PMHNP BOARD REVIEW
COMPREHENSIVE EXAM QUESTIONS
AND VERIFIED ANSWERS |GRADE A+|
JUST RELEASED
1. Which dopamine pathway is primarily responsible for the development of positive
symptoms in schizophrenia, such as hallucinations and delusions?
A. Tuberoinfundibular pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: Excessive dopamine in the mesolimbic pathway is associated
with positive symptoms like hallucinations. The mesocortical pathway is linked to negative
symptoms, the nigrostriatal to motor side effects, and the tuberoinfundibular to prolactin
regulation.
2. A 32-year-old patient taking Clozapine presents with a fever, sore throat, and mouth sores.
The PMHNP should immediately order which lab test?
A. Liver function tests (LFTs)
,B. Complete Blood Count (CBC) with differential
C. Serum Clozapine level
D. Urinalysis
Answer: B
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis.
Fever and sore throat are clinical signs of infection due to low Absolute Neutrophil Count
(ANC).
3. The ‘duty to warn’ and ‘duty to protect’ emerged from which landmark legal case?
A. O’Connor v. Donaldson
B. Rennie v. Klein
C. Durham v. United States
D. Tarasoff v. Regents of the University of California
Answer: D
Conceptual Explanation: The Tarasoff case established that mental health professionals
have a duty to warn and protect individuals who are being specifically threatened by a
patient.
4. A patient is started on Lithium for Bipolar I Disorder. Which of the following lab findings
would be most concerning for potential toxicity?
A. TSH of 2.5 mIU/L
, B. Creatinine of 0.9 mg/dL
C. Potassium of 4.0 mEq/L
D. Sodium level of 128 mEq/L
Answer: D
Conceptual Explanation: Hyponatremia (low sodium) increases lithium levels because
the kidneys reabsorb lithium in place of sodium, leading to toxicity.
5. Which brain structure is primarily involved in the processing of fear and the ‘fight or flight’
response?
A. Amygdala
B. Prefrontal Cortex
C. Hypothalamus
D. Hippocampus
Answer: A
Conceptual Explanation: The amygdala is the brain’s emotional processing center,
specifically mediating fear, anxiety, and aggression.
6. According to Erikson’s stages of psychosocial development, a 70-year-old patient reflecting
on their life with regret and feeling that their life was unproductive is likely experiencing
which crisis?
A. Ego Integrity vs. Despair
COMPREHENSIVE EXAM QUESTIONS
AND VERIFIED ANSWERS |GRADE A+|
JUST RELEASED
1. Which dopamine pathway is primarily responsible for the development of positive
symptoms in schizophrenia, such as hallucinations and delusions?
A. Tuberoinfundibular pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: Excessive dopamine in the mesolimbic pathway is associated
with positive symptoms like hallucinations. The mesocortical pathway is linked to negative
symptoms, the nigrostriatal to motor side effects, and the tuberoinfundibular to prolactin
regulation.
2. A 32-year-old patient taking Clozapine presents with a fever, sore throat, and mouth sores.
The PMHNP should immediately order which lab test?
A. Liver function tests (LFTs)
,B. Complete Blood Count (CBC) with differential
C. Serum Clozapine level
D. Urinalysis
Answer: B
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis.
Fever and sore throat are clinical signs of infection due to low Absolute Neutrophil Count
(ANC).
3. The ‘duty to warn’ and ‘duty to protect’ emerged from which landmark legal case?
A. O’Connor v. Donaldson
B. Rennie v. Klein
C. Durham v. United States
D. Tarasoff v. Regents of the University of California
Answer: D
Conceptual Explanation: The Tarasoff case established that mental health professionals
have a duty to warn and protect individuals who are being specifically threatened by a
patient.
4. A patient is started on Lithium for Bipolar I Disorder. Which of the following lab findings
would be most concerning for potential toxicity?
A. TSH of 2.5 mIU/L
, B. Creatinine of 0.9 mg/dL
C. Potassium of 4.0 mEq/L
D. Sodium level of 128 mEq/L
Answer: D
Conceptual Explanation: Hyponatremia (low sodium) increases lithium levels because
the kidneys reabsorb lithium in place of sodium, leading to toxicity.
5. Which brain structure is primarily involved in the processing of fear and the ‘fight or flight’
response?
A. Amygdala
B. Prefrontal Cortex
C. Hypothalamus
D. Hippocampus
Answer: A
Conceptual Explanation: The amygdala is the brain’s emotional processing center,
specifically mediating fear, anxiety, and aggression.
6. According to Erikson’s stages of psychosocial development, a 70-year-old patient reflecting
on their life with regret and feeling that their life was unproductive is likely experiencing
which crisis?
A. Ego Integrity vs. Despair
