dopamine in the mesocortical pathway
projecting to the dorsolateral prefrontal cortex is linked to cognitive and negative
symptoms.
4. In the treatment of Bipolar Disorder, which of the following is a symptom of severe lithium
toxicity (levels >2.5 mEq/L)?
A. Fine resting tremor
B. Mild nausea and diarrhea
C. Polyuria and polydipsia
D. Seizures and coma
Answer: D
Conceptual Explanation: Severe lithium toxicity (>2.5 mEq/L) is a medical emergency
characterized by neurological complications including seizures, coma, and cardiac
dysrhythmia.
5. Which legal standard resulted from the Tarasoff v. Regents of the University of California
case?
A. Right to refuse treatment
B. Duty to warn/protect third parties
C. Involuntary commitment criteria
D. Privileged communication in court
EXAM REVIEW 2026/2027 QUESTIONS
AND ANSWERS
1. Which cytochrome P450 enzyme is primarily responsible for the metabolism of about 25%
of all drugs, including many antidepressants and antipsychotics, and is highly prone to genetic
polymorphism?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Answer: B
Conceptual Explanation: CYP2D6 is responsible for metabolizing a significant portion of
psychotropic medications and exhibits high genetic variability, leading to ultra-rapid or
poor metabolizer phenotypes.
,2. A patient on Clozapine presents with an Absolute Neutrophil Count (ANC) of 900/mm³.
What is the most appropriate next step according to REMS guidelines?
A. Continue treatment but monitor ANC daily
B. Reduce the dose by 50% and retest in 48 hours
C. Add Granulocyte-Colony Stimulating Factor (G-CSF) and continue treatment
D. Interrupt treatment, consult hematology, and report to the registry
Answer: D
Conceptual Explanation: For general population patients, an ANC below 1000/mm³
constitutes severe neutropenia, requiring immediate treatment interruption and specialist
consultation.
3. Which brain region is primarily associated with the ‘negative symptoms’ of schizophrenia,
such as flat affect and alogia, due to mesocortical dopamine deficiency?
A. Nucleus Accumbens
B. Substantia Nigra
C. Dorsolateral Prefrontal Cortex
D. Amygdala
Answer: C
, Conceptual Explanation: Hypofunction of dopamine in the mesocortical pathway
projecting to the dorsolateral prefrontal cortex is linked to cognitive and negative
symptoms.
4. In the treatment of Bipolar Disorder, which of the following is a symptom of severe lithium
toxicity (levels >2.5 mEq/L)?
A. Fine resting tremor
B. Mild nausea and diarrhea
C. Polyuria and polydipsia
D. Seizures and coma
Answer: D
Conceptual Explanation: Severe lithium toxicity (>2.5 mEq/L) is a medical emergency
characterized by neurological complications including seizures, coma, and cardiac
dysrhythmia.
5. Which legal standard resulted from the Tarasoff v. Regents of the University of California
case?
A. Right to refuse treatment
B. Duty to warn/protect third parties
C. Involuntary commitment criteria
D. Privileged communication in court
