Georgette PMHNP Review – Exam 2025–2026 Questions
and Answers – Psychiatric-Mental Health NP Board
Section 1: Scientific Foundation
Question 1
A patient with schizophrenia is prescribed clozapine. The PMHNP understands
that the unique efficacy of clozapine in treatment-resistant schizophrenia is
primarily attributed to which receptor profile?
A. Pure D2 antagonism
B. High 5-HT2A antagonism with moderate D2 blockade
C. Selective D3 partial agonism
D. Muscarinic receptor agonism alone
Correct Answer: B
Rationale: Clozapine's superior efficacy in treatment-resistant schizophrenia is
related to its "atypical" receptor binding profile, characterized by high antagonism
at 5-HT2A receptors combined with moderate blockade of D2 receptors. This ratio
reduces extrapyramidal symptoms compared to typical antipsychotics while
maintaining antipsychotic efficacy. The 5-HT2A antagonism also contributes to
reduced negative symptoms and improved cognitive function in some patients.
Question 2
A 34-year-old female on lithium therapy reports tremor, nausea, and unsteady
gait. Her lithium level is 1.8 mEq/L. What is the priority nursing intervention?
A. Administer the next scheduled lithium dose
B. Hold lithium and contact the prescriber immediately
C. Encourage increased fluid intake
D. Reassure the patient that these are expected side effects
Correct Answer: B
, Rationale: A lithium level of 1.8 mEq/L is above the therapeutic range (0.6–1.2
mEq/L) and indicates toxicity. Signs include coarse tremor, ataxia, nausea,
vomiting, and confusion. The priority is to hold the medication and notify the
prescriber immediately. Severe toxicity (levels >2.0 mEq/L) may require
hemodialysis. Increased fluids are appropriate for therapeutic management but
not the immediate priority when toxicity is suspected.
Question 3
Which statement best describes the mechanism of action of bupropion?
A. Selective serotonin reuptake inhibition
B. Norepinephrine-dopamine reuptake inhibition
C. Monoamine oxidase inhibition
D. Serotonin antagonist and reuptake inhibitor
Correct Answer: B
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor
(NDRI). Unlike SSRIs, it does not significantly affect serotonin reuptake. This
mechanism explains its efficacy in depression and smoking cessation, as well as its
side effect profile, which includes increased energy and a lower incidence of
sexual dysfunction compared to SSRIs.
Question 4
A patient on an MAOI reports consuming aged cheese and wine at a party. He now
presents with severe headache, palpitations, and blood pressure of 210/110
mmHg. What is the most likely diagnosis?
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Acute dystonia
, Correct Answer: B
Rationale: The combination of MAOI therapy and tyramine-rich foods (aged
cheese, cured meats, fermented products, wine) can precipitate a hypertensive
crisis. MAOIs inhibit the enzyme that normally breaks down tyramine, leading to
massive norepinephrine release and severe hypertension. Symptoms include
severe headache, palpitations, nausea, and dangerously elevated blood pressure.
This is a medical emergency requiring immediate intervention.
Question 5 (SATA)
Which of the following are classic signs of neuroleptic malignant syndrome
(NMS)? Select all that apply.
A. Hyperthermia
B. Lead-pipe rigidity
C. Hyperreflexia
D. Autonomic instability
E. Bradycardia
Correct Answers: A, B, D
Rationale: NMS is characterized by the "four pillars": hyperthermia, severe
muscle rigidity (lead-pipe), autonomic instability (tachycardia, labile blood
pressure, diaphoresis), and altered mental status. Hyperreflexia is more
characteristic of serotonin syndrome. Bradycardia is not typical; tachycardia is the
expected autonomic finding. NMS is a life-threatening emergency requiring
immediate discontinuation of antipsychotics and supportive care.
Question 6
A PMHNP is reviewing the mechanism of action of lamotrigine. Which statement
is accurate?
, A. It primarily blocks dopamine D2 receptors
B. It inhibits glutamate release through sodium channel blockade
C. It increases GABA reuptake
D. It is a selective serotonin reuptake inhibitor
Correct Answer: B
Rationale: Lamotrigine is an anticonvulsant that works primarily by blocking
voltage-sensitive sodium channels, which stabilizes neuronal membranes and
inhibits the release of excitatory neurotransmitters, particularly glutamate. This
mechanism underlies its efficacy in bipolar depression maintenance and seizure
disorders. It is not a dopamine blocker, GABA reuptake inhibitor, or SSRI.
Question 7
Which laboratory monitoring is essential for a patient starting valproate?
A. Serum sodium and potassium
B. Liver function tests and complete blood count
C. Thyroid stimulating hormone
D. Serum creatinine only
Correct Answer: B
Rationale: Valproate carries risks of hepatotoxicity and thrombocytopenia.
Baseline and periodic monitoring of liver function tests (LFTs) and complete blood
count (CBC) are essential. Additionally, valproate is highly teratogenic (neural tube
defects), so pregnancy testing and counseling are critical for patients of
childbearing potential. Thyroid function is not routinely affected, and while renal
function may be monitored, LFTs and CBC are the priority.
Question 8
A patient taking fluoxetine reports bruising easily and experiencing nosebleeds.
