PMHNP ANCC CERTIFICATION EXAM QUESTIONS AND 100% CORRECT
ANSWERS WITH DETAILED EXPLANATION
1. A patient abruptly stops taking paroxetine and reports flu-like symptoms,
dizziness, irritability, and "electric shock" sensations in their head. This
presentation is most consistent with:
A) Serotonin syndrome
B) SSRI discontinuation syndrome
C) Neuroleptic malignant syndrome
D) Relapse of depression
Correct answer: B
Rationale: These symptoms match the FINISH acronym for SSRI
withdrawal/discontinuation syndrome, which occurs after abrupt cessation of
SSRIs, especially those with short half-lives like paroxetine and venlafaxine.
2. A patient presents with confusion, ataxia, nausea, and a coarse tremor. Their
medication history includes lithium. Which of the following is the priority action?
A) Draw a stat lithium level
B) Administer activated charcoal
C) Start IV fluids
D) Order an EKG
Correct answer: A
Rationale: These symptoms suggest lithium toxicity. The priority is obtaining a
serum lithium level to confirm toxicity and guide treatment. IV fluids and EKG
may follow, but the level directs management.
,3. Which of the following laboratory findings would you expect to see in a patient
with Neuroleptic Malignant Syndrome (NMS)?
A) Decreased CPK
B) Leukocytosis
C) Hypoglycemia
D) Thrombocytosis
Correct answer: B
Rationale: NMS is associated with elevated CPK (not decreased) and
leukocytosis (increased WBCs). Hypoglycemia and thrombocytosis are not
characteristic of NMS.
4. Arrange the following benzodiazepines in order from SHORTEST to LONGEST
half-life:
A) Valium, Ativan, Klonopin, Librium
B) Ativan, Klonopin, Librium, Valium
C) Klonopin, Ativan, Valium, Librium
D) Librium, Valium, Klonopin, Ativan
Correct answer: B
*Rationale: Ativan (lorazepam) has the shortest half-life at 12-18 hours, followed
by Klonopin (30-40 hours), then Librium (36-200 hours), with Valium (100 hours)
being the longest.
5. A patient on clozapine reports fatigue, sore throat, and fever. What is the
priority action?
A) Prescribe antibiotics
B) Draw a stat CBC with differential (ANC)
C) Switch to risperidone
D) Reassure the patient these are normal side effects
,Correct answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis. Sore throat
and fever may indicate neutropenia. The ANC must be checked immediately.
Clozapine requires regular ANC monitoring.
6. Which of the following medications is an SNRI?
A) Prozac (fluoxetine)
B) Wellbutrin (bupropion)
C) Cymbalta (duloxetine)
D) Remeron (mirtazapine)
Correct answer: C
Rationale: Cymbalta (duloxetine) is an SNRI. Prozac is an SSRI. Wellbutrin is an
NDRI. Remeron is a tetracyclic antidepressant.
7. A patient on lithium therapy presents with vomiting, diarrhea, confusion, and a
coarse tremor. What is the most likely diagnosis?
A) Serotonin syndrome
B) NMS
C) Lithium toxicity
D) SSRI discontinuation syndrome
Correct answer: C
Rationale: Symptoms of lithium toxicity include confusion, ataxia,
nausea/vomiting, diarrhea, coarse tremor, lethargy, and blurred vision. Severe
toxicity can lead to seizures and coma.
8. Which of the following is a first-line treatment for acute dystonia induced by
antipsychotic medication?
A) Propranolol
, B) Benztropine
C) Clonazepam
D) Amantadine
Correct answer: B
Rationale: Benztropine or diphenhydramine are first-line treatments for acute
dystonia. Propranolol is used for akathisia. Clonazepam may be used for
akathisia or tardive dyskinesia.
9. The mesolimbic dopamine pathway is associated with:
A) Positive symptoms of schizophrenia
B) Negative symptoms of schizophrenia
C) Extrapyramidal symptoms
D) Prolactin elevation
Correct answer: A
Rationale: The mesolimbic pathway is associated with positive symptoms of
schizophrenia (hallucinations, delusions). Antipsychotics block D2 receptors in
this pathway to reduce positive symptoms.
10. Which of the following medications is most likely to cause significant weight
gain and metabolic syndrome?
A) Aripiprazole (Abilify)
B) Ziprasidone (Geodon)
C) Olanzapine (Zyprexa)
D) Lurasidone (Latuda)
Correct answer: C
Rationale: Olanzapine and clozapine have the highest risk for weight gain and
metabolic side effects. Aripiprazole, ziprasidone, and lurasidone have lower
metabolic risk.
