PMHNP LMR EXAM COMPREHENSIVE
PREP 2026/2027 QUESTIONS AND
ANSWERS
1. A 24-year-old female of Han Chinese descent is diagnosed with Bipolar I Disorder. Before
initiating Carbamazepine (Tegretol), which genetic screening is essential to mitigate the risk
of Stevens-Johnson Syndrome?
A. CYP2D6 polymorphism testing
B. HLA-B*1502 allele screening
C. MTHFR gene mutation analysis
D. HLA-B*5701 allele screening
Answer: B
Conceptual Explanation: The HLA-B*1502 allele is highly associated with the
development of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in individuals
of Asian descent taking Carbamazepine.
,2. Which dopamine pathway is primarily responsible for the negative symptoms of
schizophrenia and cognitive impairment?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: A
Conceptual Explanation: Hypofunction of the mesocortical pathway is associated with
negative symptoms and cognitive deficits, whereas hyperactivity in the mesolimbic
pathway leads to positive symptoms.
3. A PMHNP is treating a patient with Clozapine. The patient’s most recent Absolute
Neutrophil Count (ANC) is 900/mm³. According to the Clozapine REMS program, what is the
appropriate intervention?
A. Continue treatment but increase monitoring to twice weekly
B. Continue treatment and monitor weekly
C. Permanent discontinuation and never rechallenge
D. Interrupt treatment and consult hematology
Answer: D
, Conceptual Explanation: For a general population patient, an ANC between 500-
999/mm³ (Moderate Neutropenia) requires treatment interruption and hematology
consultation.
4. A patient taking Phenelzine (Nardil) presents to the ER with a severe occipital headache,
palpitations, and nausea after a dinner party. Which substance most likely triggered this
hypertensive crisis?
A. Tryptophan
B. Glutamate
C. Phenylalanine
D. Tyramine
Answer: D
Conceptual Explanation: MAOIs like Phenelzine inhibit the breakdown of tyramine. High
tyramine levels (found in aged cheeses, wine) cause the release of norepinephrine, leading
to hypertensive crisis.
5. In the context of pharmacokinetics, how does the chronic use of tobacco affect the plasma
levels of Duloxetine and Olanzapine?
A. Tobacco inhibits CYP1A2, potentially increasing drug levels.
B. Tobacco inhibits CYP2D6, potentially increasing drug levels.
C. Tobacco induces CYP3A4, potentially decreasing drug levels.
PREP 2026/2027 QUESTIONS AND
ANSWERS
1. A 24-year-old female of Han Chinese descent is diagnosed with Bipolar I Disorder. Before
initiating Carbamazepine (Tegretol), which genetic screening is essential to mitigate the risk
of Stevens-Johnson Syndrome?
A. CYP2D6 polymorphism testing
B. HLA-B*1502 allele screening
C. MTHFR gene mutation analysis
D. HLA-B*5701 allele screening
Answer: B
Conceptual Explanation: The HLA-B*1502 allele is highly associated with the
development of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in individuals
of Asian descent taking Carbamazepine.
,2. Which dopamine pathway is primarily responsible for the negative symptoms of
schizophrenia and cognitive impairment?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: A
Conceptual Explanation: Hypofunction of the mesocortical pathway is associated with
negative symptoms and cognitive deficits, whereas hyperactivity in the mesolimbic
pathway leads to positive symptoms.
3. A PMHNP is treating a patient with Clozapine. The patient’s most recent Absolute
Neutrophil Count (ANC) is 900/mm³. According to the Clozapine REMS program, what is the
appropriate intervention?
A. Continue treatment but increase monitoring to twice weekly
B. Continue treatment and monitor weekly
C. Permanent discontinuation and never rechallenge
D. Interrupt treatment and consult hematology
Answer: D
, Conceptual Explanation: For a general population patient, an ANC between 500-
999/mm³ (Moderate Neutropenia) requires treatment interruption and hematology
consultation.
4. A patient taking Phenelzine (Nardil) presents to the ER with a severe occipital headache,
palpitations, and nausea after a dinner party. Which substance most likely triggered this
hypertensive crisis?
A. Tryptophan
B. Glutamate
C. Phenylalanine
D. Tyramine
Answer: D
Conceptual Explanation: MAOIs like Phenelzine inhibit the breakdown of tyramine. High
tyramine levels (found in aged cheeses, wine) cause the release of norepinephrine, leading
to hypertensive crisis.
5. In the context of pharmacokinetics, how does the chronic use of tobacco affect the plasma
levels of Duloxetine and Olanzapine?
A. Tobacco inhibits CYP1A2, potentially increasing drug levels.
B. Tobacco inhibits CYP2D6, potentially increasing drug levels.
C. Tobacco induces CYP3A4, potentially decreasing drug levels.