Which laboratory value should the PMHNP assess?
and Answers – Psychiatric-Mental Health NP Board
Section 1: Scientific Foundation
Question 1
A patient with schizophrenia is prescribed clozapine. The PMHNP understands
that the unique efficacy of clozapine in treatment-resistant schizophrenia is
primarily attributed to which receptor profile?
A. Pure D2 antagonism
B. High 5-HT2A antagonism with moderate D2 blockade
C. Selective D3 partial agonism
D. Muscarinic receptor agonism alone
Correct Answer: B
Rationale: Clozapine's superior efficacy in treatment-resistant schizophrenia is
related to its "atypical" receptor binding profile, characterized by high antagonism
at 5-HT2A receptors combined with moderate blockade of D2 receptors. This ratio
reduces extrapyramidal symptoms compared to typical antipsychotics while
maintaining antipsychotic efficacy. The 5-HT2A antagonism also contributes to
reduced negative symptoms and improved cognitive function in some patients.
Question 2
A 34-year-old female on lithium therapy reports tremor, nausea, and unsteady
gait. Her lithium level is 1.8 mEq/L. What is the priority nursing intervention?
A. Administer the next scheduled lithium dose
B. Hold lithium and contact the prescriber immediately
C. Encourage increased fluid intake
D. Reassure the patient that these are expected side effects
Correct Answer: B
, Rationale: A lithium level of 1.8 mEq/L is above the therapeutic range (0.6–1.2
mEq/L) and indicates toxicity. Signs include coarse tremor, ataxia, nausea,
vomiting, and confusion. The priority is to hold the medication and notify the
prescriber immediately. Severe toxicity (levels >2.0 mEq/L) may require
hemodialysis. Increased fluids are appropriate for therapeutic management but
not the immediate priority when toxicity is suspected.
Question 3
Which statement best describes the mechanism of action of bupropion?
A. Selective serotonin reuptake inhibition
B. Norepinephrine-dopamine reuptake inhibition
C. Monoamine oxidase inhibition
D. Serotonin antagonist and reuptake inhibitor
Correct Answer: B
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor
(NDRI). Unlike SSRIs, it does not significantly affect serotonin reuptake. This
mechanism explains its efficacy in depression and smoking cessation, as well as its
side effect profile, which includes increased energy and a lower incidence of
sexual dysfunction compared to SSRIs.
Question 4
A patient on an MAOI reports consuming aged cheese and wine at a party. He now
presents with severe headache, palpitations, and blood pressure of 210/110
mmHg. What is the most likely diagnosis?
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Acute dystonia
, Correct Answer: B
Rationale: The combination of MAOI therapy and tyramine-rich foods (aged
cheese, cured meats, fermented products, wine) can precipitate a hypertensive
crisis. MAOIs inhibit the enzyme that normally breaks down tyramine, leading to
massive norepinephrine release and severe hypertension. Symptoms include
severe headache, palpitations, nausea, and dangerously elevated blood pressure.
This is a medical emergency requiring immediate intervention.
Question 5 (SATA)
Which of the following are classic signs of neuroleptic malignant syndrome
(NMS)? Select all that apply.
A. Hyperthermia
B. Lead-pipe rigidity
C. Hyperreflexia
D. Autonomic instability
E. Bradycardia
Correct Answers: A, B, D
Rationale: NMS is characterized by the "four pillars": hyperthermia, severe
muscle rigidity (lead-pipe), autonomic instability (tachycardia, labile blood
pressure, diaphoresis), and altered mental status. Hyperreflexia is more
characteristic of serotonin syndrome. Bradycardia is not typical; tachycardia is the
expected autonomic finding. NMS is a life-threatening emergency requiring
immediate discontinuation of antipsychotics and supportive care.
Question 6
A PMHNP is reviewing the mechanism of action of lamotrigine. Which statement
is accurate?
, A. It primarily blocks dopamine D2 receptors
B. It inhibits glutamate release through sodium channel blockade
C. It increases GABA reuptake
D. It is a selective serotonin reuptake inhibitor
Correct Answer: B
Rationale: Lamotrigine is an anticonvulsant that works primarily by blocking
voltage-sensitive sodium channels, which stabilizes neuronal membranes and
inhibits the release of excitatory neurotransmitters, particularly glutamate. This
mechanism underlies its efficacy in bipolar depression maintenance and seizure
disorders. It is not a dopamine blocker, GABA reuptake inhibitor, or SSRI.
Question 7
Which laboratory monitoring is essential for a patient starting valproate?
A. Serum sodium and potassium
B. Liver function tests and complete blood count
C. Thyroid stimulating hormone
D. Serum creatinine only
Correct Answer: B
Rationale: Valproate carries risks of hepatotoxicity and thrombocytopenia.
Baseline and periodic monitoring of liver function tests (LFTs) and complete blood
count (CBC) are essential. Additionally, valproate is highly teratogenic (neural tube
defects), so pregnancy testing and counseling are critical for patients of
childbearing potential. Thyroid function is not routinely affected, and while renal
function may be monitored, LFTs and CBC are the priority.
Question 8
A patient taking fluoxetine reports bruising easily and experiencing nosebleeds.
Which laboratory value should the PMHNP assess?
