PMHNP CERTIFICATION EXAM
PRACTICE (2026/2027) QUESTIONS AND
ANSWERS
1. A 32-year-old female patient diagnosed with Bipolar I Disorder is started on Lithium. Which
of the following lab tests is MOST critical to monitor regularly to prevent toxicity?
A. Serum creatinine and TSH
B. Liver function tests (LFTs)
C. Complete Blood Count (CBC) with differential
D. HbA1c and lipid profile
Answer: A
Conceptual Explanation: Lithium is primarily excreted by the kidneys and can cause
hypothyroidism. Serum creatinine (renal function) and TSH (thyroid function) are essential
monitoring parameters.
2. Which dopamine pathway is associated with the development of extrapyramidal
symptoms (EPS) when blocked by first-generation antipsychotics?
A. Nigrostriatal pathway
,B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The nigrostriatal pathway controls motor function; blockade
here leads to EPS. The mesolimbic relates to positive symptoms, mesocortical to negative
symptoms, and tuberoinfundibular to prolactin levels.
3. A patient on Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 900/mm³. What is the priority action for the PMHNP?
A. Continue Clozapine but monitor ANC daily
B. Reduce the dose by 50% and retest in 48 hours
C. Administer a dose of Benztropine for suspected EPS
D. Immediately discontinue Clozapine and consult Hematology
Answer: D
Conceptual Explanation: An ANC below 1000/mm³ indicates severe
neutropenia/agranulocytosis. Clozapine must be discontinued immediately to prevent life-
threatening infection.
, 4. Which legal case established the ‘Duty to Warn’ potential victims of a patient’s threats of
violence?
A. O’Connor v. Donaldson
B. Durham v. United States
C. Rennie v. Klein
D. Tarasoff v. Regents of the University of California
Answer: D
Conceptual Explanation: The Tarasoff case mandated that mental health professionals
have a duty to warn and protect individuals who are being threatened by a patient.
5. In the treatment of Opioid Use Disorder, Buprenorphine acts as a:
A. Full Mu-opioid agonist
B. Partial Mu-opioid agonist
C. Full Mu-opioid antagonist
D. NMDA receptor antagonist
Answer: B
Conceptual Explanation: Buprenorphine is a partial mu-opioid agonist, which provides a
ceiling effect on respiratory depression and euphoria, making it safer for maintenance
therapy.
PRACTICE (2026/2027) QUESTIONS AND
ANSWERS
1. A 32-year-old female patient diagnosed with Bipolar I Disorder is started on Lithium. Which
of the following lab tests is MOST critical to monitor regularly to prevent toxicity?
A. Serum creatinine and TSH
B. Liver function tests (LFTs)
C. Complete Blood Count (CBC) with differential
D. HbA1c and lipid profile
Answer: A
Conceptual Explanation: Lithium is primarily excreted by the kidneys and can cause
hypothyroidism. Serum creatinine (renal function) and TSH (thyroid function) are essential
monitoring parameters.
2. Which dopamine pathway is associated with the development of extrapyramidal
symptoms (EPS) when blocked by first-generation antipsychotics?
A. Nigrostriatal pathway
,B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The nigrostriatal pathway controls motor function; blockade
here leads to EPS. The mesolimbic relates to positive symptoms, mesocortical to negative
symptoms, and tuberoinfundibular to prolactin levels.
3. A patient on Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 900/mm³. What is the priority action for the PMHNP?
A. Continue Clozapine but monitor ANC daily
B. Reduce the dose by 50% and retest in 48 hours
C. Administer a dose of Benztropine for suspected EPS
D. Immediately discontinue Clozapine and consult Hematology
Answer: D
Conceptual Explanation: An ANC below 1000/mm³ indicates severe
neutropenia/agranulocytosis. Clozapine must be discontinued immediately to prevent life-
threatening infection.
, 4. Which legal case established the ‘Duty to Warn’ potential victims of a patient’s threats of
violence?
A. O’Connor v. Donaldson
B. Durham v. United States
C. Rennie v. Klein
D. Tarasoff v. Regents of the University of California
Answer: D
Conceptual Explanation: The Tarasoff case mandated that mental health professionals
have a duty to warn and protect individuals who are being threatened by a patient.
5. In the treatment of Opioid Use Disorder, Buprenorphine acts as a:
A. Full Mu-opioid agonist
B. Partial Mu-opioid agonist
C. Full Mu-opioid antagonist
D. NMDA receptor antagonist
Answer: B
Conceptual Explanation: Buprenorphine is a partial mu-opioid agonist, which provides a
ceiling effect on respiratory depression and euphoria, making it safer for maintenance
therapy.
