Pmhnp Exam Study Guide 2026/2027 — Accurate Questions With Correct Detailed Solutions | Newest Version

PMHNP EXAM STUDY GUIDE 2026/2027 — ACCURATE QUESTIONS WITH CORRECT DETAILED SOLUTIONS | NEWEST VERSION Description: This comprehensive revision set contains 200 multiple-choice questions (MCQs) designed for Psychiatric-Mental Health Nurse Practitioner (PMHNP) board exam preparation. Each question includes four answer choices, the correct answer marked with , and a detailed rationale to reinforce clinical reasoning. Questions cover DSM-5-TR criteria, psychopharmacology, psychotherapy, legal/ethical issues, assessment, and advanced practice competencies. Answers are intentionally mixed — not aligned to any single letter pattern — to simulate the real exam. Keywords: PMHNP, psychiatric nurse practitioner, board review, psychopharmacology, DSM-5-TR, mental health, MCQ, ANCC, AANP, 2026, 2027, study guide, rationales. SECTION 1: PSYCHOPHARMACOLOGY (Questions 1–50) 1. Which medication is first-line for generalized anxiety disorder (GAD)? A. Alprazolam B. Sertraline C. Quetiapine D. Hydroxyzine Rationale: SSRIs like sertraline are first-line for GAD due to efficacy and safety. Benzodiazepines are short-term only. 2. A patient on lithium reports polyuria and polydipsia. Which adverse effect is most likely? A. Nephrogenic diabetes insipidus B. SIADH C. Hyperglycemia D. Thyroid storm Rationale: Lithium can cause nephrogenic DI, leading to polyuria/polydipsia. 3. Which antipsychotic has the highest risk of agranulocytosis? A. Risperidone B. Olanzapine C. Clozapine D. Aripiprazole Rationale: Clozapine requires ANC monitoring due to agranulocytosis risk. 4. A patient starting fluoxetine should be warned about which serious reaction when combined with MAOIs? A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Hypertensive crisis D. Tardive dyskinesia Rationale: SSRI + MAOI can cause serotonin syndrome; MAOI + tyramine causes hypertensive crisis. 5. Which mood stabilizer is most associated with teratogenicity (neural tube defects)? A. Valproate B. Lamotrigine C. Lithium D. Carbamazepine Rationale: Valproate has highest risk of neural tube defects. 6. Which benzodiazepine has the longest half-life? A. Midazolam B. Lorazepam C. Diazepam D. Triazolam Rationale: Diazepam has a long half-life with active metabolites. 7. A patient on haloperidol develops fever, rigidity, and elevated CK. What is the likely diagnosis? A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Acute dystonia D. Akathisia Rationale: NMS presents with fever, rigidity, autonomic instability, elevated CK. 8. Which antidepressant is most sedating? A. Fluoxetine B. Bupropion C. Mirtazapine D. Venlafaxine Rationale: Mirtazapine is highly sedating due to H1 blockade. 9. Which medication requires dietary tyramine restriction? A. Phenelzine B. Sertraline C. Lithium D. Buspirone Rationale: MAOIs like phenelzine require tyramine restriction to avoid hypertensive crisis. 10. Which antipsychotic is most likely to cause hyperprolactinemia? A. Quetiapine B. Risperidone C. Aripiprazole D. Clozapine Rationale: Risperidone has high D2 blockade in tuberoinfundibular pathway. 11. A patient on clozapine develops fever and sore throat. What is the priority? A. Continue clozapine B. Obtain CBC with ANC C. Start antibiotics D. Give benztropine Rationale: Rule out agranulocytosis with CBC/ANC immediately. 12. Which drug is FDA-approved for bipolar depression? A. Lamotrigine B. Quetiapine C. Lithium D. Valproate Rationale: Quetiapine is FDA-approved for bipolar depression. 13. Which SSRI is most likely to cause sexual dysfunction? A. Bupropion B. Paroxetine C. Mirtazapine D. Trazodone Rationale: Paroxetine has highest sexual side effects among SSRIs. 14. Which medication is used for opioid use disorder? A. Naltrexone B. Buprenorphine C. Disulfiram D. Acamprosate Rationale: Buprenorphine is FDA-approved for OUD. 15. Which lab must be monitored with valproate? A. CBC B. LFTs C. TSH D. B12 Rationale: Valproate can cause hepatotoxicity and thrombocytopenia. 16. Which drug causes "cheese effect"? A. Tranylcypromine B. Fluoxetine C. Sertraline D. Escitalopram Rationale: MAOIs + tyramine cause hypertensive crisis ("cheese effect"). 17. Which antipsychotic is best for a patient with metabolic syndrome? A. Olanzapine B. Clozapine C. Aripiprazole D. Quetiapine Rationale: Aripiprazole has lower metabolic risk. 18. Which medication is first-line for OCD? A. Fluoxetine B. Alprazolam