PMHNP EXAM GEORGETTE REVIEW STYLE
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES 2025
(VERIFIED ANSWERS)
1. A 34-year-old male presents with auditory hallucinations and delusions of
persecution for the past 6 months. He has no history of substance use. What is
the most likely diagnosis?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Schizoaffective disorder
Rationale: Schizophrenia requires symptoms such as delusions, hallucinations, or
disorganized speech for at least 6 months.
2. Which neurotransmitter is most implicated in the pathophysiology of
schizophrenia?
,A. Serotonin
B. Dopamine
C. GABA
D. Glutamate
Rationale: Dopamine hyperactivity, particularly in the mesolimbic pathway, is
strongly linked to the positive symptoms of schizophrenia.
3. A patient taking clozapine develops a sore throat and fever. What is the most
appropriate next step?
A. Reassure the patient
B. Obtain a complete blood count with differential immediately
C. Switch to risperidone
D. Increase clozapine dose
Rationale: Agranulocytosis is a serious adverse effect of clozapine; WBC count
must be evaluated.
4. Which of the following medications requires monitoring of liver function tests
(LFTs)?
A. Sertraline
B. Valproic acid
C. Lithium
D. Clozapine
,Rationale: Valproic acid can cause hepatotoxicity and requires regular LFT
monitoring.
5. A PMHNP is treating a 45-year-old female with major depressive disorder
who is not responding to SSRI monotherapy. What is the best augmentation
strategy?
A. Increase SSRI dose beyond maximum
B. Add benzodiazepine
C. Add atypical antipsychotic (e.g., aripiprazole)
D. Switch to MAOI
Rationale: Atypical antipsychotics like aripiprazole are FDA-approved for
augmentation in depression.
6. Which lab should be monitored every 6-12 months in a patient taking
lithium?
A. AST
B. CBC
C. EKG
D. TSH
Rationale: Lithium can cause hypothyroidism; thyroid function should be
regularly assessed.
, 7. Which defense mechanism is most commonly associated with borderline
personality disorder?
A. Projection
B. Denial
C. Splitting
D. Rationalization
Rationale: Splitting is a hallmark defense in BPD, where individuals see others as
all good or all bad.
8. A child diagnosed with ADHD is prescribed methylphenidate. Which of the
following should be monitored during follow-up?
A. Visual acuity
B. Growth parameters and blood pressure
C. Liver function tests
D. WBC count
Rationale: Stimulants can affect growth and elevate blood pressure; these must
be tracked.
9. Which benzodiazepine is preferred in liver disease due to its shorter half-life
and minimal hepatic metabolism?
A. Diazepam
B. Lorazepam
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES 2025
(VERIFIED ANSWERS)
1. A 34-year-old male presents with auditory hallucinations and delusions of
persecution for the past 6 months. He has no history of substance use. What is
the most likely diagnosis?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Schizoaffective disorder
Rationale: Schizophrenia requires symptoms such as delusions, hallucinations, or
disorganized speech for at least 6 months.
2. Which neurotransmitter is most implicated in the pathophysiology of
schizophrenia?
,A. Serotonin
B. Dopamine
C. GABA
D. Glutamate
Rationale: Dopamine hyperactivity, particularly in the mesolimbic pathway, is
strongly linked to the positive symptoms of schizophrenia.
3. A patient taking clozapine develops a sore throat and fever. What is the most
appropriate next step?
A. Reassure the patient
B. Obtain a complete blood count with differential immediately
C. Switch to risperidone
D. Increase clozapine dose
Rationale: Agranulocytosis is a serious adverse effect of clozapine; WBC count
must be evaluated.
4. Which of the following medications requires monitoring of liver function tests
(LFTs)?
A. Sertraline
B. Valproic acid
C. Lithium
D. Clozapine
,Rationale: Valproic acid can cause hepatotoxicity and requires regular LFT
monitoring.
5. A PMHNP is treating a 45-year-old female with major depressive disorder
who is not responding to SSRI monotherapy. What is the best augmentation
strategy?
A. Increase SSRI dose beyond maximum
B. Add benzodiazepine
C. Add atypical antipsychotic (e.g., aripiprazole)
D. Switch to MAOI
Rationale: Atypical antipsychotics like aripiprazole are FDA-approved for
augmentation in depression.
6. Which lab should be monitored every 6-12 months in a patient taking
lithium?
A. AST
B. CBC
C. EKG
D. TSH
Rationale: Lithium can cause hypothyroidism; thyroid function should be
regularly assessed.
, 7. Which defense mechanism is most commonly associated with borderline
personality disorder?
A. Projection
B. Denial
C. Splitting
D. Rationalization
Rationale: Splitting is a hallmark defense in BPD, where individuals see others as
all good or all bad.
8. A child diagnosed with ADHD is prescribed methylphenidate. Which of the
following should be monitored during follow-up?
A. Visual acuity
B. Growth parameters and blood pressure
C. Liver function tests
D. WBC count
Rationale: Stimulants can affect growth and elevate blood pressure; these must
be tracked.
9. Which benzodiazepine is preferred in liver disease due to its shorter half-life
and minimal hepatic metabolism?
A. Diazepam
B. Lorazepam