ANSWERS WITH DETAILED EXPLANATION
1. A patient abruptly stops taking paroxetine and reports flu-like symptoms,
dizziness, irritability, and "electric shock" sensations in their head. This
presentation is most consistent with:
A) Serotonin syndrome
B) SSRI discontinuation syndrome
C) Neuroleptic malignant syndrome
D) Relapse of depression
Correct answer: B
Rationale: These symptoms match the FINISH acronym for SSRI
withdrawal/discontinuation syndrome, which occurs after abrupt cessation of
SSRIs, especially those with short half-lives like paroxetine and venlafaxine.
2. A patient presents with confusion, ataxia, nausea, and a coarse tremor. Their
medication history includes lithium. Which of the following is the priority action?
A) Draw a stat lithium level
B) Administer activated charcoal
C) Start IV fluids
D) Order an EKG
Correct answer: A
Rationale: These symptoms suggest lithium toxicity. The priority is obtaining a
serum lithium level to confirm toxicity and guide treatment. IV fluids and EKG
may follow, but the level directs management.
,3. Which of the following laboratory findings would you expect to see in a patient
with Neuroleptic Malignant Syndrome (NMS)?
A) Decreased CPK
B) Leukocytosis
C) Hypoglycemia
D) Thrombocytosis
Correct answer: B
Rationale: NMS is associated with elevated CPK (not decreased) and
leukocytosis (increased WBCs). Hypoglycemia and thrombocytosis are not
characteristic of NMS.
4. Arrange the following benzodiazepines in order from SHORTEST to LONGEST
half-life:
A) Valium, Ativan, Klonopin, Librium
B) Ativan, Klonopin, Librium, Valium
C) Klonopin, Ativan, Valium, Librium
D) Librium, Valium, Klonopin, Ativan
Correct answer: B
*Rationale: Ativan (lorazepam) has the shortest half-life at 12-18 hours, followed
by Klonopin (30-40 hours), then Librium (36-200 hours), with Valium (100 hours)
being the longest.
5. A patient on clozapine reports fatigue, sore throat, and fever. What is the
priority action?
A) Prescribe antibiotics
B) Draw a stat CBC with differential (ANC)
C) Switch to risperidone
D) Reassure the patient these are normal side effects
,Correct answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis. Sore throat
and fever may indicate neutropenia. The ANC must be checked immediately.
Clozapine requires regular ANC monitoring.
6. Which of the following medications is an SNRI?
A) Prozac (fluoxetine)
B) Wellbutrin (bupropion)
C) Cymbalta (duloxetine)
D) Remeron (mirtazapine)
Correct answer: C
Rationale: Cymbalta (duloxetine) is an SNRI. Prozac is an SSRI. Wellbutrin is an
NDRI. Remeron is a tetracyclic antidepressant.
7. A patient on lithium therapy presents with vomiting, diarrhea, confusion, and a
coarse tremor. What is the most likely diagnosis?
A) Serotonin syndrome
B) NMS
C) Lithium toxicity
D) SSRI discontinuation syndrome
Correct answer: C
Rationale: Symptoms of lithium toxicity include confusion, ataxia,
nausea/vomiting, diarrhea, coarse tremor, lethargy, and blurred vision. Severe
toxicity can lead to seizures and coma.
8. Which of the following is a first-line treatment for acute dystonia induced by
antipsychotic medication?
A) Propranolol
, B) Benztropine
C) Clonazepam
D) Amantadine
Correct answer: B
Rationale: Benztropine or diphenhydramine are first-line treatments for acute
dystonia. Propranolol is used for akathisia. Clonazepam may be used for
akathisia or tardive dyskinesia.
9. The mesolimbic dopamine pathway is associated with:
A) Positive symptoms of schizophrenia
B) Negative symptoms of schizophrenia
C) Extrapyramidal symptoms
D) Prolactin elevation
Correct answer: A
Rationale: The mesolimbic pathway is associated with positive symptoms of
schizophrenia (hallucinations, delusions). Antipsychotics block D2 receptors in
this pathway to reduce positive symptoms.
10. Which of the following medications is most likely to cause significant weight
gain and metabolic syndrome?
A) Aripiprazole (Abilify)
B) Ziprasidone (Geodon)
C) Olanzapine (Zyprexa)
D) Lurasidone (Latuda)
Correct answer: C
Rationale: Olanzapine and clozapine have the highest risk for weight gain and
metabolic side effects. Aripiprazole, ziprasidone, and lurasidone have lower
metabolic risk.
