PMHNP Certification Exam 2026–2027
Exam Practice Questions and Correct ANSWERs With
Rationales
DOMAIN I — SCIENTIFIC FOUNDATION
Question 1
Which neurotransmitter is most directly associated with the mesolimbic pathway and positive
symptoms of schizophrenia?
A. Serotonin
B. Dopamine
C. GABA
D. Acetylcholine
Correct ANSWER: B. Dopamine
Rationale: Excess dopamine activity in the mesolimbic pathway is associated with positive
symptoms such as hallucinations and delusions.
Question 2
Which brain structure plays a major role in memory consolidation?
A. Hippocampus
,B. Medulla
C. Pons
D. Basal ganglia
Correct ANSWER: A. Hippocampus
Rationale: The hippocampus is essential for forming and consolidating new declarative
memories.
Question 3
Which neurotransmitter is the primary inhibitory neurotransmitter in the central nervous
system?
A. Glutamate
B. Dopamine
C. GABA
D. Serotonin
Correct ANSWER: C. GABA
Rationale: Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the
CNS and reduces neuronal excitability.
Question 4
Which neurotransmitter is the primary excitatory neurotransmitter in the brain?
,A. GABA
B. Glutamate
C. Glycine
D. Serotonin
Correct ANSWER: B. Glutamate
Rationale: Glutamate is the principal excitatory neurotransmitter and is involved in learning,
memory, and synaptic plasticity.
Question 5
A patient taking an antipsychotic develops sustained neck contraction and upward deviation of
the eyes. Which adverse effect is most likely?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Neuroleptic malignant syndrome
Correct ANSWER: B. Acute dystonia
Rationale: Acute dystonia commonly causes painful or sustained muscle contractions, often
involving the neck, jaw, or eyes.
Question 6
Which medication is commonly used to treat acute dystonia caused by an antipsychotic?
, A. Benztropine
B. Fluoxetine
C. Lamotrigine
D. Propranolol
Correct ANSWER: A. Benztropine
Rationale: Anticholinergic medications such as benztropine are effective treatments for acute
dystonic reactions.
Question 7
A patient develops rigidity, fever, autonomic instability, and markedly elevated creatine kinase
after an antipsychotic dose increase. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute dystonia
Correct ANSWER: B. Neuroleptic malignant syndrome
Rationale: NMS is characterized by severe rigidity, hyperthermia, autonomic instability, altered
mental status, and elevated CK.
Question 8
Exam Practice Questions and Correct ANSWERs With
Rationales
DOMAIN I — SCIENTIFIC FOUNDATION
Question 1
Which neurotransmitter is most directly associated with the mesolimbic pathway and positive
symptoms of schizophrenia?
A. Serotonin
B. Dopamine
C. GABA
D. Acetylcholine
Correct ANSWER: B. Dopamine
Rationale: Excess dopamine activity in the mesolimbic pathway is associated with positive
symptoms such as hallucinations and delusions.
Question 2
Which brain structure plays a major role in memory consolidation?
A. Hippocampus
,B. Medulla
C. Pons
D. Basal ganglia
Correct ANSWER: A. Hippocampus
Rationale: The hippocampus is essential for forming and consolidating new declarative
memories.
Question 3
Which neurotransmitter is the primary inhibitory neurotransmitter in the central nervous
system?
A. Glutamate
B. Dopamine
C. GABA
D. Serotonin
Correct ANSWER: C. GABA
Rationale: Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the
CNS and reduces neuronal excitability.
Question 4
Which neurotransmitter is the primary excitatory neurotransmitter in the brain?
,A. GABA
B. Glutamate
C. Glycine
D. Serotonin
Correct ANSWER: B. Glutamate
Rationale: Glutamate is the principal excitatory neurotransmitter and is involved in learning,
memory, and synaptic plasticity.
Question 5
A patient taking an antipsychotic develops sustained neck contraction and upward deviation of
the eyes. Which adverse effect is most likely?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Neuroleptic malignant syndrome
Correct ANSWER: B. Acute dystonia
Rationale: Acute dystonia commonly causes painful or sustained muscle contractions, often
involving the neck, jaw, or eyes.
Question 6
Which medication is commonly used to treat acute dystonia caused by an antipsychotic?
, A. Benztropine
B. Fluoxetine
C. Lamotrigine
D. Propranolol
Correct ANSWER: A. Benztropine
Rationale: Anticholinergic medications such as benztropine are effective treatments for acute
dystonic reactions.
Question 7
A patient develops rigidity, fever, autonomic instability, and markedly elevated creatine kinase
after an antipsychotic dose increase. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute dystonia
Correct ANSWER: B. Neuroleptic malignant syndrome
Rationale: NMS is characterized by severe rigidity, hyperthermia, autonomic instability, altered
mental status, and elevated CK.
Question 8
